Pharmacology - Upper Respiratory Tract Infection Treatment

What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, which facilitates the removal of viscous mucus? A. Guaifenesin B. Flunisolide C. Acetylcysteine D. Dextromethorphan

A. Guaifenesin Rationale: Actions: Enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus.

Which of the following is an adverse reaction to topical nasal steroids? A. Increased nasal drainage B. Rebound effect C. Suppression of healing D. Local ulceration

C. Suppression of healing Rationale: Adverse Effects: local burning, irritation, stinging, dryness of the mucosa, and headache; suppression of healing can occur in a patient who has had nasal surgery or trauma.

Decongestants

Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions

Mucolytics

Increase or liquefy respiratory secretions to aid clearing of airways

Expectorants

Increase productive cough to clear airways

Rhinitis Medicamentosa

Reflex reaction to vasoconstriction caused by decongestants; a rebound vasodilation that often leads to prolonged overuse of decongestants; also called rebound congestion

sympathomimetic effects

Sympathomimetic drugs (also known as adrenergic drugs and adrenergic amines) are stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system. ... Sympathomimetic drugs are used to treat cardiac arrest and low blood pressure, or even delay premature labor, among other things. The β 1 effects cause an increase in heart rate, dysrhythmias, and cardiac contractility; α effects increase vascular tone. Potent β 2 stimulants can produce unwanted symptoms: anxiety, headache, nausea, tremors, and sleeplessness. Prolonged use can lead to receptor downregulation and reduced drug response.

Antitussive agents should be used with caution in patients who have a history of addiction?

True Rationale: Caution should also be used in patients who are hypersensitive to or have a history of addiction to narcotics (codeine, hydrocodone).

Antitussives/ Dextromethorphan

-Actions: Act directly on the medullary cough center of the brain to depress the cough reflex -Indications: Control nonproductive cough -Pharmacokinetics: Rapidly absorbed, metabolized in the liver, and excreted in the urine -Contraindications: Patients who need to cough to maintain the airway Head injury or impaired CNS -Caution: Hypersensitivity or history of narcotic addiction -Adverse Effects: Drying effect on the mucous membranes CNS adverse effects GI upset

Expectorants/ Guaifenesin

-Actions: Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions -Indications: Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough -Pharmacokinetics: Rapidly absorbed, metabolism and excretion has not been reported -Adverse Effects: GI symptoms Headache Dizziness Mild rash Prolonged use may result in masking a serious underlying disorder

Topical Nasal **Steroid** Decongestants/Topical Nasal Steroid/ Fluticasone

-Actions: Exact mechanism of action is not known -Indications: Seasonal allergic rhinitis Inflammation after the removal of nasal polyps -Pharmacokinetics: Generally not absorbed systemically -Contraindications: Acute infection Caution Active infection Avoid exposure to airborne infections -Adverse Effects: Local burning, irritation, stinging, dryness of the mucosa, and headache Suppression of healing can occur in a patient who has had nasal surgery or trauma

Antihistamines/ Diphenhydramine

-Actions: Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response Anticholinergic and antipruritic effects -Indications: Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema -Pharmacokinetics: Well absorbed, metabolized in the liver, excreted in urine and feces -Contraindications: Pregnancy and lactation -Caution: Renal or hepatic impairment History of arrhythmias -Adverse Effects: Drowsiness and sedation -Anticholinergic effects Drug-to-Drug Interactions Vary based on the drug

Oral Decongestant/ Pseudoephedrine

-Actions: Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes -Indications: Promotion of drainage in the sinuses and improving air flow -Pharmacokinetics: Well absorbed, widely distributed in the body Metabolized in the liver and primarily excreted in urine -Contraindications: Any condition that might be exacerbated by sympathetic activity -Adverse Effects: Rebound congestion -Sympathetic effects: Drug-to-Drug Interactions OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects

Topical Nasal Decongestants/ Ephedrine

-Actions: Sympathomimetic Affects sympathetic nervous system to cause vasoconstriction Causing less inflammation of the nasal membrane -Indications: Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis -Pharmacokinetics: Generally not absorbed systemically Any portion of these topical decongestants that is absorbed is metabolized in the liver and excreted in the urine -Contraindications: Lesion or erosion in the mucous membranes -Caution: Any condition that might be exacerbated by sympathetic activity -Adverse Effects: Local stinging and burning Rebound congestion -Sympathomimetic effects: Drug-to-Drug Interactions Cyclopropane or halothane

