Respiratory System Drugs Flashcards
Respiratory System Medications
Antihistamines
● H₁ Antagonists (allergies, anaphylaxis)
Anti-inflammatory drugs
● Glucocorticoids (asthma, COPD)
● Leukotriene receptor antagonists (asthma)
● Monoclonal antibodies (allergy related asthma)
Bronchodilators
● β₂-adrenergic agonists
○ Short acting
○ Long acting
● Methylxanthines
● Anticholinergics
Misc.
● Expectorants (excess mucus)
● Mucolytics (excess mucus)
● Decongestants (congestion)
● Antitussives (cough)
When do we want to decrease inflammation in the respiratory system?
Asthma, COPD, allergies
Histamine (H1 & H2)
● We have two types of histamine receptors (H2 in stomach - secretion of stomach acid)
● H1 receptors in blood vessels:
○ Dilation of small blood vessels
○ Increased capillary membrane permeability (edema)
○ Bronchial smooth muscle constriction (mucus secretion)
○ Sedation - In CNS, histamine acts as a neurotransmitter – causes sedation, regulates pain and itchiness
H1 Antagonists
Suffix - ine
Names: Diphenhydramine, chlorpheniramine, clemastine, promethazine, hydroxyzine, loratadine, fexofenadine
Indication: Allergy, anaphylaxis, sedation (still getting some sedation with this)
Action: Blocks H₁ receptors: decreases flushing, edema, secretions, itching, and pain
Nursing Considerations:
● Monitor for drowsiness – monitor RR (acting on the CNS)
● 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
Glucocorticoids (Inhaled & PO)
Inhaled: Budesonide, Ciclesonide, Flunisolide, Fluticasone
PO: Methylprednisolone, Prednisolone, Prednisone
Indication: Asthma, COPD (anti-inflammatory)
Action: Decreases inflammatory mediators, infiltration of inflammatory cells, and vascular permeability (to decrease edema). Suppresses the inflammatory response (less inflammation/swelling in the airway)
Nursing Considerations
Inhaled:
● Can cause oral candidiasis (oral thrush - white coating of the tongue, fungal infection of mouth) → rinse/gargle after use!
● Not for acute attack (maintenance dose to prevent future attacks): 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 (not going to produce as many steroids), osteoporosis, hyperglycemia, PUD (peptic ulcer disease), and growth suppression
○ NEVER d/c abruptly! (due to adrenal suppression, will have NONE)
○ Stress dose needed in times of high stress (ex. surgery) if used chronically (body not making enough through the adrenal gland, want to adapt for that stress response – make sure medication is ALWAYS refilled)
Leukotriene Receptor Antagonists
Suffix - lukast
Names: Zafirlukast, montelukast
Indication: Asthma (anti-inflammatory)
Action: Suppress leukotrienes (inflammatory mediator): decrease smooth muscle constriction, bronchoconstriction, edema, and mucus secretion
Nursing Considerations:
● Long-term control medication for asthma! Cannot abort ongoing attack (maintenance therapy to prevent future attacks)
● Can cause liver injury → monitor ALT
● Rare adverse effects: Neuropsychiatric effects and Churg-Strauss Syndrome (inflammation of blood vessels)
○ If SI (suicidal ideation) - need to change meds
Monoclonal Antibodies
Suffix - mab
Names: Omalizumab, Dupilumab, Reslizumab, Benralizumab
Indication: Asthma (only useful if ALLERGY related/used when other options have failed - anti-inflammatory)
Action: Reduces the amount of IgE in the blood to limit their ability to trigger an inflammatory reaction (IgE causes the release of inflammatory mediators)
Nursing Considerations:
● Administered SubǪ - injection site reactions common. Very expensive!
● Rare: CV problems/malignancy possible
● Anaphylaxis has occurred (rare):
○ Monitor for 2 hours after first 3 doses and 30 minutes after with all subsequent doses (provide that education)!
B2-Adrenergic Agonists
Suffix - erol
Short acting (SABA): Albuterol, Levalbuterol (quick relief)
Long- Acting (LABA): Salmeterol, Arformoterol, Olodaterol, Formoterol (maintenance)
Indication: Asthma, COPD (bronchodilation)
Action: Binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways (bronchodilation)
Nursing Considerations:
● Can cause tachycardia, angina, tremors (if higher doses are used, can also act on beta 1 receptors)
● Be very cautious when using in clients with heart disease (increases HR), diabetes (can mask s/s of hypoglycemia - due to increased HR, client won’t know if it’s due to this medication or hypoglycemia), or glaucoma (can increase IOP)
● When using two inhalers: use SABA 1st during an attack, ensure at least 1 min interval between taking the next medication
Methylxanthines
Suffix - phylline
Names: Aminophylline, Theophylline (don’t use these very often)
Indication: Asthma (maintenance, NOT given during an acute attack - bronchodilation)
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 (avoid in clients with heart problems and uncontrolled seizures)
● Avoid caffeine - it intensifies the effects
● Avoid tobacco/marijuana - increases theophylline clearance leading to ineffective levels (will decrease the effects of the drug)
Anticholinergics
Suffix - ium
Names: Ipratropium, Tiotropium, Glycopyrronium bromide, Aclidinium bromide
Indication: Asthma, COPD (bronchodilation)
Action: Block muscarinic receptors in bronchi (decreased secretions), leading to decreased bronchoconstriction
Nursing Considerations:
● Can be used to abort an ongoing attack
● Available in combo products with SABAs (ex: Albuterol + Ipratropium) – sometimes they’re combined together in one inhaler
● Monitor for anticholinergic side effects
Decongestants
Suffix - rine
Names: Phenylephrine, Pseudoephedrine
Indication: Congestion (doesn’t fix a cold but helps treat symptoms)
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 side effects (restless, irritable, anxiety, insomnia) and lasts longer (but not as effective)
● Topical - act faster and are more effective, can cause rebound congestion (blood vessels get used to being constricted so they bounce back even more swollen – not a good way to fix this)
○ Don’t use for longer than 3-5 consecutive days (specific to topical)
Antitussives
Opioid: Codeine, Hydrocodone (loss dose compared to pain)
Non-Opioid: Dextromethorphan
Indication: Cough
Action: Elevates the cough threshold (cough response is not triggered as much), preventing cough
Nursing Considerations:
● There is a risk for physical dependence
○ Schedule V medications
● Monitor for respiratory depression (check RR)
Expectorants
Guaifenesin
Indication: Excess mucus
Action: Stimulates the flow of respiratory tract secretions, making the cough more productive (ex. cystic fibrosis)
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 (ex. cystic fibrosis)
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)
