3 types of decongestants
- Adrenergics: systemic and topical (largest group)
- Anticholinergics: less commonly used
- Corticosteroids: topical, intranasal steroids.
Adrenergic nasal decongestant MOA
Constrict small blood vessels that supply URI structures. As a result these tissues shrink, and nasal secretions in the swollen mucous membranes are better able to drain.
Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways. Anticholinergics bind to the ACh, resulting in an inhibition of bronchial constriction.
Work by blocking histamine from binding to H1 receptor sites. Cannot push histamine off the receptor if already bound. More effective in preventing the actions of histamine rather than reversing them. Should be given early in treatment, before all the histamine binds to the receptors. The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation:
- Vasodilation and increased capillary permeability.
- Increased respiratory secretions
Antihistamines adverse effects
Anticholinergic (drying) effects, most common: dry mouth, difficulty urinating, constipation, and changes in vision. Drowsiness: mild drowsiness to deep sleep.
Antihistamines nursing implications
- Instruct patients about possibility of sedation.
- Instruct patients to avoid driving or operating heavy machinery; advise against consuming alcohol or other CNS depressants
- Contraindicated in acute asthma. Caution in cardiac disease, HTN, and BPH.
Antitussive nursing implications
- Antitussives are for non-productive coughs.
- Instruct patients to avoid driving or operating heavy equipment because of possible sedation, drowsiness, or dizziness.
- Patients taking chewable tablets or lozenges should not drink liquids for 30 to 35 minutes afterward.
Recurrent and reversible shortness of breath. This occurs when the airways of the lungs become narrow as a result of: bronchospasms, inflammation and edema of the bronchial mucosa, and production of viscid mucus.
Relief of bronchospasms related to asthma, bronchitis, and other pulmonary diseases. Used in treatment (short-acting) and prevention (long-acting) of asthma attacks.
Beta2 -agonists [bronchodilators] MOA
Relax bronchial smooth muscle causing the bronchi and bronchioles to dilate. Quickly reduce airway constriction and restore normal airflow.
Beta agonist adverse effects
Beta-agonist may cause: insomnia, restlessness, palpitations, vascular HA, and
Continuous inflammation of the bronchi and bronchioles and chronic excessive secretion of mucus. this often occurs as a result of prolonged exposure to bronchial irritants especially cigarette smoke.
The common cold
Most common colds result from a viral infection: Rhinovirus, Cornaviruses, or Influenza virus. The virus invades the mucosa of the upper respiratory tract to cause URI (consist of the nose, pharynx,and larynx).
Dx's used for long -term control of asthma
- Long-acting beta2-agonists (salmeterol, Serevent inhaled).
- Inhaled steroids
- Leukotriene receptor antagonists
Dx's used for quick relief of asthma
- Short-acting inhaled beta2-agonists (albuterol)
- Intravenous systemic corticosteroids (emergency room)
Air spaces in the lungs enlarge as a result of the destruction of alveolar walls. As a result the surface area where gas exchange takes place is reduced. Effective respiration is impaired.
Aid in expectoration (coughing up and spitting out) of excessive mucus in the respiratory tract.
Expectorants nursing implications
- Expectorants are for productive coughs only.
- Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions.
- Report a fever, cough, or other symptoms lasting longer than a week.
- Monitor for intended therapeutic effects
Inhaled corticosteroid adverse effects
Inhaled corticosteroids may cause: pharyngeal irritation, coughing, dry mouth, oral fungal infections (Thrush); systemic effects will be rare because low doses are used for inhalation therapy.
Inhaled corticosteroids indications
Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators used for chronic asthma. Do not relieve symptoms of acute asthmatic attacks.
Inhaled corticosteroids nursing implications
- Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections.
- If a beta-agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid.
Inhaler nursing implications
- Encourage patients to take measures that promote a generally good state of health so as to prevent, relieve, or decrease symptoms of COPD. This can be done by 1) avoid exposure to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutants); 2) adequate fluid intake; and 3) avoid excessive fatigue and extremes in temperature.
