• Antihistamines: Contraindications
o Urinary retention, narrow angled
Respiratory System
• Trap foreign particles and pathogens and
prevent them from being carried to the
lower respiratory system where it can be
distributed systematically
RESPIRATORY MEDICATIONS
• Antihistamine and Decongestants
• Anti-cough Medications
o Antitussives
o Mucolytics
o Expectorants
• Bronchodilators
ANTIHISTAMINES AND DECONGESTANTS
• Antihistamines: Action
o H1 receptor antagonist
o Block the actions of histamine at
the H1 receptor inhibiting histamine
response
o Examples
✓ Diphenhydramine,
loratadine, levocetirizine
• Antihistamines: Indications
o Sneezing, runny nose, and itching
of the eyes, nose, and throat of
allergic rhinitis
• Antihistamines: Side Effects or Adverse
Effects
o Drowsiness, dry mouth, urinary
hesitancy, blurred vision,
constipation
glaucoma, enlarged prostate, GI
obstruction
• Antihistamines: Drug Interaction
o +Alcohol, CNS depressants =
Increased sedative effects
o +MAOis = Increases anticholinergic
effects
• Antihistamines: Nsx. Actions
o Do not operate motor vehicles if
drowsiness occurs
o No alcohol intake and other CNS
depressants
o Use ice chips for temporary relief of
dry mouth
• Decongestants: Action
o Acts by activating alpha-
adrenergic receptors in the
sympathetic nervous system
(sympathomimetic) resulting to
vasoconstriction of nasal passages
and drying of mucous membranes
o Examples
✓ Phenylephrine, ephedrine,
pseudoephedrine
• Decongestants: Indication
o Relief of nasal congestion or sinus
drainage
• Decongestants: Side Effects or Adverse
Effects
o Palpitations, tachycardia, nausea,
nervousness, difficulty urinating,
hypertension
• Decongestants: Contraindications
o Thyroid disorders, DM, HPN
• Decongestants: Drug Interaction
o +Sympathomimetics = Increased
CNS stimulation
o +MAOis = Hypertensive crisis
o +Caffeine = Restlessness and
palpitations
• Decongestants: Nsx. Actions
o Do not use longer than 3-5 days –
rebound congestion
o Monitor VS especially BP, HR and
ECG patterns
ANTI-COUGH MEDICATIONS
• Antitussives: Actions
o Dampens cough reflex by acting
directly on the cough center in the
medulla oblongata
o Benzonatate is a nonopioid
antitussive that acts by
anesthetizing stretch receptors in
the lungs
ANDREA NICOLE AGAPITO 1
 o Examples
✓ Codeine, hydrocodone,
dextromethorphan,
benzonatate
• Antitussives: Indication
o Nonproductive irritating cough
• Antitussives: Contraindications
o Pregnancy and breastfeeding
• Antitussives: Side Effects or Adverse Effects
o Drowsiness, nasal congestion,
headache, N/V, constipation, pupil
constriction
• Antitussives: Drug Interaction
o +MAOis = Hyperthermia, excitation,
hypotension, and coma
o +Alcohol = ↑ Sedative effects
• Antitussives: Nsx. Action
o Respiratory depression can be a
serious AE, patent airway should be
maintained
o Do not chew benzonatate = local
numbness
o X operating motor vehicles if
BRONCHODILATORS
drowsiness occurs.
o ↑ OFI of 2L to 3L/day unless
contraindicated
• Mucolytics: Action
o Liquefies bronchial secretion to
increase mucous flow and be
removed by coughing
o Example: Acetylcysteine
• Mucolytics: Indications
o Pneumonia, chronic bronchitis,
cystic fibrosis
• Mucolytics: Side Effects or Adverse Effects
o Bronchospasm, N/V, drowsiness,
rhinorrhea, and chest tightness
• Mucolytics: Contraindication
o Hypersensitivity
• Mucolytics: Drug Interaction
o Used as an antidote for
acetaminophen
• Mucolytics: Nsx. Actions
o Monitor breath sounds, cough, and
bronchial secretions
o Serious SE is bronchospasm, patent
airway should be maintained -
prepare beta 2 agonist for rescue
medication
o ↑ OFI of 2L to 3L/day unless
contraindicated
• Expectorants: Action
o Increases respiratory tract fluid
thereby reducing mucous viscosity
resulting to more productive cough
o Example: Guaifenesin
• Expectorants: Indications
o Colds, influenza, bronchial asthma,
emphysema
• Expectorants: Side Effects or Adverse
Effects
o N/V, diarrhea, headache,
abdominal pain, hives, or skin rash
• Expectorants: Contraindication
o Hypersensitivity
• Expectorants: Drug Interaction
o +Alcohol = ↑ Sedative effect
o +Anticoagulants = ↑ Bleeding
tendencies
• Expectorants: Nsx Action
o X operating motor vehicles if
drowsiness occurs
o OFI of 2L to 3L/day unless
contraindicated
o Monitor breath sounds, cough, and
bronchial secretions
• Adrenergic Agonists: Action
o Acts by increasing cyclic AMP to
relax bronchial smooth muscle
thereby bronchodilation happens
• Adrenergic Agonists: Types
o Short acting beta-adrenergic
agonists (SABA)
✓ Albuterol, levalbuterol,
terbutaline
o Long acting beta-adrenergic
agonists (LABA)
✓ Albuterol, salmeterol
o Combination:
✓ Albuterol + ipratropium
✓ Salmeterol + fluticasone
✓ Budesonide + formoterol
• Adrenergic Agonists: Indication
o First line of drug for acute
bronchoconstriction such as in
asthma, COPD, exercise induced
asthma, anaphylaxis
• Adrenergic Agonists: Contraindications
o Cardiac arrhythmias, HPN, CAD
• Adrenergic Agonists: Side Effects or
Adverse Effects
o Tachycardia, palpitations, dry
mouth, HPN, hyperglycemia,
hypokalemia
ANDREA NICOLE AGAPITO 2
 • Adrenergic Agonists: Drug Interaction
o +Beta blockers = Decrease effect
o +Theophylline = Increase effect
• Adrenergic Agonists: Nsx Action
o Do not use LABA for treatment of
acute asthma attacks
o Administer 30-60mins before
activity to prevent exercise
induced asthma
o If taking beta agonists with
corticosteroid, use bronchodilator
first then wait for 5mins before
taking corticosteroids
o Notify doctor if you need more
than 4 inhalations per day
o When using MDI, clear out your
nose and throat, breathe out then
place mouthpiece in your mouth
and inhale deeply as you release
inhaler dose and hold your breath
for a few seconds and slowly
exhale
ANTICHOLINERGICS
• Anticholinergics: Action
o Acts by competitively antagonizing
the action of acetylcholine at
receptors resulting in
bronchodilation
o Example
✓ Ipratropium, tiotropium,
aclidinium
• Adrenergic Agonists: Indications
o First line of drug for COPD,
bronchitis, emphysema, and
severe exacerbation of asthma
o Used as alternative bronchodilators
for those who cannot tolerate beta
2 adrenergic agonist
• Adrenergic Agonists: Contraindications
o Narrow angled glaucoma, GI and
urinary obstruction
• Adrenergic Agonists: Side Effects or
Adverse Effects
o Tachycardia, N/V, dry mouth,
nervousness, difficulty urination,
constipation
• Adrenergic Agonists: Drug Interaction
o +Atropine = Increase effect
• Adrenergic Agonists: Nsx. Action
o Close patient’s eyes when using,
can cause narrow angle
glaucoma
METHYLXANTINES
• Methylxanthines: Action
o Acts by decreasing airway
reactivity by inhibiting
phosphodiesterase thereby smooth
muscle relaxation and relieves
bronchospasm
o Example: Theophylline (oral),
aminophylline (IV)
• Methylxanthines: Indications
o Second- or third-line agents for
asthma, chronic bronchitis,
emphysema in long term therapy,
neonatal apnea
• Methylxanthines: Contraindication
o Symptomatic CAD
• Methylxanthines: Side Effects or Adverse
Effects
o N/V, GI disturbances, insomnia,
dizziness, arrhythmias, palpitations
• Methylxanthines: Drug Interaction
o +Caffeine, adrenergic stimulants,
antithyroid drugs = ↑ Effect
o +Smoking or marijuana, activated
charcoal, thyroid hormones = ↓
Effect
• Methylxanthines: Nsx. Actions
o Monitor BP and HR
o Take with food to prevent GI upset
o Avoid hazardous activities and do
not change position abruptly
o Avoid caffeinated foods
CORTICOSTEROIDS
• Corticosteroids: Action
o Inhibits activation of inflammatory
cells and reinforce anti-
inflammatory mediators thus
decreasing mucus production and
edema resulting to widened
airway
o Drug: Budesonide, fluticasone,
prednisone, dexamethasone,
methylprednisolone
• Corticosteroids: Indications
o Moderate to severe exacerbations
of asthma, chronic bronchitis,
allergic rhinitis
• Corticosteroids: Side Effects or Adverse
Effects
o Oral candidiasis, mouth irritation,
hyperglycemia, N/V, cough, and
hoarseness
• Corticosteroids: Contraindications
o Acute bronchospasm, adrenal
gland atrophy
• Corticosteroids: Drug Interaction
o +Hormonal contraceptives,
ketoconazole, macrolides: ↑ Effect
o +Arbiturates, cholestyramine,
phenytoin: ↓ Effect
• Corticosteroids: Nsx. Action
o Teach client to use bronchodilator
several minutes before
corticosteroid inhaler
ANDREA NICOLE AGAPITO 3
 o Rinse mouth after using inhaler

