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40 Cards in this Set
- Front
- Back
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Understanding the Common Cold
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Rhinovirus or influenza virus
invades upper resp excessive mucus sore throat, coughing, upset stomach |
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Treatment of Common Cold
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Involves combined use of antihistamines, nasal decongestants, antitussives, & expectorants
Treatment is symptomatic only, not curative |
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Antihistamines: Mechanism of Action
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Block action of histamine at H1 receptor sites
Compete with histamine for binding at unoccupied receptors Cannot push histamine off the receptor if already bound The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation Vasodilation Increased GI & respiratory secretions Increased capillary permeability The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation Vasodilation Increased GI & respiratory secretions Increased capillary permeability More effective in preventing the actions of histamine rather than reversing them Should be given early in treatment, before all the histamine binds to the receptors |
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Antihistamines: Indications
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Management of:
Nasal allergies Seasonal or perennial allergic rhinitis (hay fever) Allergic reactions Motion sickness Parkinson’s disease Sleep disorders Also used to relieve symptoms associated with the common cold Sneezing, runny nose Palliative treatment, not curative |
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Oral Decongestants
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Prolonged decongestant effects, but delayed onset
Effect less potent than topical No rebound congestion Exclusively adrenergics Example: pseudoephedrine (Sudafed) |
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Topical Nasal Decongestants
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Topical adrenergics -
Prompt onset Potent Sustained use over several days causes rebound congestion, making the condition worse |
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Nasal Decongestants: Mechanism of Action
Adrenergics |
Constrict small blood vessels that supply URI structures
As a result these tissues shrink, & nasal secretions in the swollen mucous membranes are better able to drain Nasal stuffiness is relieved |
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Nasal Decongestants: Mechanism of Action
Nasal steroids |
Antiinflammatory effect
Work to turn off the immune system cells involved in the inflammatory response Decreased inflammation results in decreased congestion Nasal stuffiness is relieved Shrink engorged nasal mucous membranes Relieve nasal stuffiness |
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Nasal Decongestants: Indications
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Acute or chronic rhinitis
Common cold Sinusitis Hay fever Other allergies May also be used to reduce swelling of the nasal passage & facilitate visualization of the nasal/pharyngeal membranes before surgery or diagnostic procedures |
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Antitussives
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Drugs used to stop or reduce coughing
Opioid & nonopioid Used only for nonproductive coughs! May be used in cases where coughing is harmful |
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Opioids: Mechanism of Action
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Suppress the cough reflex by direct action on the cough center in the medulla
Examples: codeine (Robitussin A-C, Dimetane-DC) hydrocodone |
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Non-opioids: Mechanism of Action
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Suppress the cough reflex by numbing the stretch receptors in the respiratory tract & preventing the cough reflex from being stimulated
Examples: benzonatate (Tessalon Perles) dextromethorphan (Vicks Formula 44, Robitussin-DM) |
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Antitussives: Nursing Implications
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avoid heavy machinary
avoid drinking for 30min afterwards |
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Expectorants
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Drugs that aid in the expectoration (removal) of mucus
Reduce the viscosity of secretions Disintegrate & thin secretions |
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Expectorants: Mechanisms of Action
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Reflex stimulation
Drug causes irritation of the GI tract Loosening & thinning of respiratory tract secretions occur in response to this irritation Example: guaifenesin Direct stimulation The secretory glands are stimulated directly to increase their production of respiratory tract fluids Final result: thinner mucus that is easier to remove so the tendency to cough is indirectly diminished |
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Expectorants: Indications
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Used for the relief of productive coughs associated with:
Common cold Bronchitis Laryngitis Pharyngitis Coughs caused by chronic paranasal sinusitis Pertussis Influenza Measles |
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Herbal Products: Echinacea
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Reduces symptoms of the common cold & recovery time
Adverse effects Dermatitis GI disturbance Dizziness Headache |
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Diseases of the Lower Respiratory Tract
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COPD =
Asthma Emphysema Chronic bronchitis |
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Bronchial Asthma
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Recurrent & reversible shortness of breath
Occurs when the airways of the lungs become narrow as a result of: Bronchospasms Inflammation of the bronchial mucosa Edema of the bronchial mucosa Production of viscid mucus Alveolar ducts/alveoli remain open, but airflow to them is obstructed Symptoms Wheezing Difficulty breathing |
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Asthma
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Three categories
Allergic Idiopathic Mixed allergic-idiopathic |
