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45 Cards in this Set
- Front
- Back
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Parasymphathetic
Cholinergic |
-Controls homeostasis and the body at rest, rest and digest
-Uses Acetylcholine (ACh) as a neurotransmitter |
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Sympathetic
Adrenergic |
-Controls body's responses to a perceived threat, fight or flight
-Uses Nor-epinephrine (NE) as a neurotransmitter or epinephrine (catecholamines) |
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Anticholinergic Drugs |
-Blocks ACh transmitters and has an adrenergic effect (Blocks the parasympathetic response and works like the sympathetic response) |
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Adrenergic Blocking Drugs |
-Alpha 1 Adrenergic Blockers are drugs that work on and block the alpha 1 receptors (heart) causing vasodilation and allows blood to flow more easily -Beta Blockers block catecholamines (heart, blood vessels, lungs) (Both block the sympathetic response and works like the parasympathetic response) |
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Common Cold |
-mostly caused by viral infections (rhinovirus or influenza, virus invade tissue of URT, mucus from inflammatory response drip into LRT causing cold symptoms, irritation of nasal mucosa trigger sneeze reflex, MUCOSAL IRRITATION RELEASE SEVERAL INFLAMMATORY AND VASOACTIVE SUBSTANCES...DILATING BLOOD VESSELS IN SINUSES CAUSING NASAL DECONGESTION. |
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Common Cold Treatment |
-Antihistamines, Antitussives, and expectorants -Tx is symptomatic, does not eliminate pathogen -Tx is empiric, treating most likely cause -Antivirals and antibiotics may be used but wether it is viral or bacterial? Difficult to tell.
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**********Refresher Note********** |
An antigen(foreign object) enters the body, antibodies are released to protect against these antigens, in return white blood cells are activated and mast cells release histamines, histamines go to receptor sites and cause congestion, activates the parasympathetic response! |
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Histamine-an organic compound involved in immune and inflammatory responses and regulates physiological function in the gut |
-Produced by mast cells -Involved in: 1. nerve impulse transmissions in the CNS 2. dilation of capillaries (swollen membranes=congestion) 3. contraction of smooth muscle 4. stimulation of gastric secretion 5. acceleration of the heart rate -2 Histamine Receptors: H1-mediate smooth muscle of capillaries H2- mediate acceleration of heart rate and gastric acid secretions |
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Effects of Histamine |
-Excessive amounts can = anaphylaxis and severe allergic symptoms, may also result in these changes: 1. smooth muscle contraction (stomach and lungs) 2. increase in body secretions 3. vasodilation and capillary permeability resulting in movement of fluid out of blood vessels and into tissues= DROP IN BP AND EDEMA! |
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Antihistamines-drugs that compete with Histamine for specific receptor sites. Several properties= Antihistaminic, Anticholinergic, Sedative |
-H1 antagonists commonly referred to as antihistamines (chloropheniramine, fexofenadine=Allegra, loratidine=Claritin, cetirizine=Zyrtec, diphenhyrdramine=Benadryl) -H2 blockers or H2 antagonists used to reduce gastric acid in peptic ulcer disease (cimetidine=Tagamet, ranitidine=Zantac, famotidine=Pepcid, nizatidine=Axid |
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Antihistamines Mechanism of Actions |
-H1 blockers bind to Histamine receptor sites=Block action of Histamine -Compete with Histamine for binding at unoccupied receptor sites but can not push Histamine off if already bound! -More effective in preventing actions of Histamine the reversing them (Give Tx early!) |
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Histamine vs Antihistamine Effects on Cardiovascular (small blood vessels) |
-Histamine- dilation and increased permeability (allows leakage of substances into tissues) -Antihistamine-reduce dilation of blood vessels and reduce increased permeability of blood vessels |
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Histamine vs Antihistamine Effects on Smooth muscle (on exocrine glands) |
-Histamine- stimulate salivary, gastric, lacrimal, and bronchial secretions -Antihistamine-reduce salivary, gastric, lacrimal and bronchial secretions |
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Histamine vs Antihistamine Effects on Immune system |
