RESPIRATORY REGIMEN

Bronchodilators - used to reverse bronchoconstriction,thus opening air passages in the lung

- act by stimulating beta-adrenergic sympathetic nervous system receptors
- directly relaxing bronchial smooth muscle

A. Adrenergics - acts as a beta-adrenergic receptors in bronchus to relax smooth muscle

- increase respiratory volume

B. Xanthines - act directly on bronchial smooth muscle decreasing spasm and relaxing smooth
musclee of the vasculature

C. Combination Products

Major side effect (DCPG)

1. Dizziness - decrease in blood pressure
2. CNS Stimulation - sympathetic stimulation
3. Palpitation - beta- adrenergic stimulation
4. Gastric Irritation - local effect

Mucolytic Agents and Expectorant - used to liquify secretions in the respiratory tract, thus promoting a
productivve cough
Mucolytics - act directly to break up muccous plug in the tracheobronchial passages
Expectorant - act indirect to liquify mucous by increasing respiratory tract secretion via oral absorption
Mucolytic Agents - are available in inhalation preparations,
Expectorant - are available in oral preparation

Acetylcystein (Mucomyst) - example of mucolytic/ antagonist of acetaminophen ( Tylenol)

Major Side Effect ( GSOB)

1. Gastrointestinal Irritation - local effect
2. Skin Rash - hypersensitivity
3. Oropharyngeal irritation - mucolytics
4. Brochospasm - mucolytic hypersensitivity

Ph+PCO2 - Respiratory acidosis/ Alkalosis

Ph+HCO3 - Metabolic acidosis/ Alkalosis

Antitussive - used to supress cough reflex

- inhibiting cough reflex either by direct action on medullary cough center
- indirect action peripherally on sensory nerve endings.

Major Side Effect (DND)

1. Drowsiness - CNS depression
2. Nausea - GI irritation
3. Dry mouth - anticholenergic effect of antihistamine in combination products

Narcotic Antagonist - used to reverse respiratory depression caused by narcotic overdosage

- act to displace narcotic at respiratory receptors via competitive antagonism
- available in parental preparation

Major side effect (CNP)

1. CNS depression - acts on opiod receptors in CNS
2. Nausea, vomiting
3. Pupillary constriction
Antihistamines - used to relieve symptoms of the common cold and allergies, mediated by chemical
histamine
- act by blocking the action of histamine at receptors site by competitive inhibition
- antiemetic, anticholinernergic, antitussive, CNS depressant

Major side effect (DDDGE)

1. Drowsiness - CNS Depression
2. Dizziness - CNS Depression
3. Gastrointesinal irritation - local effect
4.Dry mouth - anticholinergic effect of decreased salivation
5. Excitement - paradoxic effect

Antineoplastic Drugs

Alkylating Agents - cell cycle non specific: attack the DNA of rapidly dividing cell
Antibiotic - cell cycle specific, inhibit RNA and protein synthesis of rapidly dividing tissue
Antimetabolites - cell cycle specific, inhibit protein synthesis in rapidly dividing cells during "S" phase
Hormones - tissue specific: inhibit RNA and protein synthesis in tissue that are dependent on the
opposite hormone development
Estrogen- estramustine phosphate sodium
Mitotane - cortisol antagonist
Tamoxifen citrate - estrogen antagonist
Immune agents - involves introduction of noncancerous antigens or other antigens in the body to
stimulate production of lymphocytes and antibodies
examples : Bacillus of Calmette-Guerin (BCG) vaccine - provides active immunity
Interferin alfa-2A: Interferon alfa -2b
Miscellanous Agent
A. Leucovorin Calcium - reduced form of folic acid. antodote to folic acid antagonist
B. Paclitaxel - inhibits the reorganization of the microtubule network that is needed for interphase and
mitotic cellular functions
C. Vinblastine - an alkaloid extracted from periwinkle

Circulatory System Regimen

Cardiac Glycosides - used to improve the pumping ability of the heart, increasing cardiac output
- produced( +) inotropic - increase force of muscle contraction by inc. permeability of
cardiac muscle membrane to the calciumand sodim ions required for contarction ofmuscle fibrils
- produced( -) chronotropic effect - decreased heart rate contraction
- has diuretic effect y increased renal blood flow
- treatment of Congestive heart failure and atrial flutter and fibrillation
Major side effect (NAM)
1. Nausea, vomiting, diarrhea - local oral effect stimulates chemoreceptors zone in medulla
2. Anorexia - nausea and vomting caused chemoreceptors stimulation
3. Malabsorption of all nutrients (nausea, vomiting, diarrhea)
4. Bradychardia - increased vagal tone at AV node
5. Toxicity
a. Dysrhythmias - premature ventricular beats
b. Xanthopsia - yellow vision, effect on visual cones, blurred vision
c. muscle weakness - CNS effect, neurotoxicity, hypokalemia

