RESPIRATORY SYSTEM DRUGS.pptx

8/14/2019 RESPIRATORY SYSTEM DRUGS.pptx

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Arlyn C. Mendenilla

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Respiratory drugsThe respiratory system, extending

from the nose to the pulmonary

capillaries, performs the essentialfunction of gas exchange betweenthe body and its environment. In

other words, it takes in oxygen andexpels carbon dioxide.

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Antiasthmatic Drugs In 2002, the National Asthma Education and

Prevention Program updated guidelines for diagnosingand managing asthma.

Drugs are classified as long-term and quick reliefmedication with a stepwise approach to treatment.

Anticholinergic bronchodilators , antileukotrieneagonists, synthetic glucocorticoids, and mast cell

stabilizers are used for long term control of asthma.

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Antiasthmatic DrugsPrototype Related drugs Classification

Ipatropium (atrovent) Iotropium bromide(spiriva)

Anticholinergicbronchodilators andbeta2 antagonist

Ipatropium/albuterol

(combivent)

Combination

Anticholinergicbronchodilator

Zafirlukast (accolate) Zileuton (zyflo)Montelukast (sigulair)

Antileukotriene Antagonists

budesonide (pulmicort)

Beclomethasone(beclovent,

vanceril)Flunisolide (aerobid),fluticasone propionate(flovent, flonase)Mometasone furoate (elocon,nasonex)

Triamcinolone acetoride(azmacort, nasacort)

Synthetic

glucocorticoids



Antiasthmatic DrugsPrototype Related drugs Classification

Salmeterol fluticasone(advair diskus)

Combinationgluciocorticoid and beta2antagonist

Cromolyn (Intal,nasalcrom)

Nedocromil (tilade) Mast cell stabilizers

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Mechanism of Action

Anticholinergic Bronchodilators

Antagonizes acetylcholine, which causes

bronchodilation; action is slow and prolonged.

Antileukotriene Antagonist

Block leukotriene-mediated bronchoconstrictionthat decreases bronchial edema and

inflammation seen in asthma.

Synthetic Glucocorticoids

Decrease inflammation and enhance beta-agonist activity.

Mast cells stabilizers

May inhibit release of histamine and othermediators of mast cells

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Therapeutic use


Prevention of spasm in COPD.

Intranasal – allergic and non-allergic perennialrhinitis.

Antileukotriene antagonists

Indicated to decrease the severity and frequency of

asthma attacks, with improvement seen in about 1 week.


Treatment of chronic asthma

Used intranasally for treatment of seasonal allergies.Rhinitis not responsible to other decongestants.

Mast Cell Stabilizer

Prophylaxis of asthma. These are not used to treatacute asthma attacks.

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Adverse effects ansd side effects


Pregnancy category B, except for Tiotropium

bromide (spiriva), which is category C. CNS: headache, nervousness, blurred vision

EENT: Sore throat, cough, dry mouth.

GI: GI irritation, nausea

Antileukotriene Antagonists

Pregnancy category B, although Zileuton (Zyflo)is a category.

CNS: Headaches, dizziness GI: Nausea, vomiting and diarrhea

Increased incidence of infection over age 55

Liver dysfunction

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Pregnancy category C

CNS: Dizziness, headache

EENT: Unpleasant taste, oral fungal infection,cough

GI: GI distress

Mast Cell Stabilizers Pregnancy category B

CNS: dizziness, headache

GI: unpleasant taste

resp: cough, bronchospasm, and throatirritation

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Drug interactions Anticholinergic bronchodilators

Additive Anticholinergic effects with concurrentuse of other anticholinergics .

Antileukotriene Antagonists Zileuton (Zylo)

Concurrent use with warfarin increases risk of bleeding Concurrent use with theophylline decrease zafirlukast

and Zileuton levels.

Zafirlukast (Accolate) Concurrent use with aspirin increases zafirlukast levels.

Concurrent use with erythromycin decreases zafirlukastlevels.

Zileuton (Zyflo) Concurrent use with Propanolol increases propranolol

levels.

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Contraindication

Anticholinergic bronchodilators

Hypersensitivity to ipratropium, atropine andderivatives.

