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Arlyn C.


Respiratory drugs
The respiratory system, extending

from the nose to the pulmonary capillaries, performs the essential function of gas exchange between the body and its environment. In other words, it takes in oxygen and expels carbon dioxide.

Antiasthmatic Drugs
 In

2002, the National Asthma Education and Prevention Program updated guidelines for diagnosing and managing asthma.  Drugs are classified as long-term and quick relief medication with a stepwise approach to treatment.  Anticholinergic bronchodilators , antileukotriene agonists, synthetic glucocorticoids, and mast cell stabilizers are used for long term control of asthma.

Synthetic budesonide (pulmicort) vanceril) glucocorticoids Flunisolide (aerobid). flonase) Mometasone furoate (elocon. fluticasone propionate (flovent. nasacort) .Antiasthmatic Drugs Prototype Related drugs Classification Ipatropium (atrovent) Iotropium bromide (spiriva) Ipatropium/albuterol (combivent) Anticholinergic bronchodilators beta2 antagonist Combination Anticholinergic bronchodilator Antileukotriene Antagonists and Zafirlukast (accolate) Zileuton (zyflo) Montelukast (sigulair) Beclomethasone(beclovent. nasonex) Triamcinolone acetoride (azmacort.

Antiasthmatic Drugs Prototype Related drugs Salmeterol fluticasone (advair diskus) Cromolyn (Intal. nasalcrom) Nedocromil (tilade) Classification Combination gluciocorticoid and beta2 antagonist Mast cell stabilizers .

May inhibit release of histamine and other mediators of mast cells  Mast cells stabilizers  . Block leukotriene-mediated bronchoconstriction that decreases bronchial edema and inflammation seen in asthma. action is slow and prolonged.  Antileukotriene Antagonist   Synthetic Glucocorticoids  Decrease inflammation and enhance betaagonist activity.A n t i a s t h m a t i c D r u g s  Mechanism of Action  Anticholinergic Bronchodilators  Antagonizes acetylcholine. which causes bronchodilation.

These are not used to treat acute asthma attacks. with improvement seen in about 1 week.A n t i a s t h m a t i c D r u g s  Therapeutic use  Anticholinergic Bronchodilators   Prevention of spasm in COPD. Indicated to decrease the severity and frequency of asthma attacks. Prophylaxis of asthma. Treatment of chronic asthma Used intranasally for treatment of seasonal allergies. Rhinitis not responsible to other decongestants. Intranasal – allergic and non-allergic perennial rhinitis.  Antileukotriene antagonists   Synthetic Glucocorticoids    Mast Cell Stabilizer  .

A n t i a s t h m a t i c D r u g s

 Adverse effects ansd side effects  Anticholinergic Bronchodilators

  

Pregnancy category B, except for Tiotropium bromide (spiriva), which is category C. CNS: headache, nervousness, blurred vision EENT: Sore throat, cough, dry mouth. GI: GI irritation, nausea
Pregnancy category B, although Zileuton (Zyflo) is a category. CNS: Headaches, dizziness GI: Nausea, vomiting and diarrhea Increased incidence of infection over age 55 Liver dysfunction

 Antileukotriene Antagonists

   

A n t i a s t h m a t i c D r u g s

 Synthetic Glucocorticoids  Pregnancy category C  CNS: Dizziness, headache  EENT: Unpleasant taste, oral fungal infection, cough  GI: GI distress  Mast Cell Stabilizers  Pregnancy category B  CNS: dizziness, headache  GI: unpleasant taste  resp: cough, bronchospasm, and throat irritation

A n t i a s t h m a t i c D r u g s

 Drug interactions  Anticholinergic bronchodilators

Additive Anticholinergic effects with concurrent use of other anticholinergics .

 Antileukotriene Antagonists

Zileuton (Zylo)
 

Concurrent use with warfarin increases risk of bleeding Concurrent use with theophylline decrease zafirlukast and Zileuton levels. Concurrent use with aspirin increases zafirlukast levels. Concurrent use with erythromycin decreases zafirlukast levels. Concurrent use with Propanolol increases propranolol levels.

