MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

ANTIHISTAMINES

H1 Antagonists Anticholinergic (Drying Block action of Nasal allergies Medicated disorders

effects) most histamine at H1
Diphenhydramine common receptor sites Allergic rhinitis (hay Allergic rhinitis
(Benadryl) fever, mold, and dust
Dry mouth Compete w/histamine allergies) Anaphylaxis
Loratadine (Claritin) for binding at
Difficulty urinating Allergic reactions Angioneurotic edema
unoccupied receptors
Constipation Motion sickness Drug fevers
H2 Antagonists Binding prevents the
Changes in vision adverse Parkinson’s disease Insect bite reactions
Cimetidine consequences of
(Tagamet) histamine Sleep disorders Urticarial (itching)
stimulation-
Ranitidine (Zantac) Drowsiness mild to vasodilation,
deep sleep increased GI and
Famotidine (Pepcid) Used to reduce gastric
respiratory
acid in peptic ulcer
secretions, increased
disease
capillary permeability
Have several properties
– antihistaminic,
anticholinergic,
sedative

Decongestants: Adrenergic –Lg group – Sympathomimetic Anticholinergic-used less,- Parasympatholytics Corticosteroids-

Topical, intranasal steroids

Oral Decongestants Prolonged decongestant

effects, but delayed onset
Pseudoephedrine
(Sudafed) Effect less potent than
topical

No rebound congestion

Exclusively adrenergic
MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

Topical adrenergic Prompt onset

Phenylephrine Potent
(Neo-Synephrine
Sustained use over several
days causes rebound
congestion, making the
condition worse

Intranasal steroids Nervousness local Site of action: blood Acute or chronic rhinitis May cause hypertension,
mucosal dryness vessels surrounding palpitations, CNS
Beclomethasone nasal sinuses Common cold stimulation – avoid w/pts
dipropionate Insomnia and irritation antinflammatory that has these
Sinusitis
Flunisolide Palpitations effect
Hay fever Pt on med therapy for
(Nasalide) Turn off the immune hypertension should check
Tremors
Fluticasone system cells involved May also be used to with Doc first before taking
(Flonase) Systemic effects in the inflammatory reduce swelling of the OTC
caused by adrenergic response nasal passage and
stimulation of the facilitate visualization assess for drug allergies
heart, blood vessels, Decreased of the
inflammation results pt should avoid caffeine and
and CNS nasal/pharyngeal caffeine products
in decreased membranes before
congestion surgery of diagnostic report a fever, cough, or
Nasal stuffiness is procedures other symptoms lasting
relieved longer than a week

Shrink engorged nasal monitor for therapeutic

mucous membranes effects

Cough Physiology

Respiratory secretions and foreign objects are naturally removed by the cough reflex; which induces coughing and
expectorations, initiated by inrritation of sensory receptors in the respiratory tract

Two Basic Types of Cough

MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

Productive cough – congested, removes excessive secretions

Nonproductive cough – dry cough

Coughing – most of the time, coughing is beneficial – it removes excessive secretions and potentially harmful foreign substances

In some situations, coughing can be harmful, such as after hernia repair surgery

Antitussives Used to stop the cough Perform respiratory and

reflex when the cough assessment, and
Opioids – Suppress the cough cough is assess for allergies
reflex by direct nonproductive and/or
Codeine (Robitussin Sedation, nausea, action on the cough Instruct patients to avoid
A-C, Dimetane- vomiting, harmful
center in the medulla driving or operating heavy
DC) lightheadedness, equipment because of
constipation possible sedation,
Hydrocodone
drowsiness, or dizziness
Nonopioids
Dizziness, headache, Suppress the cough Pts taking chewable tablets
Benzonatate sedation, nausea, reflex by numbing or lozenges should not
(Tessalon Perles) the stretch receptors drink liquids for 30-35 mins
Dizziness, drowsiness, in the respiratory afterward
Dextromethorphan nausea
(Vicks Formula tract and preventing Report: cough that lasts
44, Robitussin- the cough reflex form more than a week,
DM) being stimulated persistent headache, fever,
rash

Not for nonproductive

coughs

Expectorants Direct stimulation Aid in the removal of Used with caution in the
mucus elderly or those with
Guaifenesin Nausea, vomiting, Reflex stimulation: drug asthma or respiratory
gastric irritation causes irritation of Reduce the viscosity of insufficiency
the GI tract, secretions
loosening and Pt taking expectorants
thinning or Disintegrate and thin should receive more fluids,
GI irritation, rash,
MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

Iodinated glycerol enlarged thyroid respiratory tract secretions to help loosen and liquefy
gland secretions occur in secretions
response to this Used for the relief of
irritation productive coughs Report a fever, cough, or
associated with: other symptoms lasing
longer than a week
Common cold,
Final result: thinner Bronchitis, Laryngitis,
mucus that is easier Pharyngitis, chronic
to remove paranasal sinusitis,
Pertussis, Influenza,
Measles

