1. Pharmacology II – Respiratory and Oxygenation
Kathy Plitnick RN PhD CCRN
Georgia Baptist College of Nursing of Mercer University

4. Antitussives Suppress cough Narcotics Non-Narcotics
Codeine
Non-Narcotics
Dextromethorphan
Use: dry, nonproductive cough

5. Dextromethorphan Available over-the-counter
Chemically related to opiates
Contraindicated in chronic cough
Caution in hepatic failure
Rare Side Effects
Interacts with other CNS depressants, Amiodarone, Quinidine, Alcohol

6. Decongestants Relieve nasal obstruction Adrenergic drugs
Constrict arterioles, reduce blood flow
Mainly alpha receptors
Oral, topical (sprays & drops)
Use: relieve rhinitis, preop nasal surgery
Contraindicated: HTN, CAD, glaucoma
Sudafed (pseudoephedrine)
Large doses: tachycardia, palpitations, lightheadedness

7. Antihistamines Prevent effects of histamine
Inhibit smooth muscle constriction
Decrease capillary permeablity
Decrease salivation
Use: allergic rhinitis, anaphylaxis, drug allergies, transfusions, dermatologic, motion sickness, sleep
Contraindicated: glaucoma, prostatic hypertrophy, pregnancy, bladder obstruction

9. First Generation H1 Blockers
Bind to central & peripheral H1 receptors
CNS depression/stimulation
Anticholinergic effects
Interact with alcohol, CNS depressants
Safety precautions
Baseline assessment
Increase oral fluid intake
No driving

10. Diphenhydramine (Benadryl)
High incidence of drowsiness
Short term management - insomnia
Topical, oral, IM, IV
Hypotension
Half-life 1-4 hours

11. Second Generation H1 Blockers
Produce less sedation
Less CNS depression
Fexofenadine (Allegra)
Rapid absorption
Half-life 14.4 hours
Caution in impaired renal function
Obtain thorough history of allergic reaction
Baseline pulmonary assessment
Administration with food
Safety measures

12. Expectorants Liquefy secretions OTC preparations
Guaifenesin (Robitussin)
Decreases adhesiveness, surface tension
Well absorbed
Symptomatic relief of cough
Do not use with persistent cough
Rare side effects
Assess type, severity of cough
Increase fluid intake, Humidity

13. Mucolytics Inhalation – liquefy mucus Acetylcysteine (Mucomyst)
Nebulized, Direct instillation
Acetylcysteine (Mucomyst)
Reduces viscosity
Acetaminophen overdose
Effective in 1 minute
Transient odor, irritated throat, N/V, bronchospasm

14. Bronchodilators
Adrenergic drugs that stimulate beta2 receptors, stimulate adenyl cyclase, increase production of cAMP, produces bronchodilation
Xanthines: Theophylline
Inhibits phosphodiesterase
Inhibits pulmonary edema
Helps cilia clear mucus
Strengthens diaphragm

15. Theophylline Contraindicated: gastritis, PUD
Uses: asthma, bronchitis, emphysema
Aminophylline by continuous infusion
Administer with water, after meals
Monitor plasma levels: mcg/ml
Avoid smoking
Signs of toxicity: anorexia, N/V, dizziness, shakiness, restlessness, tachycardia, hypotension, seizures

16. Beta Agonists – Albuterol
Available oral, inhalation
Bronchodilation occurs 5-15 minutes
Stimulates smooth muscle receptors in lungs, uterus, skeletal muscle
Side Effects: throat irritation, palpitations, Tachycardia, hypertension, finger tremors
Always administer prior to anti-inflammatory inhalers, steroids

17. Anticholinergics : Ipratropium/Atrovent
Block action of acetylcholine in bronchial smooth muscle
Reduces GMP
Halts bronchoconstriction due to PNS
Administration by inhalation, intranasal
Ineffective in acute bronchospasm
Adverse Effects: cough, nervousness, nausea, GI, headaches

18. Atrovent Do not use as an emergency agent
MDI’s – allow up to 1 minutes between puffs
Rinse mouth after administration

19. Anti-inflammatory: Glucocorticoids/Beclomethasone
Increase number of beta receptors
Increase responsiveness of beta receptors
Produces smooth muscle relaxation
Inhalation: decrease inflammatory cells, and swelling
Chronic asthma
Contraindicated: systemic fungal infections

20. Beclomethasone Caution: active infection, DM, PUD, HTN, CHF, RI
Rinse mouth after administration
Teach proper inhalation technique
Use bronchodilators first

21. How Can You Avoid This Medication Error?
Mr. C, 66 years old, has worsening COPD. At his last office visit, the MD added ipratropium (Atrovent) and beclomethasone (Vanceril) to his beta-adrenergic (Alupent) inhaler. He visits the office complaining of severe dyspnea. You quickly grab his Atrovent inhaler to administer a PRN dose and try to get him to relax.
What drug error has occurred, and how could this be avoided ??

22. Solution
Acute dyspnea: only short-acting beta adrenergic bronchodilators should be used (Alupent)
Teach which inhaler to use in an emergency
When prescribed multiple inhalers, canister should be a different color or marked in some way
Know what the patient is prescribed

23. Mast Cell Stabilizers: Cromolyn Sodium (Intal)
No direct anti-inflammatory
Prevents release of mast cells after exposure to allergens
Prophylactic mgmt severe asthma, seasonal rhinitis
Available oral, inhalation, nasal spray, ophthalmic

24. Cromolyn Sodium Use proper inhalation technique
Wait 10 minutes between doses
Rinse mouth after administration
Assess respiratory status

25. Leukotriene Receptor Antagonists: Zafirlukast (Accolate)
Binds to leukotriene receptors
Inhibits bronchoconstriction
Reduces airway edema, smooth muscle constriction
Rapidly absorbed
Half-life 10 hours
Chronic treatment

26. Zafirlukast (Accolate)
Aspirin increases concentration
Warfarin increases PT
Monitor SGPT
Side effects: headache, diarrhea, gastritis
Baseline LFT’s
Assess respiratory function
Increase fluid intake
Not for acute episodes
Take on empty stomach