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Nursing Pharmacology

Made Incredibly Easy!
Third edition

Chapter 6
Respiratory drugs

©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs
Chapter objectives
• To learn the classes of drugs used to treat respiratory disorders
• To learn the uses and varying actions of these drugs
• To understand how these drugs are absorbed, distributed,
metabolized, and excreted
• To learn drug interactions and adverse effects of these drugs

©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs

Types of respiratory drugs
•Beta2-adrenergic agonists
•Anticholinergics
•Corticosteroids
•Leukotriene modifiers
•Mast cell stabilizers
•Methylxanthines
•Expectorants
•Antitussives
•Decongestants
©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs
Short-acting beta2adrenergic agonists

Long-acting beta2adrenergic agonists

Albuterol

• Albuterol (oral, systemic)

Bitolterol (systemic)

• Formoterol

Levalbuterol

• Salmeterol

Metaproterenol

• Combination agents

Pirbuterol

• Albuterol and ipratropium

Terbutaline (systemic)

• Salmeterol and fluticasone
• Budesonide and formeterol

©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs
Beta2-adrenergic agonists
Pharmacokinetics
• Minimally absorbed by the GI tract
• Inhaled forms absorbed from the respiratory tract
• Metabolized in the liver
• Excreted in urine and stool

©2012 Lippincott Williams & Wilkins. All rights reserved.

All rights reserved.Chapter 6: Respiratory drugs Beta2-adrenergic agonists Pharmacodynamics •Bronchodilation Pharmacotherapeutics •Asthma •Chronic obstructive pulmonary disease (COPD) ©2012 Lippincott Williams & Wilkins. .

. All rights reserved.Chapter 6: Respiratory drugs Beta2-adrenergic agonists Drug interactions •Beta-adrenergic blockers Adverse reactions •Bronchospasm •Tachycardia •Palpitations •Tremors ©2012 Lippincott Williams & Wilkins.

.Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. All rights reserved.

All rights reserved.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. .

. All rights reserved.Chapter 6: Respiratory drugs Anticholinergics: Ipratropium Pharmacokinetics •Minimally absorbed by the GI tract •Inhaled forms exert effects locally ©2012 Lippincott Williams & Wilkins.

Chapter 6: Respiratory drugs Anticholinergics: Ipratropium Pharmacodynamics • Bronchodilation Pharmacotherapeutics • Asthma (adjunctive therapy) • COPD ©2012 Lippincott Williams & Wilkins. All rights reserved. .

All rights reserved.Chapter 6: Respiratory drugs Anticholinergics: Ipratropium Drug interactions • Uncommon Adverse reactions • Paradoxical bronchospasm • Tachycardia • Nausea and vomiting • Nervousness • Dry mouth ©2012 Lippincott Williams & Wilkins. .

All rights reserved.Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. .

.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. All rights reserved.

.Chapter 6: Respiratory drugs Inhaled corticosteroids Oral corticosteroids •Beclomethasone dipropionate •Prednisolone •Budesonide •Prednisone •Ciclesonide •IV corticosteroids •Flunisolide •Dexamethasone •Fluticasone propionate •Hydrocortisone sodium succinate •Triamcinolone acetonide •Methylprednisolone sodium succinate ©2012 Lippincott Williams & Wilkins. All rights reserved.

.Chapter 6: Respiratory drugs Corticosteroids Pharmacokinetics •Oral forms: Readily absorbed and metabolized in the liver •Inhaled forms: Minimally absorbed •IV forms: Rapid onset ©2012 Lippincott Williams & Wilkins. All rights reserved.

.Chapter 6: Respiratory drugs Corticosteroids Pharmacodynamics • Cytokine. release other inflammatory mediators Pharmacotherapeutics • Asthma ©2012 Lippincott Williams & Wilkins. All rights reserved. recruit eosinophils. leukotriene. and prostaglandin inhibition.

