 Common Cold Etiology - Rhinovirus

Symptoms
 Rhinorrhea – watery nasal discharge
 Acute Rhinitis – nasal congestion due to inflammation of mucus membranes caused by virus
(Allergic Rhinitis –cause: seasonal allergies)
 Cough
 Common Cold Contagious - (Incubation Period)
 1-4 days before onset of symptoms and
 first 3 days of symptoms
Transmission From touching contaminated surfaces From droplets due to sneezing
 Common Cold Home Remedies Chicken soup, hot toddy, Vitamin C
OTC medications Antihistamines /Decongestants /Antitussives/Expectorants

 Antihistamines Action Block the H1 histamine receptor

decrease nasopharyngeal secretions + decrease nasal itching and sneezing
Side Effects Comparison
1st Gen – drowsy, dizzy, dry mouth
2nd Gen – less, so better for daytime use
 First Generation Antihistamines Benadryl (Diphenhydramine)
Side Effects – Drowsy, dry mouth, dizzy, blurred vision, wheezing, photosensitivity, urinary
retention, constipation, GI distress, blood dyscrasias. children: excitation
Drug-Food Interaction – CNS deppre. w alc. narc. hypnotics, barbiturates. Avoid w MAOIs.
Nursing Interventions Check for food/drug interaction
 Warn not to drive or drink alcohol /Give with food to decrease GI distress
 Sugarless candy/gum/ice chips for dry mouth
 Warn elderly and parents of children that unusual excitement or irritability are possible
 Second Generation Antihistamines Zyrtec, Alegra, Claritin (oral)Astelin (nasal spray)
Side Effects – Less drowsiness so better to take during the day ; fewer anticholinergic effects:
dry mouth, blurred vision, wheeze, urinary retention
Nursing Interventions – Same as First Gen
 Nasal Congestion Nasal congestion results when fluid moves into nasal cavity tissue
spaces (transudation) from dilated nasal blood vessels
Etiology Infection, inflammation, allergy
 Nasal Decongestants (sympathomimetic amines)
Efedron (most potent), Allerest (rebound),
Afrin (long acting), Neo-Synephrine, Sudafed
Action – vasoconstriction in nasal mucosa
Route of administration oral (tablet, capsule, liquid) /nose drops spray
 Nasal Decongestant Side Effec ts
 Jittery, nervous, restless
 Use > 5 days rebound congestion
 Increase blood pressure + blood glucose
Use with caution Hypertension /Cardiac Disease/Hyperthyroid/Diabetes Mellitus
  Nasal Decongestant Drug-Drug Interaction
 Pseudoephedrine with beta-blocker: Beta-blocker is less effective.
 Decong. with MAO (monoamine oxidase inhibitor): hypertension + cardiac arrhythmias
Drug-Food Interaction Increase restless + palpitations w/ caffeine
 Systemic Decongestant (alpha-adrenergic agonists)
Ephedrine, Neo-Synephrine, Sudafed
Advantage – lasts longer than nasal decongestants
Disadvantage – side effects: hypertension + increased blood glucose
 Intranasal Glucocorticoids Rhinocort, Decadron, Flonase, Nasacort
Administration – nasal spray
Action – anti inflammatory
Side effects – rare due to short-term use
 Antitussives
Codeine (narcotic)
Benylin (non-narcotic) dextromethorphan
Robitussin-DM (combined with expectorant)
Administration – syrup, chewable, lozenges
Action - cough- center in medulla suppress cough reflex; onset 15-30 min; duration 3-6 hours
 Antitussives
Use – dry cough, non-productive cough
Nursing Implications Dont take w/alcohol/narc. sedative-hypnotics, barbiturates, or
anti-depressants
 Expectorants Robitussin (Guaifenesin)
Action –loosen bronchial secretions so they can be eliminated by coughing
Side Effect – nausea, drowsy
Best natural expectorant: increase fluids
 Sinusitis Inflamm. of mucous memb.1 or + of maxillary/frontal/ethmoid/sphenoid sinuses
Etiology - Allergy, infection
Treatment – decongestant + antibiotic
 Acute Pharyngitis Inflammation of the throat
Etiology – virus, bacteria (strep)
Symptoms – elevated temp, cough
Treatment – saline gargle, lozenges, increase fluids, anti-pyretic,
NO Antibiotics unless bacterial infection (culture positive)
 Critical Thinking
1. If your friend asked you for the name of a “good” medicine to get at the drug store so she
could breathe better through her nose, what would you say?
2. What is the difference between the antihistamines: Claritin and Benadryl?
3. What is the difference between Benadryl and Benylin?