Propellant use to make inhaled ipratropium iscontraindicated in clients with peanut allergies

Antileukotriene Antacids

Hypersensitivity, breast feeding


Hypersensitivity Mast Cell Stabilizers

Hypersensitivity,

Status asthmaticus

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Nursing Implications All antihistamine

Monitor vital signs throughout

treatment Assess lung sounds and respiratory

function throughout treatment.

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Nursing Implications Anticholinergic bronchodilators

Administered by inhalation or intranasally Contact health care provider if severe

bronchospasm present so that an alternativemedication may be ordered.

If administered with other inhalationmedications, administer adrenergicbronchodilator first, followed by ipratropium,then corticosteroid, and wait 5 minutes betweenmedications.

Antileukotriene Antacids Available orally

Periodically monitor liver function studies

Monitor and report symptom

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monitor for adverse effects and report tohealth care provider.

Mast Cell Stabilizers

Available by inhalation or intranasally,ophthalmic use for allergy.

Do not administer during an acute asthma orstatus asthmaticus.

If taking before exercise or exposure to allergy,take at least 10 to 15 minutes before exposure.

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Patient Teaching

All antihistamine

Follow directions and use medications asordered.

Consult with health care provider before takingOTC medications or herbal remedies.

Do not discontinue without consulting withhealth care provider

do not double dose if a dose is missed.

For inhaled agents, use a spacer if recommendedby health care provider.

Teach client how to use meter dose inhalers.

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Patient teaching

Anticholinergic bronchodilators

Good mouth care, water, or hard candy helps to

decrease dryness. If symptoms do not improve within 30 minutes

after taking, contact health care provider ,.

Keep a record of number of inhalation instead of

floating canister in water to estimate how muchdrug is left in the canister.

Avoid getting drugs into the eyes.

Antileukotriene Antacids

Encourage follow-up with HCP for periodic liverfunction enzyme testing.

These drugs are used for prophylaxis and chronicasthma, but not acute asthma attacks.

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Patient teaching Report symptoms of Churg- Strauss syndrome to HCP.

Churg Strauss syndrome is more apt to occur when weaning from systemic steroids. Occurs rarely, but can belife threatening.

Take on an empty stomach.

Inhaled synthetic Glucocorticoids To prevent fungal infection, rinse mouth after taking

medication.

Rinse mouthpiece in warm water after each use.

If using inhaled synthetic glucocorticoids andbronchodilator, use the bronchodilator first, and wait 5minutes.

Inhaled synthetic glucocorticoids are not used to treatacute asthma attacks but should be continued if other

agents are used. A systemic glucocorticoids may be orderedduring an acute asthma attacks.

Contact health care provider if sore mouth or throat occurs

Allow 1 to 2 minutes between inhalations if a secondinhalation is ordered.

Use a spacer if recommended by health care provided.

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Bronchodilators DrugsBronchodilators dilate the bronchi and

bronchioles and include two classes ofdrugs:

Beta – agonists

Xanthine derivatives

The beta-agonist are also calledsympathomimetic bronchodilators.

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Bronchodilators DrugsPrototype drug Related drugs Drug classification

Epinephrine (adrenalin,

primatene, bronkaid)

Isoproterenol solution

(isuprel)Isoetharine HCL(bronkosol)Metraprorenol (alupent)

Beta-agonist

(sympathomimetics) Alpha-beta-agonist(epinephrine)beta-1-beta2-agonist(isoproterenol,isoetharine HCL &

metraproterenol)(non selective beta-agonist)

Albuterol (proventil, ventolin, volmax))

Bitolterol (tornalate)Formoterol (Foradil)

Levalbuterol (Xopenex)Pirbuterol (maxair)Salmeterol (serevent)Terbutaline (brethaire,bricanyl)

Beta 2 agonist

Theophylline (Theo-Dur,

Slo-bid)

Aminophylline (truphylline)

Dyphylline (dilor, lufyllin)




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Mechanism of Action Non selective Beta1 –Beta2-Agonist

Stimulate beta1 receptors in the heart and beta2receptors in the heart and lungs; relax bronchial

smooth muscle and dilates trachea and bronchi byincrease levels of cyclic adenosine monophosphate(cAMP)

Selective Beta2-Agonists Predominately stimulate the beta2 receptors in the

lungs and increase levels of cAMP, causingbronchodilators.