Zafirlukast (Accolate)
 

Zileuton (Zyflo)

atropine and derivatives. Status asthmaticus .A n t i a s t h m a t i c D r u g s  Contraindication  Anticholinergic bronchodilators   Hypersensitivity to ipratropium. breast feeding Hypersensitivity  Antileukotriene Antacids   Synthetic Glucocorticoids   Mast Cell Stabilizers   Hypersensitivity. Propellant use to make inhaled ipratropium is contraindicated in clients with peanut allergies Hypersensitivity.

A n t i a s t h m a t i c D r u g s  Nursing Implications  All antihistamine Monitor vital signs throughout treatment  Assess lung sounds and respiratory function throughout treatment.  .

Available orally Periodically monitor liver function studies Monitor and report symptom  Antileukotriene Antacids    . followed by ipratropium. administer adrenergic bronchodilator first. If administered with other inhalation medications.A n t i a s t h m a t i c D r u g s  Nursing Implications  Anticholinergic bronchodilators    Administered by inhalation or intranasally Contact health care provider if severe bronchospasm present so that an alternative medication may be ordered. and wait 5 minutes between medications. then corticosteroid.

.A n t i a s t h m a t i c D r u g s  Synthetic Glucocorticoids  monitor for adverse effects and report to health care provider. take at least 10 to 15 minutes before exposure. ophthalmic use for allergy.  Do not administer during an acute asthma or status asthmaticus.  If taking before exercise or exposure to allergy.  Mast Cell Stabilizers  Available by inhalation or intranasally.

Do not discontinue without consulting with health care provider do not double dose if a dose is missed. use a spacer if recommended by health care provider.A n t i a s t h m a t i c D r u g s  Patient Teaching  All antihistamine       Follow directions and use medications as ordered. . Consult with health care provider before taking OTC medications or herbal remedies. Teach client how to use meter dose inhalers. For inhaled agents.

but not acute asthma attacks. water. Encourage follow-up with HCP for periodic liver function enzyme testing. or hard candy helps to decrease dryness. Avoid getting drugs into the eyes. contact health care provider .A n t i a s t h m a t i c D r u g s  Patient teaching  Anticholinergic bronchodilators     Good mouth care. If symptoms do not improve within 30 minutes after taking. These drugs are used for prophylaxis and chronic asthma.  Antileukotriene Antacids   . Keep a record of number of inhalation instead of floating canister in water to estimate how much drug is left in the canister..

Churg Strauss syndrome is more apt to occur when weaning from systemic steroids. Use a spacer if recommended by health care provided. A systemic glucocorticoids may be ordered during an acute asthma attacks. Rinse mouthpiece in warm water after each use.Strauss syndrome to HCP. and wait 5 minutes. use the bronchodilator first. Occurs rarely. If using inhaled synthetic glucocorticoids and bronchodilator. rinse mouth after taking medication. Contact health care provider if sore mouth or throat occurs Allow 1 to 2 minutes between inhalations if a second inhalation is ordered. Inhaled synthetic glucocorticoids are not used to treat acute asthma attacks but should be continued if other agents are used.  Inhaled synthetic Glucocorticoids        . but can be life threatening.A n t i a s t h m a t i c D r u g s  Patient teaching   Report symptoms of Churg. Take on an empty stomach. To prevent fungal infection.

.Bronchodilators Drugs  Bronchodilators dilate the bronchi and bronchioles and include two classes of drugs:  Beta – agonists  Xanthine derivatives  The beta-agonist are also called sympathomimetic bronchodilators.

lufyllin) . Aminophylline (truphylline) Xanthine derivatives Slo-bid) Dyphylline (dilor. volmax)) Bitolterol (tornalate) Formoterol (Foradil) Levalbuterol (Xopenex) Pirbuterol (maxair) Salmeterol (serevent) Terbutaline (brethaire.Bronchodilators Drugs Prototype drug Epinephrine (adrenalin. bricanyl) Theophylline (Theo-Dur. isoetharine HCL & metraproterenol) (non selective betaagonist) Beta 2 agonist Albuterol (proventil. primatene. bronkaid) Related drugs Isoproterenol solution (isuprel) Isoetharine HCL (bronkosol) Metraprorenol (alupent) Drug classification Beta-agonist (sympathomimetics) Alpha-beta-agonist (epinephrine) beta-1-beta2-agonist (isoproterenol. ventolin.

causing bronchodilators. Xanthine contains caffeine.B r o n c h o d i l a t o r s  Mechanism of Action  Non selective Beta1 –Beta2-Agonist  Stimulate beta1 receptors in the heart and beta2 receptors in the heart and lungs. so caffeine intake should be minimized. D r u g s  Selective Beta2-Agonists   Xanthine derivatives    . relax bronchial smooth muscle and dilates trachea and bronchi by increase levels of cyclic adenosine monophosphate (cAMP) Predominately stimulate the beta2 receptors in the lungs and increase levels of cAMP. Increase cAMP causing brochodilation Also have diuretic and positive inotropic and chronotropic effects and cause gastric acid secretion and CNS stimulation.

