respiratory med

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respiratory med
2014-06-29 16:02:49

last lecture
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  1. Antitussive medication
    tussive- cough

    suppress cough reflex

    CI- for cough asso with cold, sinusitis, pneumonia

    research does not help common cold

    Cough- protective mechanism but can become exhausting interfering with rest and sleep

    non narcotic and narcotic
  2. Non nacortic agent (antitussive)
    ex- Dextromethorphan

    MOA: supresses the cough center in medulla and raises the cough threshold. so u still have the sensation to cough but it sends msg to the brain to cool down

    SE: rare well tolerated

    • NI: available and multiple forms
    • can be cause drowiness esp with other agents
    • be careful with other OTC- u could be doubling the effect
    • best adm on even doses around the clock (do this at night for rest
    • grape fruit juice can increase the drug level
  3. Narcotic agent (antitussive)
    Ex. codiene/hydrocodone 

    • MOA: suppresses the cough reflex in the medulla
    • - elev cough threshold
    • - reduces the stimulates

    SE: CNS (sedation), nausea, vomiting, constipation

    NI: safety, contraindicted long term use- dependence
  4. Decongestant agents
    decreases nasal congestion

    oral (systemic)/intranasal (topical)

    high abuse potential

    CI: symptoms related to cold, sinusitis, rhinitis, inflammatory response in upper resp tract

    Ex. Pseudoephedrine (sudafed) (phenylephrine)

    • MOA: Stimulates the Alpha 1 receptors int he nasal mucosa
    • - decreases membrane size
    • - promotes sinus drainage
    • - vasocontriction

    • SE:SNS of the CNS and CV
    • - anxiety, restlessness and insomonia
    • - tachycardia, palpitations, HTN
    • - other dry mouth, irritation
  5. Decongestant NI
    • Careful adm with other SNS stimulants, OTC, aid or HTN, CV disorders, anxiety
    • - careful assessment of BP HR
    • - safety
    • - not to be adm more than 4 days bc it can cause rebound congestion- tolerant
    • - humidification to decrease dry mouth
    • - purchased at pharm- not on shelf
  6. Topical decongestant

    • Stimulates Alpha 1 receptors
    • adm intranasal

    SE: few localized

    • NI
    • can be used for children more than 2 yrs old
    • do not adm more than 5 days
    • assess rebound decongestion
  7. Expectorants
    Liquefy lower resp secretions, decrease the viscosity of secretions- changes surface tension- so we can cough up more easily

    Ava. OTC
  8. Expectorant Ex MOA SE
    Ex Guaifenesin (know this)

    MOA reduces the adhensiveness changes the surface tension so mucous comes out easily

    SE: GI (N/V anoeroxia)

    Onse t 30min last 4-6 hrs (teaching)

    more productive cough
  9. Expectorant NI
    OTC- be careful cause pt can be taking other agents that have exportants in them

    • - often found in combo products
    • - teach non pharm methods- fluids, humidifer
    • - no longer than a week- investagate the reason
    • - adm with meals for GI
    • - be careful if taken with meals- esp elderly- aspiration
  10. Mucolytic agents
    break down mucous

    this is to liquifey thick secretion in high risk pt. pt unable to mobilized their secretions

    also the antidote for tylenol overdose (protects liver) (also helps with pt with renal issues)
  11. Mucolytic agents
    Ex. mucomyst

    MOA- breaks down mucous so it can be exportant. this is last resort- comatose, weak

    SE: cough, bronchospasm, GI (N/V aneorexia)
  12. Mucolytic agent NI
    • adm by nebulizer or direct instillation
    • - last resort
    • - odor- eggs root beer mast it
    • - clean face after treatment can cause irritation
    • - toxicity- if for tylenol overdose best to give it within 8 hrs (esp with 24hr)
    • - monitor level LFT for any pt that was given it for toxicity
  13. Antihistamine agents
    • MOA: blocks the effects of histamine at H1 receptor found in upper resp tract (upper bronci, nose, skin)
    • - vasocontriction 
    • - decrease capillary permeabilty- doesn't allow the cell contents to leak out
    • - reduce edema
    • - decreases the sensation of pain and itching
  14. Antihistamine CI, SE, NI
    • CI- mild allergy, motion sickness, insomonia (bc it cross blood brain barrier)
    • think benadryl

