RESPIRATORY DRUGSRESPIRATORY DRUGS

Drugs used to treat Drugs used to treat Obstructive Pulmonary DisorderObstructive Pulmonary Disorder

Drugs used to treat Drugs used to treat Obstructive Pulmonary DisorderObstructive Pulmonary DisorderBronchodilatorsSympathomimeticsAnticholinergicsInhaled steroidsLeukotrine receptor antagonistsLung surfactantsMast cells stabilizers

BronchodilatorsBronchodilators / antiasthmatics / antiasthmatics

ACTIONdilate air passages in the lungs, specific

action dependent on type of drug. increase heart rate

USEbronchospasms asthma

BronchodilatorsBronchodilators / antiasthmatics / antiasthmatics

Xanthines– Action:

• Relax bronchial smooth muscles thereby producing bronchodilation

– Uses• symptomatic relief or prevention of bronchial

asthma, COPD

– Important Drugs• Caffeine (Caffedrine), theophylline (Theo-dur),

aminophylline (Phyllocontin)

BronchodilatorsBronchodilators

adverse effects GI upset nausea irritability tachycardia seizure headache dysrhythmias

contraindications hypersensitivity dysrhythmias severe cardiac

disease alcoholism

BronchodilatorsBronchodilatorsNURSING INTERVENTIONS monitor theophylline levels (normal 10 to 20

mcg/dl) monitor intake and output, and vital signs monitor EKG, vital signs during therapy teach clients

– take medication as prescribed only – report adverse effects – stop smoking & alcohol intake during therapy – take with meals – avoid OTC drugs

Sympathomimetics/ beta-adrenergics– Action:

• Dilates bronchi with increase rate & depth of respiration

- Imprtant Drugs:• Albuterol (Proventil)• Terbutaline (Brethine, Bricanyl)• Ephedrine• Epinephrine (EpiPen) – for acute bronchospasm• isoproterenol HCL (Isuprel)• Salmeterol (Serevent)

Anticholinergic Bronchodilators– Action:

• Blocks vagal nerve to relax bronchial smooth muscle leading to bronchodilation

– Uses:• COPD, bronchospasm, emphysema

– Important Drugs:• Ipratroprium (Atrovent), tiotropium (Spiriva)

Inhaled Steroids– Action:

• Steroids decrease swelling associated with inflammation thereby promote smooth muscle relaxation & inhibit bronchoconstriction

– Uses:• Prevention & treatment of chronic asthma

– Important Drugs:• Beclomethasone (Beclovent), budesonide (Pulmicort),

flunosolide (Aerobid)

Leukotrine Receptor Antagonists– Action:

• Block receptors for the production of leukotrines D4 & E4 components of SRSA

– Uses:• Prophylaxis & treatment of acute bronchial asthma

– Important Drugs:• Montelukast ( Singulair), zafirlukast ( Accolate)

Lung Surfactants– Action:

• Replace surfactant that is missing in the lungs of neonates with RDS

– Uses:• Respiratory Distress Syndrome (RDS)

– Important Drugs:• Beractant (Survanta), calfactant (infasurf)

Mast Cell Stabilizers– Action:

• Prevent the rlease of inflamatory & bronchoconstricting substances when mast cells are stimulated to release antigen

– Uses:• Mild to moderate bronchial asthma

– Important Drugs:• Cromolyn (Intal), nedocromil ( Tilade, Alocril)

Anti-inflammatoriesAnti-inflammatories

action:– stabilizes mast cells so chemical

mediators are not released as easily; decreases bronchial hyperreactivity; decreases airway inflammation

use:– to prevent asthma attacks, exercise-

induced bronchospasms

Anti-inflammatoriesAnti-inflammatories

example: – cromolyn sodium (Intal) – leukotriene receptor antagonists-

zafirlukast (Accolate), montelukast (Singulair)

– glucocorticoids- beclamethasone (Vanceril), triamcinolone (Azmacort)

