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 / antiasthmaticsACTION 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)

Bronchodilatorsadverse effects GI upset nausea irritability tachycardia seizure headache dysrhythmias contraindications hypersensitivity dysrhythmias severe cardiac disease alcoholism

BronchodilatorsNURSING 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)

BronchodilatorsEXAMPLES beta-adrenergic: abuterol (Proventil, Ventolin), metaproterenol (Alupent) xanthines: aminophylline, theophylline (Theo-Dur) acts on bronchial smooth muscle epinephrine HCL (Adrenalin) - increases the rate and strength of cardiac contraction through the sympathetic nervous system isoproterenol HCL (Isuprel) - increases the heart rate by stimulating the beta-adrenergic blocking agent of the sympathetic nervous system

AntiAnti-inflammatories action:

stabilizes mast cells so chemical mediators are not released as easily; decreases bronchial hyperreactivity; decreases airway inflammation use:

to prevent asthma attacks, exerciseinduced bronchospasms

AntiAnti-inflammatories example:

cromolyn sodium (Intal) leukotriene receptor antagonistszafirlukast (Accolate), montelukast (Singulair) glucocorticoids- beclamethasone (Vanceril), triamcinolone (Azmacort)

AntiAnti-inflammatories adverse

effects

cough CNS disturbances burning, stinging eyes throat irritation headache contraindications

status asthmaticus hypersensitivity

AntiAnti-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/expectorantsACTION 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/expectorantsexamples mucolytic: acetylcysteine (Mucomyst), dornase alfa (Pulmozyme) expectorant: guaifenesin (Robitussin)

Mucolytics/expectorantsadverse side effects oropharyngeal irritation bronchospasm gastric effects contraindications increased intracranial pressure status asthmaticus

Mucolytics/expectorantsnursing 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

Antitussivesexamples 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 (Condons 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