Pharmacology Respiratory Flashcards
Respiratory System Medications Types
Antihistamines
○ H₁ Antagonists
Anti-inflammatory drugs
○ Glucocorticoids
○ Leukotriene receptor antagonists
○ Monoclonal antibodies
Bronchodilators
○ β₂-adrenergic agonists
■ Short acting
■ Long acting
○ Methylxanthines
○ Anticholinergics
Misc.
○ Expectorants
○ Mucolytics
○ Decongestants
○ Antitussives
H₁ Antagonists
Names: Diphenhydramine, chlorpheniramine,, clemastine, promethazine,
hydroxyzine, loratadine, fexofenadine…
Indication: Allergy, anaphylaxis, sedation
Action: Blocks H₁ receptors: decreases flushing, edema, secretions, itching, and pain
Nursing Considerations:
● Monitor for drowsiness
● Anticholinergic effects
● Possible paradoxical excitation (also seen in OD)
● Education:
○ No alcohol
○ Take at night and avoid driving etc.
○ Take with food to reduce GI side effects
Anti-Inflammatory Drugs
● Glucocorticoids - maintenance
○ Inhaled - rinse mouth to prevent thrush
■ Budesonide
■ Ciclesonide
■ Flunisolide
■ Fluticasone
○ PO - can give in emergency
■ Methylprednisolone
■ Prednisolone
■ Prednisone
● Leukotriene receptor antagonists
○ Montelukast
○ Zafirlukast
● Monoclonal Antibodies
○ Omalizumab
○ Dupilumab
○ Reslizumab
○ Benralizumab
Glucocorticoids
Inhaled: Budesonide, Ciclesonide, Flunisolide, Fluticasone
PO: Methylprednisolone, Prednisolone, Prednisone
Indication: Asthma, COPD
Action: Decreases inflammatory mediators, infiltration of inflammatory cells, and vascular
permeability (to decrease edema). Suppresses the inflammatory response!
Nursing Considerations:
● Inhaled:
○ Can cause oral candidiasis → rinse/gargle after use!
○ Not for acute attack: take on a schedule. Take SABA 1st! (5 min before)
● Oral
○ Systemic therapy used in acute attacks. Best to use < 10 days.
○ Long term use - risk of: adrenal suppression, osteoporosis, hyperglycemia, PUD, and growth
suppression
■ NEVER d/c abruptly! - make sure they have their refills
■ Stress dose needed in times of high stress if used chronically*
Leukotriene (inflammatory mediator) receptor antagonists
Names: Zafirlukast, montelukast
Indication: Asthma- long term control
Action: Suppress leukotrienes: decrease smooth muscle constriction,
bronchoconstriction, edema, and mucus secretion
Nursing Considerations:
● Long-term control; cannot abort ongoing attack
● Can cause liver injury → monitor ALT*
● Rare adverse effects: Neuropsychiatric effects and Churg-Strauss Syndrome (vasculitis), SI
○ If SI - need to change meds
Monoclonal Antibodies - reduce IGE
MAB
Names: Omalizumab, Dupilumab, Reslizumab, Benralizumab
Indication: Asthma (only useful if ALLERGY related/used when other options have failed)
Action: Reduces the amount of IgE in the blood to limit their ability to trigger an inflammatory reaction
Nursing Considerations:
● Administered SubQ - injection site reactions common; very expensive
● Rare: CV problems/malignancy possible
● Anaphylaxis can occur
○ Monitor for 2 hours after first 3 doses and 30 minutes after with all subsequent
doses
Bronchodilators Types
● β₂-adrenergic agonists
○ Albuterol
○ Levalbuterol
○ Salmeterol
○ Arformoterol
○ Olodaterol
● Methylxanthines
○ Theophylline
○ Aminophylline
● Anticholinergics
○ Ipratropium
○ Tiotropium
○ Umeclidinium
○ Glycopyrronium bromide
○ Aclidinium bromide
β₂-adrenergic agonists - EROL
- mainstay acute asthma COPD
Short acting (SABA): Albuterol, Levalbuterol,
Long- Acting (LABA): Salmeterol, Arformoterol,
Olodaterol, Formoterol
Indication: Asthma, COPD
Action: Binds to Beta2 adrenergic receptors in the airway leading to relaxation of the
smooth muscles in the airways
Nursing Considerations:
● Can cause tachycardia, angina, tremor dt beta 1 activation when dose is high therefore
● Be very cautious when using in clients with heart disease (increases HR), diabetes (can
mask s/s of hypoglycemia), or glaucoma (can increase IOP)
● When using 2 inhalers: use SABA 1st, ensure at least 1 min interval between
Methylxanthines
Names: Aminophylline, Theophylline
Indication: Asthma (maintenance)
Action: Relaxes bronchial smooth muscles leading to bronchodilation
Nursing Considerations:
● Has a narrow therapeutic window
○ Monitor drug levels. If a dose is missed, do NOT double the next dose.