.Chapter 6: Respiratory drugs Corticosteroids Drug interactions •Hormonal contraceptives •Ketoconazole •Macrolide antibiotics •Barbiturates •Cholestyramine •Phenytoin ©2012 Lippincott Williams & Wilkins. All rights reserved.

insomnia •Oral candidiasis • Hyperglycemia •Upper respiratory infection (URI) • Growth suppression in children •Cough and hoarseness ©2012 Lippincott Williams & Wilkins. . All rights reserved.Chapter 6: Respiratory drugs Corticosteroids Adverse reactions (inhaled forms) Adverse reactions (oral forms) • Nausea and vomiting •Mouth irritation • Headache.

Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. . All rights reserved.

All rights reserved.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. .

. All rights reserved.Chapter 6: Respiratory drugs Leukotriene receptor agonists Leukotriene formation inhibitors •Montelukast •Zileuton •Zafirlukast ©2012 Lippincott Williams & Wilkins.

excreted in stool •Zafirlukast: Absorption decreased by food. excreted in stool •All highly protein bound ©2012 Lippincott Williams & Wilkins. .Chapter 6: Respiratory drugs Leukotriene modifiers Pharmacokinetics •Montelukast: Rapidly absorbed. metabolized in the liver. All rights reserved. metabolized in the liver.

Chapter 6: Respiratory drugs Leukotriene modifiers Pharmacodynamics • Leukotriene inhibition Pharmacotherapeutics • Asthma ©2012 Lippincott Williams & Wilkins. . All rights reserved.

All rights reserved. .Chapter 6: Respiratory drugs Leukotriene modifiers Drug interactions • Multiple drugs Adverse reactions • Headache • Dizziness • Nausea and vomiting • Myalgia ©2012 Lippincott Williams & Wilkins.

Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. All rights reserved. .

.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs Mast cell stabilizers Pharmacokinetics • Absorbed by the GI tract • Inhaled forms exert effects locally ©2012 Lippincott Williams & Wilkins. . All rights reserved.

.Chapter 6: Respiratory drugs Mast cell stabilizers Pharmacodynamics • Inflammatory mediator inhibition Pharmacotherapeutics • Asthma ©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs Mast cell stabilizers Drug interactions • Uncommon Adverse reactions • Wheezing • Pharyngeal and tracheal irritation • Cough • Bronchospasm • Headache ©2012 Lippincott Williams & Wilkins. All rights reserved. .

All rights reserved. .Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins.

Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. All rights reserved. .

. All rights reserved.Chapter 6: Respiratory drugs Methylxanthines Pharmacokinetics • Oral: Absorbed by the GI tract • Metabolized in the liver • Excreted in urine ©2012 Lippincott Williams & Wilkins.

. All rights reserved.Chapter 6: Respiratory drugs Methylxanthines Pharmacodynamics • Bronchodilation • Inflammatory mediator reduction • Bronchospasm reduction Pharmacotherapeutics • Asthma • Chronic bronchitis • Emphysema ©2012 Lippincott Williams & Wilkins.

abdominal cramping. anorexia. palpitations. and arrhythmias ©2012 Lippincott Williams & Wilkins.Chapter 6: Respiratory drugs Methylxanthines Drug interactions • Multiple drugs and substances Adverse reactions • GI: Nausea. vomiting. and diarrhea • CNS: Headache. anxiety. restlessness. insomnia. irritability. epigastric pain. All rights reserved. and dizziness • Cardiovascular: Tachycardia. .

Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. All rights reserved. .

. All rights reserved.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins.

.Chapter 6: Respiratory drugs Expectorants: Guaifenesin Pharmacokinetics • Absorbed from the GI tract • Metabolized in the liver • Excreted by the kidneys ©2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs Expectorants: Guaifenesin Pharmacodynamics • Respiratory tract fluid production increase • Mucus surface tension reduction • Mucous membrane soothing ©2012 Lippincott Williams & Wilkins. . All rights reserved.

. All rights reserved.Chapter 6: Respiratory drugs Expectorants: Guaifenesin Pharmacotherapeutics • Bronchial asthma • Bronchitis • Emphysema • Influenza • Minor bronchial irritation • Sinusitis ©2012 Lippincott Williams & Wilkins.

