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NURS 1950 Unit 5 Respiratory Drugs

NURS 1950 Unit 5 Respiratory Drugs. Nancy Pares, RN, MSN Metropolitan Community College. Basic Physiology of the Respiratory System. One of the most important organ systems Upper respiratory tract Nose, nasal cavity, pharynx, and paranasal sinuses (see pg 573 in Adams)

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NURS 1950 Unit 5 Respiratory Drugs

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  1. NURS 1950 Unit 5Respiratory Drugs Nancy Pares, RN, MSN Metropolitan Community College

  2. Basic Physiology of the Respiratory System • One of the most important organ systems • Upper respiratory tract • Nose, nasal cavity, pharynx, and paranasal sinuses (see pg 573 in Adams) • ‘air conditioning’ of the respiratory tract • Warm, humidify and clean the air

  3. Physiology of Respiratory System • Sympathetic nervous system • Constricts arterioles of the nose-widens the airway (relief of stuffiness) • Parasympathetic nervous system • Dilates the aterioles of the nose-shrinks the airway (causes stuffiness)

  4. Objective 1: Describe how the antihistamines exert their pharmacologic effects • Primary action: block the actions/attachment of histamine at the H1 receptors • Action: 15-60 min; lasts 4-6 hrs; works best early- • Causes bronchial smooth muscle relax • OTC remedies for allergic rhinitis, motion sickness and insomnia • Reduces inflammation and symptoms; used to reduce secretions and treat anaphylactic shock (IV)

  5. Antihistamines: First generation H1 receptor antagonists • Diphenhydramine (Benedryl) prototype • Action: blocks histamine from reaching its receptors • Uses: often combined with analgesics, decogestants, and expectorants; treatment of rashes, allergic reactions, Parkinson’s disease, motion sickness and insomnia

  6. Antihistamines: 2nd generation H1 receptor • Fexafenadine (Allegra) prototype • Action: reduces nasal congestion, sneezing, tearing of the eyes. • Use:same as 1st generation • Contraindication: hypersensitivity to drug; may have synergistic sedative effects.

  7. Objective 2: List 5 common side effects of antihistamines • First generation drugs have more significant side effects than 2nd generation • Side/effects • Sedation or rarely excitability • Anticholinergic effects (everything dries up) • Nursing Moms may have decreased lactation (Category C) • Respiratory secretions thicken • Young children may exhibit hypersensitivity or overdose • CNS depression, dry mouth, fixed and dilated pupils

  8. Objective 3: Identify additional uses and contraindications for antihistamines • Promenthazine (Phenergan): motion sickness and n/v • Antihistamines may also be used for vertigo and insomnia • Contraindications: • Hx of heart disease, narrow angle glaucoma, seizure disorder, CNS stimulation, renal impairment,or prostate disease.; no use with asthma

  9. Objective 4: List the antihistamines • See page 575 • Know prototypes: • Diphenhydramine (Benedryl) • Fexofenadine (Allegra)

  10. Objective 5: Describe the mechanism of action of nasal decongestants • Action: • stimulate alpha 1 adrenergic receptors in vascular smooth muscle which produces vasoconstriction. Vasoconstriction reduces the blood flow which slows the production of mucus and relieves symptoms.

  11. Decongestants • Routes of administration/side effects: • intranasal-few side effects • Rebound congestion • Use no longer than 3-5 days • If dependence is developed, change to intranasal glucocorticoid • oral • No rebound congestion • Onset of action is much slower

  12. Objective 6: List the nasal decongestants • Sympathomimetics: • Oxymetazoline (Afrin) • Anticholinergic • Ipratopium bromide (Atrovent) • Uses: decrease blood flow of nasal surg and common cold s/s

  13. Objective 7: Describe the nursing implications associated with antihistamines and decongestants • Antihistamines: • Auscultate breath sounds • Monitor VS (including ECG w HD) • Monitor thyroid labs (antihistamines may cause thyroid storm • Monitor vision changes and neuro status, especially LOC • Measure I&O • Monitor glucose levels • Observe for anticholinergic crisis

  14. Objective 7: Describe the nursing implications associated with antihistamines and decongestants • Decongestants: • Assess VS, especially pulse and BP • Monitor urinary output/flow • Do not use with other OTC cold preps • Immediately report palpitations, CP, dizziness, visual changes, excessive dry mouth • Use proper technique on use and care of nasal spray dispensers.

  15. Objective 8: Identify drugs used as antitussives and expectorants • Antitussives (opioid and non opioid) • Dampen the cough reflex • Expectorants • Reduce the thickness-increases flow • Mucolytics • Break down the chemical structure

  16. Antitussives: Opioid • Codeine/hydrocodone • Action: • raise the cough threshold in CNS; usually classified as Schedule III, IV or V • S/E • Respiratory depression • Minimal potential for dependence • Nursing Implications; • Caution use in asthma • Used in combination with antihistamines, decong (pg 590) • Monitor for drowsiness; know what s/e to report

  17. Antitussives: non opioid • Dextromethorphan(Benylin) • Action/S/E: • raises the cough threshold • s/e are rare • Nursing implications: • No risk of dependence • Contraindicated in treatment of chronic cough (asthma, smoking, emphysema); MAOI, asthma

  18. Antitussives: non opioid • Benzonatate (Tessalon) • Action: • Suppresses cough by anesthetizing stretch receptors of lungs • S/E • uncommon, may include sedation, nausea, HA • Nursing implications: • Teach not to chew the pill-numbing effects

  19. Expectorants • Guaifenesin(Robitussin) • Most common • Tolerated by most • Available OTC • Few adverse effects

  20. Mucolytics • Acetylcysteine (Mucomyst) • Action/Use: • Breaks down mucous molecule • Cystic fibrosis, chronic bronchitis • Overdose of acetaminophen • Route: • Inhalation-disease processes • IV/oral-overdose

  21. Objective 9: Describe uses of expectorants and antitussives • Critical thinking: • When would an expectorant be used? • When would an antitussive be used?

