Pharmacology

Using the Drug Handbook, make a drug study of the different agents affecting the Upper Respiratory System and the Lower Respiratory System.
A. Drugs Affecting Upper Respiratory Tract

Classification Generic Name Pharmacodynamics Indications Nursing Considerations

Decongestants Pseudoephedrine Sympathomimetic Temporary relief of Assessment & Drug Effects
(Sudafed) effects, causes nasal congestions  Monitor HR and BP, especially in those with a
vasoconstriction in caused by the history of cardiac disease. Report tachycardia or
Mucous common cold, hay hypertension.
membranes of fever, sinusitis; Patient & Family Education
nasal passages promotion of nasal  Avoid taking it within 2 h of bedtime because drug
resulting in their and sinus drainage; may act as a stimulant.
shrinkage, which relief of eustachian  Discontinue medication and consult physician if
promotes drainage tube congestion. extreme restlessness or signs of sensitivity occur.
and improvement in  Consult physician before concomitant use of OTC
ventilation. medications; many contain ephedrine or other
sympathomimetic amines and might intensify
action of pseudoephedrine.
 Do not breast feed while taking this drug without
consulting physician.
Mucolytics Acetylcysteine Splits links in the Mucolytic adjunctive BASELINE ASSESSMENT
(Mucomyst) mucoproteins therapy for Mucolytic: Assess pretreatment respirations for rate,
contained in the abnormal, viscid, or depth, rhythm. IV antidote: Obtain baseline LFT, PT/INR
respiratory mucus inspissated mucous and drug screen. For use as antidote, obtain
secretions, secretions in acute acetaminophen level to determine need for treatment with
decreasing the and chronic acetylcysteine.
viscosity of the bronchopulmonary INTERVENTION/EVALUATION
secretions; protects disorders; to lessen If bronchospasm occurs, discontinue treatment, notify
liver cells from hepatic injury in physician; bronchodilator may be added to therapy.
acetaminophen cases of Monitor rate, depth, rhythm, type of respiration
effects. acetaminophen (abdominal, thoracic). Observe sputum for color,
 toxicity. consistency, and amount. IV antidote: Administer within 8
hrs of acetaminophen ingestion for maximal hepatic
protection; ideally, within 4 hrs after immediate-release
and 2 hrs after liquid acetaminophen formulations.
PATIENT/FAMILY TEACHING
• Slight, disagreeable sulfuric odor from solution may be
noticed during initial administration but disappears quickly.
• Adequate hydration is important part of therapy.
• Follow guidelines for proper coughing and deep
breathing techniques.
• Auscultate lung sounds.
Expectorants Guaifenesin Enhances reflex Guaifenesin is an Assessment & Drug Effects
(Robitussin) outflow of expectorant that is  Monitor for therapeutic effectiveness. Persistent
respiratory tract indicated for cough may indicate a serious condition requiring
fluids by irritation of providing temporary further diagnostic work.
gastric mucosa. symptomatic relief  Notify physician if high fever, rash, or headaches
Aids in from congested develop.
expectoration by chests and coughs Patient & Family Education
reducing which may be due to  Increase fluid intake to help loosen mucus; drink
adhesiveness and a cold, bronchitis, at least 8 glasses of fluid daily.
surface tension of and/or other  Contact physician if cough persists beyond 1 wk.
secretions. breathing illnesses.  Contact physician if high fever, rash, or headache
develops.
 Do not breast feed while taking this drug.
Antihistamines Diphenhydramine Competitively Symptomatic relief of BASELINE ASSESSMENT
(Benadryl) blocks the effects of perennial and If pt is having acute allergic reaction, obtain history of
histamine at seasonal rhinitis, recently ingested foods, drugs, environmental exposure,
histamine-1 vasomotor rhinitis, and emotional stress. Monitor B/P rate; depth, rhythm,
receptor sites; has allergic conjunctivitis, type of respiration; quality, rate of pulse. Assess lung
atropine-like urticaria, and sounds for rhonchi, wheezing, and rales.
antipruritic and angioedema; also INTERVENTION/EVALUATION
sedative effects. used for treating Monitor B/P, esp. in elderly (increased risk of
motion sickness and hypotension). Monitor children closely for paradoxical
 parkinsonism and as reaction. Monitor for sedation.
a night time sleep aid PATIENT/FAMILY TEACHING
and to suppress • Tolerance to antihistaminic effect generally does not
coughs. occur; tolerance to sedative effect may occur.
• Avoid tasks that require alertness, motor skills until
response to drug is established.
• Dry mouth, drowsiness, dizziness may be an expected
response to drug.
• Avoid alcohol.
Antitussives Dextromethorpha Depresses the Control of non- Examination and Evaluation
n cough center in the productive cough.  Assess frequency and nature of cough, lung
medulla to control Temporarily relieves sounds, and amount and type of sputum
cough spasms. coughing spasm. produced. Document whether this drug is
effective in reducing cough.
 Assess dizziness that might affect gait, balance,
and other functional activities. Report balance
problems and functional limitations to the
physician, and caution the patient and
family/caregivers to guard against falls and
trauma.
Patient/Client-Related Instruction
 Caution patient to avoid taking more than the
recommended dose or taking alcohol or other
CNS depressants concurrently with this
medication; fatalities have occurred.
 Instruct patient to cough effectively: sit upright
and take several deep breaths before attempting
to cough.
 Advise patient to minimize cough by avoiding
irritants, such as cigarette smoke, fumes, and
dust. Humidification of environmental air, frequent
sips of water, and sugarless hard candy may also
decrease the frequency of dry, irritating cough.
  Advise patient that any cough lasting more than 1
wk or accompanied by fever, chest pain,
persistent headache, or skin rash warrants
medical attention.
 Instruct patient or family/caregivers to report other
problematic side effects such as severe or
prolonged nausea or sedation.

