Drugs Afecting the Respiratory System Drugs Afecting the Respiratory System

Fall 2013
Wilhelmina Rich MSN, RN
General A & P of Respiratory System General A & P of Respiratory System
Conducting Airways: nasopharyngeal airways, laryngotracheal airways, and
tracheobronchial tree
Lungs and respiratory airways
Upper airway tract: nose, sinuses, mouth and pharynx, larynx
Lower respiratory tract: trachea, bronchi, bronchioles, and respiratory lobules
Respiration is controlled by CNS.
Respiratory system proides !or oxygen and carbon dioxide exchange" regulation o!
acid#base balance, and a de!ense against in!ection.
Drug Classifcations for Allergic Rhinitis, Cough, and Colds Drug Classifcations for Allergic Rhinitis, Cough, and Colds
Antihistamines/histamines agonist: block or inhibit response o
histamine
!econgestants: ca"se #asoconstriction o nasal passages
Antit"ssi#es: s"ppress co"gh re$e%
&%pectorants : li'"e( an) thin respirator( tract secretions
Antihistamines-oral Antihistamines-oral
Fe%oena)ine/Allegra* or +,(/o
lorata)ine/-laritin* or +2 (/o
cetiri.ine//(rtec*
)iphenh()ramine/ 0ena)r(l*
1ral is 2rst line )r"gs or allergic rhinitis3
!o not re)"ce nasal congestion3
No #al"e against the common col)
Most e4ecti#e prophylactically
A)#erse e4ects mil)
ntranasal for ntranasal for
allergic Rhinitis allergic Rhinitis
Fl"ticasone/Flonase * intranasal corticosteroi)
a.elastine/Astelin* onl( intranasal antihistamine3
Non5se)ating
0ene2ts e'"i#alent to oral3
6ntranasal gl"corticoi) most e4ecti#e or pre#ention 7 treatment o
seasonal 7 perennial rhinitis3
A)#erse e4ects mil)5)r(ing m"cosa, b"rning or itching sensation3
Nasal passages sho"l) be clear beore prior to "se3
Decongestants Decongestants
S(mpathomimetic: acti#ate #asc"lar alpha 1 receptors 7 ca"se
vasoconstriction3 Will not )ecrease snee.ing, itching or rhinorhea3
A)#erse e4ect: oral ro"te5restlessness, insomnia, increase) 089 nasal
ro"te5 rebo"n) nasal congestion3
1ral #s :opical
13 :opical acts aster 7 "s"all( more e4ecti#e3
23 1ral acts longer3
33 S(stemic e4ects primaril( ;ith oral3
<3 Rebo"n) congestion ;ith topical more common
Arin*, 8hen(lphrine/Neo5s(nephrine*, 8se")oephe)rine/S")ae)*
Anticholinergic: block nasal cholinergic receptors re)"cing secretions9
)oes not )ecrease snee.ing, nasal congestion or postnasal )rip3
6pratropi"m bromi)e/Atro#ent*
-orticosteroi)s: oral, inhale), intranasal
Antitussi!es Antitussi!es
1pioi): co)eine 7 h()roco)one
-o)eine most e4ecti#e co"gh s"ppressant3 Acts orall( 7 can
)ecrease both re'"enc( 7 intensit( o co"gh3 -an s"ppress
respirations3
Sche)"le 66, e%cept ab"se is lo; as an antit"ssi#e mi%t"re ;hich is
Sche)"le = >Robit"ssin A5-?3
Rarel( recommen)e) or chil)ren3
"onopioid Antitussi!es "onopioid Antitussi!es
!e%tromethorphan/Robit"ssin5!M*3 At therape"tic )oses, )oes not
)epress respirations3 A!R mil) an) rare3 -an enhance analgesic
e4ects o opioi)3
0en.onate/:essalon 8erles*3 A!R mil)3 S;allo; caps"le intacte)3
#$pectorants & %ucolytics #$pectorants & %ucolytics
@"aienesin/M"cine%*
A(pertonic saline
Acet(lc(steine/
M"com(st*
Drugs Sites of Action Drugs Sites of Action
&ronchodilators and other drugs used in Asthma &ronchodilators and other drugs used in Asthma
Asthma: chronic )isease characteri.e) b( h(perreacti#it( o air;a(s,
