Respiratory Drug Chart

Drug Mechanism
-competes for H1 receptors

Use
-prevent & treat allergic responses -hypnoticsafe, nonnarcotic -anticholinergic -anti-emetic

Side/Adverse Effects
-CNS: drowsiness, sedation, vertigo CV: hypotension, palpitations, arrhythmias -Resp: dryness of mouth, thickened bronchial secretions -GI: anorexia, N/V, diarrhea or constipation -GU: urinary retention, dysuria

Nursing Implications
-additive depression of CNS w/ alcohol, hypnotics, antipsychotics, anti-anxiety, narcotics -anticholinergiccaution w. glaucoma, hyperthyroidism, CV dx or hypertension -avoid pregnancy /lactation -take at bedtime to avoid sedation -caution about driving -caution w/ older persons -teach proper administration of nose drops & nose sprays -caution against misuse rebound congestion DDIs: Inderal antagonizes antihistamines

Antihistamines
diphenhydramine hydrochloride-BENADRYL

ALLEGRA, CLARITIN, ZYRTEC

Beta Agonists
Nonselective: Isoproterenol, Epinephrine, Ephedrine Selective: albuterol, metaproterenol, terbutaline, salmeterol

-stimulate beta-2 adrenoreceptors -bronchial smooth muscle relaxation -stimulate mucocillary clearance

-rescue therapy during acute asthma attacks -prophylaxis for exerciseinduced asthma -prophylaxis for exposure to known antigens

-Nonselective: stimulate cardiac beta receptors tachycardia, arrhythmias, angina -CNS effects: nervousness, anxiety, insomnia, irritability, dizziness & sweating -vasoconstriction: incr. BP -systemic side effects minimal especially CV -dryness of oropharynx -cough -exacerbation of symptoms -if plasma level >20 ug/ml -CNS: nervousness, insomnia, HA, dizziness, tremors late sign -Cardiac: tachycardia, angina, hypotension -GI: nausea (1st sign), vomiting, anorexia

-assess respiratory status -decr. environmental irritants -improve humidification -avoid OTC inhalers DDIs: potentiated by MOA inhibitors, tricylcic antidepressants and other sympathomimetic drugs

Bronchodilators

Muscarinic-receptor antagonists (anticholinergics)

-inhibits ACh mediated constriction of bronchial smooth muscle -decr. vagal-stimulated mucus secretion
-inhibits phosphodiesterase leads to incr. cAMP so bronchodilation -decr. histamine release -stimulates ciliary transport of mucus -improve contractility of diaphragm -incr. CO, produces diuresis & decr. PV

-treat chronic conditions; not for acute use

Methylxanthines

-prophylaxis & treatment of asthma -relieve SOB, wheezing & dyspnea -stimulate newborns who dont breath well

-Narrow TIincr. side effect w/ caffeine -Monitor blood levels10-20 ug/ml=therapeutic range -Give during day to prevent insomnia -Take w/ food if GI upset -smokers may require incr. dosing Know DDIs

Drug Cromolyn Sodium

Mechanism
-prevents influx of Ca into mast cells, therefore inhibiting degranulation and release of histamine & leukotrines -inhibits the recruitment of inflammatory cells into airway -inhibits late bronchoconstriction -blocks the formation of leukotrienes from arachiodonic acid -prevents bronchoconstriction & airway inflammation -incr. CHO, protein & fat metabolism -suppress inflammatory process -suppress normal immune system

Use
-prophlyaxis in asthma (esp for children or exercise induced asthma) -seasonal allergic rhinitis & opthalmic adm in allergic conjunctivitis

Side/Adverse Effects
-HA -bronchospasm -dry throat

Nursing Implications
-teach proper use of inhaler & nasal sprays -drug in powder form may cause bronchospasm -assess breath sounds pre & post tx -mouth care after use to minimize irritation to the throat & oral mucosa -incr. plasma concentrations of theophylline, warfarin, betaadrenergic blockers -not for pts w/ liver dx or alcoholism -teach proper use inhaler properly -gargle & rinse mouth after each use -notify care provider ifillness or feel worse, continued asthma attacks, incr. in stressful situations -wear medical alert -assessment VS, wt, monitor glucose -assess for signs of depression -do not abruptly withdraw, taper slowly -avoid injury to skinfragile -avoid risk of infection -take care w/ application of topical -instruct not to overuse; may be addictive -limit # of days (3-5) -NO w/ incr. BP, nsg mother, w/ MAO inhibitors -caution w/ elderly, glaucoma, BPH, DM & hyperthyroidism -limit caffeine intake maintain sitting position when takin nasal sprays -avoid taking w/ diet pills

Oxymethazoline (AFRIN, DRISTAN) Phenylephrin (NEO-SYNEPHRINE) Pseudophederine + chlorpheniramine + dextromethorphan + acetaminophen (COMTREX) Pseudoephedrin hydrochloride (SINUTAB, SUDAFED)

Anti-Inflammatory

Leukotriene Inhibitors
ZYFLO, ACCOLATE

-Maintenance therapy in chronic asthma

-hepatitis w/ ZYFLO -drug allergy w/ ACCOLATE

-acute & maintenance asthma management

Inhalation: -fungal (Candida) infections -oral & nasal irritation Oral: -immunosuppressant effect -growth retardation, muscle wasting -hyperglycemia, hypertension -mood swings, physical changes

Glucocorticoids

Decongestants

-shrinks nasal membranes by a vasoconstrictive mechanism (alpha-1 adrenergic agonists)

-systemic relief of allergic rhinitis, sinusitis, colds & flu

-CNS: nervousness, restlessness, insomnia -GI: N/V -palpitations, hypertension -rebound engorgement
congestion worsens after incr. frequency of use

Drug

Mechanism
-incr. respiratory tract fluid -decr. viscosity of bronchial & tracheal secretions

Use
-persistent coughs -mucus plugs -common cold, bronchitis

Side/Adverse Effects
-allergies to the drug -GI: N/V, anorexia -pregnancy category C

Nursing Implications
-assess lung sounds & secretions -sufficient humidification -teach effective coughing -use no more than 1 wk -encourage fluid intake 2-3 L/day -drink full glass of water after each dose taken -avoid ETHOL or drugs w/ ETHOL -wait 15-20 min after taking syrup before drinking liquid -monitor use of controlled substance -take at bedtime -dryness of mouthrelieve w/ hard candy, ice chips, mouth care -caution w/ activities -pregnancy category C -not used for children< 6 yr -avoid use of ETHOL -OTC drugsread directions carefully -opiates more sedating -odor of rotten eggs may cause GI upset -administered through nebulizer -caution older adults bronchospasm -assess lung sounds & respiratory status -Oral: mix w/ iced liquid17 doses over 4 day period for overdose of acetaminophen

Expectorants
Guaifenesin (ROBITUSSIN)

-suppress cough reflex center in medulla

-suppresses nonproductive cough

-GI, sedation, anesthesia of mouth

Antitussives
Nonnarcotic
benzonatate (TESSALON) dextromethorphan (OTC cough syrups) diphenhydramine (BENYLIN)

Narcotic
codeine sulfate hydrocodone bitartrate (HYCODAN)

Mucolytic drugs
MUCOMYST

-reduce thickness of mucus -makes mucus secretions less tenacious -alters metabolism of acetaminophen

-Inhaledrespiratory conditions -Orallyacetaminophen overdose

-may irritate nasal passages