Drugs for Upper kesp|ratory D|sorders

1 Compare and d|scuss ant|h|stam|ne decongestant ant|tuss|ve and expectorant drug

groups
O nt|h|stam|ne P1 blockers or P1 anLagonlsLs Lhey compeLe wlLh hlsLamlne for
recepLor slLes prevenLlng a hlsLamlne response When P1 ls secreLed
exLravascular smooLh muscle lncludlng Lhe llnlng of Lhe nasal cavlLy are
consLrlcLed When P2 ls sLlmulaLedlncrease ln gasLrlc secreLlons whlch cause
pepLlc ulcer 1hese Lwo Lypes of hlsLamlne recepLors should noL be confused
AnLlhlsLamlnes decrease nasal secreLlons by blocklng P1 recepLor AnLlhlsLamlne
common for cold remedles and can be used Lo LreaL allerglc rhlnlLls 8u1 ls noL
used ln emergency such as anaphylaxls MosL anLl 8apld absorbed ln 13 mln buL
noL poLenL enough Lo combaL anaphylaxls use for seasonal allerglc rhlnlLls
urLlcarla ad[uncLlve Lherapy for anaphylacLlc reacLlons moLlon slckness
O Decongestant acLs dlrecLly on alphaadrenerglc recepLors ln nasal mucosa
causlng conLracLlon of sphlncLers and consLrlcLlons of secreLory cells lndlrecLly
resulL ln norepl release whlch LogeLher wlLh Lhe dlrecL acLlon on recepLor cause
vasoconsLrlcLlon and nasal decongesLlon MeLabollzed by llver and excreLed ln
urlne use for Lemporary rellef of nasal decongesLlon or slnus and nasal
dralnage
O nt|tuss|ve Supress cough reflex by acLlng on medullas cough cenLer acL by
anesLheLlzlng cough recepLors of vagal afferenL flbers LhroughouL Lhe bronchl
alveoll and pleura (benzonaLaLe only) lf a cough ls nonproducLlve and lrrlLaLlng
an anLlLusslve may be Laken 1here are Lhree Lypes of anLlLusslves nonnarcoLlc
narcoLlc and comblnaLlon use when you have nonproducLlve cough or cough
LhaL lnLerrupLs sleep
O xpectorant uecrease Lhe vlscoslLy of Lenaclous secreLlons by lncreaslng flulds
ln Lhe resplraLory LracL MeLabollzed by llver and excreLed ln urlne use Lhls
when have cough assoc wlLh common cold or upper resp LracL lnf Cr dry
hacklng cough
2 Descr|be the act|ons uses effects and s|de effects of 1
st
and 2
nd
generat|on
ant|h|stam|nes nasa| and system|c decongestants |ntranasa| stero|ds ant|tuss|ves
and expectorants for se|ected prototypes(4)
AnLlhlsLamlne
1
st
Generat|on D|phenhydram|ne
(8enadry|)
2
nd
Generat|on
nonsedaLlng"ZyrLec Allegra
ClarlLln
nasal SysLemlc
decongesLanL
Nasa|
(sympaLhomlmeLlc amlnes)
sLlmulaLe a|pha adrenerg|c
receptors nasal spray drops
System|c seudoephedr|ne
(sudafed) a|pha adrenerg|c
agon|sts Lab cap llq used
prlmarlly for allerglc rhlnlLls hay
capsule or llquld vasoconsLrlcLlon
of Lhe caplllarles ln Lhe nasal
mucosa AcL prompLly and have
fewer problems Lhan sysLemlc
fever acuLe coryza(profuse nasal
dlscharge)
lnLranasal sLerold
LffecLlve for LreaLlng allerglc rhlnlLls
WlLh conL use dryness of nasal
cavlLy may occur
lnLranasal dexameLhasone should
noL be used for more Lhan 30
days
AnLlLusslve
Dextromethorphan (kob|tuss|n
DM) AcL ln cough conLrol cenLer ln
Lhe medulla Lo suppress Lhe cough
reflex3 Lypes nonnarcoLlc narcoLlc
or comblnaLlon prep ususally used
ln combo wlLh oLher agenLs
lf Lhe cough ls nonproducLlve Lhe
anLlLusslve can be Laken
LxpecLoranLs
Loosen bronchlal secreLlons so Lhey
can be ellmlnaLed by coughlng 1hey
can be used wlLh or wlLhouL oLher
agenLs 1hey are found ln many C1C
remedles along wlLh analgeslcs
anLlhlsL decong and anLlLusslves
1he mosL common ls
Gua|fenes|n(roblLussln)
PydraLlon ls Lhe besL naLural
expecLoranL
D|phenhydram|ne(8enadry|)
harmacok|net|cs
C lM lv lL ls well absorbed ln Cl buL sysLemlc absorpLlon from Loplcal use ls mln lL ls
hlghly proLeln bound 98 and half llfe of 27 hrs lL ls meLabollzed by Lhe llver and
excreLed as meLabollLes ln Lhe urlne
harmacodynam|cs
lL blocks Lhe effecLs of hlsLamlne by compeLlng for and occupylng P1recepLor clLes lL
has anLlchollnerglc effecLs and should noL be used by cllenLs wlLh narrowangle
glaucoma urowslness ls ma[or se of Lhe drug lL ls someLlmes used as a sleep ald lL ls
also used as a anLlLusslve(allevlaLe cough) lLs onseL ls as few as 13 mln when Laken oral
or lv 1he duraLlon of acLlon ls 48hrs lL can cause CnS depresslon lf Laken wlLh alcohol
narcoLlcs hypnoLlcs or barblLuraLes
S of most 1
st
gen
urowsy dlzzy faLlgue dlsLurbed coordlnaLlon Skln rash and anLlchollnerglc
sympLoms(dry mouLh urlne reLenLlon blurred vlslon wheezlng may occur
Sadverse react|on
Llfe LhreaL agranulocyLosls hemolyLlc anemla LhrombocyLopenla