○ Toxicity: N/V/D, insomnia, restlessness, palpitations, dysrhythmias, convulsions
heart probs or seizures
● Avoid caffeine - it intensifies the effects
● Avoid tobacco/marijuana - increases theophylline clearance leading to ineffective levels
Anticholinergics
Names: Ipratropium, Tiotropium, Glycopyrronium bromide, Aclidinium bromide
Indication: Asthma, COPD
Action: Block muscarinic receptors in bronchi, leading to decreased bronchoconstriction.
Nursing Considerations:
● Can be used to abort an ongoing attack
● Available in combo products with SABAs (ex: Albuterol + Ipratropium)
● Monitor for anticholinergic side effects
Decongestants
Names: Phenylephrine, Pseudoephedrine
Indication: Congestion
Action: Activates ɑ₁-adrenergic receptors on nasal blood vessels causing vasoconstriction
and shrinking of swollen mucous membranes
Nursing Considerations:
● Oral and topical preparations available
● Oral - more systemic effects (restless, irritable, anxiety, insomnia) and lasts longer
● Topical - act faster and are more effective, can cause rebound congestion
○ Don’t use for longer than 3-5 consecutive days**otherwise rebound congestion, then go cold turkey to fix
Antitussives
Opioid: Codeine, Hydrocodone
Non-Opioid: Dextromethorphan
Indication: Cough
Action: Elevate the cough threshold, preventing cough
Nursing Considerations:
● There is a risk for physical dependence
○ Schedule V medications
● Monitor for respiratory depression
Expectorants
Guaifenesin
Indication: Excess mucus, Cystic Fibrosis
Action: Stimulates the flow of respiratory tract secretions, making the cough more
productive
Nursing Considerations:
● Don’t give with an antitussive
○ We WANT them to cough to get those secretions out!
Mucolytic
Hypertonic Saline, Acetylcysteine
Indication: Excess mucus
Action: Reacts with mucus to make it more watery; breaks up thick secretions so they are
easier to expel
Nursing Considerations:
● Don’t give with an antitussive
○ We WANT them to cough to get those secretions out!
● Rare adverse reaction: bronchospasm
● Acetylcysteine smells like rotten eggs (due to sulfur content)
Pneumothorax
Pneumothorax may be caused by chest wall trauma, insertion of a central vascular access device (subclavian or intrajugular), severe pulmonary tuberculosis, and cystic fibrosis
✓ Pneumothorax causes a loss of negative pressure in the pleural space, leading to the collapsing of the lung that causes a reduction in vital capacity
✓ Manifestations of a pneumothorax include reduced or absent breath sounds on the affected side, tachypnea, tachycardia, and hyper resonance on chest percussion
✓ Nursing care includes applying supplemental oxygen and the preparation of the physician inserting a chest tube
✓ Pneumothorax is diagnosed by chest radiograph (x-ray)
Assessment: Diminished or absent breath sounds in the affected area are an expected finding with pneumothorax. This is because air has entered the pleural space and collapsed that portion of the lung making it ineffective in gas exchange.
