DRUGS AFFECTING THE RESPIRATORY SYSTEM Xanthine Derivatives Methylxanthine

BRONCHODILATORS
➢ Inhibit phosphodiesterase, an enzyme
Sympathomimetics
responsible for breaking down CAMP, resulting
➢ Stimulate the production of cyclic adenosine to more CAMP available for bronchodilation
monophosphate (CAMP), which reduces
These agents also:
smooth muscle
➢ stimulate cardiac muscle and the CNS
Indicated for:
➢ increase CO
➢ Bronchospasm ➢ produce diuresis
➢ Chronic pulmonary disease ➢ decrease peripheral vascular reistance
➢ Asthma
Indicated for:
➢ Airway obstruction
✓ Bronchospasm
Major S/E:
✓ Asthma
➢ Anxiety ✓ Wheezing and dyspnea associated with
➢ Restlessness, insomnia pulmonary disease
➢ Tremors ✓ COPD or Chronic Airway Limitation (CAL)
➢ Palpitation, arrhythmias
Major S/E:
➢ Headache
➢ Rebound bronchospasm • CNS stimulation: tremors, nervousness,
➢ Urinary retention isomnia, agitation, convulsion
• Cardiac stimulation: tachydysrhythmia,
C/I in patients with:
tachycardia, angina, hypotension
➢ Hypertension • GI distress: nausea (first sign of toxicity),
➢ Dsyrhythmia vomiting, anorexia
➢ Increased cardiac effects with theophylline • Toxicity
preparations
Nursing Responsibilities:
Nursing Responsibilities:
➢ Give during the daytime to prevent insomnia
• Assess respiratory status and ABGs ➢ Monitor blood levels for toxicity
• Instruct patient on how to use a metered-dosed • therapeutic blood level is 10-20 ug/ml
inhaler or respiratory apparatus at home • toxicity may occur with small increases
• Monitor ECG and cardiac status >20ug/ml
• Administer with meals if GI irritation occurs ➢ Instruct client as follows:
• Emphasize compliance with dosage and • Be compliant with dosing, schedule, and blood
schedule work
• Do not crush or alter the dosage form
• Take with milk or food if GI distress occurs
• Avoid smoking because it
increasesmetabolismof the these agents
➢ Monitor for S/E and report the first sign of
cardiac disturbance
• The event of tachycardia does not warrant
discontinuing of the drug, instead, the dosage
may be decreased

Common Drugs:
Common Drugs:
✓ Aminophylline (IV only)
✓ Epinephrine (Adrenalin) ✓ Oxtriphylline (Choledyl)
✓ Isoproterenol hydrochloride (Isuprel) ✓ Theophylline (Theolair)
✓ Isoetharine hydrochloride (Bronkosol) ✓ Anhydrous theophylline (Theodur)
✓ Albuterol (Ventolin)
✓ Metaproterenol sulfate (Alupent)
✓ Terbutaline sulfate (Brethine)
 ✓ Rebound engorgement:
Anticholinergic ➢ swelling and congestion of the nasal mucosa
when the parasympathetic nervous system tries
➢ It antagonized the effect of acetylcholine
to equalize the effects of the sympathomimetic
➢ It causes a local and site specific
decongestant dugs
bronchodilation by preventing the incrrease in
intracellular cyclic guanosine monophosphate Nursing Responsibilities:
which is produced by the interaction of
• Instruct the client not to over use the agent
acetylcholine with the muscarinic receptors of
because it may be a habit forming (limit the
the bronchial smooth muscle
number of days used)
Indicated for: • Limit caffeine intake
• Maintain sitting position when taking these
➢ Acute exacerbation of COPD/CAL
drugs
➢ Used in conjunction with beta-adrenergic
• Consult pharmacist before taking these agents
stimulant for acute asthmatic attack
with diet pills
Major S/E: • Consult physician before use if hypertension is
present
• Dryness of the mouth
• Throat irritation or cough Common Drugs:

Nursing Responsibilities: ✓ Oxymetazoline (Afrin, Dristan)

✓ Phenylephrine (NeoSynephrine)
• Inform the patient that the drug is not effective
✓ Pseudoephedrine+chlorpheniramine+
for treatment of acute bronchospasm
dextrmethorphan+acetaminophen (Comtrex)
• Tell patient to avoid accidentally spraying into
✓ Pseudoepherine hydrochloride (Sinutab,
eyes (temporary blurring of vision may result)
Sudafed)
• When using more thanone inhalation, wait for
at least 2 mins before repeating Antihistamines
• When used with steroid inhaler, use
➢ Compete for H1 receptor sites
ipratropium first and then wait for 5 mins
before using the corticosteroid Indicated for:
• Tell patient to take missed dose as soon as
✓ Rhinitis
remembered unless it is almost time for the
➢ inflammation of the mucous membranes
next dose
of the nose accompanied by swelling of
➢ in this case, skip missed dose and do not double
the mucosa and nasal discharge
next dose
✓ Common cold
Common Drugs: ✓ Allergic response: itchy, watery eyes
✓ Sinusitis
✓ Ipratropium bromide
✓ Tiotropium Major S/E:

• Headache
• Anticholinergic effects:
UPPER RESPIRATORY DRUGS ✓ dry mouth
✓ urinary retention
Decongestants ✓ dilated pupils
✓ tachycardia
➢ Shrink nasal membranes by vasoconstictive ✓ decreased GI motility
mechanism • CNS: sedation; dizziness
Indicated for: ✓ antihistamines cross the blood-brain
barrier
➢ Upper respiratory tract infections (URTI) • Hypotension, palpitation
➢ Sinusitis

Major S/E:

✓ CNS stimulation
✓ Nausea, vomiting
✓ Palpitation, hypertension
Nursing Responsibities: Nursing Responsibilities:

• Take at bedtime if possible to avoid sedation • May be given by nebulization, IV, orally, or
during the day instilled in ETT
• If taken during the day, caution the client about • Dilute with sterile water to ensure that all of
safety measures with driving, operating drug is given
machinery, and ambulating • Use cautiosly in older adults or individuals with
➢ sedation usually decreases with repeated doses severe respiratory insufficiency (may cause
• Caution older adults in particular about sedative bronchospasm)
effects • Offer face cloth after inhalation (leaves sticky
coating)
Common Drugs:
• Suction and encourage coughing after
✓ Diphenhydramine hydrochloride (Benadryl) administration
✓ Terfenadine (Seldane) • Assess lung sounds and respiratory status
✓ Brompheniramine maleate (Dimetane) • Administer by mouth mixed with iced liquid,
about 17 doses over a 4-day period in
DRUGS AFFECTING COUGH acetaminophen over dose.
Diluents
Sterile Water Common Drugs:

➢ Liquefies mucus, which facilitates removal of ✓ Acetylcysteine (Mucomyst, Flumucil)

secretions Expectorants
Uses: ➢ Remove viscid secretions by reducing
➢ Helps remove secretions adhesiveness and surface tension
➢ Decrease mucus plug formation ➢ Iodide preparations act directly on bronchial
➢ Diluent given by ultrasonic nebulization tissue to increase secretion of respiratory fluids
and decrease the viscosity of the mucus
Nursing Responsibilities:
Indicated for:
• Taken systemically, tap water acts as an
expectorant ✓ Respiratory difficulty in children
✓ Bronchitis
• Consume 2 to 3 quarts of tap water per day to
✓ Persistent coughs
help eliminate secretions unless C/I by presence
✓ Mucus plugs
of CHF or fluid restrictions
✓ Influenza
Sterile Normal Saline (Sodium Chloride) ✓ Common cold
➢ Exerts osmotic pressure on plasma fluids, which Major S/E:
results in hydration of respiratory secretions
✓ Rare, may include GI upset
Nursing Responsibilities:
Nursing Responsibilities:
• Caution use by clients with cardiac problems or
• Assess lung sounds and secretions: color,
when edematous states exist
consistency, and amount
Mucolytic Drugs • Offer 2-3 quarts of fluids per day unless C/I
• Administer potassium iodide solution (SSKI)with
➢ Work directly on mucus to reduce thickness and
juice to disguise taste (have client use a straw to
make secretions less tenacious
decrease test)
➢ Alters metabolism of acetaminophen to
decease injury to the liver in overdose • Do not offer water before and afterexpectorant
agents except for SSKI
Uses:
Common Drugs:
• Inhalation
✓ Potassium iodide solution (SSKI)
✓ respiratory conditions with thick mucus
✓ Guaifenesin (Robitussin)
✓ cystic fibrosis
✓ Dextometorphan + benzocaine (Formula 44D,
• Orally: acetaminophen overdose
Vicks Cough Syrup)
Major S/E: ✓ Dextometorphan hydrobromide + guaifenesin +
phenylpropanolamine HCL (Naldecon)
✓ Nausea, vomiting
✓ Ambroxol
✓ Bronchospasm
✓ Carbocysteine
✓ Burning in back of throat
Antitussives

➢ Suppress the cough reflex in the medulla

➢ Some are peripherally acting and some are
centrally acting

Indicated for:

➢ Suppressing non-productive cough and/or assist

in nighttime sleep in children with productive
cough
➢ Can be combined with narcotic or nonnarcotic
agents

Major S/E:

✓ Dry secretions
✓ Drowsiness without respiratory depression
✓ Constipation
✓ Narcotic abuse

Nursing Respnsibilities:

• Wait 15 to 20 minutes after taking syrup before

drinking any liquid
• Monitor use because these are controled
substances
• Take at bedtime
• Monitor bowel elimination
• Humidify air durin sleeptime to improve
effectiveness

Interactions:

➢ A synergistic effect with alcohol and CNS

depressants

Common Drugs:

• Nonarcotic
✓ Benzonatate (Tessalon)
✓ Diphenhydramine HCL (Benylin)
• Narcotic
✓ Codeine sulfate
✓ Hydrocodone bitartrate (Hycodan)

Leukotriene Antagonist:

➢ Binds with cysteinyl leukotriene receptors to

prevent action of cysteinyl leukotrienes.

Commonly Drugs:

✓ Montelukast
✓ Zafirlukast