A L L E R G Y A N D R E S P I R A T O R Y M E D I C A T I O N S
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• Upper Respiratory System- filters and humidifies air that is inhaled
• Oral and nasal cavity, sinuses, pharynx, larynx, and trachea
• Lower Respiratory System- exchange oxygen and carbon dioxide between alveoli/blood
• Right and left bronchi, right and left lungs, bronchioles, and alveoli
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• Action – histamine- chemical the body produces that causes an inflammatory response
• Compete with histamine for H
1 receptor sites to limit its effect on body organs and structures
• Limits vasodilation, capillary permeability, and swelling
• Limits acetylcholine release, which dries secretions in the bronchioles and gastrointestinal system
• Sedative effect on the CNS
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• Uses
• Seasonal allergic rhinitis (SAR)
• Perennial allergic rhinitis (PAR)
• Perennial nonallergic rhinitis (PNAR)
• Relieve symptoms of allergic disorders
• Adjunctive therapy for anaphylaxis
• Sedation
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• Adverse Reactions
• Changes in blood pressure, blurred vision
• Tachycardia, insomnia, dry mouth, nausea
• Restlessness, excitability, sedation, tinnitus
• Drug Interactions (CNS depressants – hypnotics, sedatives, depressant analgesics, alcohol increase the effect. )
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Life span considerations
• Pediatrics:
• Infants and young children often have anticholinergic side/adverse effects
• Paradoxical reactions may occur: increased nervousness, confusion, or hyperexcitability
• Elderly
• More likely to develop side effects such as dizziness, syncope (fainting), confusion, and extrapyramidal reactions
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ANTI-HISTAMINE DRUGS
• First Generation – usually OTC, crosses blood-brain barrier, sedative effect
• Dimetapp, Chlor-Trimeton, Benadryl, Banophen,
Phernergan
Second Generation – most available by prescription, some OTC, rapid onset, do not cross blood-brain barrier, do not cause excessive sedation
Zyrtec, Periactin, Allegra, Allergra D, Claritin,
Claritin D
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Action
Inhibit cholinergic nerve impulses to the vomiting center of the brain
• Agents act to redirect stimulation by stopping or reducing stimulation of the vomiting center
Uses
• Prevent and treat motion sickness or the nausea and vomiting that occur with surgery, anesthesia, and cancer treatment
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ANTIEMETIC-ANTIVERTIGO AGENTS
(CONT.)
Adverse Reactions
• Drowsiness and drug tolerance with longterm therapy
• Anticholinergic reactions – dry mouth, stuffy nose, blurred vision, constipations, urinary retention
Drug Interactions
• CNS depressants increase the sedative effect of antiemetic medications.
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ANTIEMETIC-ANTIVERTIGO AGENTS
(CONT.)
Lifespan considerations –
Pediatric patients with acute illnesses are at special risk for adverse reactions (Reye syndrome)
Assessment – find out hx of allergies and medications
Diagnosis – what other considerations vomiting may indicate – nutrition, electrolyte imbalance
Planning – educate patient on sedation effect
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Compazine
Reglan
Dramamine
Benadryl
Antivert
Marinol
Scopolamine transdermal patch
Zofran
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SEDATIVE-HYPNOTIC MEDICATIONS
Action and Uses
• Sedative agent: relaxes the patient and reduces anxiety and MAY lead to sleep
• Hypnotic agent produces sleep in the patient
• They are used to relax patients and induce sleep before medical testing and surgical procedures; used to treat insomnia caused by mental and physical stress
Lorzepam (Ativan), Temazepam (Restoril),
Phenobarbital
Schedule IV controlled substances
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• Adverse Reactions – “hangover” effect, impaired coordination, headache, muscle or joint pain
• Drug Interactions- increase sedative effects of CNS depressants, analgesics, anesthetics, tranquilizers
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GASTRO-INTESTINAL
ANTI-CHOLINGERGICS
• Three major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colon
• Pre operative Medication – Tagamet Histamine 2 recepter antagonist decreases gastric acidity and volume
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Two Forms
• Natural: from opium (morphine and codeine)
• Synthetic: man-made in the hope they would not be as additive – useful for pain mgt and reversal effects of opiods – (hydrocodone, oxycodone)
Synthetic: man-made mad
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Agonist
• Binds with the receptor(s) to activate and produce the maximum response of the individual receptor
Partial agonist
• Produces a partial response
Agonist-antagonist
• Acts as an agonist at one type of receptor and as a competitive antagonist at another type of receptor
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Morphine
• Uses
• Acute care
• Hospice
Codeine, hydrocodone, oxycodone
• Uses
• Office or clinical setting
Hydromorphone
• Uses
• Severe pain unrelieved by morphine
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WONG-BAKER FACES PAIN RATING
SCALE
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Tolerance
• The same amount of a drug produces a decreased effect over time
Dependence
• A state in which the body will show withdrawal symptoms if the drug is stopped or reduced
Addiction
• The uncontrollable need to have and use a drug for nonmedical reasons
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Action
• Prevent pain perception in the central nervous system
• Produce analgesia, sleepiness, euphoria, unclear thinking, slow breathing, produce miosis, decreased peristalsis, reduced cough reflex, and hypotension
Uses
• Treat moderate to severe pain
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2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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NARCOTIC AGONIST ANALGESICS
(CONT.)
