RESPIRATORY DRUGS

Drugs used to treat

Obstructive Pulmonary Disorder
Drugs used to treat
Obstructive Pulmonary Disorder
 Bronchodilators
 Sympathomimetics
 Anticholinergics
 Inhaled steroids
 Leukotrine receptor antagonists
 Lung surfactants
 Mast cells stabilizers
Bronchodilators / antiasthmatics
ACTION
 dilate air passages in the lungs, specific
action dependent on type of drug.
 increase heart rate

USE
 bronchospasms
 asthma
Bronchodilators / 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)
Bronchodilators
adverse effects contraindications
 GI upset  hypersensitivity
 nausea  dysrhythmias
 irritability
 severe cardiac
 tachycardia
disease
 seizure
 alcoholism
 headache
 dysrhythmias
 Bronchodilators
NURSING 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-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-inflammatories
 example:
– cromolyn sodium (Intal)
– leukotriene receptor antagonists-
zafirlukast (Accolate), montelukast
(Singulair)
– glucocorticoids- beclamethasone
(Vanceril), triamcinolone (Azmacort)
Anti-inflammatories
 adverse effects
– cough
– CNS disturbances
– burning, stinging eyes
– throat irritation
– headache
 contraindications
– status asthmaticus
– hypersensitivity
Anti-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 the
Upper Respiratory Tract
Drugs acting on the
Upper Repiratory Tract
 Antitussives
 Decongestants
 Antihistamines
 Expectorants
 Mucolytics
 Mucolytics/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/expectorants
examples
 mucolytic: acetylcysteine
(Mucomyst), dornase alfa
(Pulmozyme)
 expectorant: guaifenesin
(Robitussin)
 Mucolytics/expectorants
adverse side effects
 oropharyngeal irritation
 bronchospasm
 gastric effects

contraindications
 increased intracranial pressure
 status asthmaticus
Mucolytics/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
Antitussives
 action: to supress coughs
through medullary cough center
or indirect action on sensory
nerves

 use:
– colds, respiratory congestion,
pneumonia, bronchitis, TB, cystic
fibrosis, emphysema
Antitussives
examples
 narcotic: codeine, hydrocodone
bitartrate (Hycoda)
 Non-narcotic - dextromethorphan
(Benylin)
Antitussives

 adverse effects
– drowsiness
– nausea
– dry mouth
– dizziness
 contraindications
– hypothyroidism (codeine)
– iodine sensitivity
Antitussives
 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
DECONGESTANTS
 Action:
– Causes local vasoconstriction
w/c leads to shrinking of
swollen membranes & open
clogged nasal passages
 Uses:
– Nasal congestion, colds,
sinusitis, allergic rhinitis
DECONGESTANTS
 Important Drugs:
– Ephidrine (Condon’s nasal),
phenylephrine ( coricidin)
DECONGESTANTS
 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
DECONGESTANTS
 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
Antihistamines
 Action:
– Blocks histamine to decrease allergic
response
 Uses:
– Seasonal allergic rhinitis, allergic
conjunctivitis, asthma, itchy eyes,
swelling, congestion & drippy nose
Antihistamines
 Important Drugs:
– 1st Generation
– Diphenhydramine (Benadryl), promethazine
(Phenergan), hyrozine ( vistaril), buclizine
(Bucladin-S)
– 2nd generation
• Loratadine (claritin), desloratadine
(clarinex), fexofenadine ( Allergan),
cetirizine (Zyrtec)
Antihistamines
 Adverse Effects:
– Drowsiness, sedation, drying of respiratory
& GI mucous membranes, GI upset
 Contraindications
– Pregnancy & lactation
Antihistamines
 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