MAST CELL STABILIZERS

• Mast Cell Stabilizers: Action
o Inhibits mast cell degranulation
thereby inflammatory mediators
are not released form the cell such
as histamine
o Examples: Cromolyn sodium &
nedocromolyn
• Mast Cell Stabilizers: Indication
o DOC for children with asthma,
exercise induced asthma, long
term therapy for asthma
• Mast Cell Stabilizers: Contraindication
o Hypersensitivity
• Mast Cell Stabilizers: Side Effects or
Adverse Effects
o Cough, bronchospasm, throat
irritation, sneezing and nausea
• Mast Cell Stabilizers: Nsx. Action
o Give mild analgesic if drug
induced headache occurs
o Should not be used for acute
asthma attacks

LEUKOTRIENE MODIFIERS
• Leukotriene Modifiers: Action
o Competitively inhibits leukotriene
receptor from interacting to its
receptor resulting to smooth
muscle relaxation, increased
vascular permeability and
increased secretions
o Examples: Montelukast & zafirlukast
• Leukotriene Modifiers: Indication
o Mild to moderate asthma
exacerbations, prophylaxis of
persistent, chronic asthma
• Leukotriene Modifiers: Side Effects or
Adverse Effects
o Headache, N/V, diarrhea, dizziness,
myalgia
• Leukotriene Modifiers: Contraindications:
o Hepatic impairment
• Leukotriene Modifiers: Drug Interaction
o +Warfarin = ↑ Prothrombin time
o +Aspirin, fluoroquinolones, isoniazid:
↑ Effect
o +Erythromycin, rifampin,
amiodarone: ↓ Effect
• Leukotriene Modifiers: Nsx. Action
o Can be taken 1 to 2 hours after
meals o Not used for acute asthma
attacks

ANDREA NICOLE AGAPITO 4