Study the powerpointzs below and Med Maths questions for a Short timed quiz with 25 questions.  Directives will come from student after committment. Must have a chatting  app for ease of communicatio

Drugs for the Treatment of Respiratory Disorders
N180 Pharmacology

1

Objectives
1. Discuss the nurse’s role regarding the nonpharmacologic
control of pulmonary disorders through patient teaching.
2. Describe the nurse’s role in the pharmacological treatment
of pulmonary disorders.
3. Categorize drugs used in the treatment of pulmonary
disorders based on their classification and mechanism of
action.
4. Discuss the mechanisms of administration for
pharmacological management of pulmonary disorders.
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The Respiratory System

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Anatomy of the Respiratory System
Upper Respiratory Tract
Nares, nasal cavity, pharynx, and larynx
Air enters through the upper airway, these structures help trap particulate matter and pathogens so that they do not make it to the lower airway.
Lower Respiratory Tract
Trachea, bronchi, bronchioles, alveoli
Gas exchange occurs here.
Ventilation/Perfusion
Ventilation is the process of air movement (inspiration and expiration)
Perfusion is the blood flow to the alveolar capillary bed where gas exchange takes place.
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Upper Respiratory Disorders
Colds and Allergic Rhinitis
The common cold and allergic rhinitis are common disorders of the nasopharyngeal tract.
Allergic rhinitis is often called hay fever and is caused by pollen or a foreign substance.
Symptoms of the common cold include rhinorrhea (watery nasal discharge), congestion, cough, and increased mucous.
Bacterial infections may cause nasal discharge to become tenacious, mucoid, and yellow/green.
Drug therapy involves antihistamines, decongestants, antitussives, expectorants, and mucolytics.
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Non-Pharmacologic Management of Upper Respiratory Disorders

Avoid known triggers.
Drink lots of fluid
Rest
Practice Breathing Exercises
Neti Pots
Hard candy for cough
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Pharmacologic Management of Respiratory Disorders

Preventer vs. Reliever
Treatment goal is relieve symptoms and prevent reoccurrence. This may take multiple medications.
Prevention drugs include H1 receptor antagonists, intranasal corticosteroids, and mast cell stabilizers and are targeted at preventing symptoms from occurring.
Reliever drugs include H1 receptor antagonists, decongestants, antitussives, expectorants, and mucolytics and are targeted at relieving unpleasant symptoms.

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Antihistamines
Prototypes: diphenhydramine, cetirizine
1st generation agent: diphenhydramine, 2nd generation agent: cetirizine
MOA: block H1 receptors resulting in the blockage of histamine release during allergic reactions.
Therapeutic Use: Mild allergic reactions, motion sickness, insomnia, often combined with decongestants (both a preventer and reliever)
Complications: sedation (common, will taper off), anticholinergic effects (dry mouth, constipation), GI upset (N/V, constipation), urinary retention, tachycardia, blurred vision, paradoxical excitation in children
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Antihistamines
Prototypes: diphenhydramine, cetirizine
Contraindications/Precautions: asthma, cardiac disease, seizure disorders, renal disease, urinary retention, open-angle glaucoma, hypertension, BPH (anticholinergic effects)
Interactions: increased CNS depression with alcohol, opioids, benzodiazepines
Administration: Oral, intranasal, IV. Best taken at bedtime with food due to drowsiness. Avoid any activities that require alertness (driving).
Nursing Considerations: Ensure client takes sips of water, sucks on sugarless hard candies (dry mouth) and increased fluid/fiber intake (constipation).
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1st Generation vs. 2nd Generation
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1st generation antihistamines are more likely to cause sedation and anticholinergic effects.

Additionally, the effects of 2nd generation antihistamines last longer.

