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Chapter 9
Respiratory Drugs
Chapter 9 Topics
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Asthma
Emphysema
Other Lung Diseases
Cough and Cold
Smoking Cessation
Learning Objectives
• Differentiate the pulmonary diseases
• Learn the pathophysiology and treatment of
asthma
• Define the goals of asthma treatment
• Discuss the pathophysiology and treatment
of emphysema and chronic bronchitis
Learning Objectives
• Describe other diseases related to the
lungs
• Be aware of the reemergence of
tuberculosis and of treatment for this
disease
Learning Objectives
• Understand how the antitussives,
expectorants, decongestants, and
antihistamines differ, and be able to
describe their uses
• Know why some drugs are prescribed for
their side effects
• Outline smoking cessation plans and
supportive therapy
Asthma
• Inflammatory disease that affects the
airways causing a reversible airway
obstruction
• Intermittent attacks are precipitated by
specific triggering events
• Causes a decrease in the amount of oxygen
and carbon dioxide exchanged
Asthma Classes
• Allergic
– Present in 35%-55% of patients
Asthma Classes
• Allergic
– Present in 35%-55% of patients
• Exercise Induced
Asthma Classes
• Allergic
– Present in 35%-55% of patients
• Exercise Induced
• Nonallergic
Upper and Lower Respiratory Tracts
Exchange of Oxygen and Carbon Dioxide
Asthma
• Asthmatic lung is more sensitive to lower
doses of allergens
• Asthma has shown to have genetic
predisposition
Asthma Characteristics
1. Reversible small airway obstruction
2. Progressive airway inflammation
3. Increased airway responsiveness to stimuli
These characteristics translate into:
1. Wheezing
2. Dyspnea
3. Acute and Chronic Cough
Asthma Attack –
st
1
Response
• Triggered by an antigen-antibody reaction
• Causes degranulation of mast cells:
histamine released
• Results in bronchospasm and mucus
production that plugs the small airways
Asthma Attack –
nd
2
Response
• Bronchoconstriction with delayed, sustained
reactions
• Causes self-sustaining inflammation
Asthmatic Response
Peak Flow Meter
• Assesses severity of disease and aids in
determining course of therapy
• Measures maximum flow rate in forced
expiratory maneuvers
Goals of Asthma Care
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Sleep well every night
Be able to go to work or school every day
Be free from wheezing all day
Have good control of coughing
Be able to continue with activities and
exercise
• Tolerate medicines well
Asthma Therapy
• Know the triggers and try to avoid them
• Accurately use a Peak Flow Meter regularly
• Be aware of status asthmaticus and the
treatment for it.
**This is a medical emergency.**
Stepwise Approach to Asthma
Therapy
Step 1. Short-acting oral or inhaled beta-2
agonist (less than once a week); no daily
medications
Stepwise Approach to Asthma
Therapy
Step 1. Short-acting oral or inhaled beta-2
agonist (less than once a week); no daily
medications
Step 2. Short-acting oral or inhaled beta-2
agonist (not to exceed three to four times in
one day); daily medications (e.g., inhaled
corticosteroids)
Stepwise Approach to Asthma
Therapy
Step 3. Short-acting oral or inhaled beta-2
agonist; daily medications (e.g., inhaled
corticosteroid and long-acting
bronchodilator)
Stepwise Approach to Asthma
Therapy
Step 3. Short-acting oral or inhaled beta-2
agonist; daily medications (e.g., inhaled
corticosteroid and long-acting
bronchodilator)
Step 4. Short-acting oral or inhaled beta-2
agonist; daily medications; inhaled
corticosteroid, long-acting bronchodilator,
long-acting beta-2 agonist, and oral
corticosteroids long term
Asthma Drug Therapy
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Treatment should start at the most appropriate step
Start with an aggressive initial approach
Rescue corticosteroids may be used at any time
Treatment should be reviewed every 3-6 months
For exercise-induced asthma, using terbutaline or
albuterol before exercise gives protection for 2
hours
Devices Used in Asthma Therapy
Nebulizer
• Uses a stream of air
that flows through
