drugs that affect the respiratory system
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Drugs that Affect the
Respiratory System
P. AndrewsChemeketa Community College
Paramedic ProgramFall 07
When do we consider respiratory medications?
• Asthma– Decreases pulmonary function– May limit daily activity– Presents with
• SOB• Wheezing• Coughing
Or, perhaps……
• SOB, unknown etiology• Allergic reaction• Pneumonia• Congestive heart failure• Emphysema • Others…..?
Asthma, cont.
• Has numerous components!– Bronchoconstriction– Inflammation– Edema– Mucus hypersecretion– And others….
• Usually an allergic reaction
Categories of respiratory
meds
• Bronchodilators• Beta2 specific agonists
(short-acting)• Beta2 specific agonists
(long-acting)• Methylxanthines
• Anticholinergics• Glucocorticoids• Leukotriene
antagonists• Mast-cell membrane
stabilizer
Advantages of Nebulized Meds.
• Smaller doses
• Onset Rapid
• Targeted delivery
• Less side effects
Disadvantages of Inhaled Meds
• Variables in delivery
• Usage variables– User
– Caregiver
• Requires delivery to lungs– Not always adequate depth of respiration
Remember This?
• Absorption• Distribution• Metabolism• Elimination
Absorption and Distribution
• Absorption– Ionized drugs (Ipratropium)
• Absorb poorly• Won’t distribute well to body• Mostly local effect• Used for AEROSOL
– Non-Ionized drugs (Atropine)• Absorb well• Distribute well• Systemic Effect• Poor Aerosol Drug
Quick Review of Receptors
– Sympathetic• Adrenergic
– Epinephrine or Nor-epinephrine» Primary neurotransmitters
– Parasympathetic• Cholinergic
– Acetylcholine» Primary neurotransmitter
Muscarinic
• A drug that stimulates Acetylcholine at Parasympathetic nerve endings.
• When drugs refer to muscarinic or antimuscarinic action,– It ONLY acts on Parasympathetic sites!
Adrenergic Stimulation
• Alpha 1– Vasoconstriction– Increase Blood Pressure
• Beta 1– Increase Heart Rate– Increase Force of Heartbeat
• Beta 2– Bronchial Smooth Muscle Dilation
Adrenergic Bronchodilators
• Indication– Obstructive Airway Disease
• Asthma, Bronchitis, Emphysema
• Mode of Action– Adrenergic Receptors
• Alpha 1…vasoconstriction• Beta 1…Increase HR • Beta 2…Bronchodilate (Yeah!)
Adrenergic Bronchodilators
• Adverse Effects– Dizziness, – Nausea, – Tolerance, – Hypokalemia, – Tremors– H/A
Adrenergic Bronchodilators• Nonspecific agonists
– Epinephrine (rarely used)• Beta2 Specific agonists – Short acting
– Albuterol (Ventolin, Proventil)• 2.5 mg in 3 mL NS
– Metaproterenol (Alupent)– Terbutaline (Brethine)
Bronchodilators, cont.
• Inhaled Beta2 selective (long-acting)– Salmeterol (Serevent)
Anticholinergic Bronchodilators
• Indication– Bronchoconstriction– Mainly in COPD
• Mode of Action– Competes at Muscarinic receptors– Blocks Acetylcholine at smooth muscle– Reduces Mucus Production
Anticholinergic Bronchodilators• Adverse Effects
– Watch for Cholinergic side effects– More with nebulized form than MDI
• Examples– Atrovent (ipratropium)
• 0.5 mg in 2.5 mL NS– Combivent (mixed w/ Albuterol)
• 0.5 mg Atrovent & 2.5 mg Albuterol in 3 ml NS)– Atropine
• 0.5 – 1 mg in 2 – 3 mL of NS– Robinul
• Peak effects in 1 – 2 hrs
Mucus Controlling Agents
• Indication– Excessive , thick secretions
– As in COPD and TB
• Action– Lower viscosity of mucus
Mucus Controlling Agents
• Side effects– Irritation of Airway– Bronchospasm– Pharyngitis, voice change, laryngitis– Chest pain– Rash
• Considerations– Have suction ready – Anticipate cough
Mucus Controlling Agents
• Examples– Mucomyst (Acetylcysteine)
• COPD, TB• Acetaminophen OD
– Pulmozyme• Cystic Fibrosis
– Nebulized Saline• Simple yet effective!
