Respiratory Agents

Prof. Clement C. Belvis RN, RM, MPH

PHARMACOLOGY

Assistant Professor V De La Salle- Health Sciences Campus

Respiratory System

Two major parts of respiratory tract:

Upper respiratory tract Lower respiratory tract
Trachea Bronchi Bronchioles Alveoli

Alveolar-capillary

membrane

Ventilation and Respiration

Ventilation is the movement of air from the atmosphere through the upper and lower airways to the alveoli Respiration is the process whereby gas exchange occurs at the alveolar-capillary membrane

3 Phases of Respiration
1.

2.

3.

Ventilation Perfusion, in which blood from the pulmonary circulation is adequate at the alveolar-capillary bed Diffusion of gases, in which oxygen passes into the capillary bed to be circulated and carbon dioxide leaves the capillary bed and diffuses into the alveoli for ventilatory excretion

The Chest Cavity

Closed compartment bounded by:

12 ribs Diaphragm Thoracic vertebrae Sternum Neck muscles Intercostal muscles between the ribs

Pleura are membranes that encase the lungs

Lungs
Right lung (3 lobes) Left lung (2 lobes)

Heart, lies in the midleft side of the chest cavity

Functions of the Respiratory System

Provides for gas exchange intake of oxygen for delivery to body cells and elimination of carbon dioxide produced by body cells Helps regulate blood pH Contains receptors for the sense of smell, filters inspired air and produces sounds

Respiratory Agents

Drugs for Common Upper Respiratory Infections

Antihistamines Nasal Decongestants Inhaled corticosteroids Antitussives Expectorants

Antihistamines

Histamine is a substance present in various tissues of the body, such as the:

Lungs bronchoconstriction

Antihistamines

Antihistamines are drugs used to counteract, the effects of histamine on body organs and structures

Mechanism of Action
Antihistamines block most, but not all, of the effects of histamine They do this by competing for histamine at histamine receptor sites, thereby preventing histamine from entering these receptor sites and producing an effect on body tissues Some antihistamines have additional effects, such as antipruritic, antiemetic, and sedative effects

Indications
Relief of the symptoms of seasonal and perennial allergies Allergic and vasomotor rhinitis

Relief of coughs caused by colds or allergy Adjunctive therapy in anaphylactic shock

Pharmacokinetics and Pharmacodynamics

Administration
PO IM IV

PO and IM
Onset: 15 mins. Peak: 1 hour Duration: 4-8 hours

Absorption: GI Distribution: PB 98% Metabolism: HL 2-7 hours Excretion: metabolites in the urine

IV
Onset: Immediate Peak: 0.5-1 hour Duration: 4-7 hours

Side Effects and Adverse Reactions

Drowsiness Sedation Anticholinergic effects

Dryness of mouth, nose and throat Thickening of bronchial secretions Urine retention Blurred vision Wheezing

Dizziness Disturbed coordination Fatigue Hypotension Headache Epigastric distress Photosensitivity Skin rashes

Examples

1st Generation
Brompheniramine maleate (Bromphen) Diphenhydramine (Benadryl) Promethazine HCl (Phenergan) Hydroxyzine HCl (Atarax) Azatadine maleate (Optimine)

2nd Generation
Azelastine (Astelin) Cetirizine (Zyrtec)

Nursing Considerations
Contraindications:

Hypersensitivity, pregnancy and lactating women Interactions:

Increase in anticholinergic effects when administered with MAOIs

Preadministration assessment of the patient receiving the drug depends on the reason for use Observe the patient for the expected effects of the antihistamine and for adverse reactions Give orally with food to prevent GI upset Give Astemizole and Loratadine on empty stomach For parenteral administration, give the drug deep IM rather than subcutaneously

Patient and Family Teaching

Do not drive or perform other hazardous tasks if drowsiness occurs. The effect may diminish with continued use Avoid the use of alcohol, as well as other drugs that cause sleepiness or drowsiness, while taking the drug