liquid medication to
make a fine mist to be
inhaled
• Very effective
• Must be cleaned and
taken care of to reduce
risk of contamination
Devices Used in Asthma Therapy
• Metered Dose Inhaler (MDI)
– Contains medication and compressed air
– Delivers a specific amount of medication with
each puff
Devices Used in Asthma Therapy
• Metered Dose Inhaler (MDI)
– Contains medication and compressed air
– Delivers a specific amount of medication with
each puff
• Spacer
– Used with MDIs to help get medication into the
lungs instead of depositing on the back of the
throat
Devices Used in Asthma Therapy
• Dry powder inhalers
– Starting to replace MDIs
– The patient turns the dial and a capsule full of
powder is punctured
– The patient then inhales the powder
Drug List
Asthma Agents
Bronchodilators
• albuterol (Proventil, Proventil HFA,
Ventolin, Ventolin HFA)
• epinephrine (EpiPen)
• formoterol (Foradil)
• ipratropium (Atrovent)
• ipratropium-albuterol (Combivent)
• isoetharine (Beta-2)
Drug List
Asthma Agents
Bronchodilators
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isoproterenol (Isuprel)
levalbuterol (Xopenex)
metaproterenol (Alupent)
pirbuterol (Maxair)
salmeterol (Serevent)
terbutaline (Brethine)
tiotropium (Spiriva)
albuterol (Proventil, Proventil HFA,
Ventolin, Ventolin HFA)
• Used in cases of airway obstruction
• Relaxes bronchial smooth muscle with little
effect on heart rate
• HFAs do not contain chlorofluorocarbons
which deplete the ozone
levalbuterol (Xopenex)
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Isomer of albuterol
Has fewer side effects than albuterol
Must be used with a nebulizer
Vials should be stored in foil package; once
the foil is opened, vials must be used within
1 to 2 weeks
salmeterol (Serevent)
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Indicated for maintenance therapy
Has a long duration of action
Onset of action is 30-60 minutes
Should not be used in rescue situations
Available in MDI and dry powder inhaler
ipratropium (Atrovent)
• Blocks ACh in bronchial smooth muscle
causing bronchodilation
• Used for prevention of attacks, not rescue
situations
Atrovent Dispensing Issues
Warning!
• If patient is allergic to peanuts, they may be
allergic to the suspending agent in this
inhaler
ipratropium-albuterol (Combivent)
• Combination bronchodilator
• Should inquire about peanut allergy as well
Drug List
Asthma Agents
Xanthine Derivatives
• aminophylline (Truphylline)
• theophylline
Drug List
Asthma Agents
Leukotriene Inhibitors
• montelukast (Singulair)
• zafirlukast (Accolate)
• zileuton (Zyflo)
Leukotrienes
• Increase edema, mucus, and vascular
permeability
• 100 to 1,000 times more potent than
histamine
• Inhibitors block the synthesis of or the
body’s response to leukotrienes
montelukast (Singulair)
• Indicated for the prophylaxis and chronic
treatment of asthma
• Do not use to treat acute attacks
• Approved for use in children over 12
months
• Used once a day
• Available in tablet and chewable tablet
Drug List
Asthma Agents
Corticosteroids
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beclomethasone (Beconase,Vanceril)
budesonide (Pulmicort, Rhinocort)
dexamethasone (Decadron)
flunisolide (AeroBid)
fluticasone (Flonase, Flovent)
hydrocortisone (Solu-Cortef)
Drug List
Asthma Agents
Corticosteroids
• methylprednisolone (Medrol Dose-Pack,
Solu-Medrol)
• mometasone furoate (Nasonex)
• prednisolone (Orapred, Pediapred)
• prednisone (Deltasone)
• triamcinolone (Azmacort, Nasacort AQ)
Corticosteroids
• Anti-inflammatory agent to suppress the
immune response
• Inhibit late-phase inflammatory reaction
• Reserved for more difficult cases
Corticosteroid Side Effects
• Primary:
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Oral candidiasis
Irritation and burning of the nasal mucosa
Hoarseness
Dry mouth
Corticosteroid Side Effects
• If used for a long period of time, it can
cause:
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Growth of facial hair in females
Breast development in males
Weight gain
“buffalo hump”
– “moon face”
Easy bruising
– Edema
Corticosteroid Dispensing Issues
Warning!
