DRUGS FOR RESPIRATORY SYSTEM Flashcards
Blocks cough reflex
ANTITUSSIVES
Decrease blood flow to
the upper respiratory tract and decrease the
over production of secretion
DECONGESTANTS
Block the release or action
of histamine
ANTIHISTAMINES
Increase productive cough
to clear the airway.
EXPECTORANTS
Liquefy respiratory secretion to
aid the clearing of the airways.
MUCOLYTICS
Adverse effects: drying effect on the mucous
membrane, (nausea, constipation), increased
respiratory tract secretion, feelings of
congestion, drowsiness, sedation.
MUCOLYTICS
It is the treatment of non productive
cough
ANTITUSSIVES
MOA: act directly on the medullary cough
center of the brain to depress the cough reflex
ANTITUSSIVES
codeine (generic only)
ANTITUSSIVES
guaifenesin & codeine
ANTITUSSIVES
hydrocodone bitartrate
ANTITUSSIVES
dextromethorphan (Benylin, Robitussin):
does not cause respiratory depression,
neither cause physical dependence nor
tolerance
ANTITUSSIVES
CI: head injury, CNS depression
ANTITUSSIVES
Other Antitussives
MOA: directly act on respiratory tract
ambot basta other antitussives
stimulates secretory cells in the respiratory tract lining = more copious
secretion = buffers the irritation in the
respiratory tract wall that stimulate the
cough
terpin hydrate ( generic only) = OTHER ANTITUSSIVES
acts as a local anesthetic on the respiratory passages, lung, pleura, blocking the effectiveness
of stretch receptors that stimulate cough
reflex
benzonatate (Tessalon) = OTHER ANTITUSSIVES
CI: post op; asthma, emphysema
BASTA OTHER ANTITUSSIVES BUSIT BUSIT
NURSING ACTIONS: Do not take longer than the
recommended
ANTITUSSIVES
NURSING ACTIONS: Further medical evaluation of cough
ANTITUSSIVES
NURSNG ACTIONS: Wait 15- 20 minutes after taking the syrup before drinking any liquid
ANTITUSSIVES
NURSING ACTIONS: Other measures to relieve cough (humidity, cool temperatures, fluids,
topical lozenges)
ANTITUSSIVES
For common colds, sinusitis, allergic
rhinitis, otitis media
DECONGESTANTS
Usually adrenergic or sympathomimetics( local
vasoconstriction = decrease blood flow to the irritated and dilated capillary on the mucous membranes lining the nasal passages and sinus cavities
DECONGESTANTS
Rhinitis medicamentosa = –rebound
congestion that accompany frequent
and prolonged use of these drugs
DECONGESTANTS
Sympathomimetic, immediate onset, less chance of systemic effects, available in nasal spray
TOPICAL NASAL DECONGESTANTS
ephedrine (Kondon’s nasal)
DECONGESTANTS
oxymetazoline (Aftrin)
DECONGESTANTS
phenylephrine(Coricidin)
DECONGESTANTS
tetrahydrozoline (Tyzine)
DECONGESTANTS
xylometazoline (Otrivin)
DECONGESTANTS
CI: lesion or erosion on the mucous
membrane, HPN, DM, thyroid disease,
coronary disease
DECONGESTANTS
AE: local stinging and burning sensation,
rebound congestion ( longer than 3-5 days),sympathomimetic effects ( increased
pulse, BPand urinary retention
DECONGESTANTS
DI:
+ cyclopropane/ halothane anesthesia=serious
cardiovascular effects
+ other sympathomimetics =toxic effects
+ other sympatholytics = noneffective
DECONGESTANTS
Directly block the effect of inflammation
TOPICAL NASAL STEROID DECONGESTANTS
Takes several weeks to be real effective and are more often used in cases of chronic rhinitis and post nasal polyps removal
TOPICAL NASAL STEROID DECONGESTANTS
Beclomethasone, budesonide,
dexamethasone, flunisolide, fluticasone,
triamcinolone
TOPICAL NASAL STEROID DECONGESTANTS
CI: acute infections (candida albicans infections),airborne infection (chicken pox,
measles)pulmonary tuberculosis
TOPICAL NASAL STEROID DECONGESTANTS
AE: same with topical + post nasal surgery or
trauma = monitor closely for it suppresses
healing
TOPICAL NASAL STEROID DECONGESTANTS
Shrink the nasal mucous membrane by stimulating the alpha adrenergic receptors in the nasal mucous membrane
ORAL DECONGESTANT
pseudoephedrine
ORAL DECONGESTANT
CI: conditions exacerbated by sympathetic
activity
ORAL DECONGESTANT
