Respiratory Medications NUR 154 Pharmacotherapeutics

Upper Respiratory Disorders Allergic Rhinitis - Nasal mucosa react to allergen. S/S: Sneezing, rhinorrhea (runny nose), nasal itching, watery eyes, congestion Medication Management Drug therapy: Antihistamines are the drugs of choice Benadryl, Claritin Common S.E.’s: Sedation, dry mouth, urinary retention, constipation (anticholinergic S.E.’s), Insomnia, nervousness, irritability

Lower Respiratory Disorders Obstructive Narrowed air passages Increased turbulence (secretions) Increased resistance to air flow S/S = bronchospasm, edema, inflammation, excessive mucous secretion Examples: Chronic obstructive pulmonary disease or COPD Asthma Bronchitits Cystic fibrosis

Lower Respiratory and Related Medications Expectorants Liquefy mucous by stimulating secretion of lubricant fluids in larger airways Can increase effectiveness of ciliary action and coughing Guaifenesin (Robitussin) Used in acute coryza (common cold), bronchitis, pharyngitis, sinusitis, laryngitis, COPD Used in combination with other resp. agents, such as bronchodilators, decongestants, and antihistamines Therapeutic Outcome Reduced frequency of nonproductive cough, increased expectoration of phlegm.

Lower Respiratory and Related Medications Antitussive Agents Suppress cough center in brain Used to suppress bothersome dry, hacking, nonproductive cough ***NOT normally used to suppress productive cough*** Codeine is the “gold standard” Usu. low doses, short duration of use to avoid long-term dependence Causes resp. depression in higher doses Side Effects: Drowsiness, sedation, constipation; enhanced CNS depression with other like agents, such as alcohol, sedatives, antihistamines, phenothiazines Dextromethorphan Does not cause respiratory depression or dependence! Drug of choice for children – Is in many OTC meds

Lower Respiratory & Inhalant Medications Beta-adrenergic Bronchodilators Stimulation of beta receptors relaxes smooth muscle of bronchi; if non-selective, stimulate beta receptors of heart muscle S.E.’s: Tachycardia, palpitations, nervousness, tremors; N/V Notify MD of an increase of 20 or > beats per minute Mainstay of asthma therapy and COPD *Ideally – should wait ten minutes between inhalations Common types: Albuterol (acute); Serevent (nonacute);

Lower Respiratory & Inhalant Medications Anticholinergic Bronchodilators - Atrovent Blocks cholinergic receptors in bronchial smooth muscle, with minimal anticholinergic side effects S.E.’s: Dry mouth and throat irritation, should resolve in ~ 1st – 2nd week of use. Mainstay of asthma and COPD treatment; oftentimes combined in nebulizer treatment with Albuterol *If more than 1 inhaler is ordered, you administer corticosteroids to open bronchial before administering other inhalers.

Respiratory Anti-inflammatory Medications Corticosteroids – Advair disk, Flovent Smooth muscle relaxation and decrease inflammation. P.O., IV (Prednisone or methylprednisone) or Inhalants – Flovent is a traditional aerosol inhalant Advair is dry powder inhalant (DPI) for asthma, or COPD Side effects Inhalant – oral thrush, dysphonia (spacer, gargle, and rinse after each use) P.O. or IV use: Increased susceptibility to infections, hyperglycemia, mood swings, delayed wound healing Never d/c these drugs abruptly, as they cause adrenal suppression of pt.’s own cortisol production. Always taper gradually!

Lower Respiratory and Related Medications Xanthine Derivatives – Aminophylline, Theophylline Relaxes smooth muscle of airways Acute management – IV administration Side effects: GI upset (^ gastric acid), tachy, palpitations, nervousness This category can inhibit the effects of Beta Blockers and lithium Chronic management – Oral medication, such as Theodur

Lower Respiratory and Related Medications Leukotriene Inhibitors – Zafirlukast (Accolate) Inhibit inflammatory mediators which trigger asthma, thereby reducing potential for edema, increased mucous and airway constriction These are not bronchodilating agents Do not use for acute attacks! S.E.’s: HA, nausea – subsides with continued therapy Take with food or milk. *Increases effects of theophylline and warfarin! Monitor closely and expect decreased doses of these other meds

Lower Respiratory and Related Medications Acetylcysteine (Mucomyst) Inhalant which liquefies and reduces viscosity of mucous secretions Used in emphysema, COPD, bronchiectasis and pneumonia clients Allows easier removal of secretions by coughing, percussion and postural drainage Wash client’s face and hands after administration to reduce chance for irritation. S.E.’s: N/V (drug has a rotten egg smell), bronchospasm. Do not administer concurrently with antibiotics **This Drug is also given orally as the antidote to Tylenol overdose**

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