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Transcript of CHAPTER 11 ALLERGY AND RESPIRATORY MEDICATIONS Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991...
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CHAPTER 11
ALLERGY AND RESPIRATORY MEDICATIONS
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
1
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Learning Objectives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.2
Identify major antihistamines used to treat breathing problems
Describe the action of antitussive medications
List medications used to treat and prevent asthma attacks
Describe the major actions and the adverse reactions of the two main categories of bronchodilators
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Types of AntiHistamines
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.3
ALKYLAMINESbromopheniramine
(Dimetapp)
chlorpheniramine(Chlo-Trimeton)
ETHANOLAMINESdiphenhydramine
(Benadryl)
PHENOTHIAZINEpromethazine
(Phenergan)
PIPERIDINEScetirizine (Zyrtec) fexofenadine (Allegra) lorantidine (Claritin)
PIPERAZINEhydroxyzine (Vistaril)
MISCELLANEOUSazelastine (Astelin)
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Antihistamines (cont.)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.4
UsesSeasonal allergic rhinitis (SAR)Perennial allergic rhinitis (PAR)Perennial nonallergic rhinitis (PNAR)Relieve symptoms of allergic disordersAdjunctive therapy for anaphylaxisSedation
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Antihistamines
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.5
ActionCompete with histamine for H1 receptor sites to
limit its effectivenessLimits vasodilation, capillary permeability, and
swellingLimits acetylcholine release, which dries
secretions in the bronchioles and gastrointestinal system
Sedative effect on the CNS
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Antihistamines (cont.)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.6
Adverse ReactionsChanges in blood pressure, blurred visionTachycardia, insomnia, dry mouth, nauseaRestlessness, excitability, sedation, tinnitus
Drug InteractionsNursing Process
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Antihistamines
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.7
Life span considerationsPediatrics:
Infants and young children often have anticholinergic side/adverse effects
Paradoxical reactions may occur: increased nervousness, confusion, or hyperexcitability
ElderlyMore likely to develop side effects such as
dizziness, syncope (fainting), confusion, and extrapyramidal reactions
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Question 1
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.8
Which of the following is NOT an adverse reaction that may develop from taking antihistamines?
1. Hypertension2. Hypotension3. Tachycardia4. Bradycardia
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Types of Antitussives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.9
Narcoticcodeine phosphatecodeine sulfate
Non-Narcoticdextromethorphan
RobitussinVick’s Formula 44
diphenhydramineBenadryl
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Antitussives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.10
Actions:Depress the cough center in the brainAnesthetize stretch receptors in the
respiratory tractSoothe irritated areas in the throat
Uses:Relief of overactive or nonproductive cough
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Antitussives (cont.)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.11
Adverse ReactionsConstipation, drowsiness, dry mouth, nausea,
postural hypotensionDrug InteractionsNursing Process
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ASTHMA PREVENTIONINTAL (cromolyn sodium)Action: slows destruction of mast cell which
releases the histamine resulting in decreased histamine circulation
ONLY for prophylaxis NOT A RESCUE MEDICATIONMust be inhaled on a set scheduleSymptoms improve within 4 weeksSee MD at weeks 2 & 4Do not stop drug abruptly
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Types of Asthma BronchodilatorsSympathomimetic (Rescue Drugs)
Proventil / Ventolin(albuterol***)
Adrenalin Chloride(epinephrine)
Isuprel(isoproterenol)
Alupent(metaproterenol)
Serevent (salmeterol)Brethine (terbutaline)
Xanthine (-phylline)AminophyllineSlo-Phyllin
(theophylline)
*** albuterol has less cardiac side effects & longer bronchodilation than remainder of drugs listed
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Action of BronchodilatorsOpen the airway by stimulating Beta 2
receptorsSome drugs have greater effects on Beta 1
(heart) than othersSympathomimetic drugs mimic epinephrine
stimulation as side effectsTachycardia and insomnia are frequently
seen.
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Additional Asthma medsLeukotriene receptor inhibitors (for chronic
use); decreases the interleukine release from the injured tissues. NOT a rescue medicationSingulair
(montelukast)Accolate (zafirlukast)
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Corticosteroid Use for Asthma/ COPDSystemic
methylprednisolone
prednisoloneprednisone
InhaledBeclovent
(beclomethasone)Pulmicort
(cortisone for pulmonary tract)(budesonide)
Aerobid (flunisolide)
Flovent (fluticasone propionate)
Azmacort (triamcinolone acetonide)
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Intranasal Steroids (Sprays)Beconase (beclomethasone dipropionate)Rhinocort Aqua (Budesonide)Aerobid (flunisolide)Flonase (fluticasone propionate)Nasonex (mometasone furoate)Nasocort AQ (triamcinolone acetonide)
Many are the same as inhaler medications but reformulated for spray application
Effects are topical unless swallowed
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Actions of Corticosteroid Usage‘… the most potent and consistently
effective medication for long term control of asthma.”
Anti-inflammatory; decrease reaction to allergens
Systemic steroids are used to get quick control of the airway then inhaled steroids will be used to maintain the effect.
Inhaled drugs have a local effect; better for long term use
RINSE the mouth after steroid inhalation to prevent thrush
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Remember: COME -TAPE- FIGS C = Cataracts O = Osteoporosis M = Mood changes E = Elevated blood sugar
T = Thin skin A = Addison’s disease P = Peptic ulcers E = Electrolyte imbalance
F = Fluid retention I = Increased risk of infection G = Gain Weight S = Short stature (if taken as a child)
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DecongestantsAffect alpha cells in blood vessels in nose
tissue = vasoconstriction, decreased fluid movement and edema.
Prolonged use can lead to rebound vasodilation causing more congestion.
Used for congestion in nose, middle ear and Eustachian tube. Decreasing congestion around the auditory tube allows the middle ear to better drain
NOT to be used in infants and toddlersSystemic decongestants work better than
topical but also have more side effects than topical drugs.
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Nasal DecongestantsSympathomimetic
bronchodilatorsephdrineEpinephrine *
* denotes drug used by MDs on a daily basis
InhalersAfrin / Dristan
(oxymetazoline)Neo-Synephrine
(phenylephrine)Sudafed
(pseudoephedrine sulfate)
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ExpectorantsDecrease the thickness of the mucus (by
increasing the water content) in the respiratory tract to aid in the ability to remove it. Increases ciliary movement so cough is effective.
Anti- tuss/ Robitussin/ Mucinex (guaifenesin) Used often; may increase bleeding tendency. Monitor for bruising or bleeding especially if taking anticoagulants
SSKI (iodine products) – use infrequently
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PracticeA 29 year old male comes to the ED with
c/o SOB, wheezing and chest pain when he coughs.
1. What assessments do you perform?2. What lab tests should be ordered?3. Would you start an IV (assume orders are
present)? What kind? Why?4. What medications would the nurse
anticipate being ordered?5. What patient teaching should be
considered?
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QUESTIONS?