Xanthine derivatives Increase cAMP causing brochodilation

Also have diuretic and positive inotropic andchronotropic effects and cause gastric acid secretionand CNS stimulation.

Xanthine contains caffeine, so caffeine intake shouldbe minimized.



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Therapeutic Use Beta-Agonists

Bronchial asthma, bronchitis, bronchospasm, andother pulmonary disease.

Alpha-Beta-Agonist Also used to treat hypotension and shock

Selective Beta2-Agonist Also used to treat hyperkalemia

Bitolterol (Tornalate) Has a long onset of action and use for prophylaxis of

bronchospasm in clients over age 12.

Formoterol (Foradil) Used for maintenance treatment of asthma and prophylaxis

of bronchospasm in clients over age 5 with reversibleobstructive airway disease.

Also used to prevent exercise-induced bronchpspasm inclients over age 12.



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Selective Beta2-Agonist

Isoproterenol (Isuprel)

Also indicated for heart block, shock, and ventriculardysrhythmias.

Salmeterol (Serevent) Has a long-onset of action and indicated for

maintenance therapy of asthma, prevention ofbronchospasm in selected clients over age 4 withreversible airway disease, and prevention of exercise-induced asthma.

Xanthine Derivatives

Prevention and treatment of bronchial asthma,bronchitis, and COPD

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Adverse effects and side effects Non selective beta1-beta2-agonist


CV: palpitation, tachycardia, hypertension, andcardiac arrest

CNS: anxiety, tremors, insomia, dizziness, andheadache.

Endocrine: hyperglycemia

GI: nausea and vomiting Selective beta2-agonists

Pregnancy category c except terbutaline (brethare,bricanyl), which is category B.

CV: palpitation, hypertension

CNS: tremors, nervousness, restlessness, headacheand insomia

Endocrine: hyperglycemia

GI: nausea and vomiting



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Adverse effects and side effects



CV: tachycardia, dysrhythmias, and palpitations

CNS: anxiety, headache, insomnia, seizures, andtremors.

GI: anorexia, nausea, vomiting and cramps



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Drug interactions

All bronchodilators

Concurrent use with sympathomimetic canincrease cardiac and CNS stimulation.

Beta-agonists

Concurrent use with monoamino oxidaseinhibitors (MAOIs) may cause hypertensivecrisis.

Concurrent use of beta-blockers may antagonizetherapeutic effects.

Increased risk of hypokalemia if taken withpotassium-sparing diuretics.

Concurrent use with caffeine may causestimulation effects.



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Drug interactions Xanthine derivatives

Increase theophylline levels with concurrent useof allopurinol, benzodiazepines cimetidine,erythromycin, oral contraceptives, influenza

vaccine, interferon, beta-blockers, andcorticosteroids.

Nicotine may increase metabolism and decreaseeffectiveness of xanthines.

Contraindications All brochodilators

Hypersensitivity

Beta-agonist and xanthine derivatives tachydyrhythmias



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Nursing Implications

All Bronchodilators

Monitor vital signs

Assess lung sounds

Encourage fluids unless contraindicated.

Careful monitoring of the elderly as they aremore susceptible to adverse reactions.

Beta-agonist

Available by inhalation

Albuterol, metaproterenol, and also availableorally.

Isoproterenol (Isupril) is also available IV and SL.

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Nursing Implications (cont ) Terbutaline is also available SC. Oral medication can be given with food to decrease GI

effects. Monitor cardiac status and report changes to health care

provider. xanthine derivatives

Available PO, parenterally, or rectally Give over 24 hours to maintain therapeutic levels. Monitor theophyline levels: therapeutic range 10.0 to 20.0

mcg/ml Use an infusion pump and give slowly when administered

IV. IV rate should not exceed 20 to 25 mg/min. Wait 4 to 6 hours after IV therapy is discontinued before

giving first dose orally. Monitor I & O Monitor for drug toxicity and notify health care provider if

toxicity occurs. Oral drug can be given with food if GI effects occur. Clients with cardiac history should be monitored for EKG

changes or chest pain.