AE: rebound congestion, sympathetic effects (
anxiety, tenseness, restlessness, tremors
arrhythmias, sweating, pallor)
ORAL DECONGESTANT
NURSING ACTIONS:
- Clear nasal passages before using
- Tilt the head back when applying the drops or spray
- Keep it tilted back for a few seconds
after administration
- Not to use more than 5 days (topical), not more than 7 days (PO), not more than 3 weeks ( topical steroids), seek medical care if s/sy persist
- OTC, do not inadvertently combine drugs leading to overdose
- Provide safety measures
DECONGESTANTS
Other measures to help relieve the discomfort of congestion:
- Humidity
- Fluids
- Cool environment
- Avoid smoke – filled areas
- Peppermint may be used as nasal decongestant
DECONGESTANTS
MOA: selectively block the effect of histamine – 1 receptor sites = decrease allergic response (itchy eyes, swelling, congestion, drippy nose) - Have anti- cholinergic and anti- pruritic effects
ANTIHISTAMINES
have greater anti- cholinergic effect with resultant drowsiness
FIRST GENERATION (ANTIHISTAMINES)
azatadine (Optimine)
FIRST GENERATION (ANTIHISTAMINES)
cetirizine ( Reactine)
FIRST GENERATION (ANTIHISTAMINES)
diphenhydramine (Benadryl)
FIRST GENERATION (ANTIHISTAMINES)
promethazine (Phenergan)
FIRST GENERATION (ANTIHISTAMINES)
desloratadine (Clarinex)
SECOND GENERATION (ANTIHISTAMINES)
fexofenadine (Allegra)
SECOND GENERATION (ANITHISTAMINES)
loratadine (Claritin)
SECOND GENERATION (ANTIHISTAMINES)
CI: pregnancy & lactation, hepatic & renal impairment, caution with cardiac arrhythmias (increase Q-T intervals)
ANTIHISTAMINES
AE: drowsiness & sedation, drying of respiratory and GI mucous membrane (skin eruption and itching), arrhythmias, dysuria, urinary hesitancy, GI upset, nausea, thickening of mucous, difficulty coughing, tightening of the chest
ANTIHISTAMINES
NURSING ACTIONS:
➔ Administer on an empty stomach
ANTIHISTAMINES
NURSING ACTIONS:
➔ Response is individualized
ANTIHISTAMINES
NURSING ACTIONS:
➔ Response is individualized
ANTIHISTAMINES
NURSING ACTIONS:
➔ Frequent mouth care (dry mouth may
lead to anorexia & nausea) ex.
sugarless candy and lozenges
ANTIHISTAMINES
NURSING ACTIONS:
Take at bedtime or safety measures if
taken during the day
ANTIHISTAMINES
NURSING ACTIONS:
➔ Do not drive
ANTIHISTAMINES
NURSING ACTIONS:
Do not operate dangerous machinery
Increase humidity
ANTIHISTAMINES
NURSING ACTIONS:
➔ Place pans of water throughout the
house
ANTIHISTAMINES
NURSING ACTIONS:
Avoid smoke filled area
ANTIHISTAMINES
NURSING ACTIONS:
➔ Increase oral fluid intake
ANTIHISTAMINES
NURSING ACTIONS:
➔ Void before each dose
ANTIHISTAMINES
NURSING ACTIONS
➔ Skin care
ANTIHISTAMINES
NURSING ACTIONS:
➔ Caution to avoid excessive dosage of
other OTC
ANTIHISTAMINES
NURSING ACTIONS:
➔ Avoid alcohol
ANTIHISTAMINES
- It is used for dry, non productive cough
EXPECTORANTS
MOA: liquefy the lower respiratory tract secretions= reducing viscosity =easier to
cough out
EXPECTORANTS
AE : N/A/V, HA, dizziness
EXPECTORANTS
Enhances The Output Of respiratory tract fluids by reducing adhesiveness and surface tension of these fluids = easier movement of less viscous secretions
GUAIFENESIN (ROBITUSSIN) = EXPECTORANTS
iodine preparation, bitter taste. Stimulates the
glands of the respiratory tract to increase the amount of fluid secreted
TERPIN HYDRATE (GENERIC) = EXPECTORANTS
NURSING ACTIONS:
Assess lung sounds, secretions(color, consistency, amount), know the underlying cause, should not
be used for more than one week, seek consultation if persistent
EXPECTORANTS
NURSING ACTIONS:
Deep breathing and coughing exercises
EXPECTORANTS
NURSING ACTIONS:
Increase oral fluid intake
EXPECTORANTS
NURSING ACTIONS:
Small frequent meal
EXPECTORANTS
NURSING ACTIONS:
Avoid driving or operating hazardous
machinery
EXPECTORANTS
NURSING ACTIONS:
Avoid excessive use of OTC
EXPECTORANTS
MOA: break down mucus in order to aid the
high risk respiratory patient in coughing out
thick, tenacious secretion.