Mucolytics

-Actions: Work to break down mucous in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions -Indications: Patients who have difficulty coughing up secretions Patients who develop atelectasis Patients undergoing diagnostic bronchoscopy Postoperative patients Patients with tracheostomies -Pharmacokinetics: Nebulization or direct instillation into the trachea -Caution: Acute bronchospasm, peptic ulcer, and esophageal varicies -Adverse Effects: GI upset Stomatitis and/or rhinorrhea Bronchospasm Rash

Rebound Congestion

A process that occurs when the nasal passages become congested as the effect of a decongestant drug wears off; patients tend to use more drug to decrease the congestion, and a vicious circle of congestion, drug, and congestion develops, leading to abuse of the decongestant; also called rhinitis medicamentosa

Antitussives

Block the cough reflex

Antihistamines

Block the release or action of histamine that increases secretions and narrows airways

Oral Decongestant/ Pseudoephedrine

Indication: Promote drainage in sinuses and improving air flow Pharmacodynamics: shrink nasal mucous membrane by stimulating alpha-adrenergic receptors in nasal mucous memb. Oral: Well absorbed, widely distributed, metabolized in liver, excreted in urine AE: Rebound congestion and sympathetic effects Drug-drug interactions: Pseudoephedrine Contraindications: N/A Cautions: conditions that may exacerbate sympathetic activity

Topical Nasal Decongestants/ Ephedrine

Indication: Relieve discomfort of nasal congestion with cold, sinusitis, and allergic rhinitis Pharmacodynamics: sympathomimetic, affects sympathetic nervous system to cause vasodilation, causing less inflammation of the nasal membrane Nasal: Generally not absorbed systemically; metabolized in liver; excreted in urine. AE: Local stinging/burning, rebound congestion, and sympathomimetic effects Drug-drug interactions: Cyclopropane or halothane Contraindications: lesion or erosion in mucous membranes Cautions: conditions that may exacerbate sympathetic activity

Topical Nasal Steroid/ Fluticasone

Indication: Seasonal allergic rhinitis, inflammation from nasal polyp removal Pharmacodynamics: Unknown Nasal: generally not absorbed systemically AE: Local burning, irritation, stinging, dryness of the mucosa, headache, and suppression of healing from nasal surgery or trauma. Drug-drug interactions: N/A Contraindications: Acute infection Cautions: avoid exposure to airborne infections

Antitussives/ Dextromethorphan

Indication: control nonproductive cough Pharmacodynamics: depresses cough reflex in medullary cough center of brain {route}: rapid absorption, metabolized in liver, excreted in urine AE: Drying effect on the mucous membranes, CNS issues, GI upset Drug-drug interactions: Contraindications: cough needed to maintain airway, head injury or impaired CNS Cautions: Hypersensitivity or history of narcotic addiction

Mucolytics/ Acetylcysteine

Indication: difficulty coughing up secretions, atelectasis, bronchoscopy, postoperative, tracheostomies. Pharmacodynamics: break down mucous to aid high-risk resp. patient in coughing up thick, tenacious secretions. nebulization or direct instillation into the trachea AE: GI upset, stomatitis and/or rhinorrhea, bronchospasm, and rash Drug-drug interactions: Contraindications: Cautions: acute bronchospasm, peptic ulcer, and esophageal varicies

Antihistamines/ Diphenhydramine

Indication: seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema Pharmacodynamics: Anticholinergic and antipruritic effect; selectively block effects of histamine at histamine-1 receptor sites, decreasing the allergic response {route}: well absorbed, metabolized in liver, excreted in urine and feces AE: Drowsiness, sedation, and anticholinergic effects Drug-drug interactions: Vary based on the drug Contraindications: renal or hepatic impairment; hx of arrhythmias Cautions: pregnancy and lactation

Expectorants/ Guaifenesin

Indication: systemic relief of respiratory conditions characterized by a dry, non-productive cough. Pharmacodynamics: enhances output of respiratory tract fluids by reducing adhesiveness and surface tension of fluids = easier movement of the less viscous secretions. {route}: rapidly absorbed, metabolism and excretion has not been reported. AE: GI symptoms, headache, dizziness, mild rash, prolonged used may result in masking a serious underlying disorder. Drug-drug interactions: N/A Contraindications: N/A Cautions: N/A