Nursing Process: Antihistamines
Assessment: baseline vitals, drug therapies, history of constipation and urinary retention, allergens
Diagnosis: hypoxemia, decreased gas exchange, airway obstruction, discomfort
Planning: Patient will have decreased nasal congestion, mucosal secretions, and cough.
Interventions/Education: give with food at bedtime, avoid driving and CNS depressants, monitor children and elderly adults for complications
Evaluation: Relief of allergic symptoms
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Additional Antihistamines and Their Uses

Promethazine (Phenergan): Used for nausea/emesis (blocks histamine release in the stomach)
Dimenhydrinate (Dramamine): used 30 minutes prior to events known to induce motion sickness (blocks histamine in the vomiting center of the brain-available in many forms)
Many other uses: Parkinson’s, insomnia, urticaria, rashes

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Nasal Glucocorticoids
Prototype: mometasone (Nasonex)
MOA: Decrease inflammation associated with allergic rhinitis
Other agents: fluticasone, triamcinolone, budesonide
Therapeutic Use: 1st line treatment for nasal congestion; reduce the effects of allergic rhinitis (sneezing, nasal itching, rhinorrhea)
Complications: minimal; most common is sore throat, nose bleed, headache, burning sensation in the nose
No significant precautions/interactions as the drug is delivered to site of action.
Administration: Teach the patient how to use metered-dose spray devices; should be taken daily with/without symptoms
May take up to 7-21 days to achieve peak response.
Client should take inhaled glucocorticoid AFTER taking decongestant in order to clear nasal passages first
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Intransal and Systemic Decongestants
Prototypes: oxymetazoline (Afrin), pseudophedrine (Sudafed)

MOA: stimulate the alpha-1 receptors of the sympathetic nervous system, causing reduction in the inflammation of the nasal mucosa.
Therapeutic Use: rhinitis (allergic or non-allergic), sinusitis, colds
Complications: rebound congestion (intranasal only), CNS stimulation (more common with oral agents), vasoconstriction
Contraindications/Precautions: cardiovascular disorders (due to vasoconstriction)
Administration: Teach intranasal administration, pseudophedrine requires identification at purchase as it can be converted to amphetamine
Nursing Considerations: taper use of intranasal forms over 3-5 days to avoid rebound congestion, often combined with antihistamines in cold medication preparations
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Antitussives
Prototypes: codeine (opioid), dextromethorphan (non-opioid)
MOA: suppresses the cough reflex by increasing the cough threshold in the CNS.
Therapeutic Use: nonproductive cough suppression
Complications: CNS depression (drowsiness, dizziness, respiratory depression), GI distress (N/V, constipation), opioid abuse *all complications are more common with opioid forms*
Contraindications/Precautions: Codeine is schedule II normally, but when used with other antitussives it is schedule V, respiratory depression, asthma, alcohol use, liver/kidney problems
Administration: monitor after dosage for safety (ambulation), monitor respiratory status, avoid activities that require alertness, take oral forms with food, increase fluids and fiber, use only short term
Available forms include capsules, lozenges, liquids, syrups (may contain alcohol and glucose)
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Expectorants
Prototype: guaifenesin (Mucinex)
MOA: promotes increase cough production by increasing and thinning mucous secretions, this mobilizes the secretions and allows the patient to eliminate them by coughing
Therapeutic Use: often combined with antitussives/decongestants for treatment of colds, rhinitis, cough
Complications: GI upset, drowsiness and dizziness, allergic reaction (rash)
Contraindications/Precautions: asthma (may cause bronchospasm), some forms contraindicated in children
Administration: available in tablets (no crushing) and capsules (can sprinkle on food), report cough lasting longer than one week, take with food and a full glass of water
Nursing Considerations: increase fluid intake throughout the day, stop if a rash develops and notify provider, ensure client is aware of contents of all combination cold medications
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Mucolytics
Prototype: acetylcysteine (Mucomyst)

MOA: directly breaks down and thins mucous to enhance the flow of secretions in the respiratory passages.
Therapeutic Use: acute and chronic pulmonary disorders, cystic fibrosis, antidote for acetaminophen overdose
Complications: aspiration/bronchospasm with oral forms, dizziness, drowsiness, hypotension, tachycardia, hepatotoxicity
Contraindications/Precautions: CNS depression, renal/liver disease
Administration: oral/inhalation/IV, this medication stinks-watch out for emesis/aspiration (stop treatment), warn patient they will cough, monitor LFT’s (AST/ALT)
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Cold Remedies