-Histamine-mast cells release Histamines and other substances=ALLERGIC REACTIONS -Antihistamines- binds to Histamine receptors=STOP HISTAMINE FROM CAUSING RESPONSE |
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Other Antihistamine Effects |
-Skin-reduce capillary permeability, wheel and flare formation, itching -Anticholinergic-drying effect=REDUCING nasal, salivary, and lacrimal grand secretions (runny nose, tearing, and itching eyes) -Sedative-some cause drowsiness |
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Antihistamine Indications |
-Management of nasal allergies, seasonal or perennial allergic rhinitis (hay fever), allergic reactions, motion sickness, Parkinson's disease, sleep disorders, symptoms associated with common cold (sneezing, runny nose) but palliative Tx not curative |
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Antihistamine Adverse Effects |
-Anticholinergic-drying effects (dry mouth, difficulty urinating, constipation, changes in vision) -Sedative-mild drowsiness to deep sleep |
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Two types of Antihistamines |
-Traditional -Nonsedating
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Nonsedating/Peripherally Acting Antihistamines |
-developed to eliminate adverse effects, mainly sedation -work peripherally to block Histamine actions=thus fewer CNS adverse effects -Longer duration of action (increases compliance) (ex. Allegra, Claritin, and Zyrtec) |
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Traditional Antihistamines |
-older -work both peripherally and centrally -Anticholinergic effects=more effective than nonsedating drugs in some cases (ex. Benadryl, Dimetapp, chlorpheniramine, Dramamine, Antivert, Phenergan) |
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Antihistamines Nursing Implications |
-Gather data on why they require Tx, assess for drug allergies -Contraindicated in acute asthma and LR diseases like pneumonia -USE CAUTION in increased intraocular pressure, cardiac or renal disease, hypertension, asthma, COPD, peptic ulcer disease, BPH, or pregnancy -Instruct pts to report excessive sedation, confusion, or hypotension |
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Antihistamines Nursing Implications cont'd |
-Instruct pts to avoid driving or operating heavy machinery, advise against consumption of alcohol or CNS depressants -Instruct pts not to take these with other meds without consulting prescriber -best when taken with meals= reduce GI upset -dry mouth? teach pt to perform frequent mouth care, chew gum, hard candy to ease discomfort -Monitor for intended therapeutic effects |
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Nasal Congestion |
-excessive nasal secretions -inflamed and swollen nasal mucosa -primary causes= allergies and UR infections -(vessels dilate and become semipermeable) |
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Types of Decongestants |
-Adrenergics- (constrict small arterioles that supply structures of UR tract), largest group, sympathominetics-mimic effects of transmitter substances of sympathetic nervouse system -Anticholinergics- less commonly used, parasympatholytics -Corticosteroids-topical, intranasal steroids |
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Oral Decongestants |
-prolonged decongestant effects, but delayed onset -effect less potent than topical -no rebound congestion (due to first pass effect) -exclusively adrenergics (ex. psuedoephedrine (Sudafed) |
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Topical Nasal Decongestants |
-Topical Adrenergics-prompt onset, potent, sustained use over several days=rebound congestion -Adrenergics- phenlyephrine(Neo-Synephrine) -Intranasal Steroids- (aimed at inflammation) (ex. beclomethasone dipropionate (Beconase), budesonide (Rhinocort), flunisolide (Nasalide), fluticasone (Flonase), triamcinolone (Nasacort), ciclesonide (Omnaris) -Intranasal Anticholinergic- ipratropium (Atrovent) |
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Nasal Decongestants Mechanism of Action |
-Site of action= blood vessels surrounding nasal sinuses -Adrenergics- constrict small blood vessles that supply UR tract structures=tissues shrink, nasal secretions in swollen mucous membranes better able to drain -Nasal Steroids- antiinflammatory effect, work to turn off immune system cells involved in inflammatory response, decreased inflammation=decreased congestion |
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Nasal Decongestants Drug Effects |
-shrink engorged nasal mucous membranes -relieve nasal stuffiness
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Nasal Decongestants Indications |