• Patient should rinse mouth with water after
using these inhalers to prevent oral
candidiasis
• Patient should be taught how to correctly
use these medications
fluticasone (Flonase, Flovent)
• Flonase is a nasal spray used for allergies
• Flovent is an MDI that comes in 3 different
strengths
• May take 2 weeks to reach maximum
benefit
budesonide (Entocort EC, Pulmicort
Respules, Pulmicort Turbuhaler,
Rhinocort)
• Pulmicort Turbuhaler – dry powder inhaler
that is breath activated and is easier to use
• Coughing is a less frequent side effect
mometasone furoate (Nasonex)
• Decreases the amount of inflammationcausing chemicals that are released
• Reverses dilation and permeability of
vessels
• May be used in children over 12 to prevent
allergy symptoms
Drug List
Asthma Agents
Mast Cell Stabalizers
• cromolyn sodium (Crolom, Gastrocrom,
Intal, Opticrom)
• nedocromil (Tilade)
Drug List
Asthma Agents
Monoclonal Antibody
• omalizumab (Xolair)
Drug List
Asthma Agents
Combination
• fluticasone-salmeterol (Advair Diskus)
fluticasone-salmeterol (Advair
Diskus)
• Combines corticosteroid (antiinflammatory) and a beta-2 agonist
• Indicated for maintenance therapy in
patients 12 years and older
• Available in powder for inhalation
Discussion
Are there any
problems with
this order?
Discussion
Are there any
problems with this
order?
Answer: Serevent
should be used
BID and shouldn’t
receive 3 MDIs at
a time…
Emphysema
• Characterized by destruction of air sacs
• Air sacs are not able to exchange oxygen
and carbon dioxide
• Causes tachypnea which gives the patient a
flushed look
Major Risk Factors For Emphysema
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Cigarette smoking
Occupational exposure
Air pollution
Genetic factors
Bronchitis
• Lining of the bronchial airways becomes
inflamed
• Acute
• Chronic
Bronchitis
• Lining of the bronchial airways becomes
inflamed
• Acute
– Runs a brief course
• Chronic
– Longer lasting condition
Chronic Bronchitis
• Difficult to breathe out
• Characterized by cough that produces
purulent, green, or blood-streaked sputum
• Major Risk Factors:
– Cigarette smoking, occupational hazards,
fumes, environmental pollution, bacterial
infection
The Body’s Defense System
• In a properly functioning lung:
– Immune system provides good protection
– Adequately removes potentially infectious
agents from the lungs
The Body’s Defense System
• In a properly functioning lung:
– Immune system provides good protection
– Adequately removes potentially infectious
agents from the lungs
• Types of Body Defense Cells:
– Ciliary carpet: rhythmically moves fluid or
mucus away from the lungs
The Body’s Defense System
• Types of Body Defense Cells:
– Goblet cells: produce mucus, increase due to
smoking
– Epithelial cells: produce protein-rich exudate
– Type I pneumocytes: phagocytes
– Type II pneumocytes: synthesize and secrete
surfactant
Cellular Makeup of an
Alveolus and Capillary Supply
Drug List
COPD Agents
• acetylcysteine (Acetadote, Mucomyst) –
Mucolytic
• dornase alfa (Pulmozyme) – Mucolytic
• tiotropium (Spiriva) – Anticholinergic
Other Emphysema and Bronchitis
Treatments
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Antibiotics are sometimes needed
Oxygen therapy
Expectorants (Water!!!)
Receive flu and pneumonia vaccinations
each year
Other Lung Diseases
• Prevention:
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Do not smoke
Avoid second-hand smoke
Avoid air pollution
Get vaccinated
WASH HANDS
Pneumonia
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Common lung disease that affects all ages
3 ways to become infected:
1. Inhalation of aerosolized particles
2. Entrance through the bloodstream
3. Aspiration
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Aspiration commonly occurs during sleep
X-Ray of Pneumonic Lung
X-Rays can be
performed to
check for
pneumonia or
to see the
progression of
the disease.
Discussion
Why is cigarette smoke implicated in
many diseases that affect the lung?
Discussion
Why is cigarette smoke implicated in
many diseases that affect the lung?