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Nursing Process: Cold Remedies
Assessment: any history of hypertension/cardiac disease, baseline vitals, cardiac/respiratory status, drug therapies
Diagnosis: hypoxemia, decreased gas exchange, airway obstruction, fatigue, discomfort
Planning: Patient’s nasal congestion will be relieved and patient will be free from secondary bacterial infections.
Interventions/Education: monitor vitals, observe secretions, avoid activities that require alertness, limit length of use of the medications, monitor combination cold medicine use for drug overlap, drink water, rest, avoid others (infectious), avoid airway irritants
Evaluation: Free from cough, congestion, and fever. Good fluid intake and rest.
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Lower Respiratory System
Central chemoreceptors found in the medulla respond to an increase in CO2 and a decrease in pH of the blood by increasing ventilation.
Peripheral chemoreceptors found in the major arteries (aorta, carotids) respond to changes in oxygen levels. Low levels stimulate the respiratory center in the medulla and ventilation is increased.
The airways are lined with smooth muscle. Contraction of this muscles leads to bronchoconstriction (restricted airway) and relaxation of this muscle leads to bronchodilation (open airway).
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Autonomic Nervous System Control of Respiratory Function
The sympathetic nervous system is made up of alpha and beta receptors that are activated by the hormone epinephrine.
When the beta2 receptors of the lungs are activated by epinephrine, the smooth muscle relaxes and the airway opens.
When the vagus nerve (part of the parasympathetic nervous system) is activated, acetylcholine is released and the smooth muscle constricts, restricting the airway.
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Chronic Obstructive Pulmonary Disease

Asthma: an airway disorder triggered by stimuli (stress, allergens, illness, pollutants) leading to inflamed, edematous, constricted airways. This leads to wheezing, coughing dyspnea, chest tightness, and bronchospasm.
Chronic Bronchitis: lung disease caused by smoking or chronic lung infections that leads to bronchial inflammation and excessive mucous secretion.
Emphysema: lung disease caused by smoking where the bronchioles become plugged with mucus , the alveoli enlarge, and air becomes trapped in the expanded alveoli leading to CO2 retention.

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Comparing Bronchitis and Emphysema

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Bronchial Asthma

Allergens attach themselves to mast cells and and basophils, and this leads to the release of histamine, cytokines, serotonin, and leukotrienes.
These substances stimulate bronchial constriction, mucous secretions, inflammation, and pulmonary congestion.
Drugs used to treat COPD include:
Bronchodilators: albuterol, ipratropium, theophylline
Inflammatory Mediators: beclomethasone, prednisone, montelukast, cromolyn
Expectorants: acetylcysteine
Antibiotics if bacterial infection is suspected

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Asthma

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Beta Adrenergic Agonists
Prototype: albuterol (Ventolin), salmeterol

