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Drugs for Pulmonary Disorders
Chapter 29
Respiration – Gases exchange.
Ventilation – Moving air out of the lungs.
Perfusion – Blood flow through the lungs.
Inhaled Medications
They work almost instantaneously because of the enormous surface area of the bronchioles and
alveoli and the rich blood supply to them.
1. Aerosol – suspension of minute liquid droplets or fine solid particles suspended in a gas
for an immediate onset of action.
2. Nebulizer – small machine that vaporizes a liquid medication into a fine mist that can be
inhaled. (Face mask or hand held)
3. Dry powder inhaler (DPI) – small device that is activate by the process of inhalation to
deliver a fine powder directly to the bronchial tree.
4. Metered dose inhaler (MDI) – a device commonly used to deliver respiratory drugs
using a propellant to deliver a measured dose of drugs to the lungs during each breath.
(Inhaler)
Aerosol therapy only delivers 10% to 50% of the drug to the bronchial tree. Patients should rinse
their mouth after drug use to reduce oral absorption.
Beta-Adrenergic Agonists
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Treat acute bronchospasms
Asthma & pulmonary diseases
Also known as Sympathomimetics
Fewer cardiac effects than epinephrine
Ultrashort-acting: immediate lasting 2-3 hours
 isoproterenol (Isuprel) rebound brochospasm may occur when effects wear off
 isoetharine (Bronkosol)
Short-acting: immediate lasting 5-6 hours
 metaproterenol (Metaprel)
 terbutaline (Brethine)
 pirbuterol (Maxair)
Intermediate-acting: lasts about 8 hours
 albuterol (Proventil)
 levalbuterol (Xopenex)
 bitolterol (Tornalate)
Longest-acting: last as long as 12 hours
 salmeterol (Serevent)
The longest duration of action is given orally with side effects such as tachycardia being more
frequent. Tolerance may develop.
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Do not use if patient has a history of dysrhythmias or MI. When inhaling, the patient should
inhale and hold breath for 10 seconds and wait 2 full minutes before the next inhalation.
Patients teaching should include:
 Limiting caffeine
 Immediately report difficult breathing, heart palpitations, tremor, vomiting, nervousness,
or vision changes.
Methylxanthines & Anticholinergics
Methylxanthines – compromise a group of bronchodilators chemically related to caffeine.
AVOID CAFFIENE! Given PO or IV
Drugs of choice 20 years ago:
 theophylline (Theo-Dur, others) - long term oral prophylaxis of persistent asthma
 aminophylline (Somophyllin)
Theophylline interacts with many other drugs with sides effects such as nausea, vomiting, dry
mouth, bitter taste, and CNS depression; dysrhythmias may occur with large doses.
Anticholinergic:
 ipratropium (Atrovent)
Combivent – a combination of ipratropium & albuterol in a single MDI canister.
Obtain respiration rate before and after each dose; measure I&O b/c can cause diuresis.
Report immediately:
 inability to urinate or BM
 severe headache
 heart palpitations
 difficulty breathing
 changes in vision or eye pain
Glucocorticoids
Inhaled – “long-term” prevention of asthmatic attacks without major side effects.
Oral – short-term management of acute asthma not responsive to other treatments.
Most effective drug for prevention of asthma. May be prescribed along with beta-adrenergic
agonist to reduce the dose by 50%. NOT USED DURING AN ACUTE ASTHAM ATTACK!
Glucocorticoids:
 beclomethasone (Beclovent, Vanceril, others)
 budesonide (Pulmicort Turbuhaler)
 flunisolide (AreoBid)
 fluticasone (Flovent)
 methylprednisolone (Depo-Medrol, others)
 prednisone (Deltasone, Meticorten, others)
 triamcinolone (Asmacort)
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Side effects:
 adrenal gland atrophy
 peptic ulcers
 hyperglycemia
Use steroid inhalers cautiously in patients with hypertension, GI disease, CHF, and
thromboembolic disease. Glucocorticoids inhibit the inflammatory response and can mask the
signs of infection. Rinse mouth after use to prevent fungal infections of the mouth and throat.
Report immediately:
 temperature and BP elevations
 consistent elevations of blood glucose
 tarry stools
 edema
 dizziness
 difficulty breathing
Mast Cell Stabilzers
Inhibit the release of histamine from mast cells to “prevent” asthma attacks.
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cromolyn (Intal) MDI or nebulizer – alternative to glucocorticoids
cromolyn (Nasalcrom) nasal for allergies – half life of 80 mins
nedocromil (Tilade) half life of 2-3 hours – bitter, unpleasant taste
Leukotriene Modifiers
New drugs approved in the 1990’s to reduce broncoconstriction . NOT BRONCODILATORS!
NOT FOR ACUTE ASTHMA ATTACHS!
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zileuton (Zyflo) – taken four times a day
zafirlukast (Accolate) – taken every 12 hours – works within 2 hours
montelukast (Singulair) – taken every 12 hours – works within 2 hours
Side effects:
 headache
 cough
 nasal congestion
 GI upset
Patients over age 55 must be monitored carefully for signs of infections.
Contraindicated:
 Significant hepatic dysfunction
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Chronic alcoholics
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Antitussives
Used for dry, hacking, nonproductive cough.
Opioids – most efficacious by raising the cough threshold in the CNS (small risk for dependence)
Monitor for drowsiness.
 Codeine
 hydrocodone bitartrate (Hycodan, others)
Bronchoconstriction may occur; take care with patients who have asthma or allergies.
Nonopioids:
 benzonatate (Tessalon) – if chewed can numb the mouth and pharynx
 dextromethorphan (Pedia Care, others) – most commonly used (no risk for dependence)
Avoid:
 Driving
 Alcohol
Report immediately:
 Coughing up green or yellow-tinged secretions
 Difficulty breathing
 Excessive drowsiness
 Constipation
 N&V
Expectorants & Mucolytics
Expectorants – increase bronchial secretions.
 guaifenesin (Robitussin, Resyl, others) – most commonly used with few side effects
Mucolytics – help loosen thick bronchial secretions.
 acetylcysteine (Mucomyst) – inhalation & NOT AVAILABLE OTC for large amounts of
thick bronchial secretions.
 dornase alfa (Pulmozyme) – maintenance therapy in management of secretions
COPD
Avoid taking any drugs that have beta-antagonist activity, opioids and barbiturates.
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