DRUGS AFFECTING THE

RESPIRATORY SYSTEM
 KEY TERMS:
1. COUGHING – is a protective mechanism in that helps to remove foreign matter and
excess secretions from the airway.
- reflex response to irritation in the conducting airways, results in
expelling of forced air through the mouth.
2. ANTIHISTAMINE – drugs that block the release or action of histamine, a chemical
released during inflammation that increases secretion and narrows airways.
3. BETA 1 RECEPTOR –are located in the heart. When beta 1 receptor are stimulated
they increase the heart rate and increase the heart’s strength of contraction or contractility.
4. BETA 2 RECEPTOR – are located in the bronchioles of the lungs and the arteries of
the skeletal increased cardiac contractility.
 KEY TERMS:
5. COMMON COLDS – viral infection of the upper respiratory tract that initiates the
release of histamine and prostaglandins and cause inflammatory response.
6. UPPER RESPIRATORY TRACT – comprises the nose, mouth, pharynx, larynx
and trachea – the conducting airways where no gas exchange occurs.
7. RHINITIS MEDICAMENTOSA/REBOUND CONGESTION – a process that
occurs when the nasal passages become congested as the effect of a decongestant
drug wears off.
8. Phenylpropanolamine HCl, Chlorphenamine Maleate and PARACETAMOL
(DECOLGEN) – strong nasal decongestant, clears obstructed and congested
air passages in a stuffy nose/clogged nasal sinuses.
9. LORATADINE AND PSEUDOEPHEDRINE (Claritin D) – is a combination
antihistamine and decongestant used to treat allergies, nasal congestion and sinus
pressure.
 KEY TERMS:
10. LOWER RESPIRATORY TRACT – the bronchi, and the alveoli
that make up the lungs – the area where gas exchange take place.
11. RESPIRATION – the act of breathing to allow the exchange of
gases, a basic process for living things.
12. SEASONAL RHINITIS – inflammation of the nasal cavity,
commonly called hay fever, caused by reaction to a specific antigen.
12. SNEEZE – reflex responses to irritation to receptors in the
nares, results in expelling of forced air through the nose.
 I- ANTITUSSIVE
1. ANTITUSSIVE /COUGH SUPPRESSANT
- drugs that suppress the cough reflex (Medulla) or locally as an anesthetic or to
increase secretion and buffer irritation and decrease the sensitivity of cough receptors.
- drugs that suppress a DEBILITATING, DRY, IRRITATING, HACKING AND NON-
PRODUCTIVE COUGH THAT INTERFERES WITH REST AND SLEEP.
- persistent coughing can be exhausting and can cause muscle strain and further
irritation of the respiratory tract, antitussive drugs are usually prescribed.
2 classifications of antitussive drugs are:
1. Opoids – codeine
* the most serious adverse effect is RESPIRATORY DEPRESSION
2. Non-opoids- dextromethorphan (robitussin) and guaifenesin
* Dextromethorphan used to help relieve/stop constant coughing by decreasing activity
in the brain that triggers the impulse to cough.
 TWO (2) TYPES OF ANTITUSSIVE
DRUGS:
1. CENTRALLY ACTING – reduce the irritability of the cough center.
2. PERIPHERALLY ACTING – suppresses stimuli from the tracheobronchial
system.
Drug list:
1. Delsym (dextromethorphan)
2. Tessalon perles (benzonatate)
3. Robitussin ( dextromethorphan)
4. Codeine – may cause addiction
* Pholcodine and codeine (opoids) – may cause drowsiness and
constipation
 DRUG LIST AS ANTITUSSIVE:
1. DEXTROMETHORPHAN (Robitussin, Vicks Formula, Triaminic)
Action: suppresses a cough by depressing the cough center in the
medulla oblongata or the cough receptors in the throat, trachea or lungs.
2. BENZONATE (TESSALON)
Action: acts as a local anesthetic on the respiratory passages, lungs by
blocking the effectiveness of the stretch receptors that stimulate cough
reflex.
3. CODEINE
Action: acts directly on the medullary cough center of the brain to
depress the cough reflex, they are centrally acting, they are NOT the drug of
choice for anyone who has a head injury or who could be impaired by central
nervous system (CNS) depression.
INDICATIONS OF ANTITUSSIVE DRUGS:
1. COMMON COLDS
2. SINUSITIS
3. PHARYNGITIS
4. PNEUMONIA
5. COLDS
6. FLU
7. ALLERGIES
8. BRONCHITIS
9. HAY FEVER
ADVERSE EFFECTS OF ANTITUSSIVE
DRUGS:
I. CENTRAL NERVOUS SYSTEM (OPIOIDS)
A. DROWSINESS
B. SEDATION
C. DIZZINESS
D. RESPIRATORY DEPRESSION
E. RESTLESSNESS
F. AGITATION
G. EUPHORIA
H. SEIZURE
ADVERSE EFFECTS OF ANTITUSSIVE
DRUGS:
II – GASTROINTESTINAL EFFECTS:
1. OPIOIDS
A. NAUSEA
B. VOMITING
C. ANOREXIA
D. CONSTIPATION
2. DEXTROMETHORPHAN
- NAUSEA
 ADVERSE EFFECTS OF ANTITUSSIVE
DRUGS:
III – RESPIRATORY EFFECTS:
RESPIRATORY DEPRESSION – MOST SERIOUS SIDE EFFECTS OF
OPOIDS.
• ANTIDOTE OF OPIOIDS TOXICITY – NALOXONE (NARCAN)