Patient teaching



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Patient teaching All bronchodilators

Check with health care provider taking OTC medicationsand herbal remedies.

Take exactly as prescribed and do not double up on misseddoses.

Beta-agonists Report adverse effects such as feeling jittery, palpitations,

chest pain, restlessness, insomnia, or other symptoms tohealth care provider.

Take oral medication with meals to decrease GI upset. Xanthines

Avoid caffeine, as caffeine acts as xanthine during therapy. Take with food if GI upset occurs. Do not chew or crush enteric coated or sustained release

products. Report adverse effects such as palpitations, chest pain,

nausea, vomiting, weakness, dizziness, or other sx tohealth care provider.

Avoid tobacco use as nicotine increases the metabolism ofxanthines.

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Meter-dose inhalaler

Instruct client on proper use of MDI. If taking abronchodilator and steroid, take the

bronchodilator first to open up the airways,followed by the steroid.

Fast-acting bronchodilators, such as albuterol,should be taken before slower or longer acting

brochodilators, such as salmetrol. If taking a beta-agonist with an anticholinergic

take the beta-agonist before taking the Anticholinergic, ipratropium.

Canister contains measured doses ofmedication.



Antihistamines

Also known as H1 antagonist and directly compete with histamine for specific receptor sites. Antihistamine are categorized as

1. 1st

generation which include the chemical classes ofalkylamines, ethanolamines, ethylenedilamines,phenothiazines, piperidines.

2. 2nd generation or non sedating agents. Sedation is aproblem seen with first generation antihistamines.



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Prototype drug Related drug Classificaton

Diphenhydramnie(benadryl)

Clemastine (Tavist)Dimenhydrinate(Dramamine)

TrimethobenzamideHCL (arrestin,benzacot, tigan, )

First generationsantihistamineTraditional

antihistamines(ethanolamines)

There is no prototype Bronphineramine(Dimetane)

Chlorpeniramine(chlor-trimeton)Dexchlorpheniramine(polaramine)

Alkylamines

Tripelennamine(Pyribenzamine)

Ethylenediamines

Buclizine (Bucladin-S)Meclizine (Antivert)Cyclizine (marezine)Promethazine(phenergan)

Trimeprazine (Temaril)

Phenothiazines



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Prototype Related drugs c;lassification Azatadine(optimine)Cyproheptadine(PERIACTIN)Hydroxyzine

(Atarax), vistaril,others

Piperidines

Loratidine(claritine)

Azelastine(Astelin)Cetirizine (Zyrtec)

Fexofenadine(allegra)

2nd generationantihistaminesNonsedating

histamines



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Mechanism of action H1 blockers block the effects of histamine by

competing for H1 receptor site. 2nd generation, non sedating antihistamines do

not cross the blood brain barrier,which reducesor prevents sedation.

2nd

generation antihistamines have a longerduration of action and fewer anticholinergiceffects than 1st generation antihistamines

Therapeutic use

Rhinitis, allergic, colds, nausea, adjunctivetherapy of anaphylaxis, motion sickness, vertigo, Parkinsons disease and a sleep aid (firstgeneration)

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Adverse effects

All antihistamines

Anticholinergic effects: first generation

antihistamines; dry mouth dilated pupils urinaryretention, tachycardia, and constipation: 2nd generation have minimal effects.

CNS: sedation in 1st generation

Derm : photosensitivity Blurred vision

GI: dry mouth, GI upset, diarrhea, orconstipation

GU: urinary retention

First generation Antihistamines and second



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First generation Antihistamines and secondgeneration antihistamines. Pregnancy category B, although azelastine,

brompheniramine, cyclizine, promethazine,and hydroxyzine, triamethobenzamide HCL, vistaril and others are category C.

Unclassified pregnancy category aretriplennamine and trimeprazine.

Contraindication Hypersensitivity

Lactation

Clients with lower respiratory tract disease Acute asthma attacks

Cautious use with bladder neck obstruction,narrow angle glaucoma and stenosing peptic

ulcer.