Inhaler pt education
- For any inhaler prescribed, ensure that the patient is able to self-administer the medication.
- Provide demonstration and return demonstration.
- Provide a spacer if the patient has difficulty coordinating breathing with inhaler activation.
- Ensure that the patient knows how to keep track of the number of doses in the inhaler device
- If no relief then the pt needs to call their MD or go to ED.
leukotriene receptor antagonists (LTRAs) indications
Prophylaxis and chronic treatment of asthma in adults and children older than age 12. They are NOT meant for management of acute asthmatic attacks.
leukotriene receptor antagonists (LTRAs) MOA
Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body. Leukotrienes cause inflammation, bronchoconstriction, and mucus production. This results in coughing, wheezing, and SOB. LTRAs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation. Inflammation in the lungs is blocked, and asthma symptoms are relieved.
leukotriene receptor antagonists (LTRAs) nursing indications
- Ensure that the drug is being used for chronic management of asthma, not acute asthma. Teach the patient the purpose of the therapy!
- Improvement should be seen in about 1 week.
- Teach patient to take medications every night on a continuous schedule, even if symptoms improve.
Inflamed and swollen nasal mucosa, Commonly referred to as "Stuffy nose" or "stuffed up". The primary causes are allergies and URI's (common cold).
Nasal decongestants nursing implications
- Decongestants may cause hypertension, palpitations, and CNS stimulation.
- Patients on medication therapy for hypertension or hyperthyroidism should check with their physician before taking over-the-counter decongestants.
Nasal steroid decongestants
Have an antiinflammatory effect. They work to turn off the immune system cells involved in the inflammatory response. A decrease of inflammation results in decreased congestion.
Nonopioid antitussive adverse effects
Nonopioid antitussives may cause dizziness, drowsiness, and HA.
Nonopioid antitussives MOA
Work by suppressing the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated.
Nonsedating/peripherally acting antihistamines
Developed to eliminate unwanted adverse effects, mainly sedation. Work peripherally to block the actions of histamine; thus, fewer CNS adverse effects. These will have a longer duration of action (increases compliance).
Opioid antitussive adverse effects
Opioid antitussives may cause sedation, N/V, lightheadedness, and constipation.
Opioid antitussives MOA
Work by suppressing the cough reflex by direct action on the cough center in the medulla.
Oral adrenergic decongestants
Oral Dx's have a prolonged decongestant effects, but delayed onset. The effect is less potent than topical. The benefit of oral over topical is that they have no rebound congestion effects.
Popular anticholinergic Dx's
- Ipratropium bromide inhaled (Atrovent)
- tiotropium inhaled (Spiriva)
Popular leukotriene receptor antagonists (LTRAs) Dx's
- montelukast (Singulair)
- zafirlukast (Accolate)
- zileuton (Zyflo)
Popular nasal steroid decongestants Dx's
- fluticasone (Flonase)
- triamcinolone (Nasocort)
Popular nonopioid antitussives Dx's
- benzonatate (Tessalon Perles)
- dextromethorphan (Vicks Formula 44,Robitussin-DM)
Popular nonsedating/peripherally ccting antihistamine Dx's
- fexofenadine (Allegra)
- loratadine (Claritin)
- cetirizine (Zyrtec)
Popular opioid antitussive Dx's
- codeine (Robitussin AC, Dimetane-DC)
- Hydrocodone cough syrup (Hycodan, Tussigon)
Popular traditional antihistamine Dx's
- diphenhydramine (Benadryl)
- chlorpheniramine (Chlor-Trimeton)
Symptoms of the common cold
Symptoms of the common cold include: sore throat, runny nose, congestion, sneezing, and coughing.
Topical adrenergic decongestants
Topical Dx's have a prompt onset and are potent. The disadvantage is that sustained use over several days causes rebound congestion, making the condition worse.
Work both peripherally and centrally. They
have more anticholinergic effects, making them more effective than nonsedating drugs in some cases.