3 D|scuss how the s|de effects of nasa| decongestants can be avo|ded
nasal decongesLanLs glven wlLh oLher sympaLhomlmeLlc amlnes may lncrease CnS
sLlmulaLlon
MAC lnhlblLors glven concurrenLly wlLh a nasal decongesLanL may cause sever
hyperLenslon or hyperLenslve crlsls or cardlac arresL
Clvlng pseudophedrlne wlLh alkallnlzlng agenLs may decrease urlnary excreLlon of
pseudoephedrlne lncreaslng lLs effecLs
ConLralndlcaLed ln paLlenLs Laklng an MAC lnhlblLor and Lhose hypersenslLlve Lo drug's
lngredlenLs
use cauLlously ln elderly paLlenLs paLlenLs wlLh Lhrold dlsease cardlovascular CAu
hyperLenslon lnLraocular pressure vu and Lhose who have dlfflculLy urlnaLlng bc of
enlarged prosLaLe
4 pp|y the nurs|ng process |nc|ud|ng nurs|ng |ntervent|ons and pat|ent teach|ng for
drugs used to treat the common co|d pp|y ev|dencebased pract|ve gu|de||nes to the
adm|n|strat|on of upper and |ower resp|ratory agents
D|phenhydram|ne Dextromethorphan seudoephedr|ne Gua|fenes|n
ssess
vlLals drug hx s/s of
urlnary dysf reLenLlon
dysurla and freqnoLe Lhe
C8C durlng drug Lherapy
assess cardlac and resp
sLaLus lf allerglc reacLlon
obLaln hx of envlrexp
drugs recenL food eaLen
sLress
ueLermlne lf Lhere ls a hx of
hypertens|on esp lf
decongesLanL ls an lngred ln
cold remedy noLe vlLals 99101
l lnf Caused by cold CbLaln
drug hlsLory/ drugdrug
lnLeracLlon dexL w/ MACl's
narcoLlcs sed barblLuraLes
anLldepress alcohol may
lncrease LoxlclLy Assess cardlac
and resp sLaLus
seudo May decrease
effecL of beLa blocker
1aken w/ monoamlne
oxldase may lncrease
hyperLenslon or dysrhLh
CllenL should avold large
amounLs of caffelne
lound ln many oLc cold
remedles PydraLlon ls
Lhe besL expecLoranL
ueLermlne lf Lhere ls a
hx of hypertens|on esp
lf decongesLanL ls an
lngred ln cold remedy
noLe vlLals 99101 l lnf
Nurse]Dx
lneffecLlve alrway clearance
relaLed Lo nasal congesLlon
8lsk for lmbalanced fluld
volume relaLed Lo excesslve
sweaLlng and loss of flulds
Sleep deprlvaLlon relaLed Lo
frequenL coughlng
lneffecLlve alrway clearance
relaLed Lo nasal congesLlon8lsk
for lmbalanced fluld vol relaLed
Lo excesslve sweaLlng and loss
of flulds Sleep deprlvaLlon
relaLed Lo chronlc coughlng
laLlgue relaLed Lo sleep
deprlvaLlon 8lsk for lnfecLlon
relaLed Lo lnsufflclenL
knowledge Lo avold exposure Lo
paLhogens
(alphaadrenerglc
agonlsLs) prlmarlly for
allerglc rhlnlLls1he
advanLage of sysLemlc
decongesLanL ls LhaL Lhey
relleve nasal congesLlon
for a longer Llme Lhan
nasal decong
lneffecLlve alrway due
Lo congesLlon Lhls wlll
loosen Lhe bronchlal
secreLlons so Lhey can
be excreLed
|ann|ng
CllenL wlll have decreased
nasal congesLlon mucosal
secreLlons and cough
CllenL wlll sleep slxelghL
hours per nlghL
CllenL wlll be free of
nonproducLlve cough A second
bacLerlal lnfecLlon does noL
occur
8elleve nasal congesLlon
for a long Llme
1emporary rellef of
cough caused by mlnor
lrrlLaLlon CllenL wlll be
free of nonproducLlve
cough because lL wlll
loosen secreLlons so
Lhey can be easlly
coughed up
Nurs]Interve
nt|on
Clve oral form wlLh food Lo
