Download Respiratory Agents

Respiratory Agents
I.
II.
Purpose
Antihistamines
a. Drug profiles
 Non-sedating
 Astemizole (Hismanal)
 Loratadine (Claritin)
 Fexofenadine (Allegra)
 Cetirizine (Zyrtec)
 Sedating
 Diphenhydramine (Benadryl)
 Dimenhydrinate (Dramamine)
 Promethazine (Phenergan)
 Hydroxyzine (Vistaril)
 Meclizine (Antivert)
 Doxlylamine (Unisom)
 Brompheniramine (Dimetane)
 Chlorpheniramine (Chlor-Trimeton)
b. MOA
i. Blocks H1 receptors preventing histamine from binding and
causing:_________________________
__________________________________________
c. Uses
i. Allergies, allergic reactions, allergic rhinitis
ii. Parkinson’s disease
iii. Vertigo, motion sickness, nausea
iv. Sleep aid
v. Common cold
d. Side effects
i. Drowsiness, visual changes
ii. Paradoxical excitement in children
iii. Anticholinergic:_____________________________
e. Nursing Considerations
i. Take with food
ii. Use hard candy or chewing gum to relieve dry mouth
iii.  fluids and fiber
iv. Do not take with alcohol
v. Do not take with any other OTC medication unless OK with MD
vi. Do not use with erythromycin or antifungals d/t life threatening CV
disorders
vii. Use cautiously in patients with COPD, PUD, HTN, asthma, increased
intraocular pressure, seizures, BPH, or pregnancy
B. Decongestants
a. Drug profiles
i. Naphazoline (Privine)
ii.
iii.
iv.
v.
vi.
b. MOA
i.
Phenylephrine (Neo-Synephrine)
Phenylpropanolamine
Pseudoephedrine (Sudafed)
Ephedrine (Vicks Vatronol)
Oxymetazoline (Afrin, Sinex)
Stimulate engorged blood vessels in the sinuses to constrict decreasing
pressure and allowing mucous membranes to drain; most are
sympathomimetic drugs which stimulate alpha1 receptors
c. Uses
i. Rhinitis, allergies, sinusitis, colds
d. Side effects
i. Rebound congestion
ii. Anxiety, nervousness
iii. Palpitations, hypertension
e. Nursing Considerations
i. Do not take at HS
ii. Do not take with MAOIs
iii. Topical decongestants  risk of systemic effects
C. Antitussive
a. Drug profiles
i. Opioid
1. Codeine
2. Hydrocodone
ii. Non-opioid
1. Dextromethorphan (Vicks Formula 44, Robitussin DM)
2. Benzonatate (Tessalon Perles)
b. MOA
i. Blocks the cough reflex 2o to direct action on the cough center.
ii. Tessalon:____________________________________________________
______________________________________________________
c. Uses
i. Dry, hacking non-productive cough
d. Side effects
i. Opioid: respiratory depression, drowsiness
e. Nursing Considerations
i. No fluid or food for 30 min. after cough syrup
ii. Avoid with asthma, COPD, and severe pneumonia
D. Expectorants
a. Drug profiles
i. Guaifenesin (Guiatuss, Robitussin, Mucinex)
ii. Terpin Hydrate
iii. Ammonium Chloride
b. MOA
i. Increase the flow of fluid in the respiratory tract, decrease viscosity and
facilitates removal of secretion through cough and ciliary action; irritate
the GI tract causing reflex stimulation of resp. tract.
c. Uses
i. Productive cough
d. Side effects
e. Nursing Considerations
i. Only expectorant recognized by FDA as safe and effective
ii. Has faint odor and bitter taste.
iii. Force fluids to help liquefy secretions.
E. Mucolytics
a. Drug profiles
i. Acetylcysteine (Mycomyst)
ii. Hypertonic saline
b. MOA
c. Uses
i. Thick, tenacious secretions
d. Side effects
i. Bronchospasms
ii. Nausea
e. Nursing Considerations
i. Mycomyst is administered via nebulizer treatment
ii. Have patient clear airway first
iii. Smells like rotten eggs
F. Bronchodilators
a. Xanthine derivatives
i. Drug profiles
1. Theophylline (Bronkodyl, Slo-Bid, Theo-Dur)
2. Aminophylline (Theophylline admin. IV)
ii. MOA
1. Causes bronchodilaton by cAMP. Competes to block
phosphodiesterase (PDE), which breaks down cAMP.
