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7/27/2019 Lesson 5 - Respiratory Drugs
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Respiratory Drugs 1
Antihistamines and
Nasal Decongestants
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Respiratory Drugs 2
Common Cold
Virus infection
Rhinovirus
Influenza virus
Initiates the inflammatory response
(continues)
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Respiratory Drugs 3
Common Cold
Cough reflex
Irritant stimulates sensory receptors
Removes
Respiratory secretions
Foreign object
(continued)
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Respiratory Drugs 4
Inflammatory Response
Mucosal irritation
Release of several inflammatory and
vasoactive substancesHistamine
Dilating small blood vessels in the nasalsinuses
Produces nasal congestion
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Respiratory Drugs 5
Symptomatic Treatment
Combined use of:
Antihistamines, nasaldecongestants, antitussives,
and expectorants
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Respiratory Drugs 6
Antihistamines and NasalDecongestants
Compete with histamine forreceptor sites
Two histamine receptors
H1 (histamine 1)
H2 (histamine 2)
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Respiratory Drugs 7
VasodilatationGI effects
Increase gastrointestinal andrespiratory secretions
Increase capillary permeability The binding of H1 and H2 blockers
to histamine receptors prevent
histamine stimulation
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Respiratory Drugs 8
H1 Antagonists
Respiratory antihistamines
Effects
Antihistaminic
Mild anticholinergic
Parasympathetic nervous system
Sedative
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Respiratory Drugs 9
Antihistamines
Antihistamines
Cardiovascular: small blood vessels
Histamine effectsDilation
Permeability
Antihistamine effects Prevent dilation
Prevent increased permeability
(continues)
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Respiratory Drugs 10
Skin
Prevent itching
Wheal and flare
Anticholinergic
Drying effect
SedativeDrowsiness
Antihistamines
(continues)
(continued)
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Respiratory Drugs 11
Antihistamines
Management of:
Nasal allergies
Seasonal or perennial allergic rhinitis
Allergic reactions
Motion sickness
(continues)
(continued)
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Respiratory Drugs 12
Antihistamines
More effective in prevention
Give early
Prevent binding of histaminereceptors
(continued)
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Respiratory Drugs 13
Classes of Antihistamines
Two types
Traditional: sedating
Nonsedating
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Respiratory Drugs 14
Traditional Antihistamines
Older Work both peripherally and
centrally
Anticholinergic properties Examples: diphenhydramine
(Benadryl)
and chlorpheniramine (Chlor-Trimeton)
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Respiratory Drugs 15
Nonsedating/Peripherally ActingAntihistamines
Work peripherally Eliminate sedation
Longer duration of action
Increases compliance
Examples: fexofenadine(Allegra) and loratadine
(Claritin)
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Respiratory Drugs 16
Antihistamines: NursingImplications
Assess allergy history
Contraindicated
Asthma attacks Chronic obstructive pulmonary disease
Cardiovascular disease
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Respiratory Drugs 17
Client Teaching
Instruction for traditional/sedatingantihistamines
Avoid driving
No alcohol
No central nervous systemdepressants
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Respiratory Drugs 18
Nasal Decongestants
Two main types are used:Adrenergics (largest group)
Constrict dilated blood vessels
Nasal mucosa
Corticosteroids
Reduce inflammation
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Respiratory Drugs 19
Goal of Nasal Decongestants
To reduce congestion
Two dosage forms
Oral Topical
Nasal spray
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Respiratory Drugs 20
Oral Decongestants
Prolonged effects
Less potent
No rebound congestion Exclusively adrenergics
Example: pseudoephedrine
(Sudafed)
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Respiratory Drugs 21
Topical Decongestants
Adrenergics
Prompt onset
Sustained use
rebound congestion Both adrenergics and steroids
Potent; work well
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Respiratory Drugs 22
Nasal Steroids
Anti-inflammatory
Decrease inflammation
Relieve nasal congestion
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Respiratory Drugs 23
Nasal Decongestants
Intranasal steroids Beclomethasone
dipropionate
BeconaseVancenase
Flunisolide(Nasalide)
Adrenergics Ephedrine
(Vicks)
Naphazoline(Privine)
Oxymetazoline(Afrin)
Phenylephrine(Neosynephrine)
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Respiratory Drugs 24
Nasal Decongestants: SideEffects
Adrenergics
Nervousness
Insomnia
Palpitations
Tremors
Steroids
Local mucosal dryness and irritation
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Respiratory Drugs 25
Treatment with Nasal Decongestants
Acute or chronic rhinitis
Common cold
Sinusitis Hay fever
Other allergies
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Respiratory Drugs 26
Nasal Decongestants:Nursing Implications
Avoid decongestants in the followingclients:
Heart disease
Hypertensive disease
Respiratory disease
Assess for drug allergies
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Respiratory Drugs 27
Expectorants and
Antitussive Agents
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Respiratory Drugs 28
Expectorants andAntitussive Agents
Drugs that aid in the expectoration(removal) of mucus
Reduce the viscosity of secretions Stimulate the flow of respiratory
secretions
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Respiratory Drugs 29
Secretions
By loosening and thinning sputumand bronchial secretions, thetendency to cough is indirectly
diminished.
