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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.

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. 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.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients 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. All rights reserved.

Chapter 6: Respiratory drugs


Anticholinergics: Ipratropium
Pharmacodynamics
Bronchodilation
Pharmacotherapeutics
Asthma (adjunctive therapy)
COPD

2012 Lippincott Williams & Wilkins. 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. All rights reserved.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients 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, leukotriene, and prostaglandin inhibition; recruit
eosinophils; release other inflammatory mediators
Pharmacotherapeutics
Asthma

2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs


Corticosteroids
Drug interactions
Hormonal contraceptives
Ketoconazole
Macrolide antibiotics
Barbiturates
Cholestyramine
Phenytoin

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, 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


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
Patients 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. All rights reserved.

Chapter 6: Respiratory drugs


Leukotriene modifiers
Pharmacokinetics
Montelukast: Rapidly absorbed; metabolized in the liver; excreted in
stool
Zafirlukast: Absorption decreased by food; metabolized in the liver;
excreted in stool
All highly protein bound

2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs

Leukotriene modifiers
Pharmacodynamics
Leukotriene inhibition
Pharmacotherapeutics
Asthma

2012 Lippincott Williams & Wilkins. 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. 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.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients 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.

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
Patients underlying condition improves
Patient and family demonstrate an understanding of the drug therapy

2012 Lippincott Williams & Wilkins. 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. All rights reserved.

Chapter 6: Respiratory drugs


Methylxanthines
Drug interactions
Multiple drugs and substances
Adverse reactions
GI: Nausea, vomiting, abdominal cramping, epigastric pain, anorexia,
and diarrhea
CNS: Headache, irritability, restlessness, anxiety, insomnia, and
dizziness
Cardiovascular: Tachycardia, palpitations, and arrhythmias

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.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients underlying condition improves
Patient and family demonstrate an understanding of the drug therapy

2012 Lippincott Williams & Wilkins. All rights reserved.

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.

Chapter 6: Respiratory drugs


Expectorants: Guaifenesin
Pharmacotherapeutics
Bronchial asthma
Bronchitis
Emphysema
Influenza
Minor bronchial irritation
Sinusitis

2012 Lippincott Williams & Wilkins. All rights reserved.

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.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients underlying condition improves
Patient and family demonstrate an understanding of the drug therapy

2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs


Antitussives
Benzonatate
Codeine
Dextromethorphan hydrobromide
Hydrocodone bitartrate

2012 Lippincott Williams & Wilkins. 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. All rights reserved.

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.

Chapter 6: Respiratory drugs


Antitussives
Adverse reactions
Benzonatate: Dizziness, headache, nasal congestion, nausea,
constipation, rash, chills, chest numbness
Opioid antitussives: Nausea, vomiting, sedation, dizziness,
constipation, bradycardia, hypotension, respiratory arrest

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.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients 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.

Chapter 6: Respiratory drugs


Decongestants
Pharmacokinetics
Systemic: Absorbed from the GI tract, metabolized by the liver,
excreted in urine
Topical: Act locally on alpha receptors in the nose

2012 Lippincott Williams & Wilkins. 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. All rights reserved.

Chapter 6: Respiratory drugs


Decongestants
Drug interactions
Systemic: Sympathomimetic drugs, MAOIs, alkalinizing drugs
Topical: None known

2012 Lippincott Williams & Wilkins. All rights reserved.

Chapter 6: Respiratory drugs


Decongestants
Adverse reactions: Systemic
Nervousness, restlessness, and insomnia
Nausea
Palpitations
Tachycardia
Elevated blood pressure
Difficulty urinating

2012 Lippincott Williams & Wilkins. 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.

Chapter 6: Respiratory drugs


Nursing process
Implementation
Administer drug as prescribed
Monitor for effects of drugs and report adverse reactions
Evaluation
Patients underlying condition improves
Patient and family demonstrate an understanding of the drug therapy

2012 Lippincott Williams & Wilkins. All rights reserved.