NCM 106

PHARMACOLOGY
MODULE NO: 2

MODULE TITLE: Drugs Acting on the Respiratory System

WRITER: MA. CRISTINA BENITO, RN

OPENING PRAYER

St. Thomas Aquinas: Prayer

before Study
Creator of all things,
true Source of light and wisdom,
lofty origin of all being,
graciously let a ray of Your brilliance
penetrate into the darkness of my understanding
and take from me the double darkness
in which I have been born,
an obscurity of both sin and ignorance.
Give me a sharp sense of understanding,
a retentive memory,
and the ability to grasp things correctly and
fundamentally.
Grant me the talent of being exact in my
explanations,
and the ability to express myself with thoroughness
and charm.
Point out the beginning,
direct the progress,
and help in completion;
through Christ our Lord.
RESPIRATORY SYSTEM
Amen.

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MODULE INTRODUCTION AND FOCUS QUESTIONS:

Respiratory disease is caused by airway obstruction and an example of these are patient with COPD,
lung infection like pneumonia and lung cancer. Different medications are given to the patient
depending on the severity and type of disease. Making sure that patients are given the right
medications, proper nursing care and continuous assessment of the nurse ensures patients wellbeing.

As nursing students, will you be able to provide proper nursing intervention to patients with
respiratory problem ensuring their safety, comfort and holistic care?

Online Class:

1. Enroll in the Google classroom.

2. Follow the instruction for each activity uploaded
in the Google Classroom.
3. Access the learning materials uploaded in the
Google classroom.
4. Submit the requirements posted in the Google
classroom.

Off-site:
1. Modules will be sent through courier for those
students without internet access.
2. Follow the instructions as provided in the material.
3. Take note of the schedule and place of 2
Submission as provided.
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MODULE LESSONS AND COVERAGE

Lesson Subtopics Learning Outcomes Estimated

Time
“ I SHOULD BE ABLE TO”...

2 Introduction to the Discuss the process involved in 30 min.

Respiratory System
Drugs Acting on the Upper
Respiratory Tract
Drugs Acting on the Lower
Respiratory Tract
obstructive respiratory diseases,
correlating this to the signs and symptoms
of these diseases.
Use the nursing process to care for 1 hr.
patients who are receiving
pharmacotherapy for allergic rhinitis and
the common cold
Describe the nurse’s role in the 1.5 hr.
pharmacologic treatment of lower
respiratory tract disorders.

To do well in this module, you need to REMEMBER and DO the following:

1. Open the indicated website. Explore.

2. Read and go through the module in your own time and pace.
3. Open the suggested references and video links. It will help you in understanding the whole module.
4. Honestly answer the activities and the answers will be provided for you either online or at the end of
this module.
5. Go beyond the procedure given in the net. Explore more.

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6. Before starting this module, it is best to start with a prayer to enlighten you and give you the wisdom
to understand the lesson.

Multiple Choice: Encircle the letter that best describes your

answer. Please answer all items. After taking this exam, you will
be able to check your answers. Take note of the items that you
were not able to correctly answer and look for the right answer
as you go through this module.

1. What are the precautionary measures that patients need to know when taking Antitussive
medications?

A. history of narcotic addiction

B. Any condition that might be exacerbated by sympathetic activity
C. Active infection
D. Avoid exposure to airborne infections

2. Which of the following is an adverse reaction to topical nasal steroids?

A. Increased nasal drainage

B. Rebound effect
C. Suppression of healing
D. Local ulceration

3. What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and
surface tension of the fluid, which facilitates the removal of viscous mucus?

A. Guaifenesin
B. Flunisolide
C. Acetylcysteine
D. Dextromethorphan

4. What are the adverse effects of Theophylline?

A. Sympathomimetic stimulation
B. CNS stimulation
C. hyperthyroidism
D. tachycardia

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5. Which of the following is a contraindication to using lung surfactants?

A. Prematurity
B. Older adult
C. No contraindications
D. COPD

ACTIVITY 1: Anticipation Reaction Guide

Instruction: Respond to each statement twice. Once before the lesson and again after reading the
discussion of the lesson

 Write YES if you agree with the statement

 Write NO if you disagree with the statement

Response Before Statement Response After

the Lesson the Lesson

YES 1. The common cold is a lower respiratory infection caused YES

by either a virus or bacteria.
YES 2. Cystic fibrosis is a hereditary disease that results in an YES
accumulation of thick mucus that obstructs the airways and
destroys lung tissue.