B. Drugs Affecting Lower Respiratory Tract

Classification Generic Name Pharmacodynamics Indications Nursing Considerations

Bronchodilators Albuterol Stimulates beta2- Salbutamol is BASELINE ASSESSMENT
Sympathomimetics adrenergic receptors indicated for the Assess lung sounds, pulse, B/P, color,
in lungs, resulting in symptomatic relief characteristics of sputum noted. Offer emotional
relaxation of and prevention of support (high incidence of anxiety due to difficulty
bronchial smooth bronchospasm due to in breathing and sympathomimetic response to
muscle (little effect on bronchial asthma, drug).
HR). chronic bronchitis, INTERVENTION/EVALUATION
Therapeutic Effect: reversible obstructive Monitor rate, depth, rhythm, type of respiration;
Relieves airway disease, and quality and rate of pulse; ECG; serum potassium,
bronchospasm and other chronic glucose; ABG determinations. Assess lung
reduces airway bronchopulmonary sounds
resistance. disorders in which for wheezing (bronchoconstriction), rales.
bronchospasm is a PATIENT/FAMILY TEACHING
complicating factor, • Follow guidelines for proper use of inhaler.
and/or the acute • A healthcare provider will show you know to
prophylaxis against properly prepare and use your medication. You
exercise-induced must demonstrate correct preparation and
bronchospasm and injection techniques before using medication.
other stimuli known to
induce
bronchospasm.
Bronchodilators Atropine Competitively blocks To decrease Assessment & Drug Effects
Parasympatholytics acetylcholine secretions before  Monitor vital signs. HR is a sensitive
muscarinic receptor surgery, treatment of indicator of patient's response to atropine.
sites, blocking the parkinsonism, Be alert to changes in quality, rate, and
effects of the restoration of cardiac rhythm of HR and respiration and to
parasympathetic rate and arterial changes in BP and temperature.
nervous system. pressure following  Initial paradoxical bradycardia following IV
vagal stimulation, atropine usually lasts only 1–2 min; it
relief of bradycardia most likely occurs when IV is
and syncope due to administered slowly (more than 1 min) or
hyperactive carotid when small doses (less than 0.5 mg) are
sinus reflex, relief of used. Postural hypotension occurs when
pylorospasm, patient ambulates too soon after
relaxation of the parenteral administration.
spasm of biliary and Patient & Family Education
ureteral colic and  Follow measures to relieve dry mouth:
bronchospasm, adequate hydration; small, frequent
control of crying and mouth rinses with tepid water; meticulous
laughing episodes mouth and dental hygiene; gum chewing
associated with brain or sucking sugarless sourballs.
lesions, relaxation of  Note: Drug causes drowsiness, sensitivity
uterine hypertonicity, to light, blurring of near vision, and
management of temporarily impairs ability to judge
peptic ulcer, control of distance. Avoid driving and other activities
rhinorrhea associated requiring visual acuity and mental
with hay fever, alertness.
antidote for  Discontinue ophthalmic preparations and
cholinergic overdose, notify physician if eye pain, conjunctivitis,
and poisoning from palpitation, rapid pulse, or dizziness
various mushrooms. occurs.
 Do not breast feed while taking this drug
without consulting physician.
Bronchodilators Theophylline Directly relaxes Symptomatic relief or Assessment & Drug Effects
Methylxanthines
 bronchial smooth prevention of  Monitor vital signs. Improvement in
muscle, causing bronchial asthma and respiratory status is the expected
bronchodilation and reversible outcome.
increasing vital bronchospasm  Observe and report early signs of
capacity; also associated with possible toxicity: Anorexia, nausea,
increases force of chronic bronchitis and vomiting, dizziness, shakiness,
diaphragmatic emphysema. restlessness, abdominal discomfort,
muscle. irritability, palpitation, tachycardia, marked
hypotension, cardiac arrhythmias,
seizures.
 Monitor for tachycardia, which may be
worse in patients with severe cardiac
disease. Conversely, theophylline toxicity
may be masked in patients with
tachycardia.
Patient & Family Education
 Take medication at the same time every
day.
 Avoid charcoal-broiled foods (high in
polycyclic carbon content); may increase
theophylline elimination and reduce the
half-life as much as 50%.
 Limit caffeine intake because it may
increase incidence of adverse effects.
 Cigarette smoking may significantly lower
theophylline plasma concentration.

