Drugs Acting on the Respiratory System

Upper Respiratory Tract

 Nose, mouth, pharynx, larynx, and trachea.
 Primarily involved in the movement of air in and out of the - ventilation.
 Antitussives, decongestants, antihistamines, expectorants, mucolytics.
 Drugs that affect the respiratory system work to keep the airways open and gases moving
efficiently.

A. Antitussives
 Suppress the cough reflex, nonproductive cough.
 Acts directly on the medullary cough center of the brain to depress cough reflex.

B. Decongestants
 Decrease the overproduction of secretions by causing local vasoconstriction to the upper
respiratory tract.
 Opens clogged nasal passages providing relief from the discomfort of a blocked nose.
 Rebound congestion - rhinitis medicamentosa

C. Antihistamines
 Block the release or action of histamine (chemical released
during inflammation that increases secretions and narrows
airways)
 First generation - drowsiness
 2nd generation - less-sedating

D. Expectorants
 Increase productive cough to clear the airways.
 Liquify lower respiratory tract secretions, reducing viscosity
and making it easier for the patient to cough them up.

E. Mucolytics
 Increase or liquify respiratory secretions to aid the clearing
of the airways in high-risk respiratory patients.
 Dornase alfa - specific for the treatment of patient with
cystic fibrosis.

Lower Respiratory Tract

 Includes the bronchial tree and the alveoli, where gas exchange occurs.
 Bronchiectasis, bronchitis, pneumonia, and obstructive disorders (asthma, COPD).
  First step of treatment is reducing environmental exposure to
irritants.
 Bronchodilators/antiasthmatics, drugs affecting inflammation,
lung surfactants.

Bronchodilators/Antiasthmatics
 Used to facilitate respirations by dilating the airways.
 Helpful in symptomatic relief of prevention of bronchial asthma and for bronchospasm
associated with COPD.

A. Xanthines - relatively narrow margin of safety and interacts with many other drugs
B. Sympathomimetics - mimic the effects of the sympathetic nervous system, dilation of bronchi
with increased rate and depth of respiration.
C. Anticholinergics - for patients who can’t tolerate sympathomimetics. Affects the vagus nerve,
blocking the vagal effect causes bronchodilation.

Drugs Affecting Inflammation

 Second component of treating obstructive pulmonary disorders is to alter the inflammatory
process that leads to swelling and further airway narrowing.

A. Inhaled steroids - very effective treatment for bronchospasm. Decreased inflammatory

response in the airway.
B. Leukotrine receptor antagonists - newer class, act more specifically at the site of the problem
associated with asthma.
C. Mast cell stabilizer - prevents the inflammatory and bronchoconstricting substances when mast
cells are stimulated to release these because of irritation or presence of antigen.

Lung Surfactants
 Naturally occurring compounds or lipoproteins containing lipids and apoproteins that reduce the
surface tension within the alveoli, allowing expansion of the alveoli.
 Replace surfactant that are missing in the lungs of neonates with respiratory distress syndrome
(RDS).
 Drugs Acting on the Gastrointestinal System

Drugs: GI Secretions

Drugs for GERD and Ulcer

 GERD - Gastroesophageal Reflux Disease
 These drugs work to decrease GI secretory
activity, block the action of GI secretions, or
form protective coverings on the GI lining to
prevent erosion.

A. Histamine-2 antagonists - block the release

of HCL acid in response to gastrin.
B. Antacids - neutralize stomach acidity by
direct chemical reaction.
C. Proton pump inhibitors - suppress the
secretion of HCL into the lumen of the
stomach
D. GI protectants - coat any injured area in the
stomach to prevent further injury from acid.
Promotes ulcer healing.
E. Prostaglandins - used to protect the stomach lining, increases mucus production in the stomach
thus protecting the lining.

Digestive Enzyme Dysfunction

 Digestive enzymes are substances produced in the GI tract to break down foods into usable
nutrients.
 Strokes, salivary gland disorders, extreme surgery of the head and neck, cystic fibrosis or
pancreatic dysfunction - may require a supplement to the production of digestive enzymes.

Drugs: GI Motility

 Drugs used to affect the motor activity of the GI tract.

 Can be used to speed up or improve the movement of intestinal contents. (Constipation)
 Increase the tone of the GI tract and to stimulate motility throughout the system.
  Decrease movement along the GI tract. (Diarrhea)
Laxatives
 Cathartic drugs are indicated for the short-term relief of constipation.

A. Chemical stimulants - directly stimulate the nerve plexus in the intestinal wall, causing increased
movement and the stimulation of local reflexes.
B. Bulk stimulants - mechanical stimulants, rapid-acting, aggressive laxatives that cause the fecal
matter to increase in bulk, stimulates local stretch receptors, and activates local activity.
C. Lubricants - makes defecation easier without stimulating the movement. Patients with
hemorrhoids, rectal surgery.

GI Stimulants
 Stimulate parasympathetic activity or make the GI tissues more sensitive to parasympathetic
activity.
 Increase GI secretions and motility on a general level throughout the tract.
 They do not have the local effects of laxatives.
 Indicated when more rapid movement of GI contents is desirable.

Antidiarrheals
 Block the stimulation of the GI tract for symptomatic relief from diarrhea.
 Slows the motility of the GI tract through direct action on the lining of the GI tract to inhibit local
reflexes, through direct action on muscles of the GI tract to slow activity, or through action on
CNS centers that cause GI spasm and slowing.

Drugs: Antiemetic

 Used to decrease or prevent nausea and vomiting.

 Can be centrally acting or locally acting, and varying degrees of effectiveness.
 Work by reducing the hyperactivity of the vomiting reflex in one of two ways; locally, to
decrease the response to stimuli that are being sent to the medulla to induce vomiting, or
centrally, to block the chemoreceptor zone (CTZ) or suppress the vomiting center directly.

A. Phenothiazines - centrally acting

B. Nonphenothiazine - reduces the responsiveness of the nerve cells in the CTZ.
C. Anticholinergics/antihistamines - block the transmission of of impulses to the CTZ,
recommended for motion sickness.
D. 5-HT3 receptor blockers - block those receptors associated with nausea and vomiting in the CTZ
and locally.
E. Substance P/Neurokinin 1 receptor antagonist - newest class, acts directly in the CNS to block
receptors associated with nausea and vomiting.
F. Miscellaneous agents - trimethobenzamide - drug of choice in this group because it is not
associated with as much sedation and CNS suppression as others.