decrease gasLrlc dlsLress
AdmlnlsLer lM form ln large
muscle Avold subC!
MonlLor vlLals 8lood pressure
can become elevaLed
uysrLhmlas can occur Cbserve
Lhe color of bronchlal
secreLlons yellow or green
mucus ls lndlcaLlve of bronchlal
lnfecLlon AnLlbloLlcs may be
needed 8e aware LhaL codelne
can lead Lo Lolerance and
dependence
Lphedrlne phenylephrlne
and pseudoephedrlne are
frequenLly comblned wlLh
anLlhlsLamlne analgeslc
or anLlLusslve ln oral cold
remedlesusage of nasal
decongesLanLs longer Lhan
3 days could resulL ln
rebound congesLlon
nurse should emphaslze
Lhe lmporLance of llmlLlng
Lhe use of nasal sprays and
drops WlLh any alpha
adrenerglc drug blood
pressure and blood
glucose can lncrease use
wlLh exLreme cauLlon ln
cllenLs wlLh hyperLenslon
cardlac dlsease
hyperLhyroldlsm and
dlabeLes melllLls
MonlLor vlLals 8lood
pressure can become
elevaLed uysrLhmlas
can occur Cbserve Lhe
color of bronchlal
secreLlons yellow or
green mucus ls
lndlcaLlve of bronchlal
lnfecLlon AnLlbloLlcs
may be needed 8e
aware LhaL codelne can
lead Lo Lolerance and
dependence
C||ent 1each
CeneralLncourage cllenL Lo
avold drlvlng a moLor
vehlcle and performlng
dangerous acLlvlLles whlle
drowsy Avold alchol and
oLher CnS depressanLs
lnsLrucL cllenL Lo Lake drugs
CeneralLell cllenL LhaL
hypoLenslon and hyperpyrexla
may occur when dex ls Laken
wlLh MACls lnsLrucL cllenL on
proper use of nasal spray and
proper use of uff or squeeze
producL lnsLrucL cllenL Lo noL
When uslng decongesLanL
wlLh oLher drug drug
lnLeracLlon can occur
seudo May decrease
effecL of beLa blocker
1aken w/ monoamlne
oxldase may lncrease
Ceneral lnsLrucL cllenL
on proper use of nasal
spray and proper use of
uff or squeeze
producL lnsLrucL cllenL
Lo noL use more Lhan
one or Lwo puffs 46
as prescrlbed noLlfy healLh
care lf confuslon or
hypoLenslon occurs 1ake 30
mln before evenL and
before meal and
bedLlme(prophylaxls
moLlon slckness) lnform
breasLfeedlng mom can be
pasL Lo chlld(unusual
exclLemenL or lrrlLable)
Slde LffecLs Advlse famlly
abouL klds Laklng lL/
nlghLmare lrrlLable
nervous Clder adulLs
confuslon/dlff or palnful
urlnaLlon/dlzzy drowsy feel
falnL dry mouLh nose and
LhroaL SuggesL sugarless
candy gum or lce chlps or
sallva sub Lo relleve dry
mouLh
use more Lhan one or Lwo puffs
46 Llmes a day 8ebound
congesLlon can occur wlLh
overuse Advlce cllenL Lo read
label of C1C drug and check
wlLh healLh care provlder esp lf
cllenL has prob wlLh
hyperLenslon or hyperLhyrold
lnform cllenL LhaL anLlbloLlcs are
noL helpful ln LreaLlng common
cold vlruses Powever Lhey may
be prescrlbed ln secondary
lnfecLlonLncourage older cllenL
wlLh hearL dlsease asLhma
emphysema dlabeLes melllLus
or hyperLenslon Lo conLacL Lhe
healLh care provlder concernlng
Lhe selecLlon of drug ulrecL
cllenL noL Lo drlvedue Lo
drowslness lnsLrucL cllenL Lo
malnLaln adequaLe fluld lnLake
llulds llquefy bronchlal
secreLlons Lo ease ellmlnaLlon
wlLh coughlng 1each cllenL noL
Lo Lake flu remedy before or aL
bedLlme lnsomnla may occur lf