    SE: sedation, newer one may have non sedation effects so may cause headache, GI, antichol effects

    be careful with children- paradoximal excitement 

    • NI: multple forms OTC
    • assess over the counter meds
  15. Bronchodilators
    dilates bronchials 

    two agents: sympathomimetics, anticholinergics

    CI: management of asthma, COPD, bronchitis

    • rescue inhalers- work immediately- 1st line for someone having an attack- 
    • intermiadate- take q 4-6 (slower onset)
    • Long acting- once a day effects 30mins
  16. Sympathomimetic bronchodilators
    ex- albuterol 

    • MOA; stimulates beta 2- dilates, relaxes the smooth muscle in lungs
    • - end result- relieves bronchospams, reduces airway resistance 

    • SE: sns- bronchospasm, incre BS, incre hr, contraction, incre bp
    • - inhalation
    • - PO
  17. Sympathomimetic NI
    • assess side effects
    • assess OTC drugs with sympathomimetic
    • correct use, approriate use
    • administer before steriod
    • review care of inhaler
  18. Antichol bronchodilators

    intermediate action. slowly onset

    • MOA- blocks the action of Ach at the muscurinic receptors
    • - decrease contractility of the smooth muscles 
    • - bronchodilation

    Se: antichol. cough, hoarness, throat irritation, bronchospasm
  19. Antichol bronchodilator
    • NI
    • assess side effects
    • approariate use and care 
    • correct use prevention
    • will not stop asthma attack
    • contri- soybeans, and peanuts
  20. Spiriva inhaler
    Blocks ach and relaxes the smooth muscle

    • it is a little capsule- not swallow- u put the capsule in a dispenser- puncture it and it is dry inhaler
    • not a spray. once a day
    • discard any capsules exposed to air
    • rinse mouth to aviod throat irritation

    be careful not to put the pill down 

    • NI
    • long term management
    • device only used for spiriva
  21. another Antichol agent
    Levsin and scolpolamine (transdermal)

    • CI: preventative/ treat excess secretions
    • MOA: blocks cholinergic receptors
    • SE: Antichol effects
    • NI: last resort- often used together to treat excessive secretions in the patient who is unable to manage secretions. cant cough comatose
  22. Misc astham
    • advair CI long term use to prevent asthma
    • combo products
    • combo steriod and bronchodilators
    • long acting bronchodilator

    • MOA
    • reduces inflammation- steriods
    • bronchodilates- opens airway

    Se: rhinitis, hoarness, sneezing, cough

    • NI assess mouth for thrush- because it suppresses the immune system- wipes out normal flora
    • rinse mouth after each use
  23. Glucocorticoid inhalers
    • reduce inflammation
    • CI: prevents bronchospasm with asthma, COPD, intranasal, rhinitis

    • NI
    • prevent thrush
    • often given with a beta 2 agonist to bronchodilate 1st
  24. Leukotriene modifers
    leukotriene is a chemical mediator for inflammation

    EX singulair

    • CI: treat chronic asthma
    • - improves wheezing, coughing, dyspnea
    • -long term management
    • - will not stop an asthma attack

    • MOA: decrease leukotriene which decrease inflammation
    • long acting- preventative

    not a drug to treat asthma- once a day. 

    SE: use in children. mild, h/a gastritis

    • NI
    • children can take
    • - onset 24hr full effect 1 week
    • - long term effects- once a day dosing in the evening 
    • decrease noctural awakening , improves morning lung function