Take the drug with food. Avoid ultraviolet light or sunlight. Wear sunglasses, protective clothing and a sunscreen when exposed to sunlight

Nasal Decongestants

Nasal Congestion results from dilation of nasal blood vessels caused by infection, inflammation or allergy With this transudation of fluid into the tissue spaces, resulting in swelling of the nasal cavity

Nasal Decongestants

Decongestant is a drug that reduces swelling of the nasal passages, which in turn, opens clogged nasal passages and enhances drainage of the sinuses

Mechanism of Action
The nasal decongestants are sympathomimetic drugs, which produce localized vasoconstriction of the small blood vessels of the nasal membrane Vasoconstriction reduces swelling in the nasal passages

Indications

Congestion associated with:

Rhinitis Hay fever Allergic rhinitis Sinusitis Common cold

Side Effects and Adverse Reactions

Jittery Nervousness Restlessness Rebound nasal congestion Nasal burning Stinging Dryness

ORAL DECONGESTANTS

Tachycardia Cardiac arrhythmias Nervousness Restlessness Insomnia Blurred vision N/V

Examples

Ephedrine SO4 (Efedron) Naphazoline HCl ( Allerest, Privine) Oxymetazoline HCl (Afrin) Phenylephrine HCl (Sinex) Pseudoephedrine (Novafed)

Nursing Considerations
Contraindications: Hypersensitivity, HPN, CAD Preadministration assessment: BP, Pulse,

Patient and Family Teaching

Use the product as directed by the primary health care provider or on the container label Understand that overuse of topical nasal decongestant can make the symptoms worse Nasal burning and stinging may occur with the topical decongestants If using a spray, do not allow the tip of the container to touch the nasal mucosa and do not share the container with anyone

To administer the spray, sit upright and sniff hard for a few minutes after administration

Inhaled Corticosteroids

Inhaled corticosteroids are effective for treating rhinitis because of its antiinflammatory action

Mechanism of Action

Suppression of inflammation and adrenal function

Indications

Seasonal and Allergic rhinitis

Sneezing Congestion

Bronchial Asthma

Pharmacokinetics and Pharmacodynamics

Absorption: PO, Well absorbed Distribution: PB 6591%; crosses the placenta Metabolism: 3-4 hours Excretion: In urine

PO:
Onset: Unknown Peak: 1-2 hours Duration: 24-36 days

Side Effects and Adverse Reactions

Throat irritation Hoarseness Dryness of nasal mucosa Coughing Fluid retention (during prolonged periods)
Thinning

of the skin

Purpura Abnormal SC distribution Increased blood sugar Impaired immune response Hyperglycemia

Examples

Beclomethasone (Beconase) Budesonide (Rhinocort) Dexamethasone (Decadron) Flunisolide (Nasalide) Fluticasone (Flonase) Triamcinolone (Nasacort)

Nursing Considerations
When D/C, taper the dosage slowly to prevent adrenal insufficiency Give drug with food to avoid GI ulceration

Antitussives

Coughing is the forceful expulsion of air from the lungs

Productive cough secretions from LRT are expelled Nonproductive cough dry, hacking cough that produces no secretions

Antitussives

act on the cough control center in the medulla to suppress the cough reflex
Nonnarcotic Narcotic Combination

Mechanism of Action
Some antitussives depress the cough center located in the medulla and are called centrally acting drugs. Peripheral acting antitussive drugs act by anesthetizing stretch receptors in the respiratory passages, thereby decreasing coughing

Indications
Nonproductive cough To reduce viscosity of tenacious secretions

Side Effects and Adverse Reactions

Respiratory depression Euphoria Light-headedness Sedation N/V Hypersensitivity
Drowsiness

Mild

dizziness GI upset Constipation Postural hypotension

Examples

Codeine CSS II Guaifenesin and Codeine (Robitussin) Hydrocodone bitartrate CSS III (Hycodan) Benzonatate (Tessalon) Dextromethorphan hydrobromide (Benylin)