Antidysrhythmics - used to treat abnormal variation in cardiac rate and rhythm

Examples:
Calcium ion antagonist - control atrial dsyrhythmias by dec. cardiac automaticity and impulse
conduction
Disopyramide phosphate - controls ventricular dsyrhythmias by decreasing the rate diastolic
depolarization
Lidocaine HCL - controls ventricular irritability by shortening the refractory period and supressing ectopic
foci
Phenytoin (Dilantin) - controls atrial or ventricular dsyrhytmias by decreasing automaticity without
decreasing conduction
Procainamide HCL - prolonging the refractory period of the heartand sowing the conduction of cardiac
impulses
Propanolol(Inderal) - controls supraventricular dsyrhytmias by decreasing cardiac impulse conduction
thru beta-adrenergic blocking action
Quinidine preparation - control atrial dsyrhytmias by prolonging the effective refractory period and
slowing depolarization

Major side effect

1.Hypotension - decreased cardiac output caused by vasodilation
2. Dizziness - hypotension
3. Nausea, vomting - irritation of gastric mucosa
4. Heart block - direct cardiac toxic effect
5. Anticholinergic effect - decreased parasymphathetic stimulation
6. Blood dyscrasias - decreased rbc, wbc and platelet synthesis
Toxicity
a. Diarrhea - Gi irritation
b. CNS disturbances - neurotoxicity
c. Sensory disturbances - neurotoxicity

Cardiac Stimulants - used to increased heart rate

- act by indirect or direct mechanisms affecting the autonomic nrvous system
Examples
Atropine sulfate - supressess parasympathetic nervous system control at SA and Av nodes,
allowing heart rate to increase
Epinephrine HCL(Adrenalin) - stimulates the rate and force of cardiac contraction via symphathetic
nervous system
Isoproterenol HCL (ISuprel) - stimulates beta-adrenergic receptors of the symphatetic nervous system,
increasing heart rate

Major side effect

1. Tachycardia - symphatetic stimulation
2. Headache - dilation of cerebral vessels
3. CNS stimulation - symphatetic stimulation
4. Cardiac dysrhytmias - cardivascular system stimulation
5. Atropine - anticholinergic effects dry mouth, blurred vision

Coronary Vasodilators - used to decrease cardiac work and myocardial oxygne requirements by their
vasodilatory action to decreased preload and decreased after load
- Nitrates - act directly at nitrate receptors in smooth muscle causing relaxation
- Calicium ion antagonist - inhibit the influx of calcium ion across cell membrane
during depolarization of the cardiac and vascular smooth muscle
- effective in treatment of Angina Pectoris
Major side effects
1. Headache - dilation of cerebral vessel
2. Flushing - peripheral vasodilation
3. Orthostatic Hypotension - loss of compensatory vasoconstriction with position change
4. tachycardia - reflex reaction to severe hypotension

Antihypertensives - used to promote dilation of peripheral blood vessel, decreasing blood pressure and
after load
Examples:
Captopril (Capoten) - angiotensin-converting enzyme inhibitor
Clonidine (Catapres)- sympatholytic
Diazoxide(Hyperstat IV) - direct smooth muscle relaxation, may promote hyperglycemia
Enalapril maleate - angiotensin converting enzyme ACE inhibitor
Guanethidine sulfate - sympatholytic
Methyldopa - symphatolytic
Nitrioprusside sodium - direct smooth muscle relaxation, reduces serum B12
Phentolamine - alpha adrenergic blocker
Prazosin HCl - direct smooth muscle relaxation
Propanolol - beta-adrenergic blocker
Reserphine - peripheral norepinephrine depletion

Major side effects

1.Orthostatic Hypotension
2. Dizziness - orthostatic hypotension
3. Cardiac rate alteration
a. bradychardia
b. tachychardia
4, Sexual disturbances
5. Blood dsycrasias
6. drowsiness ( cerebral hypoxia)

Diuretics - used to decreased urine output which reduces hyperolemia, decreased preload and after load
- interferes with sodium reabsorption in the kidney
Thiazide - interfere with soduim ion transport at loop of Henle and inhibit carbonic anhydrase activity at
distal tubule
Loop diuretics - interfer with active transport of sodium ions in loop of Henle and inhibit vsodium chloride
and water re-absorption at proximal tubules
Potassium spares - interfere with aldosterine-induced reabsorption of sodium ions at distal nephron site
to decrease sodium chloride excretion and decrease potassium ion loss