IV – CARDIOVASCULAR EFFECTS:
A. CIRCULATORY COLLAPSE
B. HYPOTENSION
C. TACHYCARDIA OR BRADYCARDIA
 ADVERSE EFFECTS ANTITUSSIVE
DRUGS:
V – INTEGUMENTARY EFFECTS:
A. RASH
B. ITCHINESS
C. FLUSHING
D. URTICARIA (HIVES)
VI – DRUG ALLERGY
* OPIOIDS MAY CAUSE ANAPHYLAXIS IN THE CLIENT WHO IS
ALLERGY TO IT.
 CONTRAINDICATION OF ANTITUSSIVE:

1. Severe chronic respiratory disorders or asthma due to risk of

infection.
2. Productive cough – due to the increased risk of mucus
accumulation, antitussives are not advised for the treatment of
productive, or mucous-producing cough, coughs.
Rationale:* inhibit the cough reflex , which damage a person’s airway if
they have breathing problems such as asthma.
* have a drying effect on the mucous membranes and can
increase the viscosity of respiratory tract secretions.
CONTRAINDICATIONS OF ANTITUSSIVE
DRUGS:
3. Both codeine and dextromethorphan are contraindicated with
severe respiratory disorders (e.g. ASTHMA, chronic obstructive
pulmonary disease (COPD))- COUGH SUPRESSION COULD LEAD TO AN
ACCUMULATION OF SECRETIONS AND LOSS RESPIRATORY
RESERVE. and hypersensitivity to drugs.
4. Older adults should be given lower doses of antitussive to avoid
excessive sedation and dizziness.
5. In clients taking Monoamine oxidase inhibitors, codeine and
alcohol must be used cautiously may cause CNS problems due to
potentiation.
 THERAPEUTIC NURSING
INTERVENTIONS:
1. Assess cough and sputum characteristics
2. Unless contraindicated, encourage to increase fluid
intake
3. Monitor respirations. Report rate < 10bpm
4. Promote safety precautions with opioids use
5. Monitor mental status and vital signs
6. Avoid irritants that stimulate their cough
2. BRONCHODILATORS/BRONCHOLYTIC/
ANTIASTHMATICS
- USED TO FACILITATE RESPIRATION BY DILATING THE AIRWAYS.
Actions:
1. Type of medication that make breathing easier by relaxing the muscles in the lungs
and widening the airway (bronchi).
2. used to treat long-term conditions where the airways may become narrow and
inflamed.
• Asthma common lung condition caused by inflammation of the airway.
• COPD group of lung conditions usually caused by smoking, that make breathing difficult.