Nursing Considerations

Contraindications: Hypersensitivity

Patient and Family Teaching

Instruct the patient not to exceed the recommended dose If chills, fever, chest pain, or sputum production occurs, contact primary health care provider ASAP Drink plenty of fluids. A fluid intake of 1.52L is recommended. No alcohol intake

Expectorants

Expectorants loosen bronchial secretions so they can be eliminated

Mechanism of Actions
Expectorants increase the production of respiratory secretions, which, in turn appears to decrease the viscosity of the of mucus This helps to raise secretions from the respiratory passages

Indications

Raise respiratory secretions

Side Effects and Adverse Reactions

N/V Dizziness Headache Rashes Iodine sensitivity

Examples

Guaifenesin (Robitussin) Potassium Iodide (Pima)

Nursing Considerations
Contraindications: Hypersensitivity, Potassium Iodide, is contraindicated during pregnancy Precautions: Pregnancy and lactation Interactions: No significant interactions

Patient and Family Teaching

When an expectorant is prescribed, the nurse instructs the patient to take the drug as directed and to contact the physician if any unusual symptoms or other problems occur during use of the drug or if the drug appears to be ineffective

Drugs for Acute and Chronic Lower Respiratory Disorders

Bronchodilators Mucolytics

Bronchodilators

A bronchodilator is a drug used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis and emphysema
Disorders characterized by decreased inspiratory and expiratory capacity of the lung

Mechanism of Action

Use of bronchodilating drug opens the bronchi and allows more air to enter the lungs
Sympathomimetics increase cAMP, causing dilation of bronchioles
Isoproterenol Metaproterenol

Albuterol

 Anticholinergics
Xanthine

derivatives stimulates CNS and respiration, dilate coronary and pulmonary vessels, and cause diuresis

Indications

Reversible Airway obstruction Bronchospasm Acute and Chronic Asthma Chronic bronchitis Emphysema Bronchiectasis

Side Effects and Adverse Reactions

Epinephrine beta2-adrenergics

Tremors Dizziness HPN

Headache Nervousness Increase

Tachycardia
Heart

pulse rate Increase blood glucose

Palpitations Cardiac Dysrhythmias Angina

Examples
Isoproterenol

(Isuprel) Metaproterenol (Metaprel) Albuterol (Ventolin) Ipratropium bromide (Atrovent) Theophylline (Pulmophylline)

 Observe

the patient for effectiveness of drug therapy Observe for adverse drug reactions

Patient and Family Teaching

Take

the drug exactly as prescribed If symptoms become worse, do not increase the dose or frequency unless directed to do so by the physician If GI upset occurs, take this drug with food or milk (oral form) Drink 6 to 8 glasses of water each day Do not use nonprescription drugs Teach the patient to use metered-dose inhaler Avoid smoking (when applicable)

Mucolytics
Mucolytics

act like detergents by liquefying and loosening thick mucous secretions so that they can be expectorated

Mechanism of Action

A drug with mucolytic activity appears to reduce the viscosity of respiratory secretions by direct action on the mucus.
Acetylcysteine Dornase alfa enzyme that digest DNA in thick sputum secretion of patients with CF

Indications
Bronchopulmonary

emphysema

diseases such as

Primarily given by nebulization or directly instilled into a tracheostomy Acetylcysteine - preventing liver damage and antidote for acetaminophen overdose

Side Effects and Adverse Reactions

N/V

Stomatitis
Runny Fever Drowsiness Bronchospasm Irritation

nose

of Trachea and Bronchi

Examples
Acetylcysteine

(Mucomyst) Dornase alfa (Pulmozyme)

Nursing Considerations
Contraindications:

Hypersensitivity Asses respiratory status of patient Note any increase in sputum or change in consistency

Patient and Family Teaching

Acetylcysteine

usually is administered in the hospital, but may be prescribed for the patient being discharged and renting or buying respiratory equipment for use at home The nurse gives the patient or a family member full instruction in the use and maintenance of the equipment, as well as the technique of administration of the drug