MUCOLYTICS
INDICATION:
- COPD
- Cystic fibrosis
- Pneumonia
- Atelectasis
- Post tracheostomy
- Diagnostic bronchoscopy
MUCOLYTICS
PO Protects the liver from being damaged during episodes of acetaminophen toxicity. Affects the
mucoproteins in the respiratory secretions by
splitting apart disulfide bonds that are responsible for holding the mucous together
ACETYLCYSTEINE (MUCOMYST) = MUCOLYTICS
Prepared by recombinant DNA techniques that selectively breaks down respiratory tract mucus by separating extracellular DNA of proteins. Long
duration of action, store in refrigerator & protect
from light
DOMASE ALFA (PULMOZYME) = MUCOLYTICS
CI: bronchospasm, peptic ulcer, esophageal
varices
MUCOLYTICS
AE: GI upset, stomatitis, rhinorrhea,
bronchospasm
MUCOLYTICS
NURSING ACTIONS:
Assess lung sounds and respiratory
status
MUCOLYTICS
NURSING ACTIONS:
May be given through nebulization, IV,
PO or instilled in ET tube
MUCOLYTICS
NURSING ACTIONS:
Avoid combining with other drugs in the
nebulizer
MUCOLYTICS
NURSING ACTIONS:
Dilute with sterile water for injection
MUCOLYTICS
NURSING ACTIONS:
Patients receiving by face mask should
have the residue wiped off the face mask and off their face with plain water
MUCOLYTICS
NURSING ACTIONS:
Use cautiously in adults or individuals
with severe respiratory insufficiency
MUCOLYTICS
NURSING ACTIONS:
Administer PO mix with iced liquid, about 17 doses over a 4- day period of acetaminophen overdose
MUCOLYTICS
AKA: Methylxanthine Derivatives PO, IV
XANTHINES
MOA: have direct effect on the smooth muscles
of the respiratory tract, both in the bronchi and
in the blood vessels through directly affecting
the mobilization of calcium within the cell
(stimulating prostaglandins resulting in smooth
muscle relaxation thus increasing the vital
capacity that has been impaired by
bronchospasm or air trapping
XANTHINES
Inhibit release of slow - reacting substance of
anaphylaxis (SRSA) and histamine, decreasing
bronchial swelling and narrowing
XANTHINES
aminophylline
XANTHINES
caffeine
XANTHINES
dyphylline oxtriphylline
XANTHINES
theophylline
XANTHINES
USES: bronchial asthma, bronchospasm
associated with COPD
XANTHINES
CI: GI problems, coronary disease, respiratory
dysfunction, renal/ hepatic disease, alcoholism,
hyperthyroidism
XANTHINES
AE: above therapeutic level: GI upset,
irritability, tachycardia, seizure, brain damage,
death
XANTHINES
DI: + nicotine = increase metabolism in the
liver + smoking = dosage must be increased
XANTHINES
NURSING ACTIONS:
Caution if taken with coffee, cola,
chocolate and tea
XANTHINES
NURSING ACTIONS:
Monitor blood level for toxicity (
therapeutic level 10-20 ug/mL); first sign
of toxicity = NAUSEA; late sign=
TREMORS
XANTHINES
NURSING ACTIONS:
➔ Instruct client as follows
➔ Be compliant with dosing, schedule and
blood work
➔ Do not crush or alter dosage form
➔ Take with milk or food if with GI upset
➔ Avoid smoking
XANTHINES
MOA: mimic the effects of the SNS at therapeutic level = beta 2 selective agonist (dilation of bronchi with increased rate and depth of respiration)
SYMPATHOMIMETICS
epinephrine (Adrenaline)
SYMPATHOMIMETICS
terbutaline sulfate (Brethine)
SYMPATHOMIMETICS
salbutamol ( Ventolin)
SYMPATHOMIMETICS
isoproterenol HCL ( Isuprel)
SYMPATHOMIMETICS
isoetharine HCL (Bronkosol)
SYMPATHOMIMETICS
metaproterenol sulfate (Alupent)
SYMPATHOMIMETICS
AE: anxiety, tremors, HA, tachycardia, restlessness, palpitations, rebound
bronchospasm, hyperglycemia, insomnia,
dysrhythmias, urinary retention
SYMPATHOMIMETICS
DI: + theophylline = increase cardiac effect
SYMPATHOMIMETICS
NURSING ACTIONS:
Assess respiratory, cardiac status & ABG
SYMPATHOMIMETICS
NURSING ACTIONS:
Instruct how to use inhaler or respiratory
apparatus at home
SYMPATHOMIMETICS
Administer with meal if with GI upset
SYMPATHOMIMETICS
NURSING ACTIONS:
Emphasize compliance with dosage and
schedule (minimal amount needed for
the shortest period necessary)
SYMPATHOMIMETICS
NURSING ACTIONS:
Drug of choice vary with each individual