re#ersible air;a( obstr"ction an) air;a( in$ammation3
8rinciple anti5in$ammator( )r"gs: gl"cocorticoi)s an) mast cell
stabili.er3
8rinciple broncho)ilators are beta2 agonists
Most o )r"gs gi#en b( inhalation3
:herape"tic e4ects are enhance)
S(stemic e4ects are minimi.e)
Relie o ac"te attacks is rapi)
%etered Dose nhaler #$tender %etered Dose nhaler #$tender
Glucocorticoids Glucocorticoids
S"ppression o in$ammation B re)"ction o bronchial
h(perreacti#it( 9 )ecrease air;a( m"c"s pro)"ction9 increase n"mber
o bronchial beta2 receptors an) responsi#eness to beta2 agonist3
Cse) or proph(la%is o chronic asthma3
6nhale) "se5 frst line therapy3
A!R: most common e4ects are orophar(ngeal can)i)iasis an)
)(sphonia3
0eclomethasone/0eclo#ent*, $"ticasone/Flo#ent*9 oral 8re)nisone 7
pre)nisolone
'eu(otriene %odifers 'eu(otriene %odifers
!ecrease in$ammation, brochoconstriction, e)ema, m"c"s secretion3
/ile"ton//($o* appro#e) or proph(la%is an) maintenance3 -an
inD"re li#er3 -an increase other )r"g le#els3
/a2rl"kast/Accolate*: oo) re)"ces absorption9 can ca"se rise in
other )r"g le#els3
Montel"kast/Sing"lair* maintenance therap(3 Well tolerate)3
-romol(n/6ntal*
First line proph(la%is, not "se"l in aborting an ongoing attack3
6nhalation ro"te3
S"ppresses in$ammation b( stabili.ing mast cells3
Saest o all antiasthma me)ication3
&eta)-Adrenergic Agonists &eta)-Adrenergic Agonists
0eta2 selecti#e agonists promote broncho)ilation , s"ppress
histamine release, an) increase ciliar( motilit(3
Short5acting inhale): taken prn to relie#e an ongoing attack3 Well
tolerate) ;ith minimal s(stemic e4ect o tach(car)ia, angina, tremor3
&%ample5Alb"terol
Eong5acting inhale): )osing )one on a 2%e) sche)"le3 &%ample5
Salmeterol
%iscellaneous %iscellaneous
Anticholinergic
6pratropi"m/Atro#ent*: contrain)icate) or those ;ith pean"t or so(a
allergies3
:iotropi"m/Spiri#a*
Monoclonal Antibo)( Antiasthmatic
1mali."mba/Folair
Selecti#el( bin)s 6g&
@i#en or pre#entati#e p"rposes3
Chronic *+structi!e Pulmonary Disease ,C*PD- Chronic *+structi!e Pulmonary Disease ,C*PD-
&mph(sema an) chronic bronchitis obstr"ct air$o; thro"gh air;a(s
relati#el( constant3
&mph(sema: )estr"ction o al#eolar ;alls
-hronic bronchitis: e%cessi#e m"c"s secretion an) pathologic
changes in bronchial str"ct"res3
%ethly$anthines %ethly$anthines
:heoph(llin: has narro; therape"tic range3 1ral>:heo5)"r? ro"te "se)
or maintenance o chronic stable asthma3 Cse"l in those ;ith
noct"rnal attacks3 6= emplo(e) in emergencies3
Aminoph(lline same pharmacologic properties as abo#e3 0etter as 6=
"se than theoph(lline
Patient .eaching Patient .eaching
0eta Agonists
An( potential )r"g interactions
&nco"rage a#oi)ance o precipitating e#ents lea)ing to
bronchoconstriction or ;orsening o )isor)ers
6nstr"ction on proper "se o M!6s3
Fanthines
6nteractions bet;een smoking an) %anthines
-a4eine containing oo)s/)rinks e%acerbating -NS stim"lation
6nstr"ction on proper taking o me)ication3
Monitoring o therape"tic le#els
Patient .eaching Patient .eaching
Anticholinergics
Force $"i)s
8roper inhalation techni'"e
-orticosteroi)s
8ractice goo) oral h(giene
Go"rnaling "sage
Me)ical alert i)enti2cation
-hanges in ;eight
Ee"kotriene Receptor Antagonists
&mphasi.e pre#ention "se
Monoclonal Antibo)( Antiasthmatic !r"gs
Ret"rn )emonstration o s"bc"taneo"s techni'"e