Drugs to treat upper Respiratory Disease

Upper respiratory Anatomy

+ Nose and turbinates
+ Sinuses
+ Nasopharynx
+ Pharynx
+ Tonsils
+ Eustachian tubes
+ Larynx
Review of Common Upper Respiratory Diseases
+ Rhinitis
+ Inflammation of nasal mucous membrane
+ Viral - most common “common cold”
+ Bacterial
+ Presence of foreign body
+ Drug Induced Congestion -rhinitis medicamentosa
+ TX
+ PREVENTION IS BEST
+ Taper off decongestant
+ Allergic Rhinitis

sympathomimetics vasoconstriction to reduce

+ Allergic reaction
+ Large release of histamine
+ Tx bloodflow to stuffynose thereby reducin
swelling edema
+ ID allergen - skintesting
+ Avoid exposure
+ Antihistamines
+ Decongestants
Antihistamines reducesymptoms ofallergies
stop itching runnynose sneezing
+ Intranasal anti inflammatory
+ Take allergy medication 45-60 minutes prior to exposure to allergen
+ FOR SEASONAL ALLERGIES START WEEKS LEADING UP TO ALLERGY SEASON
+ Common Cold CORYZA
+ Viral - TX
+ Limited to relieving symptoms
+ Antihistamine
+ Analgesics
+ Antipyretics
+ Expectorants
+ Antitussive
+ BEST PREVENTION IS HANDWASHING
 MEDICATIONS TO TREAT UPPER RESPIRATORY DISEASE

Medication Class Administration Use Side effects

Pseudoephedrine. Sympathomimetic + Topically (Nasal spray) + Relieve congestion + HTN

Phenylephrine Decongestants + Orally associated with rhinitis + Do not take before bed, stimulants
common cold

iii
Fexofenadine, Antihistamine + Plan to administer 45 - 60 minutes prior to + Reduce symptoms of + Assess for hx of BPH or asthma
sarcomaactin
initiensis
diphenhydramine, exposure allergic reaction + Sedative effects (1st gen)
loratadine, cetirizine + Nasal spray + Cognitive impairment (1st gen)
carminute + Tablets + Drying effects
+ Syrup (lots of water)
+ Injection + Anticholinergic effects
sexotenadine
+ Suppository
1ˢᵗgenerationknownforcausingdrowsiness
“ONE” Intranasal + Given to patients who do not respond to + Reduction of + Nasal burning
Corticosteroids antihistamines or sympathomimetic inflammation + Over use

I
+ Have patient blow nose thoroughly before + Addisonian crisis

fit + If the patient is on long term

corticosteroid treatment they must
taper off

Cromolyn Sodium Mast Cell Stabilizer + Multiple doses a day + Inhibits the release of + Nasal burning
+ Must be given 45-60 mins prior to histamine + Bronchospasm
exposure to allergen + Coughing
+ Take weeks before seasonal allergies
Aimpruitusitching
+ Nasal spray I
 Drugs to treat lower respiratory diseases
+ Anatomy
+ Larynx
+ Trachea
+ Bronchus
+ Arterioles
+ Bronchiole
+ Alveolus
+ Common Disorders
+ COPD treatment
cysticfibrosis Pulmozyme inhalation
fibrosis
+ CLAD specifictocystic
+ ASTHMA
+ CHRONIC BRONCHITIS
+ EMPHYSEMA
+ PULMONARY FIBROSIS
+ ABG’S
+ PH-- 7.35-7.45
+ HC03-- 21-28
+ PaCO2-- 35-45
+ PaO2-- 80-100
+ Sao2-- >95%
 Medications used to treat lower respiratory disease

Medications Class Administration Use Side Effects

Guaifenesin Expectorants + Oral + Enhances the output of respiratory

+ Tablets tract fluid
+ Not super helpful without the presence of
mucus

Potassium Iodide SSKI Expectorants + Liquid + Increases bronchial gland secretion + Long term use may induce goiter formation
+ Lots of water 8-12 8oz glasses of water a + Reduces mucous viscosity + Nausea
day
+ Vomiting
+ Do not admin with potassium sparing
+ Diarrhea
diuretics (spironolactone)
+ Take with food or milk to minimize GI upset givethroughstrawstainsteeth
Saline Solutions Expectorants + Effective when administered nebulized + Hydrates mucus and reduces
+ Nasal spray viscosity

Codeine Antitussives + Do not mix with other CNS depressants + Suppress cough center in the brain + DM medications can not be taken longer than 10
Dextromethorphan (the DM seen with expectorants) + Do not give with history of substance abuse + Common at bed time days d/t toxicity
Tesslon Pearles - benzonatate
+ CNS depressant - drowsiness, constipation
Hydrocodone
Sedationrespiratorydepression

