Chapter 11

1. Chapter 11 Allergy and Respiratory Medications

2. Chapter 11 Lesson 11.1

3. Learning Objectives • Identify major antihistamines used to treat breathing problems • Describe the action of antitussive medications • List medications used to treat and prevent asthma attacks

4. Learning Objectives (cont.) • Describe the major actions and the adverse reactions of the two main categories of bronchodilators

5. Respiratory System • Upper Respiratory System • Oral and nasal cavity, sinuses, pharynx, • larynx, and trachea • Lower Respiratory System • Right and left bronchi, right and left lungs, bronchioles, and alveoli

6. Antihistamines • Six Major Groups • Action • Compete with histamine for H1 receptor sites to limit its effectiveness • Limits vasodilation, capillary permeability, and swelling • Limits acetylcholine release, which dries secretions in the bronchioles and gastrointestinal system • Sedative effect on the CNS

7. Antihistamines (cont.) • Uses • Seasonal allergic rhinitis (SAR) • Perennial allergic rhinitis (PAR) • Perennial nonallergic rhinitis (PNAR) • Relieve symptoms of allergic disorders • Adjunctive therapy for anaphylaxis • Sedation

8. Antihistamines (cont.) • Adverse Reactions • Changes in blood pressure, blurred vision • Tachycardia, insomnia, dry mouth, nausea • Restlessness, excitability, sedation, tinnitus • Drug Interactions • Nursing Process

9. Antitussives • Actions: • Depress the cough center in the brain • Anesthetize stretch receptors in the respiratory tract • Soothe irritated areas in the throat • Uses: • Relief of overactive or nonproductive cough

10. Antitussives (cont.) • Adverse Reactions • Constipation, drowsiness, dry mouth, nausea, postural hypotension • Drug Interactions • Nursing Process

11. Asthma • Asthma is a condition that involves increased inflammation, swelling, and mucus production that lead to bronchiolar constriction. The person is able to breathe air into the lungs but has difficulty breathing out. Wheezing results because the person works to force air out through narrowed, mucus-filled passages during expiration. • The four classes of asthma severity include mild intermittent, mild persistent, moderate persistent, and severe persistent.

12. COPD • COPD is a chronic, disabling disorder that causes destruction of alveolar walls. This destruction creates unequal areas of ventilation and perfusion in the body, and oxygen and carbon dioxide exchange is impaired. Patients experience difficulty in expiration.

13. Asthma and COPD Medications • Prophylactic treatment • Cromolyn sodium • Nedocromil sodium • Actions: • Slows down destruction of sensitized mast cells; also may provide hyposensitization (decrease in allergic response)

14. Asthma and COPD Medications (cont.) • Bronchodilators • Sympathomimetics • Relax smooth muscle of bronchi (dilate) • Vasoconstriction of blood vessels in body (decreases mucosal and submucosal edema) • Increase the rate and force of heart contraction • Uses: • Relief of symptoms of bronchospasm in acute or chronic asthma, bronchitis, and COPD

15. Asthma and COPD Medications (cont.) • Xanthines • Relax smooth muscle in the bronchi and blood vessels in the lungs • Directly act on the kidney to produce an increase in urine production • CNS effects • Uses • Adjunctive therapy for bronchospasm in acute and chronic bronchial asthma, bronchitis, emphysema • Treatment of neonatal apnea • Acute pulmonary edema

16. Asthma and COPD Medications (cont.) • Leukotriene Receptor Inhibitors • Reduce symptoms of asthma by blocking receptors for cysteinyl leukotrienes C4, D4, and E4 • Uses • Treat acute or chronic asthma in patients unable to take inhaled glucocorticoids

17. Asthma and COPD Medications (cont.) • Corticosteroids • Block reaction to allergens and reduce airway hyperresponsiveness • Inhibit cytokine production, protein activation, and inflammatory cell migration and activation • Uses • Inhaled, long-term asthma control • Systemic; often used to get quick control of the disease when beginning long-term therapy or to speed recovery from severe episodes

18. Chapter 11 Lesson 11.2

19. Learning Objectives • Identify at least six medications commonly used as decongestants • Describe the mechanism of action for expectorants • List the major contraindications to the use of nasal steroids

20. Decongestants • Decongestants • Directly affect alpha receptors of blood vessels in the nasal mucosa, causing vasoconstriction • Uses: relieve nasal congestion from allergies and upper respiratory infections

21. Expectorants • Expectorants • Decrease the thickness of respiratory secretions, which facilitate expectoration • Uses: treat productive cough, assist with thick mucus

22. Topical Intranasal Steroids • Action • Antiinflammatory, reduce nasal congestion • Uses • Treatment of allergic, mechanical, or chemically induced local nasal inflammation or nasal polyps when usual treatment has failed to work • Adverse reactions • Asthma, headache, light-headedness, loss of sense of smell, nasal irritation and dryness, nausea, nosebleeds, perforation of nasal septum, altered sense of taste and smell

23. Complementary and Alternative Therapies • Allergy • Grape seed, stinging nettle, coleus, vitamin C • Asthma • Cordyceps, Tylophora, grape seed, coleus, vitamin C • Cold • Arabinoxylane, echinacea, elderberry, astragalus, goldenseal, grapefruit seed extract, zinc, vitamin C • Cough • Ground ivy, thyme, licorice, marshmallow