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- Upper Respiratory Drugs: Antihistamines, Decongestants, Antitussives, and Expectorants. - Bronchodilators and Other Respiratory Drugs.

2 types of antitussives

Opioid and Nonopioid.

3 types of decongestants

- Adrenergics: systemic and topical (largest group)
- Anticholinergics: less commonly used
- Corticosteroids: topical, intranasal steroids.

Adrenergic nasal decongestant Dx effects

Nasal stuffiness is relieved.

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.

Anticholinergic indications

Used to prevent bronchoconstriction. NOT used for acute asthma attacks.

Anticholinergics MOA

Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways. Anticholinergics bind to the ACh, resulting in an inhibition of bronchial constriction.

Antihistamine Dx effects

Decreased symptoms of allergies and common cold (runny nose and sneezing).

Antihistamine MOA

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.


These are drugs used to stop or reduce coughing.


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.

Beta2-agonist indications

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

Chronic bronchitis

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 MOA

Reduce viscosity of secretions by breaking down and thinning out secretions.

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 MOA

Antiinflammatory properties

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.

Nasal Congestion

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.

Nasal steroid decongestants Dx effects

Nasal stuffiness is relieved

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 adrenergic nasal decongestant Dx's

- Oral: Sudafed
- Topical Nasal Spray: Afrin

Popular anticholinergic Dx's

- Ipratropium bromide inhaled (Atrovent)
- tiotropium inhaled (Spiriva)

Popular Beta2-agonist Dx

- albuterol (Proventil)

Popular expectorant Dx

- Mucinex

Popular inhaled corticosteroids Dx's

- fluticasone (Advair)
- triamcinolone acetonide (Azmacort)

Popular leukotriene receptor antagonists (LTRAs) Dx's

- montelukast (Singulair)
- zafirlukast (Accolate)
- zileuton (Zyflo)

Popular nasal steroid decongestants Dx's

Intranasal Spray:
- 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.

Traditional antihistamines

Work both peripherally and centrally. They
have more anticholinergic effects, making them more effective than nonsedating drugs in some cases.

Tx for the common cold

Treatment of the common cold includes the combined use of: antihistamines, nasal decongestants, antitussives, and expectorants. These drugs will only relieve the symptoms of the common cold, they do not eliminate the causative pathogen.

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