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Status asthmaticus
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Prolonged asthma attack that does not respond to typical drug therapy
May last several minutes to hours Medical emergency |
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Emphysema
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Air spaces enlarge as a result of the destruction of alveolar walls
The surface area where gas exchange takes place is reduced Effective respiration is impaired |
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Drugs Used to Treat Asthma
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Long-term control
Leukotriene receptor antagonists Inhaled steroids Long-acting beta2-agonists Quick relief Intravenous systemic corticosteroids Short-acting inhaled beta2-agonists |
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Bronchodilators & Respiratory Drugs
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Bronchodilators
-Beta-adrenergic agonists -Xanthine derivatives Anticholinergics Leukotriene receptor antagonists Corticosteroids |
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Bronchodilators: Beta-Agonists
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Large group, sympathomimetics
Used during acute phase of asthmatic attacks Quickly reduce airway constriction & restore normal airflow Stimulate beta2-adrenergic receptors throughout the lungs |
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Beta-Agonists - 3 Types
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Nonselective adrenergics
Nonselective beta-adrenergics Selective beta2 drugs |
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Beta-Agonists: Mechanism of Action
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Begins at the specific receptor stimulated
Ends with dilation of the airways - Activation of beta2 receptors activates cyclic adenosine monophosphate (cAMP), which relaxes smooth muscle in the airway & results in bronchial dilation & increased airflow |
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Beta-Agonists: Indications
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Relief of bronchospasm related to asthma, bronchitis, & other pulmonary diseases
Used in treatment & prevention of acute attacks Used in hypotension & shock Used to produce uterine relaxation to prevent premature labor |
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Anticholinergics
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Ipratropium bromide (Atrovent) & tiotropium (Spiriva)
Slow & prolonged action Used to prevent bronchoconstriction NOT used for acute asthma exacerbations! |
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Anticholinergics: Mechanism of Action
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Acetylcholine (ACh) causes bronchial constriction & narrowing of the airways
Anticholinergics bind to the ACh receptors, preventing ACh from binding Result: bronchoconstriction is prevented, airways dilate |
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Xanthine Derivatives: Mechanism of Action
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Increase levels of energy-producing cAMP
This is done competitively inhibiting phosphodiesterase (PDE), the enzyme that breaks down cAMP Result: decreased cAMP levels, smooth muscle relaxation, bronchodilation, & increased airflow |
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Xanthine Derivatives: Drug Effects
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Also cause cardiovascular stimulation: increased force of contraction & increased heart rate, resulting in increased cardiac output & increased blood flow to the kidneys (diuretic effect)
Cause bronchodilation by relaxing smooth muscle in the airways Result: relief of bronchospasm & greater airflow into & out of the lungs Also cause CNS stimulation |
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Xanthine Derivatives: Indications
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Dilation of airways in asthmas, chronic bronchitis, & emphysema
Mild to moderate cases of acute asthma Adjunct drug in the management of COPD Not used as frequently because of potential for drug interactions & variables related to drug levels in the blood |
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Xanthine Derivatives: Nursing Implications
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contra : history of PUD or GI disorders
Cautious use : cardiac diease XR Be aware of drug interactions with cimetidine, oral contraceptives, allopurinol, certain antibiotics, others |
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Leukotriene Receptor Antagonists (LTRAs) : Mech
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Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body
Leukotrienes cause inflammation, bronchoconstriction, & mucus production Result: coughing, wheezing, shortness of breath LRTAs prevent leukotrienes from attaching to receptors on cells in the lungs & in circulation Inflammation in the lungs is blocked, & asthma symptoms are relieved |
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LRTAs: Indications
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Prophylaxis & chronic treatment of asthma in adults & children older than age 12
NOT meant for management of acute asthmatic attacks Montelukast is approved for use in children ages 2 & older, & for treatment of allergic rhinitis |
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LRTAs: Nursing Implications
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chronic asthma only
improvement in 1 week |
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Corticosteroids: Mechanism of Action
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For chronic asthma
Stabilize membranes of cells that release harmful bronchoconstricting substances These cells are called leukocytes, or white blood cells Increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation |
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Inhaled Corticosteroids: Indications
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Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators
NOT considered first-line drugs for management of acute asthmatic attacks or status asthmaticus |
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Inhaled Corticosteroids: Nursing Implications
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Contrai: in patients with psychosis, fungal infections, AIDS, TB
gargle and rinse afterward bronchodilator should be used several minutes before corticosteroids |
