IPATROPIUM BROMIDE, AMMNOIUM CHLORIDE, BROMHEXINE and CHLORPHENIRAMINE

IPRATROPIUM BROMIDE 

Mechanism of Action

• Decreases cyclic guanosine monophosphate levels via inhibiting cholinergic receptors in bronchial smooth muscle (cGMP). Local bronchodilation results from decreased cGMP concentrations.

Indication

• Maintenance treatment for COPD-related reversible airway obstruction, including emphysema and chronic bronchitis.

Dose

• Adults
  • 2 puffs, four times daily.

Contraindication

• Hypersensitivity

Side Effect

• Bitter flavor
• Dry membranes of the oropharynx.
• Nausea.
• Constipation.
• Cough.
• Hoarseness.
• Ulcers on the mucosa
• Epistaxis.
• Nasal drying
• A retention of urine.

Nursing Consideration

• To determine how well a medicine is working to manage bronchospasm in people with asthma and COPD, evaluate lung function both at rest and while exercising.
• When taking greater or excessive amounts, keep an eye out for any signs of paradoxical bronchospasm.
• Watch out for symptoms of allergic responses, such as pulmonary or skin reactions. If these reactions occur, inform a doctor or member of the nursing staff right away.
• Regularly check your blood pressure and compare it to the recommended range. Report hypotension (low blood pressure), especially if the patient experiences fainting or syncope
• Identify any dizziness that may have an impact on your gait, balance, or other functional activities. Inform the doctor of any balance issues and functional limitations, and advise the patient's family and caregivers to be cautious of falls and injuries.

AMMNONIUM CHLORIDE

The main coughing cause is ammonium chloride, not a pleasant taste. Expectorant and other ingredients are merely assisting factors in producing a productive cough.

Mechanism of Action

• Ammonium chloride irritates the mucosa, stimulating the bronchial mucosa glands in the process.
• It leads to the formation of too much fluid in the respiratory system, which is probably simpler to cough up.

Indication

• Coughing up blood (expel cough)

Dose

• 5–10 mL every two hours (tid) for only productive coughs

Contraindication

• Hypersensitivity Gastritis

Side Effect

• Gastrointestinal Pain

Nursing Consideration

• Only those patients who have a productive cough are advised to use a cough expectorant.
• Patients taking cough expectorants shouldn't operate a car while taking them because the majority of them contain antihistamine medications.
• Never drink water right after using an expectorant to cough.
• Bromhexine split the sputum, so it was advised to give cough treatment to older patients.
• In big doses, ipecac really causes vomiting, whereas in modest doses, the medication acts as a cough expectorant.
• It is advised against giving cough expectorants to children. Cough suppressants are required.

BROMHEXINE

A mucolytics directly interacts with mucus to increase its water content. It manifests as a productive cough.

Mechanism of Action

• It immediately depolarises mucopolysaccharides in addition to liquifying lysosomal enzymes. It dislodges stubborn sputum. Strong mucolytics and mucokinetis are present. It triggers thick, abundant bronchial secretion.

Indication

• Mucus plus helps break up sputum, which is beneficial for elderly patients. bronchitis

Dose

• 8 mg tid

Contraindication

• Creating Hypersensitive Habbits

Side Effects

• Gastrointestinal irritation caused by lacrymation rhinorrhoea (common cold).

Nursing Consideration

• This field of medicine can be beneficial to elderly individuals.
• It is advised against admitting patients who have the flu due to the release of lysosomal enzymes.
• The medication is accessible by adhatoda vasica.
• Another name for bromhexine is vasaka.
• Carbocisteine and acetyl cysteine are likewise members of the Bromhexine group.
• Avoid using it for an extended period of time (it may cause irritation and rashes)

CHLORPHENIRAMINE 

Mechanism of action

• These H 1 blockers are. Uses include treating allergies, urticaria, and colds.

Indication

• Colds and Allergies
• Itching, etc

Dose

• 2-4 mg (Chlorpheniramine) three times per day and 25 mg three times per day (Diphenhydramine)

Contraindication

• Urinary incontinence
• Driving period

Side Effects

• Drowsiness.
• Sleepy.
• Sedation
• Tinnitus (ear sound).

Nursing Consideration

• To treat the cold with cough, the majority of cough medicines contain antihistamine medications like chlorpheniramine, diphenhydramine, etc.
• Patients are advised not to take it while driving, though pregnancy is safe.
• Fexofenadine and cetirizine are non-sedative medications.
• It is advised that patients drink a lot of water along with it.
• Use of antihistamines in glaucoma and liver disease should be cautious.
• Epilepsy may also call for caution.