Term
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Definition
Limited to relief of symptoms
Decongestants are most effective agents
Antihistamines are of some benefit
Analgesics, antipyretics, expectorants, antitussive agents also beneficial, depending on symptoms
Conventional treatments: disinfect the environment, wash hands, obtain rest, and drink plenty of fluids.
Usual viral course is 6 to 10 days. |
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Term
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Definition
Identify allergens (skin testing)
Avoid exposure to allergens, if possible
Antihistamines, decongestants, intranasal anti-inflammatory agents
Saline nasal spray to reduce nasal irritation
Immunotherapy may be indicated for partially controlled symptoms, need for high doses of corticosteroids, or with complications of asthma or sinusitis. |
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Term
| Rhinitis medicamentosa (rebound congestion) |
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Definition
Caused by misuse of nasal decongestants
Leads to chronic sinusitis, atrophic rhinitis, permanent turbinate hyperplasia
Symptoms confined to the nose; consist of chronic nasal congestion
Prevention is best treatment
Several strategies can successfully wean patients off decongestants |
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Term
| Sympathomimetic Decongestants |
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Definition
Actions
Stimulate alpha adrenergic receptors of nasal mucous membranes causing vasoconstriction
Shrinks nasal mucous membranes
Reduces nasal secretion
Uses
Relieve congestion associated with rhinitis
Therapeutic outcomes
Reduced nasal congestion, easier breathing
Common adverse effects
Mild nasal irritation
Serious adverse effects
Hypertension
Often used in conjunction with antihistamines to treat allergic rhinitis.
Administered orally or topically as nasal spray; if used improperly, it can lead to rebound swelling |
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Term
| Sympathomimetic Decongestants |
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Definition
Use cautiously in pts with HTN, hyperthyroidism, cardiac disease, glaucoma(because of adrenergic effects)
Explain proper dosing and technique of nasal sprays
Teach side effects and how to monitor if necessary (pulse, BP, etc)
Evaluate other meds that may be contraindicated (hypertension meds |
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Term
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Definition
Oxymetazoline (Afrin), pseudoephedrine (Sudafed)
Administration
Nasal spray, nasal drops, tablet, capsule, liquid
Interactions
Sudafed may decrease effect of BBs
May increase HTN, dysrhythmias with MAOIs
May increase restlessness, palpitations with caffeine (e.g., coffee, tea) |
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Term
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Definition
Monoamine Oxidase Inhibitors:
MAO inactivates Norepinephrine, dopamine, epinephrine, & serotonin
SO... MAOIs INCREASE these neurotransmitters which will cause
Increase BP
Increase pulse
Increase risk for dysrhythmias |
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Term
| Nasal Decongestants (cont’d) |
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Definition
Oxymetazoline (Afrin), pseudoephedrine (Sudafed)
Side effects
Nervous, jittery, restless
Alpha-adrenergic effect (hypertension, hyperglycemia)
Frequent use
May lead to tolerance
May lead to rebound nasal congestion (especially with the nasal sprays)
Should not use longer than 5 days
Nasal acts faster and has fewer side effects than systemic decongestants |
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Term
| Drug Class: Antihistamines |
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Definition
Actions
Compete with allergy-liberated histamine for H1-receptor sites
More effective when taken before histamine is released (when symptoms first appear)
Uses
Treat allergic rhinitis, conjunctivitis
Therapeutic outcomes
Reduced symptoms of allergic rhinitis (rhinorrhea, lacrimation, sneezing, nasal itching)
Common adverse effects
Sedative effects, cognitive impairment, drying effects, anticholinergic effects |
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Term
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Definition
H1-blockers (antagonists)
First-generation antihistamines
Diphenhydramine (Benadryl)
Second-generation antihistamines
Cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin)
Nonsedating antihistamines; little to no effect on sedation |
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Term