MOA: activate the beta2 receptors in the bronchial smooth muscle resulting in bronchodilation
Therapeutic Use: short-acting beta agonists (albuterol) are used to prevent exercise induced bronchospasm, treat acute bronchospasm and asthma, and to treat status asthmaticus, long-acting beta agonists (salmeterol) are used for long-term control of asthma
Complications: tachycardia, angina, nervousness, restlessness, anxiety, tremors, hypokalemia and hyperglycemia (with prolonged use)
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Beta Adrenergic Agonists
Prototype: albuterol (Ventolin)
Contraindications/Precautions: Dysrhthmia, coronary diseases, cardia disease, hypertension, hyperthyroidism, diabetes
Interactions: Beta blockers will block the effects of this drug, certain antidepressants can increase the risk of tachycardia
Administration/Nursing Care: teach patients how to use a nebulizer or inhaler, albuterol should be taken before all other inhaled drugs (opens airway), SABA’s are used for acute attacks only, LABA’s are used for long term control/prevention of asthma, keep a log of usage of SABA’s
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Anticholinergics
Prototype: ipratropium (Atrovent)
MOA: blocks muscarinic receptors (parasympathetic nervous system) of the bronchi, resulting in bronchodilation
Therapeutic Use: long term treatment/prevention of acute bronchospasm
Complications: dry mouth, hoarseness
Contraindications/Precautions: allergy to peanuts (contains soy lecithin), glaucoma and BPH (due to anticholinergic effects)
Administration: rinse the mouth after administration to prevent dry mouth, suck sugarless hard candy and sip fluids to control dry mouth
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Methylxanthines
Prototype: theophylline (Theo-24)
MOA: relaxes bronchial smooth muscle, resulting in bronchodilation
Therapeutic Uses: oral forms are used for long-term control of asthma or COPD (IV forms are used in emergencies only)
Complications: toxicity (GI distress, dysrhythmias, seizures), hyperglycemia, tachycardia
Contraindications/Precautions: heart disease, hypertension, liver/kidney disease, diabetes
Interactions: caffeine (no coffee, tea, energy drinks), fluroquinolone antibiotics increase levels, seizure drugs may decrease levels
Administration/Nursing Care: monitor serum drug levels (should be between 5-15mcg/mL, >20=toxicity), no smoking, IV administration should be done via pump with close monitoring
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Inhaled Glucocorticoids
Prototype: beclomethasone (QVAR)
MOA: prevent inflammation, suppress airway mucus production, promote responsiveness of beta2 receptors to bronchodilators
Therapeutic Use: does not provide immediate effects, promotes decreased frequency/severity of exacerbations/attacks-used for long-term prophylaxis of asthma
Complications: difficulty speaking, hoarseness, oral candidiasis
No significant contraindications, precautions, or interactions.
Administration: Use an MDI, DPI, or nebulizer on a regular, fixed schedule for long-term therapy. Not to be used for an acute episode. Albuterol should be taken first. Rinse the mouth and gargle after use and monitor for white patches on the tongue and oral mucosa.
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Oral Glucocorticoids
Prototype: prednisone (Deltasone)
MOA: prevent inflammation, suppress airway mucus production and edema, promote responsiveness of beta2 receptors
Therapeutic Use: short-term therapy to treat manifestations following an acute asthma episode. Long-term use to treat chronic, severe asthma.
Complications: adrenocortical insufficiency (not common with short term use), bone loss (use low dose or alternate day dosing), hyperglycemia, myopathy, PUD, infection, fluid/electrolyte disturbance, increased appetite, weight gain, insomnia, thin skin, hirsutism, menstrual irregularity, GI upset, hypertension
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Oral Glucocorticoids
Prototype: prednisone (Deltasone)
Contraindications/Precautions: those who have recently received a live virus vaccine and those who have systemic fungal infections, use cautiously in children and those with DM, hypertension, heart failure, PUD, osteoporosis, kidney dysfunction
Interactions: diuretics increase the risk of hypokalemia, NSAIDS increase the risk of PUD, glucocorticoids counteract the effects of oral hypolglycemics
Administration: take with food, use short-term (3-10 days) following acute exacerbation of asthma, while on long-term therapy additional doses may be required during times of stress, taper slowly after long term use.
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Leukotriene Modifiers
Prototype: montelukast (Singulair)

MOA: suppress the effect of leukotrienes thereby reducing inflammation, bronchoconstriction, airway edema, and mucus production
Therapeutic Use: long-term therapy of asthma in adults and children, can be used to prevent exercise-induced bronchospasm (2 hours prior to activity)
Complications: depression/suicidal ideation, headache, confusion, drowsiness, dizziness
Contraindications/Precautions: Use cautiously in patients with liver problems
Interactions: phenytoin may decrease the action of montelukast
Administration: Given orally once daily at bedtime, for exercise induced bronchospasm-take 2 hours before activity, replaces daily dose, granules can be mixed with soft foods (applesauce, ice cream, mashed potatoes)
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Mast Cell Stabilizers
Prototype: cromolyn (Intal)

MOA: inhibits the release of histamine and other inflammatory mediators from mast cells to prevent asthma attacks.
Therapeutic Use: long-term prophylaxis of asthma symptoms
Complications: postnasal drip, irritation of the nose/throat, cough (decreased by drinking water before and after the drug)
No significant contraindications/precautions/interactions.
Administration: oral inhalation, MDI, nebulizer, nasal spray. Rebound bronchospasm may occur-don’t discontinue abruptly. It has only moderate effectiveness and has a short half life requiring administration 4-6 times a day-steroids are preferable.
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Administration of Pulmonary Drugs
Inhaled drugs are delivered via aerosol. This may be via nebulizer, metered dose inhaler (MDI), or dry powder inhaler (DPI).
Allows for delivery of drugs right where they need to act, leading to fewer complications/adverse effects.
Education on use of the device is required.
Spacers are recommended for patients of all ages (their use is more common in pediatrics) to help get the medication further into the pulmonary system.
Disadvantages: dose difficult to measure, only a small amount actually reaches lower respiratory tract, rinse mouth after use

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Teaching Use of Inhalers-Pg. 6 ATI