Also used to prevent exercise-induced bronchpspasm in clients over age 12.B r o n c h o d i l a t o r s  Therapeutic Use  Beta-Agonists  Bronchial asthma.  Formoterol (Foradil)   . bronchitis.  Alpha-Beta-Agonist D r u g s  Also used to treat hypotension and shock Also used to treat hyperkalemia Bitolterol (Tornalate)   Selective Beta2-Agonist   Has a long onset of action and use for prophylaxis of bronchospasm in clients over age 12. and other pulmonary disease. bronchospasm. Used for maintenance treatment of asthma and prophylaxis of bronchospasm in clients over age 5 with reversible obstructive airway disease.

and ventricular dysrhythmias. shock. and prevention of exerciseinduced asthma.B r o n c h o d i l a t o r s  Selective Beta2-Agonist  Isoproterenol (Isuprel)  Also indicated for heart block.  Xanthine Derivatives  Prevention and treatment of bronchial asthma. and COPD . bronchitis.  D r u g s Salmeterol (Serevent)  Has a long-onset of action and indicated for maintenance therapy of asthma. prevention of bronchospasm in selected clients over age 4 with reversible airway disease.

and cardiac arrest CNS: anxiety. tachycardia. nervousness. and headache. insomia. which is category B. restlessness. CV: palpitation. dizziness. tremors.B r o n c h o d i l a t o r s  Adverse effects and side effects  Non selective beta1-beta2-agonist    D r u g s   Pregnancy category C CV: palpitation. bricanyl). headache and insomia Endocrine: hyperglycemia GI: nausea and vomiting  Selective beta2-agonists      . hypertension. hypertension CNS: tremors. Endocrine: hyperglycemia GI: nausea and vomiting Pregnancy category c except terbutaline (brethare.

insomnia. nausea. GI: anorexia. headache. and tremors. vomiting and cramps . dysrhythmias. and palpitations CNS: anxiety. seizures.B r o n c h o d i l a t o r s  Adverse effects and side effects  Xanthine derivatives  D r u g s    Pregnancy category C CV: tachycardia.

B r o n c h o d i l a t o r s  Drug interactions  All bronchodilators  Concurrent use with sympathomimetic can increase cardiac and CNS stimulation. Concurrent use with monoamino oxidase inhibitors (MAOIs) may cause hypertensive crisis. Concurrent use with caffeine may cause stimulation effects. Increased risk of hypokalemia if taken with potassium-sparing diuretics. Concurrent use of beta-blockers may antagonize therapeutic effects. D r u g s  Beta-agonists     .

oral contraceptives. interferon. erythromycin. and corticosteroids. Nicotine may increase metabolism and decrease effectiveness of xanthines.  Contraindications  All brochodilators  Hypersensitivity tachydyrhythmias  Beta-agonist and xanthine derivatives  .B r o n c h o d i l a t o r s  Drug interactions  Xanthine derivatives  D r u g s  Increase theophylline levels with concurrent use of allopurinol. benzodiazepines cimetidine. beta-blockers. influenza vaccine.

Available by inhalation Albuterol.B r o n c h o d i l a t o r s  Nursing Implications  All Bronchodilators   D r u g s   Monitor vital signs Assess lung sounds Encourage fluids unless contraindicated. Isoproterenol (Isupril) is also available IV and SL. metaproterenol. and also available orally.  Beta-agonist    . Careful monitoring of the elderly as they are more susceptible to adverse reactions.