Adverse Reactions
• Bradycardia, slowed breathing
• Hypotension, fainting
• Anorexia, constipation
• Confusion, euphoria
• Dry mouth, vomiting
• Pruritus, skin rash
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• Used when a continuous infusion of opioids is required
• Pump is calibrated to ordered dose and frequency
• Patient is able to self-administer pain medication by pushing control button
• Pump can be programmed to deliver an hourly rate
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NARCOTIC AGONIST ANALGESICS
(CONT.)
Drug Interactions
• Many drugs increase or decrease effects
Nursing Implications
Patient Teaching
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NARCOTIC AGONIST-ANTAGONIST
ANALGESICS
Action
• Act on chemicals at specific nerve sites in the CNS, possibly in the limbic system
• Produce analgesia, euphoria, and respiratory and physical depression
Uses
• Relief of moderate to severe pain
• Presurgical anesthesia
• Active labor
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NARCOTIC AGONIST-ANTAGONIST
ANALGESICS (CONT.)
Adverse Reactions
• Bradycardia or tachycardia
• Hypertension or hypotension
• Changes in mood, confusion, nervousness
• Blurred vision, dizziness, headache
• Weakness, nystagmus, syncope, tingling
• Tinnitus, tremor, unusual dreams
• Nausea, vomiting, dry mouth, constipation
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NARCOTIC AGONIST-ANTAGONIST
ANALGESICS (CONT.)
Drug Interactions
• Caution with alcohol and CNS depressants
• Nursing Implications
• Patient Teaching
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2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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NONNARCOTIC CENTRALLY ACTING
ANALGESICS
Action
• Act at the level of the brain to control mild or moderate pain
Uses
• Mild to moderate pain
• Used in combination products for pain alone or when pain and fever are present
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NONNARCOTIC CENTRALLY ACTING
ANALGESICS (CONT.)
Adverse Reactions
• Postural hypotension, dizziness
• Disorientation, euphoria, headache
• Light-headedness, minor visual disturbances
• Sleepiness, slurring of speech, weakness
• Skin rashes, stomach or abdominal pain
• Dry mouth, nausea, vomiting, chills
• Difficulty urinating, stuffy nose
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2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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• Drug Interactions
• Nursing Implications
• Patient Teaching
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• Action: reduce muscle tone and involuntary movement without loss of voluntary motor function
• Centrally acting or direct myotropic blocking
• Uses: relief of pain in musculoskeletal and neurologic disorders involving peripheral injury and inflammation; relief of spasticity in chronic conditions
• Table 18-2
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• Adverse reactions: symptoms
• Drug interactions: sedatives, narcotic analgesics, antianxiety agents, hypnotics, alcohol, general anesthetics, MAOIs, and tricyclics
• Cyclobenzaprine and orphenadrine: anticholinergic effects that interfere with antihypertensive activity of alpha-adrenergic blockers
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• Nursing implications: assessment, diagnosis, planning, implementation, and evaluation
• Patient and family teaching: administration considerations; avoiding activities requiring alertness; drug interactions; missed dosages; when to contact the health care provider; HS administration; storage and safety
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2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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