Pharmacology for Nurses Unit 24 Review: Upper Respiratory Disorder Drugs

Key Concepts

• Upper respiratory disorders affect the nose, throat, and airways leading to the lungs
• Inflammation and infection are common underlying causes of upper respiratory disorders
• Medications used to treat upper respiratory disorders aim to alleviate symptoms, reduce inflammation, and combat infections
• Proper dosing, administration, and monitoring of medications are crucial for effective treatment and patient safety
• Nurses play a vital role in assessing patients, administering medications, and providing patient education

Types of Upper Respiratory Disorders

• Rhinitis involves inflammation of the nasal passages causing congestion, runny nose, and sneezing (allergic rhinitis, viral rhinitis)
• Sinusitis occurs when the sinuses become inflamed or infected leading to facial pain, headache, and nasal discharge (acute sinusitis, chronic sinusitis)
• Pharyngitis refers to inflammation of the pharynx (throat) resulting in sore throat, difficulty swallowing, and fever (streptococcal pharyngitis, viral pharyngitis)
• Laryngitis is characterized by inflammation of the larynx (voice box) causing hoarseness, loss of voice, and throat pain
• Influenza is a viral infection that affects the upper and lower respiratory tract causing fever, body aches, cough, and fatigue
• Croup is a viral infection common in children that causes inflammation of the larynx and trachea leading to a barking cough and difficulty breathing

Common Medications

• Antihistamines (diphenhydramine, loratadine) block histamine receptors to reduce inflammation and alleviate symptoms of allergic rhinitis
• Decongestants (pseudoephedrine, phenylephrine) constrict blood vessels in the nasal passages to reduce congestion
• Intranasal corticosteroids (fluticasone, mometasone) reduce inflammation in the nasal passages and are used for allergic rhinitis and sinusitis
• Antibiotics (amoxicillin, azithromycin) are prescribed for bacterial infections such as streptococcal pharyngitis and bacterial sinusitis
• Antiviral medications (oseltamivir, zanamivir) are used to treat influenza by inhibiting viral replication
• Cough suppressants (dextromethorphan) and expectorants (guaifenesin) help manage cough symptoms associated with upper respiratory disorders

Mechanism of Action

• Antihistamines compete with histamine for binding sites on histamine receptors, preventing the inflammatory response triggered by histamine release
• Decongestants stimulate alpha-adrenergic receptors causing vasoconstriction in the nasal passages, reducing blood flow and decreasing congestion
• Intranasal corticosteroids bind to glucocorticoid receptors in the nasal mucosa, suppressing the production of inflammatory mediators and reducing inflammation
• Antibiotics inhibit bacterial growth and replication by interfering with essential bacterial processes (cell wall synthesis, protein synthesis)
• Antiviral medications, such as neuraminidase inhibitors, block the action of viral enzymes necessary for viral release and spread from infected cells

Dosage and Administration

• Oral medications should be administered as directed, usually with food or water to minimize gastrointestinal side effects
  • Antihistamines: typically taken once or twice daily
  • Decongestants: usually taken every 4-6 hours as needed
  • Antibiotics: dosage varies depending on the specific medication and severity of infection
• Intranasal medications require proper technique to ensure optimal delivery and minimize systemic absorption
  • Patients should be instructed to blow their nose, tilt their head forward, and inhale gently while spraying the medication into each nostril
• Injectable medications, such as some antibiotics, may be administered intramuscularly or intravenously by trained healthcare professionals
• Dosage adjustments may be necessary for pediatric, geriatric, or patients with renal or hepatic impairment to ensure safety and efficacy

Side Effects and Precautions

• Antihistamines may cause drowsiness, dry mouth, and blurred vision; caution should be exercised when driving or operating machinery
• Decongestants can cause nervousness, insomnia, and elevated blood pressure; they should be used with caution in patients with hypertension, diabetes, or cardiovascular disease
• Intranasal corticosteroids may cause local side effects such as nasal irritation, epistaxis (nosebleeds), and rarely, septal perforation
  • Patients should be monitored for signs of systemic corticosteroid absorption, such as adrenal suppression or growth retardation in children
• Antibiotics may cause gastrointestinal side effects (nausea, vomiting, diarrhea) and allergic reactions; patients should be monitored for signs of anaphylaxis or Clostridium difficile infection
• Antiviral medications can cause nausea, vomiting, and headache; they may interact with other medications and should be used with caution in patients with renal impairment

Nursing Considerations

• Assess patients for signs and symptoms of upper respiratory disorders, including congestion, cough, fever, and difficulty breathing
• Review patient's medication history and allergies before administering medications to prevent adverse reactions and interactions
• Monitor patients for therapeutic response and potential side effects; report any adverse events to the prescribing healthcare provider
• Ensure proper storage and handling of medications, especially those requiring refrigeration or special preparation
• Collaborate with other healthcare professionals, such as physicians and pharmacists, to optimize patient care and medication management
• Document medication administration, patient response, and any nursing interventions in the patient's medical record

Patient Education

• Instruct patients on the proper use, dosage, and potential side effects of their prescribed medications
• Emphasize the importance of completing the full course of antibiotics, even if symptoms improve, to prevent antibiotic resistance
• Teach patients proper techniques for administering intranasal medications, including nasal sprays and inhalers
• Encourage patients to practice good hygiene, such as handwashing and covering their mouth and nose when coughing or sneezing, to reduce the spread of infections
• Advise patients to stay hydrated, get adequate rest, and use humidifiers to help alleviate symptoms and promote recovery
• Educate patients on the signs and symptoms of worsening or complications that warrant seeking medical attention, such as difficulty breathing, high fever, or severe headache