MDI
Shake 5-6 times
Inhale deeply and exhale,
Place inhaler/spacer to mouth,
Activate the inhaler while taking a slow, deep breath,
Hold your breath for at least 10 seconds,
Exhale slowly through pursed lips,
Rinse mouth and spacer
Wait 5 minutes between different drugs.
Wait 1 minute in between puffs of same drug.
For DPI-do not shake, must activate per manufacturer’s guidelines
Bronchodilator should always be first.
Lifespan Consideration: Older Adults
Lifespan Consideration: Pediatrics

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Nursing Process: Drugs for Respiratory Disorders
Assessment: medical/drug history, vital signs, respiratory assessment, hydration status
Diagnosis: dyspnea, airway obstruction, decreased gas exchange, fatigue
Planning: patient will be free from wheezing with clear lung fields in 2-5 days, will administer oral drugs and use inhaler as prescribed
Interventions/Teaching: monitor VS, provide hydration, watch for complications, monitor respiratory status, monitor drug levels (theophylline), teach MDI/DPI/nebulizer use, avoid smoking, wear a medical alert tag, report suicidal thoughts (montelukast), report more frequent use of rescue inhalers (albuterol)
Evaluation: free of wheezing, no complications, tolerates activity
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References
McCuistion, L.E., DiMaggio, K.V., Winton, M.B, & Yeager, J.J. (2021). Pharmacology: A patient-centered nursing process approach. (10th ed.). St. Louis, MO: Elsevier.
Assessment Technologies Institute (2019). RN pharmacology for nursing (8th ed.). Stilwell, KS: ATI Publishing.
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MEDICATION MATH PRACTICE WEEK 5

Objectives:

· Weight-Based Dosages

Required Reading:

· McCuistion Chapter 11

Practice Problems

1. Order: gentamicin 2.5mg/kg every 8 hours

Weight: 33 lbs

Supply: gentamicin 20mg/2mL

How many mg would you give per dose? _____

How many mL would you give per day? _____

2. Order: fluorouracil 12mg/kg/day IV

Weight: 176 lbs

Supply: fluorouracil 500mg/10mL

How many mL would you give per day? _____

3. Order: cefaclor suspension 20mg/kg/day in three divided doses

Weight: 66 lbs

Supply: cefaclor suspension 125mg/5mL

How many mL would you give per dose? _____

4. Order: acyclovir 12 mg/kg/dose

Weight: 115 lbs

Supply: acyclovir 100mg/2mL

How many mL would you give per dose? _____

5. Order: enoxaparin 2mg/kg daily

Weight: 155 lbs

Supply: enoxaparin 40mg/0.4mL

How many mL would you give? _____

1)

37.5mg/dose, 11.25mL/day

2) 19.2 mL

3) 8 mL

4) 12.5 mL

5) 1.4 mL

Respiratory Drugs

ATI/ PBS Crime movie

Upper Respiratory Tract
Nares, nasal cavity, pharynx, and larynx
help trap particulate matter and pathogens
Lower Respiratory Tract
Trachea, bronchi, bronchioles, alveoli
Gas exchange occurs here.
Ventilation/Perfusion
Ventilation is the process of air movement (inspiration and expiration)
Perfusion is the blood flow to the alveolar capillary bed where gas exchange takes place.

Upper airways diseases
Which do you know?
Allergic rhinitis
Common cold
Bacterial infection (sinus infection)
clear  mucoid color

Drug therapy involves antihistamines, decongestants, antitussives, expectorants, and mucolytics.

Non-Pharmacologic (drug free) Management of Upper Respiratory Disorders

Avoid known triggers.

Drink lots of fluid

Rest

Practice Breathing Exercises

Neti Pots

Hard candy for cough

Pharmacologic treatment of Respiratory Disorders

PREVENTERS

H1 receptor antagonists*

Intranasal corticosteroids

RELIEVERS
(Treat symptoms)

H1 receptor antagonists*

Decongestants

Mast cell stabilizers

Antitussives

Expectorants

Mucolytics

Antihistamine Prototypes:
1st generation agent: diphenhydramine, 2nd generation agent: cetirizine
MOA: block H1 receptors resulting in the blockage of histamine release during allergic reactions.
Therapeutic Use: Mild allergic reactions, motion sickness, insomnia, often combined with decongestants (both a preventer and reliever)
Complications:
#1 SE: Sedation (common)
#2 SE: Anticholinergic effects (dry mouth, constipation, urine retention, tachycardia, blurred vision)
#3 SE: GI upset (less common)
Diphenhydramine (Benadryl) and cetirizine (Zyrtec)
Diphenhydramine unique concerns:
Paradoxical excitation in children. More drowsiness in older adults.