Corticosteroids Prednisone Inhibits accumulation Prednisone is BASELINE ASSESSMENT

of inflammatory cells indicated as an anti- Question medical history as listed in Precautions.
at inflammation sites, inflammatory or Obtain baselines for height, weight, B/P, serum
phagocytosis, immunosuppressive glucose, electrolytes. Check results of initial tests
lysosomal enzyme drug for allergic, (tuberculosis [TB] skin test, X-rays, ECG).
release/synthesis, dermatologic, INTERVENTION/EVALUATION
 release of mediators gastrointestinal, Monitor B/P, serum electrolytes, glucose, results
of inflammation. hematologic, of bone mineral density test, height, weight in
Therapeutic Effect: ophthalmologic, children. Be alert to infection (sore throat, fever,
Prevents/suppresses nervous system, vague symptoms); assess oral cavity daily for
cell-mediated renal, respiratory, signs of Candida infection. Monitor for symptoms
immune reactions. rheumatologic, of adrenal insufficiency, immunosuppression.
Decreases/prevents infectious, endocrine, PATIENT/FAMILY TEACHING
tissue response to or neoplastic • Report fever, sore throat, muscle aches, sudden
inflammatory conditions as well as weight gain, swelling, loss of appetite, or fatigue.
process. in organ transplant. • Avoid alcohol, minimize use of caffeine.
• Report symptoms of elevated blood sugar levels
Mast Cell Cromolyn Synthetic asthma- For the management Assessment & Drug Effects
Stabilizer Sodium prophylactic agent of patients with  Withhold drug and notify physician if any
with unique action. bronchial asthma. of the following occur; angioedema or
Inhibits release of Also used in the bronchospasm.
bronchoconstrictors— treatment of vernal  Monitor for exacerbation of asthmatic
histamine and SRS-A keratoconjunctivitis, symptoms including breathlessness and
(slow-reacting vernal conjunctivitis, cough that may occur in patients
substance of and vernal keratitis. receiving cromolyn during corticosteroid
anaphylaxis) from withdrawal.
sensitized pulmonary  For patients with asthma, therapeutic
mast cells, thereby effects may be noted within a few days
suppressing an but generally not until after 1–2 wk of
allergic response. therapy.
Has no intrinsic Patient & Family Education
bronchodilator,  Throat irritation, cough, and hoarseness
antihistaminic, or can be minimized by gargling with water,
vasoconstrictor drinking a few swallows of water, or by
properties, thus only sucking on a lozenge after each
of value when taken treatment.
prophylactically.  Talk to your physician about what to do in
the event of an acute asthmatic attack.
Cromolyn is of no value in acute asthma.
 Cromolyn does not eliminate the
continued need for therapy with
bronchodilators, expectorants, antibiotics,
or corticosteroids, but the amount and
frequency of use of these medications
may be appreciably reduced.