Monitor cardiac status and report changes to health care provider. Oral medication can be given with food to decrease GI effects.0 to 20. Clients with cardiac history should be monitored for EKG changes or chest pain. Nursing Implications (cont’) B r o n c h o d i l a t o r s    Terbutaline is also available SC. IV rate should not exceed 20 to 25 mg/min. Wait 4 to 6 hours after IV therapy is discontinued before giving first dose orally. Oral drug can be given with food if GI effects occur. Available PO.  xanthine derivatives  D r u g s          . or rectally Give over 24 hours to maintain therapeutic levels.0 mcg/ml Use an infusion pump and give slowly when administered IV. Monitor I & O Monitor for drug toxicity and notify health care provider if toxicity occurs. Monitor theophyline levels: therapeutic range 10. parenterally.

dizziness. nausea. Report adverse effects such as feeling jittery. or other sx to health care provider. Take exactly as prescribed and do not double up on missed doses. Avoid caffeine. insomnia. Take oral medication with meals to decrease GI upset. palpitations.  Beta-agonists  D r u g s   Xanthines      . vomiting. Avoid tobacco use as nicotine increases the metabolism of xanthines. as caffeine acts as xanthine during therapy. restlessness. chest pain.B r o n c h o d i l a t o r s  Patient teaching  All bronchodilators   Check with health care provider taking OTC medications and herbal remedies. Report adverse effects such as palpitations. chest pain. or other symptoms to health care provider. Do not chew or crush enteric coated or sustained release products. Take with food if GI upset occurs. weakness.

ipratropium. take the bronchodilator first to open up the airways. . such as salmetrol. If taking a bronchodilator and steroid.  If taking a beta-agonist with an anticholinergic take the beta-agonist before taking the Anticholinergic. should be taken before slower or longer acting brochodilators. such as albuterol.  Canister contains measured doses of medication. followed by the steroid.B r o n c h o d i l a t o r s D r u g s  Meter-dose inhalaler  Instruct client on proper use of MDI.  Fast-acting bronchodilators.

2nd generation or non sedating agents. Sedation is a problem seen with first generation antihistamines. .Antihistamines  Also known as H1 antagonist and directly compete with histamine for specific Antihistamine are categorized as 1. receptor sites. ethanolamines. piperidines. 2. ethylenedilamines. 1st generation which include the chemical classes of alkylamines. phenothiazines.

) Bronphineramine (Dimetane) Chlorpeniramine (chlor-trimeton) Dexchlorpheniramine (polaramine) Classificaton First generations antihistamine Traditional antihistamines (ethanolamines) Alkylamines D r u g s a There is no prototype Tripelennamine (Pyribenzamine) Ethylenediamines Buclizine (Bucladin-S) Phenothiazines Meclizine (Antivert) Cyclizine (marezine) Promethazine (phenergan) Trimeprazine (Temaril) . benzacot. tigan. Prototype drug A n t r i h i s t a m i n e Diphenhydramnie (benadryl) Related drug Clemastine (Tavist) Dimenhydrinate (Dramamine) Trimethobenzamide HCL (arrestin.

vistaril. A n t i h i s t a m i n e Prototype Related drugs Azatadine (optimine) Cyproheptadine (PERIACTIN) Hydroxyzine (Atarax). others c.lassification Piperidines D r u g s Loratidine (claritine) Azelastine (Astelin) Cetirizine (Zyrtec) Fexofenadine(alle gra) 2nd generation antihistamines Nonsedating histamines .

adjunctive therapy of anaphylaxis.  2nd generation. allergic.A n t i h i s t a m i n e D r u g s  Mechanism of action  H1 blockers block the effects of histamine by competing for H1 receptor site. Parkinsons disease and a sleep aid (first generation) .  2nd generation antihistamines have a longer duration of action and fewer anticholinergic effects than 1st generation antihistamines  Therapeutic use  Rhinitis.which reduces or prevents sedation. nausea. vertigo. motion sickness. non sedating antihistamines do not cross the blood brain barrier. colds.

or constipation GU: urinary retention . tachycardia. CNS: sedation in 1st generation Derm : photosensitivity Blurred vision GI: dry mouth.A n t i h i s t a m i n e  Adverse effects  All antihistamines  D r u g s      Anticholinergic effects: first generation antihistamines. and constipation: 2nd generation have minimal effects. GI upset. dry mouth dilated pupils urinary retention. diarrhea.

