Chapter 13 Pharmacology

CHAPTER 13:
“DRUGS ACTING ON
RESPIRATORY
SYSTEM”
Castillo, Stephany C.
Malison, Jessie Lou A.
BRONCHODILATORS
Are medications that open
(dilate) the airways (bronchial
tubes) of the lung by relaxing
bronchial muscles and allow
people who have difficulty
breathing to breath better.
They are helpful in
symptomatic relief or
prevention of bronchial
asthma and bronchospasm
associated with COPD.
 THE BRONCHODILATORS ARE:
 -Xanthines
 -Sympathomimetics (beta-agonists)
 -Anticholinergics
 -Inhaled steroids
XANTHINES
 Including caffeine and theophylline, come from a
variety of naturally occurring sources. These drugs
were once main choice for treatment of asthma and
bronchospasm.
 The Xanthines include:

 -Aminophyline -Oxytriphyline
 -Caffeine -Pentoxyfilline
 -Dyphilline -Theophylline
DRUG EFFECTS OF XANTHINES
 GI upset
 Anorexia
 Vomiting
 Gastric Pain
 Nausea
 Irritability
 Tachycardia to seizures, brain damage and even
death.
IMPLEMENTATION
 Monitor vital signs and note for the BP and HR.
 Administer oral drug with food or milk to relieve GI irritation, if GI
upset is a problem.
 Provide comfort measures, including rest periods, quiet environment,
dietary control of caffeine and headache therapy as needed, to help the
patient cope with the effects of drug therapy.
 Provide adequate hydration.
 Don’t crush enteric coated and sustained release tablets.
 Encourage to stop smoking.
 Provide periodic follow-up including blood tests to monitor serum
theophylline levels.
EVALUATION
 Monitor patient response to the drug.

 Monitor adverse effects (CNS effects,
cardiac arrhythmias, GI upset, local
irritation).
THE SYMPATHOMIMETICS
-These are drugs that mimic the effects of the

sympathetic nervous system.
-One of the actions of the sympathetic
nervous system is dilation of the bronchi
and increased rate and depth of respiration.
-This is the desired effect when selecting a
sympathetic as a bronchodilator.
 Sympathomimetics that are used as bronchodilators
include the following:
-Albuterol -Ephedrine
-Bitolterol -Epinephrine
-Isoproterenol -Terbutaline
-Metaproterenol - Salbutamol
DRUG EFFECTS OF SYMPATHOMIMETICS
 Adverse effects of these drugs, which can be

attributed to sympathomimetic stimulation include:
 CNS stimulation- tremors, headache, nervousness

 GI- GI upset
 Cardio- cardiac arrhytmias, and hypertension,
tachycardia and palpitations, vasoconstriction
 Respi- bronchospasm, sweating, pallor, and flushing.
 -Hyperglycemia, Urinary retention
IMPLEMENTATION
 Assure the patient that the drug of choice will vary with
each individual. These sympathomimetics are slightly
different chemicals and are prepared in a variety of
delivery systems.
 Advise patients to use the minimal amount needed for
the shortest period of time necessary, to prevent adverse
effects and accumulation of drug levels.
 Instruct the patient on how to use the inhalers. Teach the
patients who use one of these drugs for exercise-induced
asthma to use it 30 to 60 minutes before exercising to
ensure peak therapeutic effects when they are needed.
 Provide safety measures as needed if CNS effects
become a problem, to prevent patient injury.
 Carefully teach the patient about the proper use of
the prescribed delivery system.
 Review the procedure periodically as improper use
may result in ineffective therapy.
EVALUATION

 Monitor or adverse effects ( CNS
effects, increased pulse and blood
pressure, GI upset ).
INHALED STEROIDS
 Inhaled steroids have been found to be a very

effective treatment for bronchospasm.
AGENTS include:
Beclomethasone- given via MDI inhaler
Flunisolide
Triamcinolone
Dexamethasone- is given IV and orally, not inhaled
Prenisone and Prednisolone
THERAPEUTIC ACTION AND INDICATIONS
 Inhaled steroids are used to decrease the

inflammatory response in the airway.
 In an airway swollen and narrowed by
inflammation and swelling, this action will
increase airflow and facilitate respiration.
 Inhaling the steroid tends to decrease the
numerous systemic effects that are associated with
steroid use.
When administered into the lungs by inhalation,
steroids decrease the effectiveness of the
inflammatory cells.
This has two effects:

