Chapter 54:

Drugs Acting on the Upper Respiratory Tract

LENY VICENTE-BAGUIO RN,MN

XAVIER UNIVERSITY- ATENEO DE CAGAYAN
COLLEGE OF NURSING
 Drugs Acting on the Upper Respiratory Tract SEPTEMBER 2020

Drugs Used to Treat Upper Respiratory Infections #1

❖Antitussives
o Block the cough reflex
❖Decongestants
o Decrease the blood flow to the upper respiratory tract and decrease the overproduction of
secretions
❖Antihistamines
o Block the release or action of histamine that increases secretions and narrows airways
Drugs Used to Treat Upper
Respiratory Infections #2

❖Expectorants
o Increase productive cough to clear
airways
❖Mucolytics
o Increase or liquefy respiratory secretions
to aid clearing of airways
Sites of Action of Drugs Working on
the Upper Respiratory Tract
Use of Upper Respiratory Tract Agents Across the Lifespan
 Antitussives #1
❖Suppress the cough reflex

o Codeine (generic • Hydrocodone • Dextromethorphan

only) (available in some (generic and in
combination combination products)
products)
Antitussives #2 ❖Actions
o Act directly on the medullary
cough center of the brain to
depress the cough reflex
❖Indications
o Control nonproductive cough
❖Pharmacokinetics
o Rapidly absorbed, metabolized in
the liver, and excreted in the
urine
 Antitussives #3
❖Contraindications
o Patients who need to cough to maintain the airway
o Head injury or impaired CNS
❖Caution
o Hypersensitivity or history of narcotic addiction
❖Adverse Effects
o Drying effect on the mucous membranes
o CNS adverse effects and GI upset
▪ Drug-to-drug interactions- MAOI’s
Nursing
Considerations for Assess:
Antitussives
o History and Physical Exam and history of allergy
o Temperature, respirations, adventitious sounds
o Orientation and affect
 Prototype
Antitussives
 Topical Nasal Decongestants #1
Decrease the overproduction of secretions by causing local
vasoconstriction to the upper respiratory tract

1 2 3 4

o Oxymetazoline o Phenylephrine o Tetrahydrozoline Xylometazoline

(Afrin, and others) (Coricidin, and (Tyzine)
many others) (Otrivin)
 ❖Actions
Topical Nasal o Sympathomimetic

Decongestants o Affects sympathetic nervous system to cause

vasodilatation
#2 o Causing less inflammation of the nasal
membrane
❖Indications
o Relieve the discomfort of nasal congestion
that accompanies the common cold, sinusitis,
and allergic rhinitis
Topical Nasal Decongestants #3
❖Pharmacokinetics
o Generally not absorbed systemically
o Any portion of these topical decongestants that is absorbed is metabolized in the liver and excreted
in the urine
❖Contraindications
o Lesion or erosion in the mucous membranes
❖Caution
o Any condition that might be exacerbated by sympathetic activity
 Topical Nasal Decongestants #4

❖Adverse Effects
o Local stinging and burning
o Rebound congestion
o Sympathomimetic effects

❖Drug-to-Drug Interactions
o Cyclopropane or halothane
 Nursing Considerations for
Topical Nasal Decongestants

❖Assess:
o History and Physical Exam and known allergy
o Glaucoma, hypertension, diabetes, thyroid disease, coronary disease, and
prostate problems
o Orientation and reflexes, VS and cardiac status
o Respirations and adventitious lung sounds
o Nasal mucous membrane and urinary status
o Prototype : Tetrahydrozoline
 Question #1

Please answer the following statement as

true or false.

Antitussive agents should be used with

caution in patients who have a history of
addiction.
 Oral
❖Decrease nasal congestion related Decongestants #1
to the common cold, sinusitis, and
allergic rhinitis

- Pseudoephedrine (Triaminic
Allergy Congestion, and many
combination products)
 ❖Actions
Oral o Shrink the nasal mucous membrane by stimulating the alpha-
adrenergic receptors in the nasal mucous membranes
Decongestants ❖Indications
#2 o Promotion of drainage in the sinuses and improving air flow
❖Pharmacokinetics
o Well absorbed, widely distributed in the body
o Metabolized in the liver and primarily excreted in urine
Oral Decongestants #3
❖Contraindications
o Any condition that might be exacerbated by sympathetic activity
❖Adverse Effects
o Rebound congestion
o Sympathetic effects
❖Drug-to-Drug Interactions
o OTC products that contain pseudoephedrine; taking concurrently
can cause serious side effects
Nursing Considerations for Oral Decongestants
❖Assess:
o History and Physical Exam and known allergy
o Pregnancy, lactation, hypertension, CAD
o Hyperthyroidism, diabetes mellitus, or prostate enlargement
o Orientation, reflexes, and affect
o VS and LS
o Prototype: Pseudoephedrine
 Topical Nasal Steroid Decongestants #1

