1. Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Drugs Used to Treat Respiratory Conditions 28

2. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Multimedia Directory Slide 7Asthma Video Slide 8Effects of Asthma Animation Slide 18Mechanism of Action of Salmeterol Animation Slide 45Mechanism of Action of Diphenydramine Animation

3. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 28-1A The upper respiratory tract.

4. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 28-1B The lower respiratory tract.

5. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 28-2 Bronchioles and alveoli.

6. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Asthma Chronic disease caused by increased reactivity of the tracheobronchial tree to various stimuli Affects about 16 million Americans Classified according to cause: allergy, exercise-induced, or infections of respiratory tract

7. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Asthma Video Click on the screenshot to view a video on the topic of asthma. Back to Directory

8. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Effects of Asthma Animation Back to Directory Click on the screenshot to view an animation on the effects of asthma.

9. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 28-3 The effects of asthma on the bronchioles.

10. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Isoproterenol Isoproterenol (Isuprel) is often used to treat asthma in children. However, this use is not a labeled indication for the drug. Advise parents and children that saliva and sputum may appear pink after inhalation—this is normal.

11. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 The Most Common Antiasthma Drugs

12. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 (continued) The Most Common Antiasthma Drugs

13. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 (continued) The Most Common Antiasthma Drugs

14. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 (continued) The Most Common Antiasthma Drugs

15. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 (continued) The Most Common Antiasthma Drugs

16. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 (continued) The Most Common Antiasthma Drugs

17. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-1 (continued) The Most Common Antiasthma Drugs

18. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mechanism of Action of Salmeterol Animation Click on the screenshot to view an animation showing the mechanism of action of salmeterol. Back to Directory

19. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Bronchodilators Agents that widen the diameter of bronchial tubes: –Beta 2 -adrenergic agonists –Xanthines

20. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Beta 2 -Adrenergic Agonists: Uses Drugs of choice in acute bronchospasm; produce bronchodilation by relaxing smooth muscles of bronchial tree Used to relieve bronchospasm of asthma, to treat bronchitis and other obstructive airway diseases

21. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Beta 2 -Adrenergic Agonists: Adverse Effects Restlessness Headache Dizziness Palpitations Insomnia Nausea and vomiting Anorexia Tachycardia

22. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Beta 2 -Adrenergic Agonists: Contraindications Contraindicated in glaucoma, cardiogenic shock Safety during pregnancy and lactation not established

23. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Beta 2 -Adrenergic Agonists: Contraindications Cautious use in older adults or debilitated patients; and in those with prostatic hypertrophy, hypertension, diabetes, hyperthyroidism, Parkinson’s disease, tuberculosis, and psychoneurosis

24. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Beta 2 -Adrenergic Agonists: Patient Information Instruct patients to not exceed dosage. Advise patients to eat small, frequent meals to prevent nausea. Instruct patients to report chest pain, dizziness, insomnia, weakness, tremors, irregular heartbeat, difficulty breathing, productive cough, or lack of therapeutic effects.

25. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Xanthines: Uses Drugs chemically related to caffeine that dilate bronchioles by relaxing smooth muscle Used for prophylaxis and symptomatic relief of bronchial asthma and bronchospasm associated with chronic bronchitis and emphysema

26. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Xanthines: Adverse Effects Common: palpitations, tachycardia, flushing, hypotension, insomnia, nervousness, nausea and vomiting, diarrhea, tachypnea Serious: respiratory arrest

27. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Xanthines: Contraindications Should not be given to patients with coronary artery disease, history of angina, or severe renal or liver impairments Safety during pregnancy and lactation not established

28. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Xanthines: Contraindications Cautious use in children and older adults; those with hyperthyroidism, hypertension, peptic ulcer, prostatic hypertrophy, glaucoma, and diabetes

29. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Xanthines: Patient Information Advise patients to take at same time each day. Instruct patients to avoid charbroiled food, limit caffeine intake, and avoid smoking. Women should not breast feed while taking these drugs.

30. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Corticosteroids: Uses Mechanism of action believed to be diminished activation of inflammatory cells and increased production of anti- inflammatory mediators Used to treat respiratory conditions such as nasal congestion and allergic conditions such as rhinitis and asthma

31. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Corticosteroids: Adverse Effects Irritation of mucous membranes Headache Pharyngitis Epistaxis Nausea and vomiting Coughing

32. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Corticosteroids: Contraindications Contraindicated in children younger than 4 years Cautious use in pregnancy and lactation, and in those with immune system infections, tuberculosis, herpes simplex, ulcers, and nasal surgery or trauma

33. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Corticosteroids: Patient Information Advise patients to avoid exposure to chickenpox or measles.

34. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Leukotriene Inhibitors: Uses Block synthesis of, or the body’s inflammatory response to, leukotrienes Used in prophylaxis and treatment of chronic asthma or allergic rhinitis

35. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Leukotriene Inhibitors: Adverse Effects Arrhythmias Dizziness Anxiety Headache Euphoria Dry mouth

36. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Leukotriene Inhibitors: Contraindications Contraindicated in those with severe asthma attacks, bronchoconstriction, status asthmaticus, or during lactation Cautious use in children younger than 1 year, pregnancy, and patients with severe liver disease

37. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Leukotriene Inhibitors: Patient Information Instruct patients not to use for severe asthma attacks.

38. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Oral Administration Advantage The advantage of leukotrienes is oral administration. Some patients (especially children) do not adhere to inhaled medication therapy.

39. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mast Cell Stabilizers: Uses Inhibit release of bronchoconstrictors such as histamine from pulmonary mast cells Used for prophylaxis of mild to moderate seasonal and perennial bronchial asthma and allergic rhinitis; prevention of exercise-related bronchospasm; prevention of acute bronchospasm

40. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mast Cell Stabilizers: Adverse Effects Nausea and vomiting Dry mouth Throat irritation Cough Hoarseness

41. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mast Cell Stabilizers: Adverse Effects Headache Dizziness Urticaria Rash

42. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mast Cell Stabilizers: Contraindications Contraindicated in patients with coronary artery disease or history of arrhythmias, dyspnea, acute asthma, and status asthmaticus; during pregnancy; or in children younger than 6 years Cromolyn should be used cautiously in those with renal or hepatic dysfunction.

43. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mast Cell Stabilizers: Patient Information Advise patients to gargle with water or to suck on lozenges after each treatment to reduce throat irritation, cough, and hoarseness.

44. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-2 Major Types of Cough Suppressants

45. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mechanism of Action of Diphenhydramine Animation Click on the screenshot to view an animation showing the mechanism of action of diphenhydramine. Back to Directory

46. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Antitussives: Uses Opioids work by causing respiratory depression; nonopioids reduce activity of peripheral cough receptors and appear to increase threshold of central cough center Opioids are used to suppress nonproductive cough; nonopioids offer temporary relief of cough spasms.

47. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Antitussives: Adverse Effects Difficulty breathing Drowsiness Rash Itching Dizziness Nausea Nervousness and restlessness

48. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Antitussives: Contraindications Contraindicated in asthma, emphysema, diabetes, heart disease, seizures, thyroid conditions, chronic bronchitis, and liver disease Cautious use in pregnancy and lactation

49. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Antitussives: Patient Information Advise patients to call physician if coughing continues longer than 1 week or mucus is yellow.

50. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Natural Expectorant Wild cherry bark acts as an expectorant and a mild sedative. It is available in syrup or tincture forms. It should not be used during pregnancy.

51. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Opioids for Cough Opioid analgesics are among most effective drugs used as cough suppressants: 15-mg doses are often sufficient.

52. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-3 Expectorants and Mucolytics

53. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Expectorants and Mucolytics: Uses Work by lowering viscosity and facilitating removal of mucous secretions (acetylcysteine) or enhancing reflex outflow of respiratory tract fluids by irritating gastric mucosa (guaifenesin) Used to treat bronchopulmonary disease and cystic fibrosis

54. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Expectorants and Mucolytics: Adverse Effects and Contraindications Common adverse effects: very few Contraindicated in pregnancy and lactation Guaifenesin may interact with heparin.

55. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Expectorants and Mucolytics: Patient Information Instruct patients to increase fluid intake. Tell patients to report a persistent cough beyond 1 week.

56. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-4 The Most Commonly Used Decongestants

57. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 28-4 (continued) The Most Commonly Used Decongestants

58. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Decongestants: Uses Vasoconstricting agents that shrink swollen mucous membranes of nasal airway passage Used for relief of nasal congestion due to common cold, upper respiratory allergies, and sinusitis

59. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Decongestants: Adverse Effects Nervousness and restlessness Insomnia Dizziness Headache Irritability

60. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Decongestants: Contraindications Diabetes Heart disease Uncontrolled hypertension Hyperthyroidism Prostatic hypertrophy Concomitant use of other sympathomimetic drugs

61. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Decongestants: Patient Information Instruct patients to avoid taking oral decongestants with 2 hours of bedtime because they may act as stimulants. Advise patients to discontinue and immediately report extreme. restlessness or signs of sensitivity Women should not breast feed.