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Drug interactions

Concurrent use with alcohol or other CNSdepressants, antidepressants, kava-kava,

valeria, and chamomile may cause additiveCNS depression.

Concurrent use with MAOIs can intensifyantihistamine effects

Concurrent use of erythromycin orketoconazole with loratidine and fexofenadineincreases concentrations of loratidine andfoxefenadine.



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Nursing implications Give PO; some antihistamines may also be given

SC, IM, IV, PR, or topically. Azelastine Asteline is available as nasal and

opthalmic agent. Monitor VS Assess lung sounds, secretions, and allergy

symptoms Unless contraindicated, encourage fluid intake If client is undergoing allergy testing, discontinue

antihistamine use for atleast 4 days before testing,as antihistamine may decrease skin response toallergy test.

When anti histamine are used as sleep aid, theyshould be given at least 2o minutes before bedtime.

Antihistamine used for motion sickness should begiven at least 30minutes before exposure tosituations that may cause motion sickness.

Patient teaching



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Patient teaching Avoid driving or operating heavy machinery.

Avoid alcohol and taking other CNS

depressants. If possible take at bedtime to avoid daytime

sedation.

Inform health care provider and dentist if

taking antihistamines. Take with food to decrease GI upset

Encourage fluids and hard candy to minimizeanticholinergic effects of dry mouth.

Wear sunscreen and protective gear to preventphotosensitivity

As many of these drugs are available OTC, takeas directed.



Decongestant Drugs Decongestant are used to decrease nasal congestion

caused by stimulation of the alpha1-adrenergicreceptors on the nasal blood vessels, which causes vasoconstriction, in turn shrinking mucous membrane

and relieving congestion. Decongestant are available orally and topically. Oral

decongestants have a delayed onset with prolongedand less potent effects while topical decongestants

produce rapid and potent effects.



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Prototype drug Related drugs Drug classificationEphedrine (Pretz-D) Naphazoline (privine)

Oxymetazoline (afrin)Phenylephrine(neoSynephrine,Coricidin, others)

Pseudo-ephedrine hcl(sudafed, dorcol,decofed)Tetrahydrozoline(Tyzine) Xylometazoline

(otrivin)

Decogestants(sympathomimetics)

Mechanism of Action



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Mechanism of Action Causes vasoconstriction through the stimulation of

the alpha1 adrenergic receptors on the nasal blood vessel causing shrinkage of the nasal membranes.

Therapeutic use Congestion seen with acute or chronic rhinitis,

sinusitis and colds.

Adverse effects and side effects. Pregnancy category C CV: hypertension, palpitations, and tachycardia,

dyspnea seen more frequently with oral agents

CNS: stimulation, headache, nervousness,

restlessness, seen more frequently with oral agents GI: N&V

Other: rebound congestion with topical agents,fever

Drug Interaction



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Drug Interaction Concurrent use with other sympathomimetic can

increase toxicity.

Concurrent use with MAOIs can causehypertensive crisis.

Contraindications Hypersensitivity

Hypertension (oral use)

CAD (oral use)

Nursing implications Many decongestants are OTC agents

Monitor vital signs and assess lung sounds andcongestion periodically throughout the therapy.

Monitor for hypertension, palpitations, ortachycardia and report symptoms to health careprovider.

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Patient Teaching

Avoid concurrent use of OTCs and herbal remedies without consulting health care provider.

Avoid caffeine while taking decongestants. May cause cardiac or CNS stimulation, such as

palpitations, restlessness, or insomnia. Report sx toHCP.

Take exactly as directed Topical decongestants should not be taken for more

than 3 to 5 days to avoid rebound decongestion

Contact HCP if sx persist for more than a week or if

rash occurs. Encourage fluids unless contraindicated.

Avoid taking near bedtime to prevent insomni.



Antitussive Drugs Antitussive drugs suppress or inhibit coughing. They

are typically used to treat dry, non-productive coughs.

There are two categories of Antitussive; they areopiods and non-opioids.

Prescriptions antitussives are usually indicated whenOTC preparations have not been effective.