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Respiratory Drugs 30
Cough Relief
Relief of nonproductive coughs:
Pertussis
Common cold
Bronchitis
Laryngitis
Sinusitis
Influenza Pharyngitis
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Respiratory Drugs 31
Expectorants: Side Effects
Common side effects
Guaifenesin Nausea, vomiting
Gastric irritation
Terpin hydrate
Gastric upset (elixir has high alcohol
content)
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Respiratory Drugs 32
Expectorants: Nursing Implications
Use with caution.
Elderly
Encourage client to drink fluids. Monitor for therapeutic effects.
Report a fever lasting longer than a
week.
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Respiratory Drugs 33
Antitussives
Drugs used to control coughing
Opioids and nonopioids
Narcotics
Used for nonproductivecoughs
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Respiratory Drugs 34
Opioid Antitussives
Suppress the cough reflex by directaction on the cough center in themedulla
Example: codeine + guiafenesin =Robitussin AC
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Respiratory Drugs 35
Non-narcotic Antitussives
Dextromethorphan
Suppresses the cough reflex by directaction on the cough center in the
medulla; a chemical derivative of theopiate narcotics
Result: diminished cough
Produces no respiratory depression,analgesia, or dependence
Example: Robitussin-DM
(continues)
( ti d)
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Respiratory Drugs 36
Non-narcotic Antitussives
Benzonatate
A derivative of procaine (local anestheticaction); impairs the sensation of the
stretch receptors in the respiratory tract Example
Tessalon
(continued)
d
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Respiratory Drugs 37
Antitussive Agents: SideEffects
Benzonatate
Dizziness, headache, sedation
DextromethorphanDizziness, drowsiness, nausea
Opioids
Sedation, nausea, vomiting,lightheadedness, constipation
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Respiratory Drugs 38
Antitussive Agents: NursingInterventions
Perform respiratory assessment.
Instruct clients to:
Avoid driving or operating heavyequipment
Not drink liquids for 30 to 35 minutesafter taking a cough syrup or using a
cough lozenge
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Respiratory Drugs 39
Antitussive Agents: Client Teaching
Report any of the followingsymptoms to the healthcare professional:
Cough that lasts more than 2weeks
A persistent headache
FeverRash
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Respiratory Drugs 40
Bronchodilators and OtherRespiratory Agents
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Respiratory Drugs 41
Bronchodilators
Medications used to relax andopen the airways
Open or maintain the
bronchial airways
Treat several diseasesyndromes
Chronic obstructive pulmonarydisease
Asthma
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Respiratory Drugs 42
Classes of Bronchodilators
Sympathomimetic agents
Xanthine bronchodilators
Anticholinergics
Leukotriene receptorantagonists
5-lipoxygenase inhibitors Mast cell stabilizers
Corticosteroids
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Respiratory Drugs 43
Sympathomimetics
Beta2-adrenergic receptors
Used during the acute phaseof asthmatic attacks
Quickly reduce airwayconstriction and restorenormal airflow
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Respiratory Drugs 44
Uses for Sympathomimetics
Treat acute attacks as well as preventattacks
Quickly reduce airway constriction andrestore normal airflow
Relief of bronchospasm, bronchialasthma, bronchitis, and other pulmonary
diseases Treat hypotension and shock
Produce uterine relaxation to prevent
premature labor
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Respiratory Drugs 45
Sympathomimetic Agents
Nonselective adrenergics
Stimulate alpha1, beta1 (cardiac), andbeta2 (respiratory) receptors
Example: epinephrine
(continues)
(continued)
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Respiratory Drugs 46
Sympathomimetic Agents
Nonselective beta-adrenergics
Stimulate both beta1 and beta2 receptors
Example: isoproterenol (Isuprel)
Selective beta2 drugs
Stimulate only beta2 receptors
Example: albuterol
(continues)
(continued)
(continued)
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Respiratory Drugs 47
Sympathomimetic Agents
Frequent use leads to beta1 receptorsbeing stimulated
Albuterol loses its action
General side effects
Nausea, increased anxiety, palpitations,tremors, and increased heart rate
(continued)
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Respiratory Drugs 48
Xanthines
Chemical class of agents
Contain caffeine
Oldest class of bronchodilators
Used in ancient times
X thi B h dil t
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Respiratory Drugs 49
Xanthine Bronchodilators:Mechanism of Action
Increase levels of energy-producingcAMP
Inhibit phosphodiesterase
Enzyme that breaks down cAMP Result
Smooth muscle relaxation Bronchodilation Increase airflow (oxygen/carbon dioxide)
in the lungs Cause cardiac life-threatening side effects
Xanthine Derivatives:
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Respiratory Drugs 50
Xanthine Derivatives:Side Effects
Nausea, vomiting, anorexia
Gastroesophageal reflux during sleep
Sinus tachycardia, extrasystole,palpitations, ventricular dysrhythmias
Transient increased urination
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Respiratory Drugs 51
Anticholinergics: Mechanism of Action
Acetylcholine (ACh) causesbronchial constriction.
