Respiratory meds: Nasal congestion
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What is Nasal congestion?
Dilation of the nasal blood vessels
What causes this dilation of blood vessels that in turn causes nasal congestion?
What is the etiology of nasal congestion?
the dilation of nasal blood vessels causes transudation of fluid into tissue spaces, leading to the swelling of the nasal cavity.
What is the action of nasal decongestants?
- stimulate alpha adrenergic receptors:
- produce nasal vascular vasoconstriction
- shrinks nasal mucous membranes
- reduces nasal secretion
- *Agonists: ^BP (contraindicated in HTN)
Name some nasal decongestants.
- Oxymetazoline (Afrin)
- Nahazoline (Allerest)
- Pseudoephedrine (Sudafed)
What ways are nasal decongestants administered?
- Nasal spray (topicals are no longer than 5days)
- Nasal drops (d/t rebound congestion)
What are the possible interactions with Afrin, Allerest, & sudafed?
- Sudafed may <effect of betablockers
- ^HTN, Dysrhythmias with MAOIs
- ^Restlessness, palpitations w/caffeine
What are the s/e of nasal decongestants?
- Nervous, Jittery, restless
- Alpha-adrenergic effect: HTN, tachy, hyperglycemia
- Rebound nasal congestion: topically
Frequent use of nasal decongestants can cause what?
- Rebound nasal congestion
- **use no longer than 5 days
What should a nurse teach a client started on nasal decongestants?
- Read OTC labels
- Don't take longer than 5 days
- Lie down or hyperextend neck to instill
- Blow nose prior to instillation of sprays or solutions
What is an Intranasal Glucocorticoid?
- Steroids, effective for Tx of Allergic Rhinitis.
- Have antiinflammatory axn thus <s/s like rhinorrhea, sneezing, & congestion
The Intranasal Glucocorticoids; Fluticasone (Flonase) & Triamcinolone (Nasacort) are Antiinflammatory agents used for what?
- Tx of Allergic Rhinitis
- Used alone on in combo w/H1 antihistamines
The intranasal Glucocorticoid "Dexametasone" (Decadron) should be used no longer than how many days & why?
- 30 days
- to avoid systemic effects
What is the action of Antitussives?
They act on the cough-control center in the medulla to suppress the cough reflex.
Why would a client need an Antitussive?
for suppression of an irritating & nonproductive cough.
What are the three different types of Antitussives?
- Narcotic: Codeine
- Nonnarcotic: Dextropmethorphan (Benylin DM)
- Combination preparations
What forms do Antitussives come in?
- Throat sprays
What are the s/e of Antitussives?
- Inability to cough
- Narcotic extra s/e: Resp depression, constipation, dependence
What patient teaching should be done when a client is given an Antitussive Rx?
- Do NOT drink fluids for 30min after taking lozenges or chewables
- Do NOT mix w/alcohol or other sedating meds
- Caution: driving car or machinery
- Prevent constipation
- NO long term use
What is the purpose of Expectorants?
to loosen bronchial secretions so they can be eliminated by coughing.
What is the best natural expectorant?
Name the Expectorant meds.
- Guaifenisin (Robitussin, Humibid)
- Iodinated Glycerol
Which drug is an Antitussive/Expectorant?
What are the s/e of Expectorants?
minimal w/Guaifenesin: N/V
What patient teaching is done with Expectorants?
Enc. fluids to help thin secretions
With the combination of Guaifenesin & Codeine (Cheratussin, Gusiatussin), what is the action?
- Suppress cough reflex by acting on cough center in the medulla.
- Reduce viscosity of tenacious secretion
What is the indications for Cheratussin or Gusiatussin? (Guaifenesin & codeine combo)
Nonproductive & irritating cough
What are the s/e of the combo drug Cheritussin or Gusiatussin? (Guaifenesin & codeine)
What is the action of Corticosteroids?
Anti-inflammatory agents used to reduce airway inflammation.
What forms do Corticosteroids come in?
- Nasal sprays
What are the Corticosteroids indicated for?
- Allergic Rhinitis
The nasal or oral Inhalant Corticosteroids have fewer s/e, which drugs are they?
- Fluticansone (Flonase)
- Beclomethasone (Vanceril)
- Flunisolide (Aerobid)
- Triamcinolone (Nasacort, Azmacort)
- Budesonide (Rhinocort)
What Corticosteroid is given orally?
What Corticosteroid is given via IV?
What are the s/e of Corticosteroids?
- Local Effects: Throat irritation, cough
- Cardiac, fluid, electrolyte disturbances
- ^blood sugar
- MS: Osteoporosis, Retarded growth
- GI: bleeding, ^appetite
- Suppression of immune system
What patient teaching needs to be done when a client is started on Corticosteroids?
- Told potential s/e
- Steps for proper use of MDIs
- Do NOT abruptly stop med
- Take every dose
- Notify MD if taking other meds
- Avoid exposure to infections
- Take orals meds w/meals
- Administer Bronchodilators first
- Notify MD of any s/e
- Daily calcium/Vit D supplements
- Monitor blood sugars
What are the proper steps to administering an inhaler such as an MDI?
- Shake canister well
- Inhale slowly
- Hold breath for 10 seconds
- Wait 3-5min before next puff
- Rinse mouth
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