Antihistamines: diphenhydramine, cetirizine
Drug side effects Nursing Considerations
Dry upper/lower airway Contraindicated in Asthma
Can cause seizures Contraindicated in Seizure disorders
Anti-cholinergic effects:
Urine retention
Pupil dilation
Constipation
Tachycardia
Dry mouth Contraindicated in:
Urinary retention, BPH,
Open angle glaucoma
Teach to increase fiber/ fluid
Cardiac disease
Teach to sip water/ sugarless hard candy
Sedation
Increased CNS depression with alcohol, opioids, benzodiazepines

Diphenhydramine (Benadryl) combinations

Nursing Process: Antihistamines

Assessment:

History of asthma, cardiac disease, BPH constipation, seizures,

Nursing Diagnosis/Problem:

Ineffective airway clearance, discomfort,

Goals:

Relief of allergic symptoms

Interventions/Education:

Patient will have decreased nasal congestion, mucosal secretions, and cough

Evaluation:

give diphenhydramine with food at bedtime, avoid driving and CNS depressants, monitor children and elderly adults for complications

Swelling (steroids decrease swelling)
Sepsis (risk of infection)
Sugar (increase blood sugar)
Slowly taper off

Steroids: “sone” drugs:
Prednisone, dexamethasone
Background info

Intranasal Meds

Nasal Glucocorticoids Prototype:
MOA: Decrease inflammation associated with allergic rhinitis
Other agents: fluticasone (flonase), triamcinolone, budesonide
Therapeutic Use: 1st line treatment for nasal congestion; reduce the effects of allergic rhinitis (sneezing, nasal itching, rhinorrhea)
Complications: minimal; most common is sore throat, nose bleed, headache, burning sensation in the nose
No significant precautions/interactions as the drug is delivered to site of action.
Administration: Teach the patient how to use metered-dose spray devices; should be taken daily with/without symptoms
May take up to 7-21 days to achieve peak response.
Client should take inhaled glucocorticoid AFTER taking decongestant in order to clear nasal passages first

mometasone (Nasonex)

Reference: PIXORIZE: https://youtu.be/9DeGX0snl0c
Dilated pupils
Vasoconstriction
Sphincter constriction (bladder)
Alpha 1 receptor effects (SNS)

Patho page

Intranasal- oxymetazoline (Afrin)
Oral-
pseudoephedrine (Sudafed)
MOA: stimulate the alpha-1 receptors of the sympathetic nervous system, reduction in the inflammation/ constriction of nasal blood vessels/ mucosa
Therapeutic Use: rhinitis (allergic or non-allergic), sinusitis, colds
Complications: rebound congestion (intranasal only), CNS stimulation (more common with oral agents), vasoconstriction
Contraindications/Precautions: cardiovascular disorders (due to vasoconstriction)
Administration: Teach intranasal administration, pseudophedrine requires identification at purchase as it can be converted to amphetamine (meth)
Nursing Considerations: taper use of intranasal forms over 3-5 days to avoid rebound congestion, often combined with antihistamines in cold medication preparations
Intranasal and Systemic Decongestants
Prototypes:

Ephedrine is a sympathomimetic amine and substituted amphetamine. It is similar in molecular structure to methamphetamine, and epinephrine (adrenaline). Used to make meth.
Stimulant properties
Hyperactivity
Extreme focus
Elevated heart rate
Difficulty sleeping

Pseudo- ephedrine = “Suedo- adrenalin”
Background info

Anti- tuss ives
Prototypes:

1. codeine (opioid)
2. dextromethorphan (non-opioid)
MOA: suppresses the cough reflex by increasing the cough threshold in the CNS !!!!
Therapeutic Use: non-productive cough suppression (dry)
Complications: #1 SE: CNS depression (drowsiness, dizziness, respiratory depression), GI distress (N/V, constipation), opioid abuse *all complications are more common with opioid forms*
Contraindications/Precautions: Codeine is schedule II normally, but when used with other antitussives it is schedule V, respiratory depression, asthma, alcohol use, liver/kidney problems
Administration: monitor after dosage for safety (ambulation), monitor respiratory status, avoid activities that require alertness, take oral forms with food, increase fluids and fiber, use only short term, opioid concerns: overdose: naloxone, GI upset
Available forms include:
-capsules- lozenges-liquids
-syrups (may contain alcohol and glucose)
– combined in many OTC drugs

Tuss / tos= cough

Expectorants Prototype:

MOA: Increases cough secretions by thinning mucous
Makes it easy to move mucous out and up via coughing
Does not destroy mucous directly
Therapeutic Use: often combined with antitussives/decongestants for colds, rhinitis, cough
Complications: GI upset, drowsiness (no driving), allergic reaction (rash)
Contraindications/Precautions: asthma (may cause bronchospasm), some forms contraindicated in children
Administration: available in tablets (no crushing) and capsules (can sprinkle on food), report cough lasting longer than one week, take with food and a full glass of water
Nursing Considerations: Drink enough water (water is best expectorant), stop if a rash develops and notify provider, ensure client is aware of contents of all combination cold medications
guaifenesin (Mucinex)

Cool video: https://youtu.be/qT291qi6XZY

Mucolytics
Prototype: acetylcysteine (Mucomyst)
MOA: directly breaks down and thins mucous to enhance the flow of secretions in the respiratory passages.
Therapeutic Use: acute and chronic pulmonary disorders, cystic fibrosis, antidote for acetaminophen overdose
Complications: aspiration/bronchospasm with oral forms, dizziness, drowsiness, hypotension, tachycardia, hepatotoxicity
Contraindications/Precautions: CNS depression, renal/liver disease
Administration: oral/inhalation/IV, this medication stinks-watch out for emesis/aspiration (stop treatment), warn patient they will cough, monitor LFT’s (AST/ALT)

**reserved for severe infections
-pneumonia
– cystic fibrosis
**prescription drug
Actually destroys mucous
Acetylcysteine (imagine a cyst filled with mucus)
IV oral- For what type of overdose?
Respiratory use: nebulizer/ inhaler
Patient will begin coughing immediately
May cause severe bronchospasm (disease concern?)
Smells like rotten eggs
Can cause vomiting ( smell and cough) risk of aspiration
Oral: hard on liver, (labs?) CNS depression, sedation
Education: Inhaled: this is going to stink, stop if nauseous, will make you cough, but if you can’t breathe, stop
Mucolytic Prototype:
acetylcysteine
(Mucomyst)

Nursing Process: Cold Remedies
Assessment: any history of hypertension/cardiac disease, baseline vitals, cardiac/respiratory status, drug therapies
Diagnosis: hypoxemia, decreased gas exchange, airway obstruction, fatigue, discomfort
Planning: Patient’s nasal congestion will be relieved, and patient will be free from secondary bacterial infections.
Interventions/Education: monitor vitals, observe secretions, avoid activities that require alertness, limit length of use of the medications, monitor combination cold medicine use for drug overlap, drink water, rest, avoid others (infectious), avoid airway irritants
Evaluation: Free from cough, congestion, and fever. Good fluid intake and rest.

Week 5 Prototypes

Beta2-adrenergic agonists – albuterol (Proventil, Ventolin), salmeterol (Serevent)

Inhaled anticholinergics – ipratropium (Atrovent, Atrovent HFA)

Methylxanthines – theophylline (Theo-24, Theolair, Theochron)

Leukotriene modifiers – montelukast (Singulair)

Oral glucocorticoid – prednisone (Deltasone)

Inhaled glucocorticoid– beclomethasone dipropionate (QVAR)

Mast cell stabilizers – cromolyn (Intal)

Intranasal glucocorticoid – mometasone (Nasonex)

Sedating antihistamines – diphenhydramine (Benadryl)

Non-sedating antihistamines – cetirizine (Zyrtec)

Sympathomimetic Decongestants – pseudophedrine (Sudafed), oxymetazoline (Afrin)

Antitussive (non-opioid) – dextromethorphan

Antitussive (opioid)-codeine

Expectorants – guaifenesin

Mucolytics – acetylcysteine (Mucomyst)