Acetylcysteine Mucolytic Agents + Nebulizer treatment + Dissolves abnormally viscous mucus

+ Wash hands and face post administration
d/t sticky residue
+ Acetaminophen antidote
+ Rotten egg smell
+ Do ot give with ABX
Medication Class Administration Use Side Effects

“Corts” + flovent and beclomethasone Anti Inflammatory agents + Rinse mouth well after to avoid thrush + Given to patients unresponsive to
(corticosteroids)
It stash nowbetetent xanthine and sympathomimetic

tt fcanons
any corticosteroids
commonly endinone +
agents
Easier to breath

+ Short acting - SABA Bronchodilators + Oral + Reverse airway constriction + Nervousness increase bloodglucose
+ Albuterol + Aerosol “rescue inhalers” + Anxiety
Beta drugs
adrenergic
+ Levalbuterol + Nebulizer
+ Headache
+ Long acting LABA + Parenteral
+ Nausea/vomiting
+ Arformoterol + Patient education
+ Salmeterol + Wait 1-2 minutes between ADVERSE SIDE EFFECTS
each puff FOR SAME MED + Tachycardia
+ Wait 5 mins between puffs of + Tremors
DIFFERENT MEDICATIONS --Contraindicated with patients that have heart issues Diabete

patients
+
+
Ipratropium bromide (short acting)
Tiotropium Bromide (long acting)
Anticholinergic Bronchodilators + Preferred bronchodilator of patients with
heart issues
+ Long term treatment of COPD

remonssema 1919 gYadfmttanatnsawp.lt

+ You can mix and match with beta adrenergic

and anticholinergic bronchodilators
“duoneb” antionong EE
+ Double benefits without
increased
smogingigures doubling side effects

+ Theophylline Xanthine Derivative + Maintain medication + Dilates tracheobronchial tree + Lots and lots of SE
Bronchodilator + PO, parental + Nausea
+ Typically late stage COPD
+ Vomiting
+ Dyspepsia angraproned
ADVERSE SIDE EFFECTS
+ Tachycardia
+ Dysrhythmias
+ Tremors
+ Toxicity
MONITOR FOR TOXICITY
+ Normal 10-20
+ Cardiac dysrhythmias
+ n/v
+ LOC changes
Medication Class Administration Use Side Effects

+ Montelukast Antileukotriene Agents + Pill + Daily use for asthma + Agitation

+ zafirlukast + Not for acute distress + Does not bronchodilator + Aggression
+ Decrease severity and frequency of + Suicidal ideation
zyloaccolatesingular attacks

Roflumilast Phosphodiesterase + One tab daily WITH FOOD + Bronchodilator for COPD + Dyspepsia
Inhibitors + Nausea
+ Diarrhea
+ Weight loss
+ Headache
ADVERSE SIDE EFFECTS
+ Insomnia
+ Anxiety
+ Depression
+ Suicidal ideation

“UMAB” Immunomodulators + Sub q injection + Reduces frequency of asthma + Injection site reaction
attacks
expensive
Tuberculosis Review
+ Tuberculosis Infection - latent TB
+ Tuberculosis Disease - active case
+ Two types of drug therapy
+ Preventative - we know the patient has been exposed and we want to beat it to the punch
+ Active tuberculosis
+ Nursing interventions
+ Emphasis on the importance of drug therapy compliance
+ Do not take antacids with TB drugs
+ Decreases absorption
+ INH and Rifampin administration 1 hour ac or 2 hour pc
 Medications used for the treatment of Tuberculosis

Medication Class Administration Use Side Effects

Isoniazid (INH) antitubercular + Educate patient to + Preventative therapy + Tingling

+ Used in + Numbness
combination with + Nausea
other medications + Vomiting
+ No alcohol + PERIPHERAL NEURITIS
+ TAKE WITHOUT + BURNING AND
FOOD TINGLING IN HAND
AND FEET
+ ADMIN B6 TO HELP
+ HEPATOTOXIC

Rifampin antitubercular + Route PO, IV + TURNS SECRETIONS RED

+ DO NOT TAKE WITH FOOD AT + HEPATOTOXICITY
ALL + THROMBOCYTOPENIA
+ Monitor cbc, liver enzyme, + RENAL FAILURE
renal function test + Drowsiness
+ Nausea / vomiting
+ Anorexia

Ethamutol / myambutol antitubercular + Oral + Red green vision changes

+ IM + N/V
+ TAKE WITH FOOD + Skin rash
+ Contact HP if vision changes + Fever
occur ADVERSE SIDE EFFECTS
+ Not for pediatric kids + Peripheral neuropathy
+ Hypersensitivity
+ LOC changes
+ EXACERBATION OF GOUT