3. relax bronchial smooth muscle bands

4. dilates the bronchi and bronchioles that are narrowed.
5. helpful in symptomatic relief or prevention of bronchial asthma for bronchospasm
associated with COPD.
 II.) BRONCHODILATORS/BRONCHOLYTIC
The most widely used bronchodilators are:
1. BETA-2 AGONIST (TEROL)- (salbutamol, salmeterol, formoterol and vilanterol)
2. ANTICHOLINGERICS(TROPIUM)- (ipratropium and tiotropium)- PRODUCE
RELAXATION OF AIRWAY SMOOTH MUSCLE.
3. XANTINES (PHYLLINE) - (THEOPHYLLINE, AMINOPHYLLINE) –RELAXES THE
SMOOTH MUSCLES LOCATED IN THE BRONCHIAL AIRWAYS AND PULMONARY
BLOOD VESSELS.
PURPOSES:
1. MAKE BREATHING EASIER – by relaxing the muscles in the lungs and widening
the airways (bronchi)
2. used to treat long-term conditions where the airways may become narrow and
inflamed.
 BRONCHODILATORS CAN BE:

1. SHORT ACTING BRONCHODILATORS – USED AS SHORT-

TERM RELIEF FROM SUDDEN, UNEXPECTED ATTACKS OF
BREATHLESSNESS.

2. LONG ACTING BRONCHODILATORS – USED REGULARLY

TO HELP CONTROL BREATHLESSNESS IN ASTHMA AND COPD AND
INCREASE THE EFFECTIVENESS OF CORTICOSTEROIDS IN
ASTHMA.
 INDICATIONS OF BRONCHODILATORS:

*SINCE THERE’S AIRWAY DYSFUNCTION, THESE ARE USEFUL TO

CLIENTS WITH:
1. BRONCHIAL ASTHMA
2. ACUTE/CHRONIC BRONCHITIS
3. EMPHYSEMA
4. PULMONARY DISEASE
 THREE COMMON TYPES OF
BRONCHODILATOR:
1.) BETA2 LONG ACTING AGONISTS - “TEROL” – albuterol, formoterol
Action: - dilates airways by stimulating the b2-adrenergic receptors in
the lungs.
Three (3) types of Beta2- agonist:
1. NONSELECTIVE ADRENERGIC DRUGS – stimulate the Beta 1 (Cardiac)( this
causes the heart to beat faster and to pump blood with more force) and Beta 2
(respiratory receptor)( treatment of any respiratory diseases)
2. NONSELECTIVE B-ADRENERGIC – stimulate both Beta 1 (B1) and Beta 2 (B2)
receptor
3. SELECTIVE B2 DRUGS – stimulate the B2 receptor.
 THREE COMMON TYPES OF
BROCHODILATORS:
2.) ANTICHOLINERGIC BTRONCHODILATORS – “TROPIUM” – ipratropium,
tiotropium.
*acetylcholine – (Ach) causes bronchial constriction and narrowing of the
airway. Anticholinergic bind to the acetylcholine receptors preventing acetylcholine from
binding as a result –bronchoconstriction is prevented thus airway dilate.
Action: prevents binding of cholinergic substances and sometimes used in the
treatment of chronic asthma.
* block the parasympathetic nerve reflexes that cause the airways to
constrict, so allow the air passage to remain open.
SIDE EFFECTS: 1. dry mouth and throat (decrease secretion) 3. heart palpitation
2. nasal congestion 4. GI distress
 THREE (3) MOST COMMON
BRONCHODILATORS:
3.) XANTHINES – “PHYLLINE”- theophylline, aminophylline
Action: smooth muscle relaxation
: dilates the constricted bronchi and bronchioles
: directly relaxing smooth muscle of the bronchial airway and pulmonary
blood vessels.
: relieves bronchospasm, increases vital capacity, produces cardiac
arrhythmias and skeletal muscle stimulation.
* Drug of choice for: asthma and bronchospasm
Side-effects:
1. GI distress – nausea, vomiting and dyspepsia 2. tachycardia
 ADVERSE EFFECTS
BRONCHODILATORS:
1.) CNS effects:
* Both adrenergic and xanthines stimulate the CNS – resulting restlessness,
agitation and insomnia
* Xanthines may cause convulsion
2.) Cardiovascular effects:
* Adrenergic that affect beta1 adrenergic receptors as well as beta 2 adrenergic
receptor can cause tachycardia, hypertension and cardiac arrhythmias.
* Xanthines also stimulate the heart causing tachycardia and cardiac
arrhythmias.
 DRUG INTERACTIONS:

1. NONSELECTIVE BLOCKERS – ENHANCED RISK OF

HYPERTENSION(VASOCONSTRICTION)
2. MAOI’S – ENHANCED FOR HYPERTENSION (VASOCONSTRICTION)
3. DIGOXIN – INCREASED TOXICITY WITH XANTHINES DERIVATIVES
4. DIABETIC DRUGS- BETA AGONISTS (HYPOGLYCEMIC/HYPERGLYCEMIC
AGENTS)
5. BETA BLOCKERS (ATENOLOL)- CAUSE BRONCHOSPASM
6. NSAIDS (NAPROXEN/IBUPROPEN) –WORSEN ASTHMAS]
 THERAPEUTIC NURSING
INTERVENTIONS
1. MONITOR PULSE, BLOOD PRESSURE, RESPIRATORY STATUS AND MENTAL STATUS
(ADRENERGIC AND XANTHINES BRONCHODILATORS)
2. REPORTS OF SERUM THEOPHYLLINE LEVELS. NOTIFY PRESCRIBER IF HIGHER THAN 20
MCQ/ML.
*DRAW BLOOD FOR PEAK LEVELS 15-30 MINUTES AFTER IV LOADING DOSE.1-2 HOURS AFTER
EXTENDED RELEASE FORMS.
3. WHEN IPRATROPIUM (ATROVERT) IS GIVEN WITH OTHER INHALATION MEDICATIONS GIVE
OTHER MEDICATION FIRST AND WAIT 5 MINUTES BEFORE GIVING IPRATROPIUM.
* IF A STEROID IS ALSO PRESCRIBED, IT SHOULD BE USED/ADMINISTERED LAST.
* DURING ASTHMA ATTACK 3 DRUGS USED IN SEQUENCE:
ALBUTEROL(SYMPATHOMIMETICS) 1ST USED DURING BRUTAL ASTHMA ATTACK---
IPRATROPIUM (ANTICHOLENERGIC)----METHY-PREDNISOLONE (STEROID) (ACTS
SLOWLY).
 THERAPEUTIC NURSING
INTERVENTIONS:

4. CHILDREN AND CIGARETTE SMOKERS USUALLY NEED HIGHER DOSAGES

TO MAINTAIN THERAPEUTIC BLOOD LEVELS – THEOPHYLLINE METABOLIZES
RAPIDLY.
5. THERE IS NO ANTIDOTE FOR XANTHINES OVERDOSE, STANDARD FIRST AID
MEASURE (CHARCOAL, EMESIS OR GASTRIC LAVAGE)
 Antihistamine are generally
contraindicated with the ff:
1. Angle closure glaucoma attack (when fluid is completely blocked from leaving
the eye, causing a dangerous rise in pressure)
2. PROSTATIC HYPERTROPHY (OTC COLD AND FLU PREPARATIONS THAT
CONTAIN BOTH ANTIHISTAMINE AND DECONGESTANTS CAN CREATE A
“PERFECT STORM” FOR MEN WITH SYMPTOMATIC BENIGN PROSTATIC
HYPERPLASIA (bph). These product s could substantially worsen symptoms of
BPH, make it harder to urinate and may trigger complete urinary retention.
3. Peptic ulcer- the h2 antihistamine block h2 histamine receptors that are found
in the gastric acid producing parietal cell s of the stomach. Therefore, these
antihistamines will reduce the amount of gastric acid being secreted in the
stomach.
 III - DECONGESTANT
NASAL CONGESTION- usually characterized by “nasal stuffiness” and drainage. Common
manifestation of the COMMON COLDS AND ALLERGIC RHINITIS.
NASAL DECONGESTANT reduces nasal congestion stimulates Alpha1 agonist/alpha-
adrenergic receptor( sympathomimetics such as phenylephrine and epinephrine)
VASOCONSTRICTION OF BLOOD VESSELS in the nose, throat and paranasal sinuses
reduces inflammation and tends to open clogged nasal passages, providing relief from
the discomfort of a blocked nose and promoting drainage of secretions and improve
airflow.
ACTIONS: 1. to relieve congestion by shrinking blood vessels in the nasal membranes of the
nose and air passage.
2. help reduce swelling in the passage ways of nose, which relieves the feeling of pressure and
improves the flow of air-to facilitate breathing.
3. provide short-term relief for a blocked or stuffy nose (nasal congestion)
4. decreases the overproduction of secretions by causing local vasoconstriction to the URT.
 MOST COMMON DECONGESTANT