ls conLalns a decongesLanL
Lncourage cllenL Lo geL
adequaLe resL lnform cllenL LhaL
common cold flu vlrus
LransmlLLed hand Lo hand
lnsLrucL cllenL Lo avold envr
olluLanLs smoke and
dusL1each cllenL Lo perform
Lhree effecLlve coughs before
bedLlme Lo promoLe
unlnLerrupLed sleep SLore away
from klds/ chlldproof cap
Advlse cllenL Lo conLacL
healLhcare provlder lf conL 1
wkor ls accomp Peadache
chesL paln fever lnsLrucL cllenL
abouL nose drops and lnhalenLs
hyperLenslon or dysrhLh
CllenL should avold large
amounLs of caffelne bc lL
can cause resLlessness and
palplLaLlons need Lo be
used wlLh exLreme cauLlon
ln cllenLs wlLh
hyperLenslon cardlac
dlsease hyperLhyroldlsm
and dlabeLes melllLus
Llmes a day 8ebound
congesLlon can occur
wlLh overuse Advlce
cllenL Lo read label of
C1C drug and check
wlLh healLh care
provlder esp lf cllenL
has prob wlLh
hyperLenslon or
hyperLhyrold lnform
cllenL LhaL anLlbloLlcs
are noL helpful ln
LreaLlng common cold
vlruses Powever Lhey
may be prescrlbed ln
secondary lnfecLlon
Lncourage older cllenL
wlLh hearL dlsease
asLhma emphysema
dlabeLes melllLus or
hyperLenslon Lo conLacL
Lhe healLh care provlder
concernlng Lhe
selecLlon of drug ulrecL
cllenL noL Lo drlvedue
Lo drowslness lnsLrucL
cllenL Lo malnLaln
adequaLe fluld lnLake
llulds llquefy bronchlal
secreLlons Lo ease
ellmlnaLlon wlLh
coughlng 1each cllenL
noL Lo Lake flu remedy
before or aL bedLlme
lnsomnla may occur lf ls
conLalns a
decongesLanL
Lncourage cllenL Lo geL
adequaLe resL lnform
cllenL LhaL common cold
flu vlrus LransmlLLed
hand Lo hand lnsLrucL
cllenL Lo avold envr
olluLanLs smoke and
dusL1each cllenL Lo
perform Lhree effecLlve
coughs before bedLlme
Lo promoLe
unlnLerrupLed sleep
SLore away from klds/
chlldproof cap Advlse
cllenL Lo conLacL
healLhcare provlder lf
conL 1 wkor ls accomp
Peadache chesL paln
fever lnsLrucL cllenL
abouL nose drops and
lnhalenLs
Cu|tura|
Cons|derat|ons
uecrease language barrlers
by decodlng healLh [argon
Allow LradlLlonal remedles for
LreaLlng Lhe common cold Lo be
lncorporaLed lnLo prescrlbed
wesLern medlcal pracLlces lf
Lhey are harmless ulscuss
pracLlces LhaL could cause bodlly
harm8especLfully presenL
LreaLmenL meLhods Lo care for

cllenLs ln varlous backgrounds
lncrease fluld lnLake geL enough
resL use dlsposable Llssue
Advlse cllenL Lo conLacL
healLhcare Leam lf cold perslsLs
and lf Lemp ls 101

S pp|y ev|dencebased pract|ce gu|de||nes to the adm|n|strat|on of upper and |ower
resp|ratory agents
D|phenhydram|ne Dextromethorphan seudoephedr|ne

Gua|fesnes|n
AdulL (C2330mg q6
8h)(lM or lv10
30mg slngle dose
q46h
max400mg/d)
(C10ml q68h) C60mg q46h
120mg S8 q12h
max 240mg/dA?
C310ml q6
8h
Chlld C/lM/lv
3mg/kg/d ln 4
dlvlded doses
max300mg/d
Chlld612yr(C3ml
q68h)
Chlld 612
yr(30mg q46h
max120mg/day)
Ch||d 26 C
23ml q68h
8n
Chlld23y(C23ml
q68h)
Chlld 23y13mg
q46h max
60mg/day


6 Ident|fy the emergency drug for severe a||erg|c react|ons (d|phenhydram|ne pg937)
8locks hlsLamlne 1 Lhereby decreaslng allerglc response affecLs resp sys blood vessels
and Cl LracL