Secretory glands are

stimulated directly to
increase their
production of
respiratory tract
fluids

BRONCHODILATOR
S

Bronchodilators- Epinephrine- Begins at the specific Relief of bronchospasm Quickly reduce airway
Beta-Agonists Insomnia, receptor stimulated related to asthma, constriction and restore
Nonselective Restlessness, bronchitis normal air flow
adrenergic Anorexia, Vascular Ends with dilation of the
Epinephrine headache, airways, activation Used in treatment and Encourage pt to take
Hyperglycemia, of beta2 receptors prevention of acute measures that promote a
Nonselective beta- Tremor, Cardiac activates cyclic attacks generally good state of
adrenergic Stimulation adenosine health to prevent, relieve,
Metaproterenol monophosphate(cAM Used in hypotension or decrease symptoms of
(Alupent) Metaproterenol- P), which relaxes and shock COPD
Cardiac stimulation, smooth muscle in the Used to produce uterine
Selective beta2 tremor, angina pain, airway and results in Avoid exposure to conditions
Albuterol (Proventil) relaxation to prevent that precipitate
vascular headache, bronchial dilation and premature labor
hypotension increased airflow bronchospasm (allergens,
Stimulates beta2- smoking, stress, air
Albuterol- Therapeutic –
MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

Hypotension or decreased dyspnea, adrenergic receptors pollutants)

hypertension, wheezing, throughout the lungs
vascular headache, restlessness, and Adequate fluid intake
tremor anxiety Compliance with medical
Improved activity treatment
tolerance Avoid excessive fatigue, heat
extremes in temp, caffeine

Beta-agonist derivatives –

Albuterol, if used too frequently, loses its beta2-specific actions at larger doses. As a result, beta1 receptors are stimulated,
causing nausea, increased anxiety, palpitations, tremors, and increased heart rate

Ensure that patients take medications as prescribed, no omissions or double doses

Inform patients to report insomnia jitteriness, restlessness, palpitations, chest pain or any change in symptoms

Anticholinergic dry mouth or throat Acetylcholine (Ach) To prevent Slow and prolonged action
Ipratropium causes bronchial bronchoconstriction
bromide (Atrovent) nasal congestion constriction and NOT used for acute asthma
narrowing of the exacerbation
Tiotropium (Spiriva) heart palpitations
airways
gastrointestinal
distress Anticholinergic bind to
the Ach receptors,
headache preventing Ach form
binding
coughing
Result:
anxiety bronchoconstriction
is prevented, airway
no known drug
dilated
interactions

Xanthine Nausea, vomiting, Increased levels of Dilation of airways in Contraindications in history

Derivatives anorexia, energy-producing asthmas, chronic of PUD or GI disorders
Plant alkaloids: Gastroesophageal cAMP done bronchitis, and
MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

Caffeine, reflux during sleep, competitively emphysema Use Caution: Cardiac disease
theobromine, inhibiting
sinus tachycardia, phosphodiesterase Mild to moderate cases Report to physician:
Theophylline-only extrasystole, (PDE) of acute asthma
one used as a Palpitations
bronchodilator palpitations, Result: decreased cAMP Adjunct drug in the
management of Weakness
ventricular levels, smooth
muscle relaxation, COPD Convulsions
dysrhythmias,
Synthetic xanthines bronchodilation, and Not used as frequently
transient increased increased airflow Nausea
because of potential
Aminophylline urination of drug interactions Dizziness
Cardiovascular
Dyphilline strimulation: and variable related
to drug levels in the Vomiting or chest pain
increased force of
contraction and blood
Be aware of drug
increased heart rate, interactions with
resulting in increased Cimetidine, Oral
cardiac output and contraceptives, Allopurinol,
increased blood flow certain antibiotics
to the kidneys
(diuretic effect)

LEUKOTRIENE RECEPTOR ANTAGONISTS (LTRAs)

Montelukast Leukotrienes released Prophylaxis and chronic Blocking leukotrienes:

(Singulair) when a trigger, such treatment of asthma prevent smooth muscle
as cat hair starts a contraction of the bronchial
series of chemical NOT meant for airways
Headache, nausea, management of acute
Zafirlukast diarrhea, liver reactions in the body
asthmatic attacks Decrease mucus secretion
(Accolate) dysfunction Cause inflammation,
bronchoconstriction, Montelukast is prevent vascular
and mucus approved for use in permeability
Zileuton (Zyflo) production children >2 for
treatment of allergic decrease neutrophil and
Result: coughing, rhinitis leukocyte infiltration to the
wheezing, SOB lungs, preventing
MEDICATION Adverse Effects Action Indications NURSING CONSIDERATIONS

LRTAs prevent inflammation

leukotriene’s from
attaching to ensure drug is being used for
receptors on cells in chronic management of
the lungs and in asthma, not acute
circulation improvement should be seen
Inflammation in the in about 1 week
lugs is blocked and assess liver function before
asthma symptoms therapy
are relieved

CORTICOSTEROIDS

Beclomethasone Pharyngeal irritation Stabilize membranes of Treatment of Contraindicated in pt’s

dipropionate cells that release bronchospastic w/psychosis, fungal
(Beclovent, Coughing harmful disorders that are not infections, AIDS, TB
Vanceril) Dry mouth bronchoconstricting controlled by
substances conventional Pt’s should gargle and rinse
Triamcinolone Oral fungal infections (leukocytes or white bronchodilators the mouth with lukewarm
Acetonide blood cells) water afterward to prevent
(Azmacort) Systemic effects are NOT considered first- the development of oral
rare Increase line drugs for fungal infections
Dexamethasone responsiveness of management of acute
sodium phosphate bronchial smooth asthmatic attacks or It a beta-agonist
(Decadron muscle to beta- status asthmaticus bronchodilator and
Phosphate adrenergic corticosteroid inhaler are
Respilhaler) stimulation both ordered, the
bronchodilator should be
Fluticasone(Flovent used several mins before
, Flonase) the corticosteroid to
provide bronchodilation
before admin of
corticosteroid