❖Actions- relieve inflammation

o Exact mechanism of action is not known
❖Indications
o Seasonal allergic rhinitis
o Inflammation after the removal of nasal polyps
❖Pharmacokinetics
o Generally not absorbed systemically
 Topical Nasal Steroid Decongestants #2
❖Contraindications
o Acute infection
❖Caution
o Active infection
o Avoid exposure to airborne infections
❖Adverse Effects
o Local burning, irritation, stinging, dryness of the mucosa, and
headache
o Suppression of healing can occur in a patient who has had nasal
surgery or trauma
 ❖Assess:
Nursing o History and Physical Exam and known
Considerations allergy
for Topical o Nasal mucosa, respiration and
Nasal Steroid adventitious sounds
Decongestants o Temperature
Prototype Topical
Nasal Steroid
Decongestants
 Antihistamines #1
❖Relieve respiratory symptoms and treat allergies
❖First-generation and second-generation antihistamines include:

o Carbinoxamine o Chlorpheniramine( o See table 54.3

Brompheniramine (J-Tan) (Histex, Palgic) Aller-Chlor) and
many others
 Antihistamines #2

❖Actions
o Selectively block the effects of histamine at the histamine-1 receptor sites,
decreasing the allergic response
o Anticholinergic and antipruritic effects
❖Indications
o Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated
urticaria, and angioedema
❖Pharmacokinetics
o Well absorbed, metabolized in the liver, excreted in urine and feces
❖Contraindications
o Pregnancy and lactation
Antihistamines #3 ❖Caution
o Renal or hepatic impairment
o History of arrhythmias
❖Adverse Effects
o Drowsiness and sedation
o Anticholinergic effects
❖Drug-to-Drug Interactions
o Vary based on the drug
 Nursing Considerations for Antihistamines

❖Assess:
o History and Physical Exam and known allergy
o Pregnancy or lactation; and prolonged QT interval, renal or hepatic
impairment
o Skin, orientation, affect, and reflexes
o Respirations and adventitious sounds
o Appropriate lab values
Prototype Antihistamines
 Expectorants #1

❖Increase productive cough to clear the

airways. They liquefy lower respiratory tract
secretions, reducing the viscosity of these
secretions and making it easier for the patient
to cough them up
o Guaifenesin(Mucinex, and many others).
 Expectorants #2
• Actions
–Enhances the output of respiratory tract fluids by reducing the adhesiveness and
surface tension of these fluids, allowing easier movement of the less viscous
secretions
–Indications
–Symptomatic relief of respiratory conditions characterized by a dry, non-productive
cough
• Pharmacokinetics
–Rapidly absorbed, metabolism and excretion has not been reported
 Expectorants #3
❖Adverse Effects
o GI symptoms
o Headache
o Dizziness
o Mild rash
o Prolonged use may result in masking a serious underlying
disorder
 Nursing Considerations for Expectorants

❖Assess:
❖History and Physical Exam and known allergy
❖Persistent cough due to smoking, asthma, or emphysema
❖Skin, temperature, respirations and adventitious sounds, and orientation
and affect
Prototype Expectorants
 Question #2

Which of the following is an adverse reaction to topical nasal

steroids?
A. Increased nasal drainage
B. Rebound effect
C. Suppression of healing
D. Local ulceration
Mucolytics #1
❖Increase or liquefy respiratory secretions
to aid the clearing of the airways in high-
risk respiratory patients who are coughing
up thick, tenacious secretions
❖Acetylcysteine (generic)
❖Dornase alfa (Pulmozyme)
Mucolytics #2 ❖Actions
o Work to break down mucous in order to
aid the high-risk respiratory patient in
coughing up thick, tenacious secretions
❖Indications
o Patients who have difficulty coughing up
secretions
o Patients who develop atelectasis
o Patients undergoing diagnostic
bronchoscopy
o Postoperative patients
o Patients with tracheostomies
Mucolytics #3 ❖Pharmacokinetics
o Nebulization or direct instillation into
the trachea
❖Caution
o Acute bronchospasm, peptic ulcer,
and esophageal varicies
❖Adverse Effects
o GI upset
o Stomatitis and/or rhinorrhea
o Bronchospasm
o Rash
Nursing ❖Assess:
o History and Physical Exam and
Considerations for known allergy
o Presence of acute bronchospasm,
peptic ulcer and esophageal varices
Mucolytics
o Skin, B/P, pulse, respirations and
adventitious sounds
Prototype
Mucolytics
 What drug enhances the output of
Question #3 respiratory tract fluid by reducing
the adhesiveness and surface
tension of the fluid, which
facilitates the removal of viscous
mucus?
A. Guaifenesin
B. Flunisolide
C. Acetylcysteine
D. Dextromethorphan