and hydroxyzine. .  Pregnancy category B. brompheniramine. narrow angle glaucoma and stenosing peptic ulcer.A n t i h i s t a m i n e D r u g s  First generation Antihistamines and second generation antihistamines. promethazine.  Unclassified pregnancy category are triplennamine and trimeprazine. triamethobenzamide HCL.  Contraindication  Hypersensitivity  Lactation  Clients with lower respiratory tract disease  Acute asthma attacks  Cautious use with bladder neck obstruction. although azelastine. cyclizine. vistaril and others are category C.

antidepressants. and chamomile may cause additive CNS depression. . kava-kava. valeria.A n t i h i s t a m i n e D r u g s  Drug interactions  Concurrent use with alcohol or other CNS depressants.  Concurrent use with MAOIs can intensify antihistamine effects  Concurrent use of erythromycin or ketoconazole with loratidine and fexofenadine increases concentrations of loratidine and foxefenadine.

discontinue antihistamine use for atleast 4 days before testing.  Antihistamine used for motion sickness should be given at least 30minutes before exposure to situations that may cause motion sickness.  Monitor VS  Assess lung sounds.  Azelastine Asteline is available as nasal and opthalmic agent. PR. .A n t i h i s t a m i n e D r u g s  Nursing implications  Give PO. IM. and allergy symptoms  Unless contraindicated. encourage fluid intake  If client is undergoing allergy testing. or topically. they should be given at least 2o minutes before bedtime. secretions. IV. some antihistamines may also be given SC.  When anti histamine are used as sleep aid. as antihistamine may decrease skin response to allergy test.

 Take with food to decrease GI upset  Encourage fluids and hard candy to minimize anticholinergic effects of dry mouth.  If possible take at bedtime to avoid daytime sedation.  Avoid alcohol and taking other CNS depressants. take as directed.A n t i h i s t a m i n e D r u g s  Patient teaching  Avoid driving or operating heavy machinery.  Wear sunscreen and protective gear to prevent photosensitivity  As many of these drugs are available OTC. .  Inform health care provider and dentist if taking antihistamines.

. Oral decongestants have a delayed onset with prolonged and less potent effects while topical decongestants produce rapid and potent effects. in turn shrinking mucous membrane and relieving congestion.  Decongestant are available orally and topically.Decongestant Drugs  Decongestant are used to decrease nasal congestion caused by stimulation of the alpha1-adrenergic receptors on the nasal blood vessels. which causes vasoconstriction.

dorcol. Coricidin. decofed) Tetrahydrozoline (Tyzine) Xylometazoline (otrivin) Drug classification Decogestants (sympathomimetics) a n t . others) Pseudo-ephedrine hcl (sudafed. D e c o n D g s t r g s e u Prototype drug Ephedrine (Pretz-D) Related drugs Naphazoline (privine) Oxymetazoline (afrin) Phenylephrine (neoSynephrine.

and tachycardia. dyspnea seen more frequently with oral agents  CNS: stimulation.  Adverse effects and side effects. fever . restlessness. palpitations. headache. sinusitis and colds. seen more frequently with oral agents  GI: N&V  Other: rebound congestion with topical agents.D e c o n D g s t r g s e u a n t  Mechanism of Action  Causes vasoconstriction through the stimulation of the alpha1 adrenergic receptors on the nasal blood vessel causing shrinkage of the nasal membranes.  Pregnancy category C  CV: hypertension. nervousness.  Therapeutic use  Congestion seen with acute or chronic rhinitis.

 Contraindications  Hypersensitivity  Hypertension (oral use)  CAD (oral use)  Nursing implications  Many decongestants are OTC agents  Monitor vital signs and assess lung sounds and congestion periodically throughout the therapy.D e c o n D g s t r g s e u a n t  Drug Interaction  Concurrent use with other sympathomimetic can increase toxicity. palpitations. .  Concurrent use with MAOIs can cause hypertensive crisis. or tachycardia and report symptoms to health care provider.  Monitor for hypertension.

D e c o n D g r e u s g t a n s t  Patient Teaching  Avoid concurrent use of OTCs and herbal remedies without consulting health care provider.  May cause cardiac or CNS stimulation.  Encourage fluids unless contraindicated. .  Avoid caffeine while taking decongestants. or insomnia. Report sx to HCP.  Avoid taking near bedtime to prevent insomni.  Take exactly as directed  Topical decongestants should not be taken for more than 3 to 5 days to avoid rebound decongestion  Contact HCP if sx persist for more than a week or if rash occurs. restlessness. such as palpitations.

