Lesson 5 - Respiratory Drugs

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

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Respiratory Drugs 3

Common Cold

Cough reflex

Irritant stimulates sensory receptors

Removes

Respiratory secretions

Foreign object

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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

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Respiratory Drugs 10

Skin

Prevent itching

Wheal and flare

Anticholinergic

Drying effect

SedativeDrowsiness

Antihistamines

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Antihistamines

Management of:

Nasal allergies

Seasonal or perennial allergic rhinitis

Allergic reactions

Motion sickness

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Antihistamines

More effective in prevention

Give early

Prevent binding of histaminereceptors

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Classes of Antihistamines

Two types

Traditional: sedating

Nonsedating


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Traditional Antihistamines

Older Work both peripherally and

centrally

Anticholinergic properties Examples: diphenhydramine

(Benadryl)

and chlorpheniramine (Chlor-Trimeton)


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Nonsedating/Peripherally ActingAntihistamines

Work peripherally Eliminate sedation

Longer duration of action

Increases compliance

Examples: fexofenadine(Allegra) and loratadine

(Claritin)


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Antihistamines: NursingImplications

Assess allergy history

Contraindicated

Asthma attacks Chronic obstructive pulmonary disease

Cardiovascular disease


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Client Teaching

Instruction for traditional/sedatingantihistamines

Avoid driving

No alcohol

No central nervous systemdepressants


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Nasal Decongestants

Two main types are used:Adrenergics (largest group)

Constrict dilated blood vessels

Nasal mucosa

Corticosteroids

Reduce inflammation


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Goal of Nasal Decongestants

To reduce congestion

Two dosage forms

Oral Topical

Nasal spray


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Oral Decongestants

Prolonged effects

Less potent

No rebound congestion Exclusively adrenergics

Example: pseudoephedrine

(Sudafed)


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Topical Decongestants

Adrenergics

Prompt onset

Sustained use

rebound congestion Both adrenergics and steroids

Potent; work well


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Nasal Steroids

Anti-inflammatory

Decrease inflammation

Relieve nasal congestion


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Nasal Decongestants

Intranasal steroids Beclomethasone

dipropionate

BeconaseVancenase

Flunisolide(Nasalide)

Adrenergics Ephedrine

(Vicks)

Naphazoline(Privine)

Oxymetazoline(Afrin)

Phenylephrine(Neosynephrine)


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Nasal Decongestants: SideEffects

Adrenergics

Nervousness

Insomnia

Palpitations

Tremors

Steroids

Local mucosal dryness and irritation


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Treatment with Nasal Decongestants

Acute or chronic rhinitis

Common cold

Sinusitis Hay fever

Other allergies


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Nasal Decongestants:Nursing Implications

Avoid decongestants in the followingclients:

Heart disease

Hypertensive disease

Respiratory disease

Assess for drug allergies


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Expectorants and

Antitussive Agents


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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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Secretions

By loosening and thinning sputumand bronchial secretions, thetendency to cough is indirectly

diminished.


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Cough Relief

Relief of nonproductive coughs:

Pertussis

Common cold

Bronchitis

Laryngitis

Sinusitis

Influenza Pharyngitis


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Expectorants: Side Effects

Common side effects

Guaifenesin Nausea, vomiting

Gastric irritation

Terpin hydrate

Gastric upset (elixir has high alcohol

content)


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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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Antitussives

Drugs used to control coughing

Opioids and nonopioids

Narcotics

Used for nonproductivecoughs


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Opioid Antitussives

Suppress the cough reflex by directaction on the cough center in themedulla

Example: codeine + guiafenesin =Robitussin AC


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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

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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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Antitussive Agents: SideEffects

Benzonatate

Dizziness, headache, sedation

DextromethorphanDizziness, drowsiness, nausea

Opioids

Sedation, nausea, vomiting,lightheadedness, constipation


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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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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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Bronchodilators and OtherRespiratory Agents


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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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Classes of Bronchodilators

Sympathomimetic agents

Xanthine bronchodilators

Anticholinergics

Leukotriene receptorantagonists

5-lipoxygenase inhibitors Mast cell stabilizers

Corticosteroids


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Sympathomimetics

Beta2-adrenergic receptors

Used during the acute phaseof asthmatic attacks

Quickly reduce airwayconstriction and restorenormal airflow


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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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Sympathomimetic Agents

Nonselective adrenergics

Stimulate alpha1, beta1 (cardiac), andbeta2 (respiratory) receptors

Example: epinephrine

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Nonselective beta-adrenergics

Stimulate both beta1 and beta2 receptors

Example: isoproterenol (Isuprel)

Selective beta2 drugs

Stimulate only beta2 receptors

Example: albuterol

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Frequent use leads to beta1 receptorsbeing stimulated

Albuterol loses its action

General side effects

Nausea, increased anxiety, palpitations,tremors, and increased heart rate

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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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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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Xanthine Derivatives:Side Effects

Nausea, vomiting, anorexia

Gastroesophageal reflux during sleep

Sinus tachycardia, extrasystole,palpitations, ventricular dysrhythmias

Transient increased urination


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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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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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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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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

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By blocking leukotrienes:

Prevent smooth musclecontraction of the

bronchial airwaysDecrease mucus secretion

Prevent vascular permeability

Decrease neutrophil andleukocyte infiltration to thelungs

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( )

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Currently available agents:

Montelukast (Singulair)

Zafirlukast (Accolate)

( )

Leukotriene Receptor Antagonists:


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Leukotriene Receptor Antagonists:Side Effects

Headache

Nausea

Diarrhea

Liver dysfunction

Leukotriene Receptor Antagonists:


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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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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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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

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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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Mast Cell Stabilizers:Examples

Cromolyn (Nasalcrom, Intal)

Nedocromil (Tilade)

Mast Cell Stabilizers: Side


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Mast Cell Stabilizers: SideEffects

Coughing

Taste changes

Sore throat Dizziness

Rhinitis

Headache Bronchospasm


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Inhaled Corticosteroids

Anti-inflammatory Inhaled forms

Reduce systemic effects

Used for chronic asthma Does not relieve acute

asthma

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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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Inhaled Corticosteroids:Examples

Beclomethasone dipropionate(Beclovent, Vanceril)

Triamcinolone acetonide

(Azmacort)

Flunisolide (AeroBid)

Inhaled Corticosteroids:


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Inhaled Corticosteroids:Side Effects

Pharyngeal irritation

Coughing

Dry mouth

Oral fungal infections

Systemic effects are rare


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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

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Lesson 5 - Respiratory Drugs