| Diphenhydramine (Benadryl |
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Definition
Action
Competes with histamine for receptor sites preventing a histamine response
Reduces nasopharyngeal secretions, itching, sneezing
Use
Treat acute and allergic rhinitis, antitussive
Contraindications/cautions
Severe liver disease, narrow-angle glaucoma, urinary retention |
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Term
| Diphenhydramine (Benadryl |
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Definition
Administration: oral, IM, IV
Interactions
Increase CNS depression with alcohol and other CNS depressants
Avoid use of MAOIs
Side effects
Drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dyscrasias |
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Term
| Second-generation antihistamines |
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Definition
Differences
Less sedation
Fewer anticholinergic effects
Dry mouth, blurred vision, wheezing, urinary retention
May be taken with a moderate amount of alcohol, but this is not recommended |
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Term
| intranasal corticosteroids |
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Definition
Actions
Reduce inflammation; mechanism of action unknown
Uses
For patients who do not respond to antihistamines or sympathomimetic agents
Therapeutic outcomes
Reduced rhinorrhea, rhinitis, itching, sneezing
Common adverse effect
Nasal burning |
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Term
| Fluticasone (Flonase), triamcinolone (Nasacort) |
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Definition
Action
Antiinflammatory
Decreases allergy symptoms (sneezing, congestion, runny nose)
Use
Treat allergic rhinitis (short-term use)
May be used alone or in combination with H1 antihistamines
Dexamethasone should not be used longer than 30 days to avoid systemic effects |
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Term
| cromolyn sodium (Nasalcrom |
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Definition
Actions
Stabilize mast cells, reducing the release of histamine and other mediators
Uses
In conjunction with other drugs to treat severe allergic rhinitis
Common adverse effect
Nasal burning, irritation (sneezing)
Serious adverse effects
Bronchospasm, coughing (notify MD if these occur) |
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Term
| cromolyn sodium (Nasalcrom |
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Definition
Nonprescription.
Usefulness is often limited because of the need for frequent dosing.
May be most beneficial when used as a prophylactic treatment before an anticipated allergen exposure or in patients whose medical conditions do not allow the use of other medications (e.g., pregnancy). |
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Term
| cromolyn sodium (Nasalcrom) |
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Definition
Nursing considerations
MUST be taken before body receives a stimulus to release histamine
Have pt blow nose before use
Do not share bottle with anyone
Instruct pt that may take 2-4 weeks for effectiveness to be seen
Must continue therapy even when symptom-free to ensure full effectiveness
Using a decongestant along with a corticosteroid will facilitate penetration |
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Term
| Arterial Blood Gases (ABGs) |
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Definition
pH – 7.35-7.45
PaCO2 – 35-45 mm Hg
PaO2 – 80-100 mm Hg
HCO3 – 21-28 mEq/L
SaO2 (oxygen saturation) 95% |
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Term
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Definition
Actions
Enhance output of respiratory tract fluid, decrease mucus viscosity, promote ciliary action
Uses
Relieve dry, nonproductive cough
Treat symptoms of common cold, bronchitis, laryngitis, pharyngitis, sinusitis
Common adverse effects
GI upset, nausea, vomiting |
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Term
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Definition
Supplied:
solution: mix in water or juice
Syrup
tablets
Actions
Expectorant; stimulates increased secretions, making it easier to cough
Uses
Treat chronic pulmonary diseases such as bronchial asthma, bronchitis, emphysema
Common adverse effects
Nausea, vomiting, diarrhea |
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Term
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Definition
Patients should notify the prescriber if taking any other medications containing potassium.
Concurrent use of humidification in patients taking expectorants helps to decrease the viscosity of secretions.
Long-term use may result in goiter; thyroid function tests are important. |
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Term
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Definition
Commonly given to pediatric pts who cannot take antihistamines or cough suppressants
Actions
Hydrate and stimulates a productive cough by irritating resp passages, reduce viscosity
Uses
Expectorant, administered by nebulization
Common adverse effects
None noted |
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Term
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Definition
Drugs
Benzonatate (Tessalon Perles)
Codeine
Dextromethorphan (Robitussin, Delsym)
Diphenhydramine (Benadryl, Tusstat)
Actions
Suppress cough center in brain
Uses
Suppress disruptive spasms
Common adverse effects
Dry mouth, drowsiness, constipation |
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Term
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Definition
Nursing Considerations
Assess allergies
Suppressing a productive cough is not recommended
Assess if pt taking any CNS depressants
Codeine is especially constipating, enc adequate fluid intake, mobility, and possible use of bulk stool softeners
Do not administer Codeine to someone who has resp depression |
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Term
| acetylcysteine (Mucomyst (Mucolytic agents) |
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Definition
Actions
Dissolve chemical bonds in mucus
Liquifies and loosens thick mucus secretions
Uses
Dissolve abnormally viscous mucus
Treat chronic emphysema, emphysema with bronchitis, asthmatic bronchitis, pneumonia
Common adverse effects
Nausea, vomiting
Serious adverse effects
Bronchospasm |
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Term
| Acetylcysteine (Mucomyst) |
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Definition
Administration
Nebulizer treatment
Administer 5 minutes after a bronchodilator
Should not be mixed with other drugs
Adequate po fluid intake can help loosen secretions as well
Also an antidote for acetaminophen overdose if within 12-24 hours
Give orally diluted in juice or soft drink |
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Term
| Beta-Adrenergic Bronchodilating Agents |
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Definition
Actions
Stimulate beta receptors within smooth muscle of tracheobronchial tree
Uses
Reverse airway constriction
Mainstay of all asthma therapy
Serious adverse effects
Tachycardia, palpitations, tremors, nervousness, anxiety, restlessness, headache, dizziness, nausea and vomiting |
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Term
Selective beta2-adrenergic agonists
Albuterol (Proventil), Metaproterenol (Alupent) |
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Definition
Used for acute attacks
Action: relaxes smooth muscle of bronchi & enhances bronchodilation
Administration: oral, inhalation
Side effects: tremors, restlessness, anxiety, headaches, nervousness,
Has fewer side effects than the non-selective beta-adrenergic agonists
These are used for quick relief of asthmatic symptoms, because onset is rapid and enhances bronchodilation |
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Term
| Selective beta2-adrenergic agonists |
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Definition
Nursing Considerations
Have pt wait 5-10 minutes between each inhalation to allow med to dilate bronchioles so second dose can be inhaled more deeply
Obtain baseline vitals and pulse oximetry before AND after administration.
Notify MD if pulse inc to 20 beats/min after administration.
Obtain baseline mental status (nervousness, anxiety) and report significant changes to MD
Always report palpitations and suspected dysrhythmias to MD, a decrease in dose may be necessary. |
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Term
| Anticholinergic Bronchodilating Agents |
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Definition
ipratropium bromide (Atrovent), tiotropium bromide (Spiriva)
Used in combination with beta adrenergic bronchodilators.
Best used for prophylaxis and maintenance and not for acute attacks.
Tiotropium longer in duration of action than ipratropium. |
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Term
| ipratropium bromide (Atrovent), tiotropium bromide (Spiriva) |
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Definition
Actions
Produce bronchodilation
Uses
Long-term treatment of reversible bronchospasm associated with COPD
Common adverse effects
Mouth dryness, throat irritation (these tend to decrease with continued therapy)
Serious adverse effects
Tachycardia, urinary retention, exacerbation of symptoms |
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Term
| : Anticholinergic Bronchodilating Agents |
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Definition
ipratropium bromide (Atrovent)
tiotropium bromide (Spiriva)
Used in combination with beta adrenergic bronchodilators.
Best used for prophylaxis and maintenance and not for acute attacks.
