Beruflich Dokumente
Kultur Dokumente
Chapter 69
Outcomes
Identify concepts related to medication classifications and application to manage allergic reactions, conditions of the upper respiratory system, acid indigestion and gastric reflux. Choose nursing interventions related to the applied pharmacokinetics and pharmacodyanmics specific to these medications Implement the nursing process in the administration of medication classes covered herein
Background
Histamines (Predominantly H1)
Endogenous Vessel effects Bronchi effects Stomach effects
Secretes Mucus
Greatest interest
Allergic reactions (mild / anaphylaxis) PUD (Peptic Ulcer Disease)
3
Histamine Release
Allergic response
Requires IgE antibodies Prior exposure to allergen
Vessel wall cells contract (If this, then?) Bronchoconstriction (If this, then?) Trouble breathing Itching & pain Mucus secretion CNS effect cognition / memory / sleep
H2 Stimulation
Severe
Anaphylactic shock (bronchocontriction, hypotension, & edema of glottis) Sxms caused by? leukotrienes TX? (ch 17) Epi
Other Uses
Common cold runny nose
Highly sedating
MOA
Blockers (1st Gen)
Selectively bind to histaminic receptors Can also bind to nonhistaminic receptor (muscarinic)
7
Clinical uses
Mild allergies, seasonal rhinitis, acute urticaria, allergic conjunctivitis, mild transfusion reactions Some block muscarinic & H1 receptor sites useful for motion sickness
promethazine [Phenergan] and dimenhydrinate [Dramamine]
Adverse Effects
CNS
Sedation = to excess ETOH (If this, then?) Dizziness, lack of coordination, confusion Paradoxical: insomnia, excitation, tremors, convulsions
GI
N, V, Diarrhea / constipation, loss of appetite
10
Anticholinergic effects
Dry mouth, throat, nasal passages, thickened secretions, (cautions?) urinary hesitancy, constipation, palpitations
Contraindications third trimester Precautions: asthma, children/elderly, urinary retention, HTN, OA glaucoma, prostatic hypertrophy
11
DD
ETOH, barbs/benzos/ opioids, antidepressants
Toxicity
Sxms similar to atropine poisoning (anticholinergic), hyperpyrexia (super fever, can kill children) Can lead to death in children via excitation, hallucinations, convulsion, coma, CV collapse, death. Tx: remove and support may use charcoal followed with cathartics
12
Allergic Rhinitis
Review of sxms Commonly associated disorders Seasonal vs. Perennial
15
Antihistamines
First line - oral Prophylaxis first No use against cold Adverse effects
1st gen - sedation, anticholinergic 2nd gen - rare
16
Intranasal Glucocorticoids
Prototype: fluticasone (Flonase) Action / Use
Predominantly local anti-inflammatory First line - Most effective against all sxms
Adverse Effects
Drying, burning, or itching (when applied topically) Rare - sore throat, epistaxis and HA Rare - systemic adrenal suppression / slowed growth in children
Intranasal Cromolyn
Prototype: cromolyn (NasalCrom) Action / Use
Suppresses release of histamine Best suited for prophylaxis May not see results for week or more
Adverse effects
Negligible
18
Adverse effects
Rebound congestion CNS stimulation Cardiovascular Hemorrhagic stroke w phenylporpanolamine Abuse (pseudoephedrine and ephedrine)
19
Sympathamometics (contd)
Nasal sprays
2 3 sprays every 4 hours needed not to exceed 5 consecutive days (to reduce dependence)
What cocaine is
20
Anticholinergics
Prototype: ipratropium bromide (Atrovent) Action / Use
Blocks cholinergic receptors and inhibits secretions to relieve rhinorrea in allergic rhinitis and asthma No systemic effects
Leukotriene Antagonist
Prototype: montelukast (Singulair) Action / Uses;
Blocks binding of leukotrienes to receptors thereby relieving nasal congestion
Leukotrienes normally vasodilate and increase vascular permeability, causing congestion
22
Treatment of Coughs
Antitussives
Antitussives (cough suppressants)
Actions / use: elevate cough threshold in common cold and URTI
Opioid (codeine and hydrocodone) best (stops cough in the brain)
Dosage: codeine 10 to 20 mg up to 6 times daily
24
Expectorants
Prototype - guaifenesin (Mucinex)
MOA / Use increases flow of respiratory tract secretions
Dont use for COPD or something else read the friggin book
25
Mucolytics
Prototype acetylcysteine (Mucomyst)
Can also use hypertonic saline
Adverse effects
Can trigger bronchospasm
Antidote for tylenol!
26
Colds
Drug regimen
Symptomatic Combination products
Decongestants Antitussives Analgesics Antihistamines - anticholinergic to suppress mucus Caffeine
27
Adrenergic Agonist
Prototype - epinephrine MOA/Use
Direct receptor binding ( 1&2, 1&2) mimicing the sympathetic nervous system
Also known as sympathomimetic & catecholamine (think of these to mean stimulation)
ADME
Broken down quickly in stomach & significant 1st pass effect (cant take it PO) Cant cross blood-brain Discolors (pink/brownish) as it degrades (If, then?) 29 (Throw it away!)
Adverse effects:
HTN, necrosis, bradycardia w HTN, tachycardia, tremor, chest pain, elevated blood sugar
30
Table 17-3
DD
MAOIs TCAs General anesthestics (myocardial effects)
Precautions
IV admin can cause potentially fatal effect check concentrations! Insure patent and healthy IV site (you dont want epi going into the tissues
The range can be from 1:100,000 to 1:1,000 make sure to read the label!!!!
31
EpiPen
Anaphylactic deaths
PCN, venoms & foods
Histamine2-Receptor Antagonists
Prototype: cimetadine (Tagamet)
First choice for gastric / duodenal ulcers Action / Uses:
Promote healing through acid reduction GERD, Aspiration Pneumonitis (aspiration of acid in the lungs) in obese & gyne prior to anesthesia
Adverse effects
Low incidence of gynecomastia (breasts devlpmnt in men), reduced libido, impotence, CNS depression / excitement, pneumonia
DD
Inhibits hepatic drug metabolism therefore? Major Drugs of concern warfarin, phenytoin, theophylline, lidocaine
34
Famotidine (Pepsid)
For Heartburn, acid indigestion, sour stomach Cut dose in renal compromise/failure No antiandrogenic effects No effect on hepatic metabolism of other drugs
Doesnt cause a lot of the things that Tagamet does
35
Adverse effects
HA, diarrhea, N & V Long term may increase risk of CA
36
Antacids
Prototypes - magnesium hydroxide / aluminum hydroxide Action / Uses alkaline agents that neutralize acid & decrease destruction of gut wall
And prophylactically to prevent aspiration pneumonia
ADME
Take regularly to promote healing In PUD: 1 and 3 hr after each meal & at bedtime Goal is gastric pH greater than 5
37
Adverse effects
Constipation (aluminum base) / Diarrhea (magnesium base) Sodium loading High levels in renal failure clients
38