YES 3. Sinusitis is an infection of the sinuses that, if untreated, can YES

cause infection of the brain.
YES 4. Benzonatate (Tessalon) should not be used by pregnant YES
women because of the potential adverse effects on the fetus.
NO 5. Pseudoephedrine (Sudafed, Decofed) is used to treat NO
patients with glaucoma because it decreases ocular pressure.
NO 6. Patient teaching for the use of a nasal decongestion spray NO
should include ensuring that the tip of the bottle is placed into
the nasal passage and slowly squeezed to ensure that the
medication reaches the sinuses.
NO 7. Women taking montelukast (Singulair) for asthma may NO

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continue the medication during the preconception period and
pregnancy.
NO 8. Premature infants are at risk for alveoli collapse because of NO
an overproduction surfactant, which causes the sacs to stick
together.
YES 9. Beractant (Survanta) should be instilled directly into the YES
trachea and is indicated for rescue treatment of infants who
have developed respiratory distress syndrome.
YES 10. The adverse effects of xanthines are directly related to YES
toxic concentrations of theophylline in the blood.

At the end of this lesson go back to this ARG and answer

the third column. Compare your answer to your previous
answer

END OF STUDY:

Your grasp of the lesson will further be enhanced as you go through the next phase.
Try to incorporate everything that you’ve learned from everyday experience especially
as you start your clinical practice.

Activity 2: Enhance your knowledge

ONLINE: Download the PowerPoint presentation uploaded in google classroom.

OFFLINE: A copy of the Power Point presentation is enclosed at the end of this module.
Here are some questions to help you when going through your Learning Materials.

GUIDE QUESTIONS:

1. What are the major structures of the respiratory system, including the role of each in
respiration?
2. What are the underlying physiological events that can occur with upper respiratory
disorders? 6
3. What are the underlying pathophysiology involved in obstructive pulmonary disease and
how can you correlate this information with the presenting signs and symptoms?
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1. The upper respiratory tract humidifies and cleans incoming air. The nasal mucosa is richly supplied
with vascular tissue and is the first line of immunologic defense.
2. Allergic rhinitis is a disorder characterized by sneezing, watery eyes, and nasal congestion.
Pharmacotherapy is targeted at preventing the disorder or relieving its symptoms.
3. Intranasal corticosteroids have become drugs of choice in treating allergic rhinitis due to their high
efficacy and wide margin of safety. For maximum effectiveness, they must be administered 2 to 3 weeks
prior to allergen exposure.
4. Antitussives are effective at relieving cough caused by the common cold. Opioids are used for severe
cough. Nonopioids such as dextromethorphan are used for mild or moderate cough.
5. Expectorants promote mucus secretion, making it thinner and easier to remove by coughing.
Mucolytics directly break down mucus molecules.
6. Asthma is a chronic disease that has both inflammatory and bronchospasm components. Drugs are used
to prevent asthmatic attacks and to terminate an attack in progress.
7. Inhaled corticosteroids are often drugs of choice for the long-term prophylaxis of asthma. Oral
corticosteroids are used for the short-term therapy of severe, acute asthma.
8. Monoclonal antibodies offer a newer approach for the prevention of asthma symptoms. These drugs are
only used for persistent cases of the disease when other therapies have been unsuccessful.
9. Chronic obstructive pulmonary disease (COPD) is a progressive disorder treated with multiple
pulmonary drugs. Bronchodilators, expectorants, mucolytics, antibiotics, and oxygen may offer
symptomatic relief.
10. The most commonly used decongestants are oral and intranasal sympathomimetics that alleviate the
nasal congestion associated with allergic rhinitis and the common cold. Intranasal drugs are more
efficacious but should be used for only 3 to 5 days due to rebound congestion.

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Activity 3: Watch the video on Respiratory Drugs

Click the link:

https://youtu.be/SKGJsGOFBMI

https://youtu.be/k-EQb3OVhU4

https://youtu.be/_7tWc5s4z80

https://youtu.be/ls3zzWPFEPM

PATHOPHYSIOLOGY OF ALLERGIC RHINITIS

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Changes in the bronchioles during an asthma attack:

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END OF RESEARCH:

Information is power. Now it’s time for you to apply your understanding on the topic.

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Instructions: Read and understand the situation provided below then answer
correctly the question.

Note: Answers that are just copied from the internet will not be given a score/point.

EXERCISE 1: CRITICAL THINKING

A 74-year-old male patient informs the nurse that he is taking diphendydramine (Benadryl) to reduce
seasonal allergy symptoms. This patient has a history of an enlarged prostate and mild glaucoma
(controlled by medication).

a. What is the nurse’s response?

ANSWER: The nurse needs to give his patient enlightenment and proper education about the
potential side effects of the anticholinergic effects as his medication, which gives potent
symptoms of as blurred vision, dry mouth, constipation, and urinary retention.