Answer: Destroys the walls of the
lungs, including the protective
mechanisms
Cystic Fibrosis
• Hereditary disease that affects the
gastrointestinal and respiratory systems
• This is a fatal disease; death is associated
with the pulmonary system
• Patients have an increase in production and
viscosity of mucus as well as decreased
pancreatic enzymes needed for digestion
Cystic Fibrosis Therapy
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Percussion
Nebulizer therapy
Antibiotic therapy
Strict diets
Respiratory Distress Syndrome
(RDS)
• Occurs in newborns during the first few
hours of life
• Acute asphyxia with hypoxia and acidosis
inhibit the production of surfactant
Respiratory Distress Syndrome
(RDS)
• Occurs in newborns during the first few
hours of life
• Acute asphyxia with hypoxia and acidosis
inhibit the production of surfactant
• 2 Causes:
– Prematurity
– Maternal diabetes
Drug List
Surfactants for RDS
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beractant (Survanta)
calfactant (Infasurf)
colfosceril palimate (Exosurf Neonatal)
poractant alfa (Curosurf)
beractant (Survanta)
• Drug of choice for RDS
• Extracted from cattle lung
• Lowers surface tension between the alveoli
to keep them from collapsing
beractant (Survanta)
• Prophylactic therapy: for high risk infants
• Rescue therapy: to be used within 8 hours
of birth
Tuberculosis
• Caused by mycobacterium tuberculosis
• Primarily affects the lungs, but may also
affect the bone and kidney tissue
• Transmission: through inhaled droplets
from an infected person (droplets descend
1-2 inches per hour)
Tuberculosis
• Seen primarily in:
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Alcoholics
Prison population
Immunocompromised
Elderly
2 Classes of Tuberculosis
1. Exposed, but no disease
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Test positive on TB test, but show no signs of
active disease
2 Classes of Tuberculosis
1. Exposed, but no disease
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Test positive on TB test, but show no signs of
active disease
2. Exposed and have active organisms
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Signs and symptoms are present: weight loss,
spitting blood, night sweats, night fever, chest
pain, malaise
TB Test
• A protein derivative from killed bacteria is
injected intradermally
• If the patient has been exposed to this
organism, the test will be positive
• If positive, the patient must have x-rays
taken to look for signs of active disease
Goals of TB Therapy
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Initiate treatment promptly
Convert sputum culture to negative ASAP
Achieve cure without relapse
Prevent emergence of drug-resistant
strains
Drug List
Tuberculosis Agents
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capreomycin (Capastat)
ciprofloxacin (Cipro)
cycloserine (Seromycin)
ethambutol (Myambutol)
ethionamide (Trecator-SC)
isoniazid(INH) (Laniazid, Nydrazid)
Drug List
Tuberculosis Agents
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isoniazid-pyrazinamide-rifampin (Rifater)
isoniazid-rifampin (Rifamate)
ofloxacin (Floxin)
pyrazinamide
rifampin (Rifadin, Rimactane)
rifapentine (Priftin)
streptomycin
Treatment Regimens
• Patients with no symptoms, but a positive
x-ray:
– INH 300 mg QD X 12 months
Treatment Regimens
• Patients with no symptoms, but a positive
x-ray:
– INH 300 mg QD X 12 months
• Patients with clinical disease:
– At least 2 agents at a time to prevent drugresistance
Multidrug Resistant Tuberculosis
• New strain has developed that is resistant to
several drugs
• Risk factors for acquiring MDR-TB:
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Being exposed to MDR-TB
Not completing TB therapy
Being prescribed the inappropriate agents
Having immune deficiencies
Having recurrence of TB
rifampin Side Effects
• Causes a reddish-orange discoloration of:
– Urine
– Tears, sweat
– Other body fluids
• Can permanently stain soft contact lenses
Discussion
Why is patient compliance such an
issue with tuberculosis patients?
Discussion
Why is patient compliance such an
issue with tuberculosis patients?
Answer: Length of therapy, side
effects, inherent in some patient
groups
Histoplasmosis
• Fungal pulmonary disease
• Caused by breathing in spores from
droppings of chickens, pigeons, starlings
and other birds and bats
• Called the summer flu because of the flulike symptoms
• Amphotericin B and itraconazole are used
for treatment
Cough and Cold
• Common colds are the most prevalent
respiratory tract infections
• Symptoms:
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Mild malaise
Runny nose
Sneezing
Scratchy throat
Fever
Colds