2. Inhibits___________Builds up____________ Causes __________________
iii. Uses
1. COPD, asthma, chronic bronchitis, emphysema
2. Pneumonia
3. Cystic fibrosis
4. Increase ease of breathing
iv. Side effects
1. GI: N/V, anorexia, GERD
2. CV: tachycardia, palpitations, ventricular dysrhythmias
3. GU: U/O
v. Nursing Considerations
1. Aminophylline is given to patients who have not responded to fastacting beta-agonists
2. Therapeutic level: 8-20
b. Beta agonists
i. Drug profiles
1. Albuterol (Proventil)—Beta2
2. Epinephrine (Adrenalin)—Alpha/Beta
3. Isoproterenol (Isuprel)—Beta1&2
Short-acting
4. Metaproterenol (Alupent)—Beta1&2
5. Terbutaline (Brethine)—Beta2
6. Salmeterol (Serevent)—Beta2
Long-acting
7. Salbuterol (Salbuvent)—Beta2
ii. MOA
1. Imitate the effect of norepinephrine on alpha and beta-receptors.
Bronchodilation occurs when _____ is stimulated.
iii. Uses
1. Acute asthma attacks
2. Anaphylaxis or other serious allergic reactions
iv. Side effects
1. CNS: nervousness, tremors
2. CV: tachycardia, HTN
v. Nursing Considerations
1. Contraindicated in heart disease, dysrhythmias, HTN, seizures
2. Salmeterol, salbuterol, metaproterenol are all long-acting
bronchodilators
c. Anticholinergic
i. Drug profiles (-tropium)
1. Ipratropium (Atrovent)
2. Tiotropium (Spiriva)
3. Combivent (Albuterol and Atrovent)
ii. MOA
1. Blocks PSNS and causes bronchodilation of larger airways
iii. Uses
1. Asthma
iv. Side effects
1. Nervousness, tremors, dry mouth, palpitations
v. Nursing Considerations
1. Contraindicated in BPH and glaucoma
2. Teach patient how to use metered dose inhaler (MDI)
3. Not for acute asthma attacks
G. Anti-inflammatory
a. Antileukotrienes
i. Drug profiles
1. Zileuton (Zoflo)
2. Zafirlukast (Accolate)
3. Montelukast (Singulair)
ii. MOA
1. Blocks leukotrienes from attaching to receptors located on
circulating cells as well as cells within the lungs, blocks
inflammation and reduces edema
iii. Uses
1. Asthma, allergies
iv. Side effects
v. Nursing Considerations
1. Contraindicated in patients with hepatic dysfunction
b. Corticosteroid
i. Drug profiles
1. Prednisone
2. Flunisolide (AeroBid)
3. Dexamethasone (Decadron)
4. Budesonide (Rhinocort)
5. Fluticasone (Flonase)
6. Triamcinolone (Azmacort)
7. Beclomethasone (Beclovent, Vanceril)
ii. MOA
1. Stabilizes the cell membrane inhibiting release of histamine and
SRS-A release
iii. Uses
iv. Side effects
1. Adrenocortical insufficiency
2.  susceptibility to infection
3. F & E imbalances
4. Endocrine:  blood glucose
5. Dermatological:
6. CNS:
v. Nursing Considerations
1. NEVER stop drug abruptly
c. Indirect acting anti-asthmatics
i. Drug profiles
1. Cromolyn (Nasalcrom, Intal, Opticrom)
2. Nedocromil (Tilade)
ii. MOA
1. Stabilize the cell membrane and prevent release of harmful
substances
iii. Uses
1. Prevent asthma attacks
iv. Side effects
1. Coughing, sore throat, rhinitis, bronchospasms, taste changes,
dizziness, and HA
v. Nursing Considerations
1. May take up to 4 weeks to work
2. Used for prevention not rescue treatment