Inhaled Corticosteroids
• Indications– Asthma– Anti-Inflammatory MAINTENANCE– Require Hours to Act! Preventative drug
• Mode of Action– Modifies RNA/DNA action in Cells– Complicated Stuff
Inhaled Corticosteroids
• Adverse Effect– Small incidence with nebulized
• Oral doses have high incidence
• Considerations– Not valuable in Acute Care– Watch for these in Pt Drug Lists
Corticosteroids
• Examples– Beclovent, Vanceril– Azmacort– Aerobid– Flovent– Pulmicort– Advair®
• fluticasone (steroid) and salmeterol (bronchodialator)
Glucocorticoids
• Indications– Prophylactic treatment of Asthma
– Hayfever
Glucocorticoids (cont)
• Mode of Action– Lowers release of Histamine in Mast Cells– Lowers release of Inflammatory Response
• Prevents Bronchospasm, airway inflammation– Acts in allergic and non-allergic asthma– Not a bronchodilator!
• Not for use in acute setting• Controllers, not relievers
Glucocorticoids (cont)
• Adverse Effects– Include
• H/A
• Nausea
• Diarrhea
Cromolyn sodium
• Similar to glucocorticoids
• Adverse Effects
– Only coughing or wheezing
Anti-inflammatory Agents, cont.
• Corticosteroids - Injected– Methylprednisolone (Solu-Medrol)
• Children; 0.25 mg/kg (max dose 125 mg IVP)• Adults; 125 mg IVP
– Dexamethasone (Decadron)
Nasal Decongestants
• Alpha1 agonist– Phenylephrine– Pseudoephedrine– Phenylpropanolamine
• Administered as mist or drops• Side Effects – rebound congestion (use
greater than 7 days)
Antihistamines• Blocks histamine receptors• Common 1st generation – cause sedation
– Chlor-Trimeton– Benadryl– Phenergan
• Common 2nd generation – does not cause sedation– Seldane– Claritin– Allegra
• Caution: thickens bronchial secretions – do not use in Asthma!
Cough Suppressants
• Antitussive meds – suppress cough stimulus in CNS– Codeine, hydrocodone
A couple of ‘odd’ ones
Epinephrine Racemic Epinephrine
(microNEFRIN)• Class
– Bronchodilator (adrenergic agonist)• Action
– Affects both beta1 and beta2 receptors sites. Bronchodilation, reduces subglottic edema
– Also increases pulse rate and strength– Also Alpha effects, vasoconstriction, Increased
BP
Epinephrine
• Indications– Croup, Epiglottitise
• Bronchospasm
• Absorption – Absorption occurs following inhalation
• Half-life– Unknown
Epinephrine
• Contraindications– Hypersensitivity
• Precautions– Watch for Rebound Worsening– Watch ECG for changes– Increases Myocardial O2 demand
• Side effects– Nervousness, restlessness, tremor, arrhythmias,
hypertension, tachycardia
Epinephrine
• Interactions– Beta blockers may negate effects
• Route and dosage– Inhalation
• One time Only• 1 mg Epinephrine, 1:1000 in 3 mL NS
• Considerations– Give ENROUTE– ONLY if patient in Extreme Distress
Epi, cont.
• May also consider Epi SQ – Patients who can’t cope with aerosol admin.– 0.3 – 0.5 mg SQ, then Neb treatment once
patient can move air• Or Infusion;
– 1 mg Epinephrine 1:1000 in 250 mL NS (concentration 4 mcg/mL) infuse at 1 mcg/min, titrating to effect
Magnesium Sulfate
• Not usually admin. in pre-hospital setting• Can be used to treat moderate to severe
asthma in patients who respond poorly to beta-agonists
• Don’t use in patients with heart blocks, myocardial damage, or hypertension
• 2 gm in 100 mL NS, given over 2 – 5 min.
Status Asthmaticus
•
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