SYMPATHOMIMETICS
NURSING ACTIONS:
For exercise induced asthma: take
30-60 minutes before exercising
SYMPATHOMIMETICS
MOA: blocks the action of neurotransmitter
acetylcholine at vagal mediated receptor sites
ANTICHOLINERGIC BRONCHODILATOR
Ipratropium bromide (Atrovent) –less systemic
effect + albuterol sulfate (Combivent) more
effective and longer duration of action
ANTICHOLINERGIC BRONCHODILATOR
AE: anticholinergic effects (dizziness, HA,
fatigue, nervousness, dry mouth, sore throat,
palpitations, and urinary retention
ANTICHOLINERGIC BRONCHODILATOR
NURSING ACTIONS:
➔ Adequate hydration
➔ Void before each use
➔ Safety measures
➔ Review use of inhalator with the patient
(caution not to exceed 12 inhalations in
24 hours)
➔ Small frequent meal & lozenges
ANTICHOLINERGIC BRONCHODILATOR
MOA: decrease inflammatory response in the airway : promotion of beta 2 adrenergic receptor activity
INHALED STEROIDS
Inhaled: beclomethasone
Tablet: triamcinolone, dexamethasone, prednisone, prednisolone,
methylprednisolone
IV: dexamethasone, hydrocortisone
INHALED STEROIDS
CI: emergency, infection of respiratory system
INAHLED STEROIDS
AE: sore throat, hoarseness, coughing, dry
mouth, pharyngeal & laryngeal fungal infection
INHALED STEROIDS
NURSING ACTIONS:
Rapidly absorbed but tale 1-4 weeks to
reach effective level
INHALED STEROIDS
Do not administer to treat an acute asthma attack or status asthmaticus
INAHALED STEROIDS
NURSING ACTIONS:
Taper systemic steroid carefully
INHALED STEROIDS
NURSING ACTIONS:
Use decongestant drops before using
the inhaled steroids
INHALED STEROIDS
NURSING ACTIONS:
Rinse mouth after using inhaled steroid
INHALED STEROIDS
NURSING ACTIONS:
Monitor signs of respiratory infection
INHALED STEROIDS
MOA: blocks receptors for the production of
leukotrienes D4 and E4 (components of
SRSA): block
Neutrophil & eosinophil migration
Neutrophil & monocyte aggregation
Leukocyte adhesion
Increased capillary permeability
Smooth muscle contraction
LEUKOTRIENE RECEPTOR ANTAGONIST
Zafirlukast (Accolate)
LEUKOTRIENE RECEPTOR ANTAGONIST
montelukast (Singulair)
LEUKOTRIENE RECEPTOR ANTAGONIST
zileuton (Zyflo)
LEUKOTRIENE RECEPTOR ANTAGONIST
CI: hepatic / renal impairment, pregnancy &
lactation
LEUKOTRIENE RECEPTOR ANTAGONIST
AE: HA, dizziness, myalgia, N/V, diarrhea, abdominal pain, increase liver enzyme
LEUKOTRIENE RECEPTOR ANTAGONIST
NURSING ACTIONS: Oral granule packets should not be opened until ready for use (max 15 min)
LEUKOTRIENE RECEPTOR ANTAGONIST
NURSING ACTION: If + aspirin hypersensitivity / NSAIDS
=bronchoconstriction
LEUKOTRIENE RECEPTOR ANTAGONIST
NURSING ACTIONS: Recommended for prevention
LEUKOTRIENE RECEPTOR ANTAGONIST
NURSING ACTIONS: Chewable tablets = swallowing whole
altered absorption
LEUKOTRIENE RECEPTOR ANTAGONIST
NURSING ACTIONS: Take during evening = maximum effectiveness
LEUKOTRIENE RECEPTO ANTAGONIST
neonates with RDS; birth wt1350g with
evidence of lung immaturity
LUNG SURFACTANT
MOA: naturally occurring compounds of
lipoproteins containing lipids and opoproteins that reduce the surface tension within the alveoli = expansion of the alveoli for gas exchange
LUNG SURFACTANT
(instilled into the trachea) beractant
LUNG SURFACTANT
(Survanta) calfactant
LUNG SURFACTANT
(Infasurf) colfosceri
LUNG SURFACTANT
(Exosurf Neonatal) poractant(Curosurf)
LUNG SURFACTANT
AE: patent ductus arteriosus, hypotension,
intraventricular hemorrhage,pneumothorax,
hyperbilirubinemia, sepsis
LUNG SURFACTANT
NURSING ACTIONS:
➔ Continuous monitoring
➔ Ensure: proper placement of ETT,
bilateral chest movement and sounds
➔ Suction before administration; do not
suction for 2 hours after administration
➔ Provide support and encouragement to
parents
➔ Continue other supportive measures
related to the immaturity of the infant
LUNG SURFACTANT
MOA: prevents the release of inflammatory
and bronchoconstriction substances when
mast cells are stimulated to release these
substances because of irritation or presence of antigen.