They are typically used to treat dry. .Antitussive Drugs  Antitussive drugs suppress or inhibit coughing.  There are two categories of Antitussive. they are opiods and non-opioids.  Prescriptions antitussives are usually indicated when OTC preparations have not been effective. non-productive coughs.

Tussar SF) Related drugs Drug classification Non-opioid antitussives Benzonanate (tessalon) There is no related drugs at this time Hydrocodone (hycodan) Non-opioid antitussives Locally acting Antitussive antihistamine Opioid antitussive .Antitussive Drugs Prototype Dextromethorphan (Vicks formula 44. Robitussin DM) Diphenhydramine (benylin. benadryl) Codeine (Dimetane-DC.

 Antitussive antihistamines  Antagonize histamine effects at H receptor sites.  Non-opioid antitussives (locally acting)  Anesthetize or numb the stretch receptors and keep the cough reflex being stimulated in the medulla. They are available OTC. and suppress cough. They do not cause addiction nor CNS depression like the opiods antitussives . with analgesic effect. CNS depressant and anticholinergic effects.  Opioid antitussives  Narcotic analgesics available by prescription only. . Suppress the cough reflex through direct action to the medullary cough center.Antitussive Drugs  Mechanism of Actions  Nonopioid Antitussives  Suppress the cough reflex through direct action to the cough center. Available only by prescription.

headache. Nausea . and sedation  Derm: pruritus  EENT: Nasal Congestion  GI: constipation. drowsiness GI: Nausea  Non-opioid antitussives (Locally acting)  Pregnancy category C  CNS: dizziness.  Adverse effects and sideeffects  Non-opioid antitussives    Pregnancy category unknown CNS: dizziness.Antitussive Drugs  Therapeutic use  Symptomatic relief for non-productive coughs or in situations when coughing may be harmful.

nausea and vomiting  GU: urinary retention  Resp: respiratory depression . anticholinergic effects. constipation. and headache  GI: constipation.Antitussive Drugs  Antitussive antihistamines  Pregnancy category B  CNS: drowsiness. headache and dizziness  GI: dry mouth. and diarrhea  Derm: Photosensitivity  Opioid antitussives  Pregnancy category C  CV: Hypertension  CNS: confusion. anorexia. sedation.

antihistamines and sedative/hypnotics and opiods. sedation.  Antitussive antihistamine  Additive CNS depression with alcohol. nausea and vomiting  GU: urinary retention  Resp: respiratory depression .  Additive anticholinergic effects with TCA.  MAOIs intensify and prolong anticholinergic effects of antihistamine. antihistamines and antidepressants.  opioid antitussives  Pregnancy category C  CV: hypertension  CNS: confusion. or quinidine. and headache  GI: constipation. sedative/hypnotics and opiods. sedative/hypnotics and opiods.  Non-opioid antitussives (locally acting)  Additive CNS depression with alcohol. disopyramide. Interactions  Non-opioid antitussives   Antitussive Drugs Concurrent use with MAOIs may cause serotonin syndrome Additive CNS depression with alcohol. antihistamines and antidepressants.

 Contradictions  All antitussives   Antitussive Drugs Hypersensitivity Should not be used for chronic productive cough  Non-opioid antitussives  Clients taking MAOIs  May contain alcohol and should be avoided by recovering alcoholics  Non-opioid antitussives (locally acting)  Cross sensitivity to benzonatate or related compounds.  Antitussive – antihistamines  Acute asthma attacks  Lactation  Liquid products may contain alcohol and should be avoided by recovering alcoholics.  Opioid antritussives  Clients with severe respiratory disorders or respiratory depression  Seizure disorders  Increased intracranial pressure .

Antitussive Drugs  Nursing Implications  All antitussives   Administered orally Assess lung sounds. .  Shake oral suspensions before giving.  Non-opioid antitussives (locally acting)  Instruct client to chew capsule. as a benzonate from capsules may cause a local anaesthetic effect and choking  Opioid antitussives  Assess for constipation  Antidote: nalaxone (narcan)  Prolonged use can lead to physical or psychological dependence. cough and type and amount of sputum  Non-opioid antitussives  Do not gives immediately after administering to prevent dilution of drug.

nonproductive cough. . fever.  Encourage fluid intake unless contraindicated  Avoid drinking fluids for at least 30 minutes after taking an antitussive  Contact health care provider if cough persists for more than a week. or persistent headache occurs. or if a rash.Antitussive Drugs  Patient Teaching  Avoid concurrent use of OTCs and herbal remedies without consulting with physician.  Use an antitussive for a dry.  Avoid driving or operating heavy machinery while taking antitussives as they may cause drowsiness.

