Respiratory meds

Question 1

Antitussives: Opioids (Hydrocodone & Codeine)

Answer 1

MOA: Suppresses cough by acting on the CNS to increase cough threshold

Use: Chronic non-productive cough to decrease frequency/intensity

CNS effects: Dizzy, lightheaded, drowsy, resp. depression

GI effects: n/v/constipation

Education: Change position slowly, avoid activities that require being alert
-increase fluids and fiber
-potential for abuse

Schedule drug: II alone but V if mixed with antitussive

Question 2

Antitussives: Non-opioids (Dextromethorphan)

Answer 2

MOA: Suppresses cough through action on CNS

Use: Cough Suppression, can reduce pain if combo w/ opioid

Complications: Mild nausea, dizziness, sedation, euphoria in high doses

Education: Some forms contain alcohol and/or sucrose, Available in capsules, lozenges (>12 yo), liquids, syrups

Question 3

Expectorants (Guaifenesin)

Answer 3

MOA: Promotes cough by increasing and thinning mucous (cough it out)

Use: Alone or in combo for upper and lower respiratory disorders

Complications: GI upset, drowsy, dizzy, rash, caution in asthma (bronchospasm)

Education: take with full glass of water, read label to see what else it could be taken with

Question 4

Mucolytics (Acetylcysteine)

Answer 4

MOA: thin and enhance flow of secretions in the respiratory passages

Use: Acute/chronic pulmonary disorders exacerbated by large amounts of secretions, cystic fibrosis, antidote for acetaminophen poisoning

Complications: Aspiration and bronchospasm, dizzy, drowsy, hypotension, tachycardia, hepatotoxicity

Education: smells like rotten eggs

Question 5

Decongestants (Phenylephrine)

Answer 5

MOA: Sympathomimetic decongestants stimulate alpha1-adrenergic receptors, cause reduction in inflammation in nasal membranes

Use: Allergic or nonallergic rhinitis, decongestant

Complications: Rebound congestion, CNS stimulation, Vasoconstriction, can’t use if pt has closed-angle glaucoma. Caution in patients with CAD, HTN, CVD, and dysrhythmias

Education: proper use (clean it each time), Phenylephrine found by FDA in 2023 to not be more effective than placebo, Better versions include pseudoephedrine and ephedrine (can make meth so ID for purchase), Don’t use topical (nasal spray) more than 3-5 days, switch to oral

Question 6

Antihistamines

Answer 6

MOA: Action on H1 receptors results in blocking of histamine release in the small blood vessels, capillaries, and nerves, Relieve itching, sneezing, rhinorrhea, but not nasal congestion 1st gen produces anticholinergic effects and drowsiness

Use: mild allergic reactions, anaphylaxis (hypotension, acute laryngeal edema, bronchospasm), motion sickness, insomnia, Often used in combination with sympathomimetics to provide a nasal decongestant effect

Complications: sedation, avoid alcohol/sedatives, n/v/constipation, acute toxicity, excitation, hallucinations, incoordination, seizures in kids (give activated charcoal and cathartic, Tylenol for fever, apply ice packs/cool sponge baths)

Education: sip water, hard candy, 2-3L of water daily, can take with meals, notify if toxicity occurs

Question 7

Nasal Glucocorticoids (Mometasone)

Answer 7

other meds: Fluticasone, triamcinolone, Budesonide

MOA: Decrease inflammation in allergic rhinitis, first line med for nasal congestion

Use: Allergic rhinitis and sinusitis

Complications: Sore throat, nosebleed, HA, nasal burning

Education: Administer daily, not just with manifestations, up to 21 days, Clear blocked nasal passages w/ decongestant prior to steroid admin

Question 8

1st gen antihistamines

Answer 8

Diphenhydramine, promethazine, dimenhydrinate

Question 9

2nd gen antihistamines

Answer 9

Loratadine, cetirizine, fexofenadine, desloratadine

Question 10

Inhalant antihistamines

Answer 10

Azelastine, Olopatadine