4. What is the difference between Robitussin AC and Robitussin DM?
Chronic Obstructive Pulmonary Disease (COPD) alveoli damage
Causes Chronic bronchitis/Bronchiectasis /Emphysema/Asthma
Restrictive Pulmonary Disease Causes
Pulmonary edema or fibrosis
o Pneumonitisin (i nflammation of air sacs in lungs, usually caused by a virus )
o Lung tumors
o Thoracic deformities (scoliosis) or muscle wall disorders(myasthenia gravis)
COPD – Chronic Bronchitis Airway obstruction from inflammation + excessive mucus secretion
Cause - due to smoking, chronic infections
Assessment - rhonchi- inspiratory + expiratory with productive cough
Danger - respiratory acidosis due to hypercapnia and hypoxemia
COPD - Bronchiectasis Airway obstruction from breakdown of epithelium from bronchial mucosa
Cause Frequent infection and inflammation
COPD - Emphysema Loss in the fiber and elastin network in the alveoli
Cause Cigarette smoking/Contaminants in air
o Lack of protein that prevents enzymes from destroying alveoli (air sacs) resulting in
trapped air in over expanded alveoli and inadequate O2 - CO2 exchange
COPD - Bronchial Asthma Periods of bronchospasm (bronchoconstriction)
resulting in wheezing and difficulty breathing.
Cause - allergy to animal dander, dust mites, food, drugs; temperature change, fumes
(perfume, smoke), exercise, stress, pollen
COPD – Bronchial Asthma Assessment Wheeze on auscultation/Cough/Elevated eosinophils
PATHOPHYSIOLOGY
o Cyclic adenosine monophysphate (cAMP) maintains bronchodilation
o Bronchoconstriction results when cAMP action is inhibited by histamine and leukotrienes
o cAMP is increased by sympathomimetic (adrenergic) bronchodilators and methylxanthines …
SO
Asthma – First line of defense
Short-acting sympathomimetics
o Promote cAMP production
o Enhance bronchodilation
Epinephrine (Adrenalin)- non selective alpha1, beta1, beta2 agonist (Sub Q)
Epinephrine Side Effects
o Tremors/Dizzy
o Hypertension/Tachycardia/Cardiac dysrhythmias/Angina
Adrenergic – beta2 Albuterol (Proventil, Ventolin)
Selective for beta2 receptors Bronchodilation with long duration of action
Adrenergic – beta2
Albuterol Side Effects
o Tremors/Headache/Nervous
o Increased heart rate /blood glucose(caution Diabetics)
Adrenergic – beta2 Metaproterenol (1961) (Alupent, Metaprel)
Administration - Oral or by inhalation
Onset : SQ 1-5 min, Peak 1 hr, Duration 3-4 hr (onset – fast, duration – short )
Isoproterenol (1941) Isuprel Seldom prescribed due to side effects: increased heart rate,
tachycardia Use of inhaler See page 610
Anticholinergics Atrovent
Action – dilate bronchioles
Side Effects - FEW
Administration - aerosol
5 minutes BEFORE steroid or cromolyn
5 minutes AFTER beta-agonist (Albuterol)
Methylxanthine Derivatives Aminophylline (1936), Theophylline
Action - Stimulate CNS and respirations, dilate coronary + pulmonary vessels, cause
diuresis; bronchodilator by increasing cAMP Not used much due to adverse effects.
Theophylline Adverse Effects Dysrhythmia, convulsions, cardiorespiratory collapse
Narrow therapeutic drug range (10-20 mcg/mL) (>20 = TOXIC)
Theophylline Interactions Drug-Drug Interactions
Beta-blockers
Cimetidine (Tagamet)
Propranolol (Inderol)
Erythromycin
Barbiturate
Beta-adrenergic
Digitalis
Lithium
LT Receptor Antagonists + Synthesis Inhibitors Singulair
Indication – Exercise induced asthma, prophylactic and maintenance drug therapy for
chronic asthma Safe for children
Glucocorticoids (Steroids)
Action – anti-inflammatory
Administration – aerosol, tablet, injection
Patient Teaching
o Wean off oral med to avoid exacerbation and suppression of adrenal function
o Take with food to avoid GI ulceration
o Alert for fungal infection in mouth
Cromolyn and Nedocromil
Use – prophylactic treatment of asthma, not for acute attack
Action – anti-inflammatory, suppress release of histamine
Administration – inhalation
Side effects – cough, bad taste, rebound bronchospasm
Mucolytics Mucomyst
Action –liquefies thick mucus secretions
Administration – 5 minutes after a bronchodilator, not to be mixed with other drugs
Antidote for acetaminophen overdose if within 12-24 hours (PO with juice)
Respiratory Tract Infections