Chapter 6: Respiratory drugs Expectorants: Guaifenesin Drug interactions • None known Adverse reactions • Nausea and vomiting • Diarrhea • Abdominal pain • Drowsiness • Headache • Hives and rash ©2012 Lippincott Williams & Wilkins. . All rights reserved.

Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. . All rights reserved.

. All rights reserved.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins.

Chapter 6: Respiratory drugs Antitussives •Benzonatate •Codeine •Dextromethorphan hydrobromide •Hydrocodone bitartrate ©2012 Lippincott Williams & Wilkins. . All rights reserved.

All rights reserved. .Chapter 6: Respiratory drugs Antitussives Pharmacokinetics • Absorbed from the GI tract • Metabolized in the liver • Excreted by the kidneys ©2012 Lippincott Williams & Wilkins.

Chapter 6: Respiratory drugs Antitussives Pharmacodynamics • Benzonatate: Stretch receptor anesthetization • Codeine. dextromethorphan. and hydrocodone: Cough reflex suppression Pharmacotherapeutics • Cough ©2012 Lippincott Williams & Wilkins. All rights reserved. .

.Chapter 6: Respiratory drugs Antitussives Drug interactions • Monoamine oxidase inhibitors (MAOIs) • CNS depressants ©2012 Lippincott Williams & Wilkins. All rights reserved.

respiratory arrest ©2012 Lippincott Williams & Wilkins. . nausea.Chapter 6: Respiratory drugs Antitussives Adverse reactions • Benzonatate: Dizziness. dizziness. chills. sedation. nasal congestion. headache. vomiting. constipation. rash. All rights reserved. chest numbness • Opioid antitussives: Nausea. bradycardia. constipation. hypotension.

Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. . All rights reserved.

All rights reserved.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. .

. All rights reserved.Chapter 6: Respiratory drugs Decongestants Topical decongestants •Systemic decongestants •Ephedrine •Ephedrine •Epinephrine •Phenylephrine •Phenylephrine •Pseudoephedrine •Naphazoline •Tetrahydrozoline ©2012 Lippincott Williams & Wilkins.

. All rights reserved. excreted in urine • Topical: Act locally on alpha receptors in the nose ©2012 Lippincott Williams & Wilkins.Chapter 6: Respiratory drugs Decongestants Pharmacokinetics • Systemic: Absorbed from the GI tract. metabolized by the liver.

All rights reserved.Chapter 6: Respiratory drugs Decongestants Pharmacodynamics • Systemic: Vasoconstriction through alpha-adrenergic receptors in blood vessels of the body • Topical: Vasoconstriction through alpha-adrenergic receptors in nasal blood vessels Pharmacotherapeutics • Acute coryza • Allergic rhinitis • Common cold • Sinusitis • Vasomotor rhinitis ©2012 Lippincott Williams & Wilkins. .

. MAOIs. alkalinizing drugs • Topical: None known ©2012 Lippincott Williams & Wilkins.Chapter 6: Respiratory drugs Decongestants Drug interactions • Systemic: Sympathomimetic drugs. All rights reserved.

and insomnia • Nausea • Palpitations • Tachycardia • Elevated blood pressure • Difficulty urinating ©2012 Lippincott Williams & Wilkins.Chapter 6: Respiratory drugs Decongestants Adverse reactions: Systemic • Nervousness. restlessness. . All rights reserved.

.Chapter 6: Respiratory drugs Decongestants Adverse reactions: Topical • Rebound nasal congestion • Burning and stinging of nasal mucosa • Sneezing • Mucosal dryness or ulceration ©2012 Lippincott Williams & Wilkins. All rights reserved.

.Chapter 6: Respiratory drugs Nursing process Assessment •Assess for signs and symptoms of adverse reactions •Assess for therapeutic effects of the drug Planning •Therapeutic effects of the drug will be observed •Patient will demonstrate correct drug administration ©2012 Lippincott Williams & Wilkins. All rights reserved.

All rights reserved.Chapter 6: Respiratory drugs Nursing process Implementation •Administer drug as prescribed •Monitor for effects of drugs and report adverse reactions Evaluation •Patient’s underlying condition improves •Patient and family demonstrate an understanding of the drug therapy ©2012 Lippincott Williams & Wilkins. .