1.) XYLOMETAZOLINE – is used for temporary relief of congestion in the nose

caused by various conditions including common colds, sinusitis, allergic rhinitis
and relieves pressure of otitis media.
- It works by narrowing the blood vessels in the nose area, reducing swelling and
congestion.
ADVERSE EFFECTS;
1. tremors 4. headache
2. palpitation 5. light-headness
3. hypertension
 MOST COMMON DECONGESTANT:
2.) PSEUDOEPHEDRINE –” FED” (SUDAFED/DECOFED BIOFED,CENAFED,
DIMETAPP)
Action: - primary stimulates alpha-adrenergic receptor ( stimulation of the alpha-
adrenergic receptor responsible of the constriction of blood vessels in nasal mucosa).
- Is a decongestant that helps breathe more easily if nose is stuffy or
blocked (nasal congestion).
Indications: 1. colds
2. allergies
3. sinus congestion/pressure
* pseudoephedrine will relieve symptoms but will not treat the cause of
symptoms or speedy recovery.
 MOST COMMON DECONGESTANT:
3. PHENYLEPHRINE – selective alpha agonist. (vasoconstriction)
Action: works by decreasing swelling in the nasal mucosa and ears, thereby lessening discomfort
and making it easier to breathe.
- increased drainage of the sinus cavities.
Uses: 1. stuffy nose
2. sinus
3. ear symptoms caused by common colds, flu and allergies
Side-effects:
1. stomach upset (mild) 5. nervousness
2. trouble sleeping 6. shaking
3. lightheadedness 7. fast heart beats
4. headache
 DECONGESTANT
INDICATIONS:
1. Common colds
2. Flu
3. Allergies
4. Sinusitis
5. Rhinorrhea
6. Swollen nasal tissue – swelling is due to inflammed blood vessels located in
the nasal mucosa
7. mucous buildup in nasal passages
ADVERSE EFFECTS OF DECONGESTANT
1. Oral decongestant – more systemic adrenergic effect than topical preparation.
2. CENTRAL NERVOUS SYSTEM EFFECTS:
A. ORAL DECONGESTANT STIMULATES THE CNS CAUSING:
- restlessness
- irritability
- anxiety
- insomnia
B. DECONGESTANTS APPLIED BY NASAL SPRAY OR DROPS ARE UNLIKELY
TO CAUSE CNS EFFECTS
ADVERSE EFFECTS OF DECONGESTANT:
3. CARDIOVASCULAR EFFECTS:
- oral decongestant can stimulate the heart and constrict cardiac and
peripheral blood pressure causing:
-tachycardia
- palpitation
- cardiac arrhythmias
- hypertension
4. gastrointestinal effect:
-excessive use (> 10 days) of topical agents can lead to chronic nasal
congestions, rebound congestion (rhinitis medicamentosa) and red edematous
mucosa.
 KEY POINTS TO REMEMBER OF DRUGS
AFFECTING THE RESPIRATORY SYSTEM:
2.) Antihistamines are classified as first or second generation.
First generation drugs more drowsiness and have more drowsiness and have more
anticholinergic side effects.
- First generation antihistamines also pass the blood-brain barrier and thus have a
potential for activity in the brain.
Example: brompheniramine (dimetapp)diphenhydramine (benadryl), chlorphenamine
(Drowsiness due to unrelated to the immune system, in which histamine is also produced in the
brain, where it plays an important part in feeling awake. Antihistamines used to treat respiratory
symptoms can get into the brain and interrupt this work, making the person feel dizzy).
Antihistamine, decongestant and anticholinergic combinations (diphenhydramine like benadryl),
brompheniramine (dimetapp) and dimenhydrinate (dramamine) ability to decrease nasal secretory
response like stuffy nose and runny nose caused by allergies and/or common colds.
Second generation antihistamine are less likely produce sedation ( loratadine,
cetirizine)