EXERCISE 2: CRITICAL THINKING

A 7-year-old boy with a history of asthma goes to the health room at his elementary school and states that
he has increased shortness of breath and chest tightness. On assessment, the school nurse notes scattered
expiratory wheezes throughout his upper and middle lung fields and a decreased peak meter flow. The
current therapeutic regimen for this child includes salmeterol (Serevent) two puffs every 12 h,
montelukast (Singulair) 5 mg/day PO in the evening, triamcinolone (Azmacort) two puffs tid, and
albuterol (Proventil) two puffs every 4 h prn. After observing the child’s technique in using the metered-
dose inhaler (MDI), the school nurse wishes to reinforce the child’s education as it relates to the
administration technique of his inhalants.

a. What areas should be emphasized?

ANSWER:
1. Remove protective cap from the end of the mouthpiece
2. Prime the inhaler by shaking it well then press down on the canister to release the sprays
into the air, away from your face.
3. Shake the inhaler well
4. Exhale as completely as possible through your mouth followed by normal breath.
5. Hold the canister with the mouthpiece on the bottom, facing you and the canister pointing
upward. Place the open end of the mouthpiece into your mouth and close your lips tightly
around the mouthpiece.
6. Breathe in slowly and deeply for about 10 seconds through the mouthpiece. At the same

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time, press down once on the container to spray the medication into your mouth.
7. Wait approximately for 2 minutes before taking the second dose
8. Replace the protective cap on the inhaler
9. Rinse mouth with water after each use, especially after steroids.

Output of this activity can be submitted in the following portals:

1. Google classroom
2. Messenger
3. Email: macristina.benito@ust-legazpi.edu.ph

END OF ANALYSIS:

Now is the time to assess yourself whether you need additional time to study and
go through the module again or you can now go to the next phase

Multiple Choice: Encircle the letter that best describes your

answer. Please answer all items. After taking this exam, you will
be able to check your answers. Take note that this is already an
evaluation of your learning. If you score below the expected
level, its best to go through the module again.

1. What are the adverse effects of Theophylline?

A. Sympathomimetic stimulation
B. CNS stimulation
C. hyperthyroidism

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D. tachycardia

2. What are the precautionary measures that patients need to know when taking
Antitussive medications?

A. History of narcotic addiction

B. Any condition that might be exacerbated by sympathetic activity
C. Active infection
D. Avoid exposure to airborne infections

3. What drug enhances the output of respiratory tract fluid by reducing the adhesiveness
and surface tension of the fluid, which facilitates the removal of viscous mucus?

A. Guaifenesin
B. Flunisolide
C. Acetylcysteine
D. Dextromethorphan

4. Which of the following is an adverse reaction to topical nasal steroids?

A. Increased nasal drainage

B. Rebound effect
C. Suppression of healing
D. Local ulceration

5. A client has a prescription for fluticasone (Flonase). Place the instructions that follow in the
order in which the nurse will instruct the client to use the drug.

3. A. Instill one spray directed high into the nasal cavity.

2. B. Clear the nose by blowing.
1. C. Prime the inhaler prior to first use.
4. D. Spit out any excess liquid that drains into the mouth.

END OF ACTION

You are almost done with Lesson 2 of your module, go back to the last column of your
ARG and answer the questions again. This time compare your previous answers to your
latest answers. Was there any improvement?

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SELF REFLECTION

Learning Skills

I’m an Expert I still need to Oh no, I need help

Practice

1. I Can Discuss the process 

involved in obstructive
respiratory diseases, correlating
this to the signs and symptoms
of these diseases.
2. I Can Use the nursing 
process to care for patients who
are receiving pharmacotherapy
for allergic rhinitis and the
common cold
3. I Can Describe the nurse’s 
role in the pharmacologic
treatment of lower
respiratory tract disorders.

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Textbook:

1. Smith, B.T., Pacitti, D., 2020. Pharmacology for Nurses, 2 nd Edition. Jones &Barlett Learning, LLC,
Burlington, Massachusette.

2. Karch, Amy M., 2017, Focus on Nursing Pharmacology, , 7th edition. Wolters Kluwer Health

3. Adams, M., Holland, N., Urban, C., 2020. Pharmacology for Nurses: A Pathophysiologic Approach, 6 th
Edition. Pearson

4. Lippincott William & Wilkins, 2015. Pharmacology A 2-in-1 Reference for Nurses, Lippincott William
& Wilkins

Links:
https://youtu.be/SKGJsGOFBMI
https://youtu.be/k-EQb3OVhU4
https://youtu.be/_7tWc5s4z80
https://youtu.be/ls3zzWPFEPM

CLOSING PRAYER

May God the Father bless us.

May God the son Heal us.

May God the Holy Spirit enlighten us, and give us eyes to see
with, ears to hear with, hands to do the work of God with, feet to
walk with, a mouth to preach the word of salvation with and the 15
angel of peace to watch over us and lead us at last, by our Lord’s
gift to the kingdom, AMEN.
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