Lobert 1

PTP 546Module 7

Respiratory Pharmacology

Jayne Hansche Lobert, MS, RN, ACNS-BC, NP

Lobert 2

Respiratory Pharmacology

• Antitussives– Ex: Dextromethorphan (Robitussin DM)– Action: inhibits cough by direct effect on

brainstem; raises the cough threshold– Therapeutic Effect: reduces cough– Side Effect: retention of secretions related to

cough suppression• Should not be used very often, as the body needs to

cough.• Often used with codeine (opioide)

Lobert 3

Respiratory Pharmacology

• Decongestants– Ex: Pseudoephedrine (Sudafed)

• Can be used to make meth

– Ex: Oxymetazxoline (Afrin)– Action: binds with alpha receptors in blood vessels

of the nasal mucosa to stimulate vasoconstriction – Therapeutic Effect: reduces local congestion of nasal

pathways– Side Effects: nervousness, increased blood pressure

Lobert 4

Respiratory Pharmacology

• Antihistamines– Ex: Cetrizine (Zyrtec); Diphenhydramine

(Benadryl), Loratadine (Claritin)– Action: blocks the action of histamine on upper

respiratory tissues– Therapeutic Effect: treatment of allergic symptoms

of sneeze, runny nose & tearing; treatment of allergic response

– Side Effects: sedation, fatigue, dizziness, nausea,

Lobert 5

Respiratory Pharmacology

• Expectorants & Mucolytics– Ex: expectorant: Guaifenesin (Robitussin)

• Increases fluids in respiratory

– Ex: mucolytic: Acetylcysteine (Mucomyst)• Decreases the viscosity by breaking chemical structures

– Action: expectorants increases respiratory tract fluids facilitate the production and ejection of mucus; mucolytics directly decrease the viscosity of secretions by breaking the chemical structure of mucus ejection of secretions

– Therapeutic Effect: treatment of coughs associated with upper airway infections, etc.

– Side Effects: rarely noted, dizziness, nausea– Want pts to max out on fluid in-take: DRINK WATER!

Lobert 6

Respiratory Pharmacology

• Pharmacologic agents used to treat/prevent of diseases of airway obstruction (Asthma, Bronchitis, Emphysema)– Beta Adernergic Agonists– Xanthine Derivatives– Anticholinergics– Cromones Mast Cell Stabilizers– Glucocorticoids– Leukotriene Inhibitors

Lobert 7

Respiratory Pharmacology

• Beta Adrenergic Agonists– Similar to fight or flight response: we need air, open up.– Ex: Short Acting Beta Agonist (SABA) Albuterol

(Proventil)=inhaler – Ex: Long Acting Beta Agonist (LABA) Formoterol (Foradil);

Salmeterol (Serevent)– Action: short or long acting stimulation of beta receptors

relaxation of bronchiole smooth muscles– Therapeutic Effect: prevents or inhibits airway obstruction in

bronchospastic disease– Side Effects: nervousness, shaking, tremors, restlessness,

tachycardia, palpitations, paradoxical bronchospasms

Lobert 8

Respiratory Pharmacology

• Xanthine Derivatives– Ex: Theophylline (Theo-Dur); Aminophylline

• Has a therapeutic window

– Action: possible blocking of adensosine smooth muscle relaxation; possible blocking of phosphodiesterase (PDE) inhibition of inflammatory response

– Therapeutic Effect: prevent bronchoconstriction in obstructive airway disease

– Side Effects: toxicity that presents as nausea, irritability, restlessness

Lobert 9

Respiratory Pharmacology

• Anticholinergics• Can’t spit, see, shit, pee

– Ex: Ipratropium (Atrovent)= faster acting– Ex: Tiotropium (Spiriva) – Action: short or long acting muscarinic receptor blockers reduction of acetylcholine induced bronchoconstriction

– Therapeutic Effect: improves airway flow in bronchospastic diseases

– Side Effects: constipation, dry mouth, blurred vision, urinary retention

Lobert 10

Respiratory Pharmacology

• Cromones (Mast Cell Stabilizers)– Used for asthma prevention, not acute attack– Ex: Cromolyn Sodium (Intal) – Ex: Nedocromil Sodium (Tilade)– Action: inhibits the release of inflammatory mediators

reduction of histamine and leukotrienes– Therapeutic Effect: prophylaxis; prevention of asthma

attacks prior to activities that are known to precipitate an asthma attack (exercise, exposure to animal hair)

– Side Effects: nasal and upper respiratory tract irritation following inhalation

Lobert 11

Respiratory Pharmacology

• Leukotriene Inhibitors– Ex: Montelukast (Singular); Zafirlukast (Accolate)– Action: reduces the synthesis of leukotrienes or

blocks the receptors for leukotrienes– Therapeutic Effect: management of the

inflammatory component of bronchoconstrictive diseases

– Side Effects: liver dysfunction noted rarely

Lobert 12

Respiratory Pharmacology

• Glucocorticoids– Ex: Hydrocortisone (Cortef); Methylprednisolone (Medrol)

(IV/Orally); Triamcinolone (Azamacort); Fluticasone (Flovent-inhaler)

– Action: inhibit proinflammatory products (cytokines, prostaglandins, leukotrienes) while increasing antiinflammatory proteins

– Therapeutic Effect: treatment of inflammation associated with hyperresponsive airways

– Side Effects: gi bleed, dyspepsia, hyperglycemia, delayed wound healing, osteoporosis, fluid retention, hypertension, “moon face”, truncal obesity, back acne, buffalo hump, mood swings.

Lobert 13

Respiratory Pharmacology

• Treatment of Cystic Fibrosis– Goal: Maintain airway patency

• Pharmacologics– Bronchodilators– Mucolytics and Expectorants: break it up/cut the

mucus – Glucocorticoids: decrease inflammation – Anti Infectives: proflective, prevents infection.

– Others: