Bronchodilators and Other Respiratory Agents Chapter 16 Bronchodilators and Other Respiratory Agents

Bronchodilators p393 Medications used to relax and open the bronchi Rescue or maintenance drugs Used to treat: Chronic obstructive pulmonary disease Asthma

Sympathomimetic bronchodilators Table 16-1 p395-397 Stimulate Beta2 adrenergic receptors Examples Albuterol (Proventil) Levalbuterol (Xopenex) Salmeterol (Serevent)

Uses for Sympathomimetics p394 Rescue drugs and maintenance drugs Quickly reduce airway constriction Treat hypotension and shock (epinephrine p395) Produce uterine relaxation to prevent premature labor (terbutaline sulfate p397)

Sympathomimetic bronchodilators p394 Side effects come from CNS stimulation and Beta1 receptor stimulation Nausea Insomnia Anxiety Palpitations Tremors GI disturbances Increased heart rate and blood pressure

Xanthine bronchodilators p394 Table 16-2 p399 Oldest class of bronchodilators Used in ancient times Caffeine is a xanthine Action Bronchial smooth muscle relaxation Bronchodilation Examples: Aminophylline Theophylline (Elixophyllin)

Xanthine side effects p394 Nausea Vomiting Anorexia Tachycardia Palpitations Dysrhythmias Transient increased urination (diuresis) Insomnia

Teaching Xanthines p399 Table 16-2 Patient teaching Take with food Limit caffeine in diet Monitor for tachycardia Toxicity Nausea, GI upset, convulsions, restlessness, arrhythmia Smokers require more frequent dosing

Anticholinergic bronchodilators p 399 Mechanism of action: Acetylcholine causes bronchial constriction Anticholinergics bind to the ACh receptors, preventing ACh from binding Result: bronchoconstriction is prevented, airways dilate

Anticholinergic Bronchodilators examples p399 Ipratropium bromide (Atrovent) Maintenance drug Tiotropium bromide (Spiriva HandiHaler) Slow and prolonged action Used to prevent bronchoconstriction

Anticholinergics: Side Effects p400 Usually not absorbed systemically If absorbed, have the potential to produce: Dry mouth Blurred vision Constipation Urinary retention

Leukotriene Receptor Antagonists p398 Leukotrienes are inflammatory molecules Cause the bronchials to constrict Development of edema in the lungs Leukotriene receptor antagonists directly prevent bronchoconstriction Popular and effective

Leukotriene Receptor Antagonists p398 Examples Montelukast (Singulair) Zafirlukast (Accolate) Side effects Headache Nausea Diarrhea Liver dysfunction

Leukotriene Receptor Antagonists: Client Education Teaching Used for chronic management of asthma, not acute asthma Improvement should be seen in about 1 week

Mast Cell Stabilizers p400 Prophylactic drugs No direct bronchodilator activity Indirect-acting Adjuncts to the overall management of clients with lung disease Prevent bronchospasm from: Cold air Exercise Allergens Dry air Examples: Cromolyn (Nasalcrom, Intal) Nedocromil (Tilade)

Mast Cell Stabilizers: Side Effects Coughing Taste changes Sore throat Dizziness Rhinitis Headache Bronchospasm

Inhaled Corticosteroids p400 Table 16-3 p402 Anti-inflammatory Inhaled forms Reduced systemic effects Used for chronic asthma Does not relieve acute asthma attacks Examples Beclomethasone (Beclovent, Vanceril) Triamcinolone (Azmacort) Flunisolide (AeroBid)

Inhaled Corticosteroids: Side Effects Pharyngeal irritation Coughing Dry mouth Oral fungal infections (thrush) Systemic effects are rare

Combination Respiratory Agents p401 Fluticasone propionate and salmeterol (Advair): a dry powder in a circular diskus Salmeterol: long-acting bronchodilator Fluticasone is a corticosteroid: anti-inflammatory agent

Nursing assessment Assessment of pt with COPD or asthma focuses on signs and symptoms of respiratory distress Dyspnea Cyanosis Activity tolerance Assessment of effectiveness of therapy Changes in cough Ease of respiration Skin, mucous membrane color Nature and quantity of secretions Breath sounds Oxygen saturation

Respiratory Agents: Client Education Instruct clients to: Receive flu and pneumonia vaccination Receive prompt treatment for any illness Check with health care provider before taking other medications Shake inhalers prior to use Allow 1 minute between inhaler doses

Client education cont Use bronchodilator first, corticosteroid inhaler second Once a day dose: administer in morning Encourage 3000-4000 ml fluid a day HOB elevated 30 degrees Orthopneic position