Antitussive Drugs

Prototype Related drugs Drug classification

Dextromethorphan(Vicks formula 44,Robitussin DM) Benzonanate (tessalon)

Non-opioid antitussives

Non-opioid antitussives

Locally actingDiphenhydramine(benylin, benadryl)

There is no related drugsat this time

Antitussive antihistamine

Codeine (Dimetane-DC,Tussar SF)

Hydrocodone (hycodan) Opioid antitussive



Antitussive Drugs

Mechanism of Actions Nonopioid Antitussives

Suppress the cough reflex through direct action to the cough center.They do not cause addiction nor CNS depression like the opiodsantitussives . They are available OTC.

Non-opioid antitussives (locally acting) Anesthetize or numb the stretch receptors and keep the cough reflex

being stimulated in the medulla. Available only by prescription.

Antitussive antihistamines Antagonize histamine effects at H receptor sites, CNS depressant

and anticholinergic effects, and suppress cough.

Opioid antitussives Narcotic analgesics available by prescription only. Suppress the

cough reflex through direct action to the medullary cough center, with analgesic effect.



Antitussive Drugs Therapeutic use

Symptomatic relief for non-productive coughs or insituations when coughing may be harmful.

Adverse effects and sideeffects Non-opioid antitussives

Pregnancy category unknown CNS: dizziness, drowsiness

GI: Nausea

Non-opioid antitussives (Locally acting) Pregnancy category C

CNS: dizziness, headache, and sedation Derm: pruritus

EENT: Nasal Congestion

GI: constipation, Nausea



Antitussive Drugs Antitussive antihistamines

Pregnancy category B CNS: drowsiness, anticholinergic effects, headache and

dizziness GI: dry mouth, anorexia, constipation, and diarrhea Derm: Photosensitivity

Opioid antitussives Pregnancy category C CV: Hypertension CNS: confusion, sedation, and headache GI: constipation, nausea and vomiting GU: urinary retention Resp: respiratory depression



Antitussive Drugs Interactions

Non-opioid antitussives Concurrent use with MAOIs may cause serotonin syndrome Additive CNS depression with alcohol, antihistamines and antidepressants,

sedative/hypnotics and opiods.

Non-opioid antitussives (locally acting) Additive CNS depression with alcohol, antihistamines and sedative/hypnotics and

opiods.

Antitussive antihistamine Additive CNS depression with alcohol, antihistamines and antidepressants,

sedative/hypnotics and opiods. Additive anticholinergic effects with TCA, disopyramide, or quinidine. MAOIs intensify and prolong anticholinergic effects of antihistamine.

opioid antitussives Pregnancy category C

CV: hypertension CNS: confusion, sedation, and headache GI: constipation, nausea and vomiting GU: urinary retention Resp: respiratory depression



Antitussive Drugs Contradictions

All antitussives Hypersensitivity Should not be used for chronic productive cough

Non-opioid antitussives Clients taking MAOIs May contain alcohol and should be avoided by recovering alcoholics

Non-opioid antitussives (locally acting) Cross sensitivity to benzonatate or related compounds.

Antitussive – antihistamines Acute asthma attacks Lactation Liquid products may contain alcohol and should be avoided by

recovering alcoholics.

Opioid antritussives Clients with severe respiratory disorders or respiratory depression Seizure disorders Increased intracranial pressure



Antitussive Drugs Nursing Implications

All antitussives Administered orally

Assess lung sounds, cough and type and amount of sputum

Non-opioid antitussives Do not gives immediately after administering to prevent dilution of

drug. Shake oral suspensions before giving.

Non-opioid antitussives (locally acting) Instruct client to chew capsule, as a benzonate from capsules may

cause a local anaesthetic effect and choking

Opioid antitussives Assess for constipation

Antidote: nalaxone (narcan)

Prolonged use can lead to physical or psychological dependence.



Antitussive Drugs Patient Teaching

Avoid concurrent use of OTCs and herbal remedies withoutconsulting with physician.

Use an antitussive for a dry, nonproductive cough.

Avoid driving or operating heavy machinery while takingantitussives as they may cause drowsiness.