• Bacterial sinusitis and otitis media are
frequent complications warranting antibiotic
therapy
• OTC remedies are often used for symptom
relief
• Technicians should be knowledgeable about
OTC preparations and be able to explain
proper uses and side effects
Antitussives
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Coughing clears the airways of excess
secretions and foreign materials
Antitussives can be useful for dry,
nonproductive coughs by causing:
1. CNS depression of the cough center (reflex)
2. Suppression of the nerve receptors in the
respiratory tract
Cough Reflex
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Stimulated by stretch receptors and irritant
receptors
Follows a series of 6 events:
1. Inspiration interrupts regular breathing rhythm
2. Thorax and abdominal muscles contract rapidly
3. Airway closes
Cough Reflex
4. Peristaltic muscular wave moves over the
bronchi and bronchioles
5. Pressure forces the glottis open and the
laryngeal muscles relax
6. Air flows outward, carrying mucus and
foreign bodies
Drug List
Antitussives
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benzonatate (Tessalon)
codeine
dextromethorphan (Delsym)
diphenhydramine (Benadryl)
hydrocodone-homatropine (Hycodan)
promethazine-codeine
Drug List
Antitussives
Dextromethorphan Combos
• dextromethorphan-pseudoephedrinebrompheniramine (Bromfed-DM,
Myphetane DX)
• guaifenesin-dextromethorphan (Mucinex
DM)
• promethazine-dextromethorphan
codeine
• Considered the “Gold Standard”
• Has a drying effect on respiratory mucosa
– Dangerous for patients with asthma or
emphysema
• Can be purchased without a prescription in
some states; dispensing must be done by the
pharmacist
Codeine Side Effects
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Nausea
Drowsiness
Light-headedness
Constipation
benzonatate (Tessalon)
• Has local anesthetic effects
• Numbs the stretch receptors in the airway,
lungs, and pleura
• Very dangerous if chewed
dextromethorphan (Delsym)
• Works as well as codeine without analgesic
properties
• Does not depress respiration or have abuse
potential
• Often combined with other cough and cold
preparations
Expectorants
• Help rid the lungs and airway of mucus
when coughing
• Decrease thickness and stickiness of mucus,
decrease viscosity and increase
expectoration of mucus
• Used for dry and productive coughs
Water
• Can work as well as, if not better than,
medication expectorants
• Staying well-hydrated thins mucus and
allows for easier expectoration
Drug List
Expectorants
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guaifenesin (Mucinex)
potassium iodide (Iossat, Lugol solution)
guaifenesin-codeine (Robitussin A-C)
guaifenesin-pseudoephedrine (Mucinex D)
guaifenesin
• Loosens phlegm and thins bronchial
secretions
• Available in capsule, tablet, sustainedrelease, and liquid forms
• Frequently combined with other cough and
cold preparations
• Okay for patients with asthma or emphysema
Decongestants
• Swelling and stuffiness are caused by
vasodilation and leakage of fluids into the
nasal mucosa
• Decongestants cause constriction which
promotes drainage, improves nasal
ventilation, and relieves stuffiness, which
then allows the sinus cavities to drain
Decongestants
• Length of therapy should not exceed 3-5
days
• Topical decongestants may cause rebound
rhinitis medicamentosa
• Available in topical and oral forms
Decongestant Dispensing Issues
Warning!
• Should be avoided in patients with:
– Diabetes
– Heart disease
– Uncontrolled hypertension
– Hyperthyroidism
– Prostatic hypertrophy
– Tourette’s syndrome
Drug List
Decongestants
• pseudoephedrine (Sudafed)
Combinations:
• APAP-clemastine-pseudoephedrine (Tavist
Allergy/Sinus/Headache)
• brompheniramine-pseudoephedrine (Efidac
24)
Drug List
Decongestants
Pseudoephedrine Combos
• cetirizine-pseudoephedrine (Zytrec-D)
• dexbrompheniramine-pseudoephedrine
(Drixoral)
• fexofenadine-pseudoephedrine (Allegra-D)
• ibuprofen-pseudoephedrine (Advil Cold and
Sinus, Sine-Aid IB)
Drug List
Decongestants
Pseudoephedrine Combos
• loratadine-pseudoephedrine (Claritin D)
• naproxen-pseudoephedrine (Aleve Cold and
Sinus)
Decongestant Side Effects
• Oral:
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Anxiety
CNS stimulation
Dizziness
Hallucinations
Headache
Increased BP
Increased heart rate
Insomnia
Tremor
• Topical:
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Burning sensation
Contact dermatitis
Dry mouth
Rhinitis
medicamentosa
– Sneezing
– Stinging sensation
pseudoephedrine (Sudafed)
• Most-used decongestant; available in many
combinations
• Current evidence shows that if hypertension
is well controlled, these patients may be
able to take decongestants