MAST CELL STABILIZER
cromolyn – inhaled , may not reach
its peak effect for 1 week, pt>2 yo,
maintenance
MAST CELL STABILIZER
nedocromil – prevent
bronchospasm and acute asthma attack; pt>
12yo, more effective
MAST CELL STABILIZER
CI: hypersensitivity, pregnancy, lactation
MAST CELL STABILIZER
AE: occasional (cromolyn) = swollen eyes,
HA, nausea, dry mucosa (nedocromil)= HA,
dizziness, fatigue, tearing, GIupset, cough
MAST CELL STABILIZER
NURSING ACTIONS:
➔ Avoidance of dry and smoky
environment,humidifier, fluids
➔ Do not abruptly discontinue
➔ Po administer before meal and at
bedtime
➔ Safety precautions
MAST CELL STABILIZER
INDICATIONS:
- Increase production of secretions or
thick, sticky secretions. With impaired
removal of secretions Ineffective
coughing
CHEST PHYSIOTHERAPY
Techniques of chest physiotherapy
- postural drainage
- percussion
- vibration
Hand is pressed firmly over the
appropriate segment of chest wall, and
muscles of upper arm and shoulder are
tensed(isometric contraction), done with
flattened, none cupped hands
VIBRATION
Involves clapping with cupped hands on
the chest wall
PERCUSSION
Uses gravity and various positions
POSTURAL DRAINAGE
Nursing Considerations o
● Perform 3 hours AC or PC
● Bronchodilators 20 minutes prior
● Remove tight/ constricting clothing
● Each prescribed position for postural
drainage = 3- 5 minutes
● Place towel over the area percussed
(approx 3 minutes during inspiration
expiration)
● Vibrate each area during exhalation of
4-5 deep breaths
CHEST PHYSIOTHERAPY
Any process that limits airflow expiration
, a group of chronic lung diseases
associated with persistent or recurrent
obstruction of airflow
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
The air sacs (alveoli) of the lungs are
enlarged and damaged, which reduces
the surface area for the exchange of
oxygen and carbon dioxide
PULMONARY EMPHYSEMA (PINK PUFFERS)
Is a condition when
repeated lung inflammation damages
the lungs.
CHRONIC BRONCHITIS
Chronic inflammation in the lungs
causes scarring of the airways and
excessive production of mucus that
results in a chronic cough.
CHRONIC BRONCHITIS
Some call it a “smoker’s” cough.
CHRONIC BRONCHITIS
Chronic, irreversible dilation of the
bronchi and bronchioles
BRONCHIECTASIS
Pulmonary infections and obstruction in
the bronchus; aspiration of foreign
bodies or any material from the
respiratory system; pressure from
tumors, dilated blood vessels and
enlarged lymph nodes
BRONCHIECTASIS
Inflammatory disorder that involves the
hyperresponsiveness characterized by
bronchospasm, wheezing, mucus
secretions and dyspnea.
ASTHMA
DRUGS USED TO TREAT OBSTRUCTIVE
PULMONARY DISEASE:
● XANTHINES
● SYMPATHOMIMETICS
● ANTICHOLINERGICS
● INHALED STEROID
● LEUKOTRIENE RECEPTOR
ANTAGONISTS
● SURFACTANTS
● MAST CELL STABILIZERS
