NCM 2144 - Respiratory Agents
NCM 2144 - Respiratory Agents
NCM 2144 - Respiratory Agents
RESPIRATORY SYSTEM
That within my 1 - hour span of discussion, the students will be able to:
I. ANTIHISTAMINE
§ Diphenhydramine
II. ANTITUSSIVE
§ Dextromethorphan
III. DECONGESTANT
§ fluticasone furoate
IV. EXPECTORANT
§ guaifenesin
Common Cold
§ Caused by rhinovirus and affects primarily the
nasopharyngeal tract.
Acute Rhinitis
§ Acute inflammation of the mucus membranes of the
nose, usually accompanies the common cold.
Allergic Rhinitis
§ often called as ‘hay fever’ caused by pollen or a
foreign substance.
¡ Cold: contagious 1 – 4 days before the onset of
symptoms, and during the first 3 days of cold.
¡ Transmission: frequently from touching
contaminated surfaces then touching the nose
and mouth, viral droplets released by sneezing.
¡ Symptoms: rhinorrhea, nasal congestion, cough
and increase mucosal secretions.
¡ Bacterial: infectious rhinitis (nasal discharge
becomes tenacious, mucoid and yellow/yellow
green)
ANTIHISTAMINES
¡ H1 blockers or H1 antagonist
¡ Compete with Histamine for receptor sites thus preventing a
histamine response
¡ Decrease nasopharyngeal secretions by blocking the H1 receptor.
§ Excretion
§ IV: ONSET Immediate
§ In urine as metabolites
PEAK 0.5 – 1 hour
DURATION 4 – 7 hours
ANTIHISTAMINES
q DOSAGE
Adult:
§ PO: 25 – 50 mg q 6 – 8 hrs
§ IM/IV: 10 – 50 mg as single
dose, q 4 – 6 hrs;
MAX: 400 mg/ day
Children:
§ PO/IM/IV: 5 mg/kg/day in 4 divided
doses
MAX: 300 mg/day
ANTIHISTAMINES
Ø (butamirate citrate)
Sinecod Forte
Ø (levodropropizine)
Levopront
EXPECTORANTS
q Mode of Action:
§ Reduces viscosity of tenacious secretions by
increasing respiratory fluid
EXPECTORANTS
q DOSAGE
Adult: q DRUG-LAB-FOOD INTERACTIONS
§ PO: 200 – 400 mg q 4 hrs
MAX: 2.4 g/d
§ None significant
Children:
§ 6 – 12 years: 100 – 200 mg q 4 hrs
MAX: 1.2 g/d
q SIDE EFFECTS
q ADVERSE EFFECTS
§ dizziness, headache, nausea,
§ urticaria
diarrhea, stomach pain,
vomiting, rashes
EXPECTORANTS
Ø (ambroxol HCl) Ambrolex, Mucosolvan, Ambroxol
Ø (lagundi leaf) Ascof, Ascof Forte, Lagundex
Ø (guaifenesin) Benadryl Expectorant, Robitussin
Ø (bromhexine HCl) Bisolvon, Bisolvon Forte
Ø (acetylcysteine) Exflem, Fluimucil, Nacetyl
Ø (carbocisteine) Loviscol, Solmux
DECONGESTANTS
¡ Sympathomimetic amines, stimulate the alpha adrenergic
receptors thus producing vascular constriction of the capillaries
within the nasal mucosa.
¡ Shrinking of the nasal mucus membrane and a reduction in fluid
secretion.
¡ Nasal congestion results from dilation of nasal blood vessels
caused by infection, inflammation or allergy.
¡ There is a transudation of fluid into the tissue spaces, resulting to
swelling of the nasal cavity.
DECONGESTANTS
Ø (diphenhydramine HCl, phenylpropanolamine HCl) Allerin Reformulated
Ø (fluticasone furoate) Avamys
NURSING RESPONSIBILITIES
ASSESSMENT
§ Determine whether there is a history of hypertension, especially
if a decongestant is an ingredient in the cold remedy.
§ Obtain baseline VS. an elevated temperature may indicate a viral
infection caused by a cold.
§ Obtain drug history, report if drug-drug interaction is possible.
§ Assess for signs/symptoms of urinary dysfunction (retention,
dysuria and frequency).
§ Assess CBC during drug therapy; also, the cardiac and
respiratory status
NURSING RESPONSIBILITIES
DIAGNOSIS
§ Impaired tissue integrity
§ Fluid volume deficit
§ Fatigue
§ Disturbed sleeping pattern resulting from
chronic coughing
§ Risk for infection
NURSING RESPONSIBILITIES
PLANNING
§ Client will be free of nonproductive cough. A secondary
bacterial infection does not occur.
NURSING INTERVENTIONS
§ Monitor VS. BP can become elevated when a decongestant is
taken. Dysrhythmias can also occur.
§ Observe color of bronchial secretions. Yellow or green mucus
(bronchial infection). Antibiotics may be needed.
NURSING RESPONSIBILITIES
NURSING INTERVENTIONS
§ Instruct the client on proper use of a nasal spray and proper use
of puff or squeeze products.
§ Advise the client to read the label on OTC drugs.
§ Inform the client that antibiotics are not helpful in treating common
cold viruses.
§ Advise elderly clients with heart disease, asthma, emphysema, DM
or hypertension to inform physician concerning the selection of
drug, including OTC drugs.
NURSING RESPONSIBILITIES
NURSING INTERVENTIONS
§ Advise client not to drive during initial use of a cold remedy
containing an antihistamine.
§ Increase OFI.
§ Instruct not to take a cold remedy before or at bedtime.
(Decongestant: insomnia)
§ Encourage to get adequate rest and sleep.
§ Educate the client on the mode of transmission of common cold
and flu.
NURSING RESPONSIBILITIES
NURSING INTERVENTIONS
§ Instruct to avoid environmental pollutants, smoking, and dust.
§ Instruct to perform three effective coughs before bedtime.
§ Advise client to cough effectively; take a deep breath before
coughing and must be in upright position.
§ Keep the drug out of reach of small children. Request childproof
caps.
§ Advise to contact physician if cough persist for more than 1 week
or is accompanied with fever, chest pain and headache.
NURSING RESPONSIBILITIES
INTERVENTIONS (Antihistamines)
§ Avoid driving a motor vehicle and performing other dangerous
activities if drowsiness occurs.
§ Avoid alcohol and other CNS depressants.
§ Instruct to notify Physician if confusion or hypotension occurs.
§ Take drug at least 30 minutes before offending event and also
before meals and at bedtime during the event (prophylaxis of
motion sickness).
NURSING RESPONSIBILITIES
INTERVENTIONS (Antihistamines)
§ Inform breastfeeding mothers that small amounts of drug pass
into the breast milk.
§ Instruct family members that children and elderly are more
sensitive to the effects of diphenhydramine:
§ Children: nightmares, nervousness, irritability
§ Elderly: confusion, difficult or painful urination, dizziness, drowsiness, feeling
faint, dryness of the mouth, nose and throat
§ Excretion
§ In urine as metabolites
SYMPATHOMIMETICS
q DOSAGE
Adult:
§ PO: 25 – 50 mg q 6 – 8 hrs
§ IM/IV: 10 – 50 mg as single
dose, q 4 – 6 hrs;
MAX: 400 mg/ day
Children:
§ PO/IM/IV: 5 mg/kg/day in 4 divided
doses
MAX: 300 mg/day
SYMPATHOMIMETICS
q SIDE EFFECTS q ADVERSE EFFECTS
§ Nervousness, tremors, § tachycardia, palpitations,
restlessness, insomnia, hypertension
headache, nausea, vomiting,
hyperglycemia, muscle
cramping of the lower
extremities
ANTICHOLINERGICS
I. IPRATROPIUM BROMIDE
§ Distribution
§ SR: ONSET 1 – 3 hours
§ PB: approx. 60% PEAK 4 – 8 hours
§ Metabolism DURATION 8 – 24 hours
§ Metabolism § PO (chew):
§ t½: 2.7 – 5.5 hours
ONSET within 24 hours
§ Excretion PEAK 2 – 2.5 hours
§ Assess hydration
NURSING RESPONSIBILITIES
DIAGNOSIS
§ Ineffective airway clearance
§ Activity intolerance
§ Knowledge deficit (OTC)
PLANNING
§ Client will be free of wheezing or significantly improved.
§ Client’s lungs will be clear within 2 to 5 days.
NURSING RESPONSIBILITIES
INTERVENTIONS
§ Monitor VS. BP may decrease & HR may increase. Check for
cardiac dysrhythmias.
§ Teach client to monitor PR.
§ Provide adequate hydration.
§ Monitor serum plasma theophylline levels
§ Administer at regular RTC to have a sustained therapeutic levels
NURSING RESPONSIBILITIES
INTERVENTIONS
§ Administer after meals, decrease GI distress.
§ Do not crush enteric coated tablet or SR tablets/ capsules.
§ Provide pulmonary therapy (chest tapping, postural drainage)
§ Advise client not to take OTC drugs without consulting a
physician.
§ Instruct client to avoid smoking.
§ Discuss ways to alleviate anxiety; relaxation techniques & music.