CHAPTER 11

ALLERGY AND RESPIRATORY MEDICATIONS

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1

Learning Objectives

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.2

Identify major antihistamines used to treat breathing problems

Describe the action of antitussive medications

List medications used to treat and prevent asthma attacks

Describe the major actions and the adverse reactions of the two main categories of bronchodilators

Types of AntiHistamines

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ALKYLAMINESbromopheniramine

(Dimetapp)

chlorpheniramine(Chlo-Trimeton)

ETHANOLAMINESdiphenhydramine

(Benadryl)

PHENOTHIAZINEpromethazine

(Phenergan)

PIPERIDINEScetirizine (Zyrtec) fexofenadine (Allegra) lorantidine (Claritin)

PIPERAZINEhydroxyzine (Vistaril)

MISCELLANEOUSazelastine (Astelin)

Antihistamines (cont.)

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UsesSeasonal allergic rhinitis (SAR)Perennial allergic rhinitis (PAR)Perennial nonallergic rhinitis (PNAR)Relieve symptoms of allergic disordersAdjunctive therapy for anaphylaxisSedation

Antihistamines

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ActionCompete with histamine for H1 receptor sites to

limit its effectivenessLimits vasodilation, capillary permeability, and

swellingLimits acetylcholine release, which dries

secretions in the bronchioles and gastrointestinal system

Sedative effect on the CNS

Antihistamines (cont.)

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Adverse ReactionsChanges in blood pressure, blurred visionTachycardia, insomnia, dry mouth, nauseaRestlessness, excitability, sedation, tinnitus

Drug InteractionsNursing Process

Antihistamines

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Life span considerationsPediatrics:

Infants and young children often have anticholinergic side/adverse effects

Paradoxical reactions may occur: increased nervousness, confusion, or hyperexcitability

ElderlyMore likely to develop side effects such as

dizziness, syncope (fainting), confusion, and extrapyramidal reactions

Question 1

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Which of the following is NOT an adverse reaction that may develop from taking antihistamines?

1. Hypertension2. Hypotension3. Tachycardia4. Bradycardia

Types of Antitussives

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Narcoticcodeine phosphatecodeine sulfate

Non-Narcoticdextromethorphan

RobitussinVick’s Formula 44

diphenhydramineBenadryl

Antitussives

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Actions:Depress the cough center in the brainAnesthetize stretch receptors in the

respiratory tractSoothe irritated areas in the throat

Uses:Relief of overactive or nonproductive cough

Antitussives (cont.)

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Adverse ReactionsConstipation, drowsiness, dry mouth, nausea,

postural hypotensionDrug InteractionsNursing Process

ASTHMA PREVENTIONINTAL (cromolyn sodium)Action: slows destruction of mast cell which

releases the histamine resulting in decreased histamine circulation

ONLY for prophylaxis NOT A RESCUE MEDICATIONMust be inhaled on a set scheduleSymptoms improve within 4 weeksSee MD at weeks 2 & 4Do not stop drug abruptly

Types of Asthma BronchodilatorsSympathomimetic (Rescue Drugs)

Proventil / Ventolin(albuterol***)

Adrenalin Chloride(epinephrine)

Isuprel(isoproterenol)

Alupent(metaproterenol)

Serevent (salmeterol)Brethine (terbutaline)

Xanthine (-phylline)AminophyllineSlo-Phyllin

(theophylline)

*** albuterol has less cardiac side effects & longer bronchodilation than remainder of drugs listed

Action of BronchodilatorsOpen the airway by stimulating Beta 2

receptorsSome drugs have greater effects on Beta 1

(heart) than othersSympathomimetic drugs mimic epinephrine

stimulation as side effectsTachycardia and insomnia are frequently

seen.

Additional Asthma medsLeukotriene receptor inhibitors (for chronic

use); decreases the interleukine release from the injured tissues. NOT a rescue medicationSingulair

(montelukast)Accolate (zafirlukast)

Corticosteroid Use for Asthma/ COPDSystemic

methylprednisolone

prednisoloneprednisone

InhaledBeclovent

(beclomethasone)Pulmicort

(cortisone for pulmonary tract)(budesonide)

Aerobid (flunisolide)

Flovent (fluticasone propionate)

Azmacort (triamcinolone acetonide)

Intranasal Steroids (Sprays)Beconase (beclomethasone dipropionate)Rhinocort Aqua (Budesonide)Aerobid (flunisolide)Flonase (fluticasone propionate)Nasonex (mometasone furoate)Nasocort AQ (triamcinolone acetonide)

Many are the same as inhaler medications but reformulated for spray application

Effects are topical unless swallowed

Actions of Corticosteroid Usage‘… the most potent and consistently

effective medication for long term control of asthma.”

Anti-inflammatory; decrease reaction to allergens

Systemic steroids are used to get quick control of the airway then inhaled steroids will be used to maintain the effect.

Inhaled drugs have a local effect; better for long term use

RINSE the mouth after steroid inhalation to prevent thrush

Remember: COME -TAPE- FIGS C = Cataracts O = Osteoporosis M = Mood changes E = Elevated blood sugar

T = Thin skin A = Addison’s disease P = Peptic ulcers E = Electrolyte imbalance

F = Fluid retention I = Increased risk of infection G = Gain Weight S = Short stature (if taken as a child)

DecongestantsAffect alpha cells in blood vessels in nose

tissue = vasoconstriction, decreased fluid movement and edema.

Prolonged use can lead to rebound vasodilation causing more congestion.

Used for congestion in nose, middle ear and Eustachian tube. Decreasing congestion around the auditory tube allows the middle ear to better drain

NOT to be used in infants and toddlersSystemic decongestants work better than

topical but also have more side effects than topical drugs.

Nasal DecongestantsSympathomimetic

bronchodilatorsephdrineEpinephrine *

* denotes drug used by MDs on a daily basis

InhalersAfrin / Dristan

(oxymetazoline)Neo-Synephrine

(phenylephrine)Sudafed

(pseudoephedrine sulfate)

ExpectorantsDecrease the thickness of the mucus (by

increasing the water content) in the respiratory tract to aid in the ability to remove it. Increases ciliary movement so cough is effective.

Anti- tuss/ Robitussin/ Mucinex (guaifenesin) Used often; may increase bleeding tendency. Monitor for bruising or bleeding especially if taking anticoagulants

SSKI (iodine products) – use infrequently

PracticeA 29 year old male comes to the ED with

c/o SOB, wheezing and chest pain when he coughs.

1. What assessments do you perform?2. What lab tests should be ordered?3. Would you start an IV (assume orders are

present)? What kind? Why?4. What medications would the nurse

anticipate being ordered?5. What patient teaching should be

considered?

QUESTIONS?