-Relief of nasal congestion associated with acute or chronic rhinitis, common cold, sinusitis, hay fever, other allergies -may also be used to reduce swelling of the nasal passage and facilitate visualization of nasal/pharyngeal membranes before surgery or diagnostic procedures |
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Nasal Decongestant Adverse Effects |
-Adrenergics- nervousness, insomnia, palpitations, tremors, (systemics effects caused by adrenergic stimulation of the heart, blood vessels, and CNS) -Steroids- local mucosal dryness and irritation |
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Nasal Decongestants Nursing Implications |
-may cause hypertension, palpitations, and CNS stimulations, avoid in pts with these conditions -pts on medication therapy for hypertension should check with prescriber before taking OTC decongestants -assess for drug allergies -avoid caffeine and caffeine containing products -report for fever, cough, or other symptoms lasting longer than a week -monitor for intended therapeutic effects |
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Cough |
-respiratory secretions and foreign objects removed by cough reflex -cough reflex (medulla oblongata)- induces coughing and expectoration-initiated by sensory receptors in respiratory tract
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Two Types of Cough |
-productive cough-congested, removes excessive secretions -nonproductive cough-dry cough -most of time coughing is beneficial due to removal of excessive secretions and potentially harmful foreign substances -some situations coughing can be harmful such as after hernia repair surgery |
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Antitussives |
-drugs used to stop or reduce coughing -opioid and nonopiod -used only for nonproductive coughs! -may be used in some cases where coughing is harmful
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Antitussives Mechanism of Action |
Opiods-(psychoactive chemical that resemble morphine; one of the oldest known drugs from poppy plant)-suppress cough reflex by direct action on cough center in medulla -ex. codeine (Robitussin A-C, Dimetane-DC), hyrdrocodone |
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Antitussives Mechanism of Action |
Nonopiods- suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated -ex. benzonatate (Tessalon Perles), dextromethorphan (Vicks Formula 44, Robitussin-DM) |
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Antitussives Indications |
-used to stop the cough reflex when the cough is nonproductive and/or harmful |
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Anitussives Adverse Effects |
-benzonate-dizziness, headache, sedation, nausea, and others -dextromethorphan-dizziness, drowsiness, nausea -opiods-sedation, nausea, vomiting, lightheadedness, constipation
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Anitussives Nursing Implications |
-perform respiratory and cough assessment and assess for allergies -instruct pt to avoid driving or operating heavy machinery -report symptoms of cough lasting more than a week, fever, persistent headache, fever, rash -ANTITUSSIVE DRUGS ARE FOR NONPRODUCTIVE COUGHS -monitor for intended therapeutic effects -
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Expectorants |
-drugs that aid in the expectoration (removal) of mucus -reduce the viscosity (thickness) of secretions -disintegrate and thin secretions -ex. guaifenesin (Mucinex) |
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Expectorants Mechanisms of Action |
-reflex stimulation- drug causes irritation of GI tract, loosening and thinning of respiratory tract secretions occur in response to this irritation -direct stimulation- secretory glands are stimulated directly to increase their production of respiratory tract fluids -final result? = thinner mucus that is easier to remove |
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Expectorants Drug Effects |
-by loosening and thinning sputum and bronchial secretions=the tendency to cough is indirectly diminished |
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Expectorants Indications |
-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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Expectorants Nursing Implications |
-should be used with caution in the elderly or those with asthma or respiratory insufficiency -patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions -report fever, cough, or other symptoms lasting longer than a week -monitor for intended therapeutic effects |
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Echinacea: Herbal Product |
-reduces symptoms of the common cold and recovery time -adverse effects- dermatitis, GI disturbance, dizziness, headache |
