1. Bronchodilators and Other Respiratory Agents
Chapter 16
Bronchodilators and Other Respiratory Agents

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

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

4. 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)

5. 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

6. 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)

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

8. 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

9. 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

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

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

12. 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

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

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

15. 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)

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

17. 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)

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

19. 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

20. 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

21. 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

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