Anti-inflammatoriesAnti-inflammatories

adverse effects – cough – CNS disturbances – burning, stinging eyes – throat irritation – headache

contraindications – status asthmaticus – hypersensitivity

Anti-inflammatoriesAnti-inflammatories

nursing interventions – monitor eosinophil count – monitor respiratory status – store in tightly closed light-resistant container;

keep cool – teach client

• how to use the inhaler • rinse mouth after using steroid inhaler • when to call health care provider if medications are

not effective

• that therapeutic effect may take up to four weeks

Drugs acting on theDrugs acting on the Upper Respiratory Tract Upper Respiratory Tract

Drugs acting on theDrugs acting on the Upper Repiratory Tract Upper Repiratory Tract Antitussives Decongestants Antihistamines Expectorants Mucolytics

Mucolytics/expectorantsMucolytics/expectorants ACTION

mucolytics: break down mucus to aid in coughing up thick, tenacius secretions

expectorants: liquefy respiratory tract secretions, reducing viscocity, to aid the clearing of the airways

USES asthma acute or chronic bronchopulmonary disease cystic fibrosis mucomyst: acetaminophen toxicity

Mucolytics/expectorantsMucolytics/expectorants

examples mucolytic: acetylcysteine

(Mucomyst), dornase alfa (Pulmozyme)

expectorant: guaifenesin (Robitussin)

Mucolytics/expectorantsMucolytics/expectorants

adverse side effects oropharyngeal irritation bronchospasm gastric effects

contraindications increased intracranial pressure status asthmaticus

Mucolytics/expectorantsMucolytics/expectorants

nursing interventions monitor respiratory status teach client take no fluids directly after oral

administration do take plenty of fluids encourage coughing and deep breathing,

especially before treatment Dilute the concentrate with sterile water

AntitussivesAntitussives

action: to supress coughs through medullary cough center or indirect action on sensory nerves

use:– colds, respiratory congestion,

pneumonia, bronchitis, TB, cystic fibrosis, emphysema

AntitussivesAntitussives

examples narcotic: codeine, hydrocodone

bitartrate (Hycoda) Non-narcotic - dextromethorphan

(Benylin)

AntitussivesAntitussives

adverse effects – drowsiness – nausea – dry mouth – dizziness

contraindications – hypothyroidism (codeine)– iodine sensitivity

AntitussivesAntitussives

nursing interventions – monitor blood counts with long

term therapy (1 week tx)– increase fluid intake – humidify client's room – teach client

• increase fluid intake if not contraindicated

• do not to take fluids immediately after medication

• avoid driving and other hazardous activity especially if taking narcotic type

• antitussives add to the effects of alcohol

DECONGESTANTSDECONGESTANTS

Action:– Causes local vasoconstriction

w/c leads to shrinking of swollen membranes & open clogged nasal passages

Uses:– Nasal congestion, colds,

sinusitis, allergic rhinitis

DECONGESTANTSDECONGESTANTS

Important Drugs:– Ephidrine (Condon’s nasal),

phenylephrine ( coricidin)

DECONGESTANTSDECONGESTANTS

Adverse Effects:– Stinging & burning sensation, rebound

decongestion after 3-5 days of use (rhinitis medicamentosa)

Contraindications:– Lesions or erosions in the mucous membranes

Cautions:– Glaucoma, hypertension, diabetes

DECONGESTANTSDECONGESTANTS

Nursing Implications:– Teach client of proper administration– Caution client not to use drug longer than 5

days– Stop the drug if stinging & burning

sensation occurs

AntihistaminesAntihistamines

Action:– Blocks histamine to decrease allergic

responseUses:

– Seasonal allergic rhinitis, allergic conjunctivitis, asthma, itchy eyes, swelling, congestion & drippy nose

AntihistaminesAntihistamines

Important Drugs:– 1st Generation

– Diphenhydramine (Benadryl), promethazine (Phenergan), hyrozine ( vistaril), buclizine (Bucladin-S)

– 2nd generation• Loratadine (claritin), desloratadine

(clarinex), fexofenadine ( Allergan), cetirizine (Zyrtec)

AntihistaminesAntihistamines

Adverse Effects:– Drowsiness, sedation, drying of respiratory

& GI mucous membranes, GI upsetContraindications

– Pregnancy & lactation

AntihistaminesAntihistamines

Nursing Considerations:– Administer on an empty stomach– Suggest sugar-free candies or lozenges for

dry mouth– Provide safety measures– Increase humidity– Avoid alcohol use during therapy