Tiotropium longer in duration of action than ipratropium. |
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Term
| tiotropium bromide (Spiriva |
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Definition
Nursing Considerations
Powder form: has longer duration of action than Atrovent
Not to be used for acute episode
Ensure pt can properly administer (p.493)
Do NOT breathe into the mouthpiece
Keep mouthpiece clean. Wash with hot water |
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Term
| ipratropium bromide (Atrovent) |
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Definition
Nursing Considerations
Instruct pt on proper administration (p.492)
Instruct pt this is not to be used for an acute episode of bronchospasm
Ensure adequate and regular oral hygiene
Ice chips and hard candy can help alleviate mouth dryness
Check medical record for history of glaucoma |
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Term
| Xanthine Derivative Bronchodilating Agents |
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Definition
Actions
Act directly on smooth muscle of tracheobronchial tree to dilate bronchi
Uses
Reverse airway constriction
Treat acute and chronic bronchial asthma, bronchitis, emphysema
Common adverse effects
Nausea, vomiting, epigastric pain, abdominal cramps
Serious adverse effects
Tachycardia, palpitations, tremors, nervousness, restlessness, anxiety, headache |
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Term
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Definition
LOW THERAPEUTIC INDEX: must monitor serum levels
Action: relaxes smooth muscle of bronchi, bronchioles
Use: maintenance therapy for chronic stable asthma
TheophyllineTherapeutic range: 10-20 mcg/ml (toxicity greater than 20) MUST KNOW THIS VALUE!!!! |
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Term
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Definition
Nursing Considerations
Adminster with food to decrease GI symptoms caused by increased gastric acid
MONITOR PLASMA LEVELS
Obtain baseline VS and mental assessment and monitor at regular intervals
Tobacco and marijuana use decreases therapeutic effects.
Antagonistic effect with beta-adrenergic blockers used for HTN. Observe for signs of decreased effect of either drug |
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Term
| Respiratory Anti-inflammatory Agents |
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Definition
Actions
Inhibit inflammatory responses
Smooth muscle relaxation
Aerosols enhance effect of beta-adrenergic bronchodilators
Uses
For patients unresponsive to sympathomimetic agents or xanthine derivatives
Prevent symptoms of asthma
Common adverse effects
Hoarseness, dry mouth
Serious adverse effects
Thrush
Aerosols enhance effects of beta-adrenergic bronchodilators and have a direct effect on smooth muscle relaxation.
Oral hygiene following inhalation is recommended and can prevent fungal infections. |
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Term
| Respiratory Anti-inflammatory Agents |
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Definition
Corticosteroids
Aerosol inhaler: fluticasone (Flovent)
Powder Inhaler: fluticasone-salmeterol (Advair Diskus) combo corticosteroid & beta-adrenergic bronchodilator
Nursing Considerations
Oral care to prevent fungal infections
May take 4 weeks to se maximum effects
Bronchodilator BEFORE corticosteroid
Do not discontinue therapy without consulting doctor |
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Term
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Definition
Montelukast (Singulair)
Zafirlukast (Accolate) |
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Term
Montelukast (Singulair)
Zafirlukast (Accolate) |
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Definition
Actions
Selective and competitive receptor antagonist of cysteinyl leukotriene receptor. Leukotrienes are part of the inflammatory pathway that causes bronchoconstriction.
reduce inflammatory process and decrease bronchoconstriction
Uses
prophylactic and maintenance for chronic asthma NOT acute asthma attacks. Used in combination with other drugs to treat asthma
Not bronchodilators; given orally. Should not be used to treat acute episodes of asthma.
The cysteinyl leukotriene receptor is the one that leukotriene D4 and E4 stimulates to trigger asthma symptoms. |
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Term
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Definition
Side effects: dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis
Nursing Considerations
Should be used continually, not for acute symptoms
May take with food or milk to decrease GI discomfort
Accolate increases the activity of warfarin (Coumadin) important to monitor PT/INR. |
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Term
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Definition
Actions
Mast cell stabilizer; inhibits release of histamines and other mediators of inflammation
Uses
In combination with other agents to treat severe bronchial asthma or allergic rhinitis
Common adverse effects
Oral irritation, dry mouth
Serious adverse effects
rebound bronchospasm (so should NOT be stopped abruptly) coughing
Used for prophylactic management of bronchospasms and asthma.
Also used just before exposure to conditions or substances that cause bronchospasm (wheezing or difficulty in breathing).
Will not help an asthma or bronchospasm attack that has already started. |
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Term
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Definition
Sections on Nursing Process for Upper & Lower Resp. Diseases (especially Assessment)
Sections on Pt Education & Health Promotion
Nursing Process material for specific drugs
Many items will be the same, so focus on what is DIFFERENT about a drug in that classification
I encourage you to make tables, note cards, or any other study tools you need to keep these classifications & meds organized |
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