• Will very likely become a prescription drug
due to abuse potential
Antihistamines
• Histamine is found throughout the body
• Causes increased gastric secretions,
increased heart rate, and mediates
hypersensitivity
• 2 Types of histamine receptors:
– H1 – located in upper respiratory system
– H2 – located in gastrointestinal tract
Antihistamines
• Well absorbed and widely distributed in
tissues
• Crosses the blood-brain barrier
– Causes sedation
• Crosses the placenta
– Adversely affects fetus
Drug List
Antihistamines (H1)
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azatadine (Optimine)
azelastine (Astelin, Optivar)
cetirizine (Zyrtec)
clemastine (Tavist Allergy)
cyproheptadine
desloratadine (Clarinex)
Drug List
Antihistamines (H1)
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diphenhydramine (Benadryl)
fexofenadine (Allegra)
hydroxyzine (Atarax, Vistaril)
loratadine (Claritin)
meclizine (Antivert)
promethazine (Phenergan)
Drug List
Antihistamine (H1)
Combinations
• brompheniramine-dextromethorphanpseudoephedrine (Bromfed-DM)
• chlorpheniramine-pseudoephedrine (ChlorTrimeton)
• hydrocodone-chlorpheniramine (Tussionex)
• triprolidine-pseudoephedrine
Therapeutic Uses
• Allergies
• Insomnia
• Rash, edema, and hay
fever
• Cough
• Vertigo
• Nausea and vomiting
• Serum sickness
• Control venom
reactions
• Lessens
extrapyramidal side
effects of
antipsychotics
• Prevent certain drug
reactions and allergies
• Hypersensitivity
Hypersensitivity Reactions
• Excessive immune response to a foreign
agent
• Can range from a rash to a deadly reaction
Antihistamine Side Effects
• Anticholinergic responses
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Dry mouth
Drying of the URT mucosa
Blurred vision
Constipation
Urinary retention
• Hyperactivity in some children
• Sedation is the most common
Smoking Cessation
• On average, cigarette smokers lose about 15
years of life
• The smoke contains 4,000 chemical
compounds with at least 43 carcinogens
• Secondhand smoke contains all 43
carcinogens
Smoking
• Can lead to:
– Leukemia
– Cancers of the mouth, pharynx, larynx, esophagus,
pancreas, cervix, kidney, bladder, ovaries, uterus, and
prostate
• Increases risk of:
– Heart disease
– COPD
– Stroke
Smoking
• Is related to birth defects of smoking
mothers
• Secondhand smoke puts children at risk of
developing asthma
• Nicotine can react with certain medications
Nicotine Effects
• CNS and PNS
stimulation and
depression
• Respiratory
stimulation
• Skeletal muscle
relaxation
• Increase in BP
• Increase in heart rate
• Increase in cardiac
output
• Increase in oxygen
consumption
• Physical and
psychological
dependence
Personal Benefits to Smoking
Cessation
• Improved performance
in sports and sex
• Better-smelling home,
car, clothing, and
breath
• Economic savings
• Freedom from
addiction
• Healthier babies
• Improved health
• Improved self-esteem
• Improved sense of
taste and smell
• No concern about
exposing others to
smoke
• Setting a good
example
5 Step Quit Plan
1. Set a date
5 Step Quit Plan
1. Set a date
2. Inform family, friends and coworkers
5 Step Quit Plan
1. Set a date
2. Inform family, friends and coworkers
3. Remove cigarettes from daily life
5 Step Quit Plan
1.
2.
3.
4.
Set a date
Inform family, friends and coworkers
Remove cigarettes from daily life
Review previous attempts and analyze
what caused relapse
5 Step Quit Plan
1.
2.
3.
4.
Set a date
Inform family, friends and coworkers
Remove cigarettes from daily life
Review previous attempts and analyze
what caused relapse
5. Anticipate challenges
Smoking Cessation
• Abstinence is the key
• Some fears that keep people from quitting:
– Weight gain
– Nicotine withdrawal
Symptoms of Nicotine Withdrawal
• Anxiety
• Craving tobacco
• Decreased blood
pressure and heart rate
• Depression
• Difficulty in
concentrating
• Drowsiness
• Frustration, irritability
• Gastrointestinal
disturbances
• Headache
• Hostility
• Increased appetite
• Increased skin temp
• Insomnia
Drug List
Smoking Cessation Agents
• bupropion (Wellbutrin SR, Zyban)
• nicotine (Commit, Habitrol, Nicoderm CQ,
Nicorette, ProStep, Nicotrol)
Smoking Cessation Agent
Dispensing Issues
Warning!
• Smoking while on nicotine replacement
therapy could cause signs of nicotine excess
Symptoms of Nicotine Excess
•
•
•
•
•
•
Abdominal pain
Confusion
Diarrhea
Dizziness
Headache
Hearing loss
•
•
•
•
•
•
Hypersalivation
Nausea
Perspiration
Visual disturbances
Vomiting
Weakness
Smoking Cessation Agent
Dispensing Issues
Warning!
• Lozenges should not be chewed
• Patch application site should be rotated to
prevent skin reactions
Discussion
You are trying to get a friend to stop
smoking. Name 5 reasons he/she
should quit.