Anticholinergics bind to the
ACh receptors, preventingACh from binding.
Result: bronchoconstriction is
prevented, airways dilate
Anticholinergic
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Respiratory Drugs 52
AnticholinergicBronchodilators
Ipratropium bromide (Atrovent)
Tiotropium bromide (Spiriva HandiHaler)
Actions
Local effects
Slow and prolonged action
Used to prevent bronchoconstriction
Not used for acute asthma exacerbations!
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Respiratory Drugs 53
Anticholinergics: Side Effects
Usually not absorbed systemically
If absorbed, have the potential toproduce:
Dry mouth or dry throat
Gastrointestinal distress
Headache
Coughing
Anxiety
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Respiratory Drugs 54
Leukotriene Receptor Antagonists
Directly prevent bronchoconstriction
Developed to treat asthma
Popular and effective Leukotrienes are inflammatory
molecules
Released by mast cells
Cause the bronchials to contract
Development of edema in the lungs
(continues)
(continued)
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Respiratory Drugs 55
Leukotriene Receptor Antagonists
By blocking leukotrienes:
Prevent smooth musclecontraction of the
bronchial airwaysDecrease mucus secretion
Prevent vascular permeability
Decrease neutrophil andleukocyte infiltration to thelungs
(continues)
( )
(continued)
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Respiratory Drugs 56
Leukotriene Receptor Antagonists
Currently available agents:
Montelukast (Singulair)
Zafirlukast (Accolate)
( )
Leukotriene Receptor Antagonists:
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Respiratory Drugs 57
Leukotriene Receptor Antagonists:Side Effects
Headache
Nausea
Diarrhea
Liver dysfunction
Leukotriene Receptor Antagonists:
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Respiratory Drugs 58
Leukotriene Receptor Antagonists:Client Education
Educate the client.
Use for chronic management ofasthma, not acute asthma
Improvement should be seen inabout1 week
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Respiratory Drugs 59
5-Lipoxygenase Inhibitors
New class of leukotriene receptorantagonists
Action
Inhibit the formation of leukotrienes
Used to inhibit some cancer growth
Outcome
Prevent lung inflammation
Example
One agent: Zileuton
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Respiratory Drugs 60
Mast Cell Stabilizers
Used prophylactically
No direct bronchodilator activity
Indirect-acting Stabilize the cell membranes of the
inflammatory cellsmast cells,monocytes, macrophages
Prevent release of harmful cellularcontents
(continues)
(continued)
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Respiratory Drugs 61
Mast Cell Stabilizers
Adjuncts to the overall managementof clients with lung disease
Prevent bronchospasm when exposedto:
Cold air
Exercise
Allergens
Dry air
Mast Cell Stabilizers:
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Respiratory Drugs 62
Mast Cell Stabilizers:Examples
Cromolyn (Nasalcrom, Intal)
Nedocromil (Tilade)
Mast Cell Stabilizers: Side
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Respiratory Drugs 63
Mast Cell Stabilizers: SideEffects
Coughing
Taste changes
Sore throat Dizziness
Rhinitis
Headache Bronchospasm
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Respiratory Drugs 64
Inhaled Corticosteroids
Anti-inflammatory Inhaled forms
Reduce systemic effects
Used for chronic asthma Does not relieve acute
asthma
(continues)
(continued)
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Respiratory Drugs 65
Inhaled Corticosteroids
Stabilize membranes of cellsthat release harmfulbronchoconstricting
substancesAlso increase responsiveness
of bronchial smooth muscle to
beta-adrenergic stimulation
Inhaled Corticosteroids:
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Respiratory Drugs 66
Inhaled Corticosteroids:Examples
Beclomethasone dipropionate(Beclovent, Vanceril)
Triamcinolone acetonide
(Azmacort)
Flunisolide (AeroBid)
Inhaled Corticosteroids:
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Respiratory Drugs 67
Inhaled Corticosteroids:Side Effects
Pharyngeal irritation
Coughing
Dry mouth
Oral fungal infections
Systemic effects are rare
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Respiratory Drugs 68
Respiratory Agents
Combination product
Fluticasone propionate and salmeterol(Advair): a dry powder in a circular
diskus Salmeterol: long-acting bronchodilator
Corticosteroid: anti-inflammatory agent
Used daily
Respiratory Agents:
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Respiratory Agents:Client Education
Instruct clients to:
Receive flu and pneumonia vaccination
Receive prompt treatment for any
illness
Check with health care provider beforetaking other medications