  22. Objective 10: Describe nursing interventions associated with antitussives and expectorants • Monitoring cough characteristics • Assess history of the cough • Use antitussives when cough interferes with ADL’s, rest or sleep • Teach goals of therapy • Caution food and water immediately following taking med • Teach about environmental modifications • Do not suppress productive cough • Maintain adequate fluid intake • Teach to read label-do not take more than recommended dose • Teach not to use prescription with OTC • Keep all meds out of reach of children-call Poison Control if ingested---no use of Ipecac (gag reflex diminished)

  23. Objective 11: Describe the actions of bronchodilators • Basic Physiology of lower resp. tract • Trachea, bronchus, lung • See page 590 in Adams • Bronchioles are elastic smooth muscle which dilate and constrict based on metabolic needs. • Controlled by autonomic nervous system • Fight or flight response • Beta 2 adrenergic receptors stimulated=bronchodilation • Parasympathetic nervous system action • bronchoconstriction

  24. Routes for Pulmonary Drugs • Aerosol • Delivers to immediate site of action=fewer systemic effects • Used for bronchospasm or decrease viscosity of mucous in bronchi • Nebulizer • Machine that vaporizes liquid via face mask or handheld • Dry Powder Inhaler (DPI) • Takes fine powder directly to bronchi • Metered Dose Inhalers (MDI) • Uses a propellant to deliver measured dose to the lungs with each breath • MUST USE DEVICES CORRECTLY: ONLY 10-50% OF DRUG ACTUALLY REACHES LUNGS.

  25. Objective 11: Describe the actions of bronchodilators General info: -relax bronchial smooth muscle=widening the airway -beta agonists alone have no anti-inflammatory properties -some agents activate beta 1 and beta 2 receptors -newer agents only activate beta 2 receptors -inhaled beta adrenergic agents have little systemic toxicity

  26. Catagories of bronchodilators • Beta agonists/sympathomimetics • Methylxanthines • anticholinergics

  27. Beta agonists/sympathomimetics • Action/Use: bronchodilatation via beta 2 receptor activation • Classification by duration of action • Ultra short (effects last 2-3 hrs) • Short (effects last 5-6 hrs) • Intermediate ( 8 hrs) • Long (12 hrs) Formoterol (Foradil) • Prototype: salmertol (Seravent) • S/E • Cardiac (tachycardia, dysrhythmias), hyperglycemia, tolerance of med, insomnia, nervousness, tremor • Nursing Interventions/contraindications: • Monitor VS- especially BP; no MAOI’s, TAD, or antihistamines; teach about meds (timing, use of , s/s to report)

  28. Methylxanthines • Action/use: • Bronchodilatation; chronic persistent asthma • Related to caffeine; stimulate CNS • Route: IV or po (not inhaled) • Nursing Interventions: • Assess VS-esp RR and lung sounds;monitor K+ levels, monitor for insomnia, hyperstimulation; limit use of caffeine and smoking; teach about meds (timing, use, as prescribed) • Prototype: theophylline (Theo-dur)

  29. Anticholinergic bronchodilators • Action/use: • Blocks cholinergic receptors in bronchial smooth muscle; chronic bronchitis, nasal congestion • S/E/route: • Irritation of upper respiratory tract, dry mouth, GI distress, HA and anxiety; bitter taste • MDI • Prototype: ipratropium bromide (Atrovent) • Nursing interventions: • Wait 5 min between this med and any other, proper technique, rinse mouth, report changes in urinary pattern

  30. Corticosteroids • Action/Use: • Anti inflammatory; prophylactic treatment of bronchial asthma • S/E/routes: • Local: hoarseness; systemic: adrenal gland atrophy, peptic ulcers, osteoporosis; growth a concern in children • Oral = prednisone; IV= Solu-Medrol • Nursing interventions: • Monitor VS, Assess for s/s of infection, assess lung sounds, oxygen sats, weight gain/loss, teach about meds.

  31. Objective 13: covered on slide 21Objective 14: Describe the nursing process as it relates to clients receiving respiratory drugs. • Assessment: • Gas exchange • Cyanosis, activity tolerance, labs, pulm tests • Monitor effectiveness of therapy • Change in cough, resp. effort, lung sounds, nature and quality of secretions • Monitor for adverse effects of drugs

  32. Nursing Process: Nursing diagnosis • Ineffective airway clearance RT bronchoconstricion • Impaired gas exchange RT disease process • Risk for injury RT adverse effects of drugs • Deficient knowledge RT disease process and medication regime

  33. Nursing Process:Goals • The client will: • Experience effective cough and clear breath sounds… • Have 02 sats >90% …. • Verbalize improvement in respiratory secretions ….

  34. Nursing ProcessImplementation • Disease specific (amounts of 02) • Drug specific monitoring • Monitor for S/E

  35. Nursing ProcessEvaluation • Were the goals met?

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