Pharmacology: Upper and Lower Respiratory Drugs

What is Viral Rhinitis and what are its symptoms?
The Common Cold – virus invades mucosa of upper respiratory tract

sneezing, coughing, sore throat, runny nose, congestion

What is Allergic Rhinitis and how is it different than Viral Rhinitis?
Airborne allergens bind to immunoglobulin antibodies on mast cells and trigger the release of histamine & leukotriene (inflammatory)

sneezing, runny nose, nasal congestion, itchy/watery eyes

When should patients with allergies take their antihistamines?
On a regular basis throughout allergy season to prevent histamine from binding to the receptors in the first place – they can only prevent the actions of histamine before it bind, but they cannot reverse them!

Antihistamines: mechanism of action and drug effects
Block histamine from binding to H1 receptors – therefore prevents vasodilation; CNS depressant

Causes decreased symptoms of rhinitis (runny nose/sneezing)

What are the two types of Antihistamines? Give specific medication examples for each.
First Generation = central acting, more sedating but shorter duration; Benadryl

Second Generation = peripheral acting, less sedating but longer duration; Allegra, Claritin, Zyrtec

What are some Adverse Effects for Antihistamines?
dry mouth, difficulty urinating, constipation, changes in vision, mild drowsiness

With what conditions would you want to be careful to use Antihistamines?

What is nasal congestion caused by?
Membranes lining the nose becoming too swollen from inflamed blood vessels

Adrenergic Decongestants : mechanism of action and medication examples
Sympathomimetic decongestants (mimics SNS) stimulate alpha1-adrenergic receptors – causes vasocontriction of swollen vessels; stuffiness is relieved

Sudafed (oral), Afrin (topical)

Difference between Oral and Topical Adrenergic Decongestants
Oral = delayed onset but longer duration; less potent
Topical = very quick onset but shorter duration; very potent; could cause REBOUND CONGESTION!

What is Rebound Congestion?
prolonged use of topical adrenergic decongestants could cause a rebound where the medication starts to do the opposite and the nasal congestion gets worse!

What Adverse Effects could adrenergic decongestants cause (Sudafed/Afrin)?
hypertension – due to vasoconstriction
palpitations – due to stimulation of adrenergic receptors
CNS stimulation

Why do we cough?
What triggers a cough?
To try and remove secretions or foreign objects from our respiratory tract.

Cough reflex – irritation of sensory receptors in respiratory tract that are picked up by Cough Center in Medulla

What are the two basic types of cough?
Productive cough – expels sputum
Nonproductive cough – dry, no sputum

Expectorants (guaifenesin): mechanism of action and medication examples
Aids in expectoration of mucus/secretions for Productive Coughs by thinning out the secretions

Mucinex (guaifenesin)

What are some nursing considerations for patients relieving Expectorants?
Patients should receive extra fluids to help further loosen their secretions
Report fever/cough that lasts longer than a week

Bronchodilators Beta2-Agonists: mechanism of action and medication examples
Stimulate beta2-adrenergic receptors on bronchial smooth muscle –> relaxation and bronchodilation

Albuterol inhaler – short acting

What is the difference between the Beta2-Agonists Bronchodilators and the Anticholinergic Bronchodilators?

Beta2-Agonists are used during an asthma attack, while Anticholinergics are used to help prevent asthma attacks but not used during them

Should a Beta2-Agonist be used before or after a Inhaled Glucocorticoid, and why?
It should be used BEFORE so that it can bronchodilate the respiratory tract in order to allow more passage of the inhaled corticosteroid

Difference between Opioid Antitussives (codeine) and Nonopioid Antitussives (dextromethorphan)?
Opioid = suppress nonproductive cough by directly acting on cough center in medulla.
Nonopioid = suppresses nonproductive cough by numbing stretch receptors that prevent the cough reflex.
Codeine = Robitussin AC
Dextromethorphan = Robitussin DM

Pathophysiology of the common cold The virus invades the mucosa of the upper respiratory tract to cause upper respiratory tract infection (URI) nose->pharynx->larynx Pathophysiology of allergies Inflammatory disorder triggered by airborne allergens, which bind to immunoglobulin E (IgE) anitbodies on …

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beta 2 adrenergic bronchodilators (front door bronchodilators) – short acting beta 2 agonists SABA rescue/ quick relief medications indicated for treatment of acute episodes of bronchospasm -albuterol (ventolin or Proventil) = dose 2.5 mg in 3 ml NS Q1-Q6 hours …

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