Expectorant Drugs  Expectorants stimulate the flow of the respiratory tract secretions. which makes the cough more effective. . which makes more productive.  Guafenesin (Robitussin) is a widely used and popular expectorant.  Expectorant can be given as a single agent or in combination with other drugs. Mucolytics work directly on mucus to make it more watery.

Expectoraants Prototype Guaifenesin (robitussin.others) Related Drugs There are no related drugs Drug classification Expectorants Acetylcysteine (Mucomyst) Dornase alfa (pulmozyme) Mucolytics (antidote: acetaminophen Tylenol) Cystic fibrosis drug .

more soluble. Split links in the respiratory mucoprotein molecules into smaller. which mobilizes and allows for expectoration of mucus. Also indirectly irritates the GIT.  Mucolytics   . which can cause N&V Decreases viscosity of pulmonary secretions. In acetaminophen (tylenol) overdose. it alters hepatic metabolism to decrease liver injury.Expectorants  Mechanism of action  Expectorants   Reduces viscosity of secretions by increasing respiratory tract fluid. and less viscous strands.

Expectorants  Therapeutic use  Expectorants  Relief of coughs associated with viral upper respiratory tract infactions  Mucolytics    Adjunct treatment of thick tenacious mucus in cystic fibrosis and bronchopulmonary disease Antidote for acetaminophen toxicity Dornase alfa used for management of cystic fibrosis .

N&V Pregnancy category B CNS: dizziness. wheezes Other: conjunctivitis.Expectorants  Adverse effects and sideeffects  Expectorants   Pregnancy category C GI: GI upset. hepatotoxicity. hemoptysis. drowsiness GI: Nausea. stomatitis. rhinorrhea Resp: cough pharyngitis. chest pain  Mucolytics      Dornase alfa   . unpleasant odor (sulfur in drug may smell like rotten eggs) Resp: bronchospasm.

Expectorants  Interactions  Expectorants  Non significant Acetylcysteine contains hydrogen sulfide and will discolor iron.  Mucolytics  . copper and harden rubber.

Expectorants  Contraindications  All expectorants and Mucolytics  Hypersensitivity Some – guaifenesin-containing products contain alcohol and should be avoided by recovering alcoholics  Expectorants   Mucolytics   Status asthmaticus and increased ICP Dornase alfa hypersensitivity .

and characterestics.Expectorants  Nursing implications  All expectorants and mucolytics  Assess lung sounds and cough including: type. instillation via endotracheal tube or orally  Monitor vital signs  Encourgae coughing after administration  Suction if indicated after treatment  Maintain good oral hygiene  Percussion and good postural drainage may assist client in eliminating secretions  Administer treatment at least 30 minutes to 1 hour before meals to prevent nausea  Use within 48 hours after opening and store in refrigerator . frequency.  Expectorants  Hypersensitivity  Acetylcysteine (mucomyst)  Available by inhalation via nebulizer.

electrolytes. BUN.  Antidote use of mucomyst    . acetamenophen levels. if 24 hours or less. Monitor liver function test.Expectorants  Nursing implications (cont)  Dornase alfa   Store in refrigerator and protect from light Review use of nebulizer Give immediately. and cardiac function Oral use: can be given with water and use within an hour.

 Acetylcyteine  Has a charecteristic rotten egg odor due to release of hydrogen sulfide  Use good oral hygiene during therapy . unless contraindicated. Dispose of tissues and secretions properly. Encourage fluid intake to help liquefy secretions. cough. Cough effectively by splitting up. taking several slow deep breaths before coughing. or other symptoms lasting longer than 1 week to health care provider. Guaifenesin  Liquid product may contain alcohol and sugar and recovering alcoholics and diabetic clients should avoid use. Report fever.Patient teaching  Avoid concurrent use of OTCs and herbal medicines without      consulting with physicians. headache.

Thanks for listening Happy Vacation Guys .