Encourage fluid intake unless contraindicated

Avoid drinking fluids for at least 30 minutes after taking an

antitussive Contact health care provider if cough persists for more than a

week, or if a rash, fever, or persistent headache occurs.



Expectorant Drugs

Expectorants stimulate the flow of the respiratory tractsecretions, which makes the cough more effective.Mucolytics work directly on mucus to make it more watery, which makes more productive.

Guafenesin (Robitussin) is a widely used and popularexpectorant.

Expectorant can be given as a single agent or incombination with other drugs.



ExpectoraantsPrototype Related Drugs Drug classification

Guaifenesin(robitussin,others)

There are no relateddrugs

Expectorants

Acetylcysteine(Mucomyst)

Dornase alfa(pulmozyme)

Mucolytics(antidote: acetaminophenTylenol)

Cystic fibrosis drug



Expectorants

Mechanism of action Expectorants

Reduces viscosity of secretions by increasing respiratory tractfluid, which mobilizes and allows for expectoration of mucus.

Also indirectly irritates the GIT, which can cause N&V

Mucolytics

Decreases viscosity of pulmonary secretions. Split links in therespiratory mucoprotein molecules into smaller, more soluble,and less viscous strands.

In acetaminophen (tylenol) overdose, it alters hepaticmetabolism to decrease liver injury.



Expectorants

Therapeutic use Expectorants

Relief of coughs associated with viral upper respiratory tractinfactions

Mucolytics Adjunct treatment of thick tenacious mucus in cystic fibrosis

and bronchopulmonary disease

Antidote for acetaminophen toxicity

Dornase alfa used for management of cystic fibrosis

Expectorants



Expectorants Adverse effects and sideeffects

Expectorants Pregnancy category C

GI: GI upset, N&V

Mucolytics

Pregnancy category B CNS: dizziness, drowsiness

GI: Nausea, stomatitis, hepatotoxicity, unpleasant odor (sulfurin drug may smell like rotten eggs)

Resp: bronchospasm, hemoptysis, rhinorrhea

Dornase alfa

Resp: cough pharyngitis, wheezes

Other: conjunctivitis, chest pain



Expectorants

Interactions

Expectorants

Non significantMucolytics

Acetylcysteine contains hydrogen sulfide

and will discolor iron, copper andharden rubber.



Expectorants

Contraindications All expectorants and Mucolytics

Hypersensitivity

Expectorants

Some – guaifenesin-containing products contain alcohol andshould be avoided by recovering alcoholics

Mucolytics

Status asthmaticus and increased ICP

Dornase alfa hypersensitivity

E t t



Expectorants Nursing implications

All expectorants and mucolytics Assess lung sounds and cough including: type, frequency, and

characterestics.

Expectorants Hypersensitivity

Acetylcysteine (mucomyst)

Available by inhalation via nebulizer, instillation via endotrachealtube or orally Monitor vital signs Encourgae coughing after administration Suction if indicated after treatment Maintain good oral hygiene

Percussion and good postural drainage may assist client ineliminating secretions Administer treatment at least 30 minutes to 1 hour before meals to

prevent nausea Use within 48 hours after opening and store in refrigerator



Expectorants Nursing implications (cont)

Dornase alfa

Store in refrigerator and protect from light

Review use of nebulizer Antidote use of mucomyst

Give immediately, if 24 hours or less.

Monitor liver function test, electrolytes, BUN, acetamenophenlevels, and cardiac function

Oral use: can be given with water and use within an hour.



Patient teaching Avoid concurrent use of OTCs and herbal medicines without

consulting with physicians. Dispose of tissues and secretions properly. Cough effectively by splitting up, taking several slow deep breaths

before coughing. Encourage fluid intake to help liquefy secretions, unless

contraindicated. Report fever, cough, headache, or other symptoms lasting longer than 1

week to health care provider. Guaifenesin

Liquid product may contain alcohol and sugar and recoveringalcoholics and diabetic clients should avoid use.

Acetylcyteine Has a charecteristic rotten egg odor due to release of hydrogen sulfide Use good oral hygiene during therapy

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RESPIRATORY SYSTEM DRUGS.pptx