1. Decreased swelling associated with inflammation;
2. and promotion of beta adrenergic receptor activity-
which may promote smooth muscle relaxation and
inhibit broncho-constriction.
CONTRAINDICATIONS/CAUTIONS
 Inhaled corticosteroids are not for emergency use

and not for use during an acute asthma attack or
status of asthmaticus.
 They should not be used during pregnancy or

lactation.
DRUG EFFECTS OF INHALED STEROIDS
 Respiratory- Sore throat, hoarseness,

coughing, dry mouth and pharyngeal and
laryngeal fungal infections are the most
common side effects encountered.
 If a patient does not administer the drug
appropriately or develops lesions that allow
absorption of the drug, the systemic side
effects associated with steroids may occur.
IMPLEMENTATION
 Do not administer the drug to treat an acute

asthma attack or status asthmaticus, as these
drugs are not intended for treatment of acute
attack.
 Have the patient rinse the mouth after using the
inhaler.
 Monitor the patient for any sign of respiratory
infection.
EVALUATION

 Monitor for adverse effects (nasal irritation,
fever, GI upset).
EXPECTORANT
-A medicine which promotes the

secretion of sputum by the air
passages, used to treat coughs.
SIDE EFFECTS AND PRECAUTIONS
-Nausea or vomiting may occur.
-This product may contain inactive

ingredients, which can cause allergic
reactions or other problems.
EXAMPLE:
 Guaifenesin-Promotes drainage of
mucus from the lungs by thinning the
mucus, and also lubricates the irritated
respiratory tract.
-Guaifenesin may have a bitter taste.
-Do not split the tablets unless they have a score line
and your doctor or pharmacist tells you to do so.
-If you are using the liquid form of this medication,
carefully measure the dose using a special measuring
device/spoon.
-For powder packets, empty the entire contents of the
pocket onto the tongue and swallow.
-Dosage is based on your age, medical condition, and
response to treatment. Do not take more than 6
doses in a day.
-Drink plenty of fluids while taking this
medication.
-Tell your Doctor if your cough is
accompanied by fever, severe sore throat,
rash, persistent headache or if it persists,
returns, or worsens after 7 days.These may
be signs of a serious medical problem.
5 Natural Expectorants to Kill Your Cough
1.Moisture
2.Hydration
3.Honey
4.Peppermint
5.Ivyleaf
HOW TO USE EXPECTORANT?
-take this medication by mouth with or

without food, as directed by your
doctor, usually every 4hours.
ANTITUSSIVES
-Antitussives are medicines that suppress

coughing, also known as cough suppressants.
-However, their use is not without controversy and
they should only be considered for dry, irritating
coughs that do not involve mucus production.
- These agents are not given to patients who have
undergone thoracic and abdominal surgeries.
HOW TO USE ANTITUSSIVE
 If you are taking the over-the-counter product, read all

the directions on the product package before taking this
medication. If you have any questions, consult your
pharmacist. If your doctor has prescribed this
medication, take it as directed.
 Take this medication by mouth with or without food with

a full glass of water.
 If you are using the liquid form, use a medication

measuring device to carefully measure the prescribed
dose.
 If you are taking the extended release capsules,
swallow them whole. Do not crush or chew
extended capsules or tablets.
 If you are taking the powder, mix it thoroughly in
the proper amount of liquid and stir well.
 The dosage is based on your age, medical
condition and response to therapy.
2 CLASSIFICATION OF ANTITUSSIVE
 1. NARCOTIC/ OPIOID ANTITUSSIVE

- Codeine
-Hydrocodone
2. NON-NARCOTIC/ NON OPIOID ANTITUSSIVE

-Dextromethorphan
- Benzonatate
- Dipenhydramine
DRUG EFFECTS OF ANTITUSSIVE
 Drowsiness
 Dizziness
 Headache
 Blurred Vision
 Upset stomach
 Nausea
 Constipation
 Dry mouth, nose and throat
PRECAUTIONS
 Before taking this product, tell your doctor

or pharmacist if you are allergic to it; or if
you have any other problems.
 Also your medical history especially e.g.,
asthma, emphysema, etc.
THE
END

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CHAPTER 13:

 The Xanthines include:

 Monitor patient response to the drug.

-These are drugs that mimic the effects of the

 Adverse effects of these drugs, which can be

 CNS stimulation- tremors, headache, nervousness

 Monitor patient response to the drug.

 Inhaled steroids have been found to be a very

 Inhaled steroids are used to decrease the

This has two effects:

 Inhaled corticosteroids are not for emergency use

 They should not be used during pregnancy or

 Respiratory- Sore throat, hoarseness,

 Do not administer the drug to treat an acute

 Monitor patient response to the drug.

-A medicine which promotes the

-Nausea or vomiting may occur.

-This product may contain inactive

-take this medication by mouth with or

-Antitussives are medicines that suppress

 If you are taking the over-the-counter product, read all

 Take this medication by mouth with or without food with

 If you are using the liquid form, use a medication

 1. NARCOTIC/ OPIOID ANTITUSSIVE

2. NON-NARCOTIC/ NON OPIOID ANTITUSSIVE

 Before taking this product, tell your doctor

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