Drugs Affecting the Respiratory System

Drugs Affecting the Respiratory System Antihistamines, Decongestants, Antitussives, and Expectorants

Understanding the Common Cold Most caused by viral infection (rhinovirus or influenza virus—the “flu”)

Understanding the Cold Virus invades tissues (mucosa) of upper respiratory tract, causing upper respiratory infection (URI). Excessive mucus production results from the inflammatory response to this invasion. Fluid drips down the pharynx into the esophagus and lower respiratory tract, causing cold symptoms: sore throat, coughing, upset stomach.

Irritation of nasal mucosa often triggers the sneeze reflex. Mucosal irritation also causes release of several inflammatory and vasoactive substances, dilating small blood vessels in the nasal sinuses and causing nasal congestion.

Involves combined use of antihistamines, nasal decongestants, antitussives, and expectorants. Treatment is SYMPTOMATIC only, not curative. Symptomatic treatment does not eliminate the causative pathogen.

Upper Respiratory Tract

Treatment of the Common Cold Difficult to identify whether cause is viral or bacterial. Treatment is “empiric therapy,” treating the most likely cause. Antivirals and antibiotics may be used, but viral or bacterial cause may not be easily identified.

Antihistamines Drugs that directly compete with histamine for specific receptor sites. Two histamine receptors: H1 histamine H2 histamine

Antihistamines: Mechanism of Action The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation: Vasodilation Increased gastrointestinal and respiratory secretions Increased capillary permeability

Histamine vs. Antihistamine Effects Smooth Muscle (on exocrine glands) Histamine effects: Stimulate salivary, gastric, lacrimal, and bronchial secretions Antihistamine effects: Prevent salivary, gastric, lacrimal, and bronchial secretions

Histamine vs. Antihistamine Effects Immune System (Release of substances commonly associated with allergic reactions) Histamine effects: Mast cells release histamine and other substances, resulting in allergic reactions. Antihistamine effect: Binds to histamine receptors, thus preventing histamine from causing a response.

Antihistamines: Other Effects Skin: Block capillary permeability, wheal-and-flare formation, itching Anticholinergic: Drying effect that reduces nasal, salivary, and lacrimal gland secretions (runny nose, tearing, and itching eyes) Sedative: Some antihistamines cause drowsiness

Antihistamines: Therapeutic Uses Management of: Nasal allergies Seasonal or perennial allergic rhinitis (hay fever) Allergic reactions Motion sickness Sleep disorders

Antihistamines: Side effects Anticholinergic (drying) effects, most common: Dry mouth Difficulty urinating Constipation Changes in vision Drowsiness (Mild drowsiness to deep sleep)

Decongestants

Nasal Congestion Excessive nasal secretions Inflamed and swollen nasal mucosa Primary causes: Allergies Upper respiratory infections (common cold)

Decongestants Two main types are used: Adrenergics (largest group) Corticosteroids

Decongestants Two dosage forms: Oral Inhaled/topically applied to the nasal membranes

Topical Nasal Decongestants Adrenergics: ephedrine (Vicks) naphazoline (Privine) oxymetazoline (Afrin) phenylephrine (Neo Synephrine) Intranasal Steroids: beclomethasone dipropionate (Beconase)

Nasal Decongestants: Therapeutic Uses Relief of nasal congestion associated with: Acute or chronic rhinitis Common cold Sinusitis Hay fever Other allergies

Antitussives

Cough Physiology Respiratory secretions and foreign objects are naturally removed by the cough reflex Induces coughing and expectoration Initiated by irritation of sensory receptors in the respiratory tract

Two Basic Types of Cough Productive Cough Congested, removes excessive secretions Nonproductive Cough Dry cough

Coughing Most of the time, coughing is beneficial Removes excessive secretions Removes potentially harmful foreign substances In some situations, coughing can be harmful, such as after hernia repair surgery

Antitussives Drugs used to stop or reduce coughing Opioid and nonopioid (narcotic and non-narcotic) Used only for NONPRODUCTIVE coughs!

Antitussives: Mechanism of Action Opioid Suppress the cough reflex by direct action on the cough center in the medulla. Examples: codeine ,,,hydrocodone

Antitussives: Mechanism of Action Nonopioid Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated. Examples: benzonatate (Tessalon) dextromethorphan (Vicks Formula)

Antitussives: Therapeutic Uses Used to stop the cough reflex when the cough is nonproductive and/or harmful

Antitussives: Side Effects Dextromethorphan Dizziness, drowsiness, nausea Opioids Sedation, nausea, vomiting, lightheadedness, constipation

Expectorants

Expectorants Drugs that aid in the expectoration (removal) of mucus Reduce the viscosity of secretions Disintegrate and thin secretions

Expectorants: Mechanisms of Action Direct stimulation or Reflex stimulation Final result: thinner mucus that is easier to remove

Expectorants: Mechanism of Action Direct stimulation: The secretory glands are stimulated directly to increase their production of respiratory tract fluids. Examples: iodine-containing products such as iodinated glycerol and potassium iodide (direct and indirect stimulation)

Expectorants: Mechanism of Action Reflex stimulation: Agent causes irritation of the GI tract. Loosening and thinning of respiratory tract secretions occur in response to this irritation. Examples: guaifenesin, syrup of ipecac

Expectorants: Common Side Effects guaifenesin Nausea, vomiting Gastric irritation

Nursing Implications: Expectorants Expectorants should be used with caution in the elderly, or those with asthma or respiratory insufficiency. Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions. Report a fever, cough, or other symptoms lasting longer than a week.

Bronchodilators

Bronchodilators: Xanthine Derivatives Plant alkaloids: caffeine, theobromine, and theophylline Only theophylline is used as a bronchodilator

Bronchodilators: Xanthine Derivatives Side Effects Nausea, vomiting, anorexia Gastroesophageal reflux during sleep Sinus tachycardia, palpitations, ventricular dysrhythmias Transient increased urination