respiratory medications nur 154 pharmacotherapeutics

Respiratory MedicationsRespiratory Medications

NUR 154

Pharmacotherapeutics

Upper Respiratory DisordersUpper Respiratory DisordersAllergic Rhinitis - Allergic Rhinitis - Nasal mucosa react to

allergen.S/S: Sneezing, rhinorrhea (runny nose), nasal

itching, watery eyes, congestionMedication ManagementMedication Management

Drug therapy: Antihistamines are the drugs of choice Benadryl, Claritin Common S.E.’s: Sedation, dry mouth, urinary

retention, constipation (anticholinergic S.E.’s), Insomnia, nervousness, irritability

Lower Respiratory DisordersLower Respiratory Disorders Obstructive

– Narrowed air passagesNarrowed air passages– Increased turbulence Increased turbulence

(secretions)(secretions)– Increased resistance to air flowIncreased resistance to air flow– S/S = bronchospasm, edema, S/S = bronchospasm, edema,

inflammation, excessive inflammation, excessive mucous secretionmucous secretion

– Examples: Examples: – Chronic obstructive Chronic obstructive

pulmonary diseasepulmonary disease or or COPDCOPD AsthmaAsthma BronchititsBronchitits

– Cystic fibrosisCystic fibrosis

Lower Respiratory and Related MedicationsLower Respiratory and Related Medications

Expectorants– Liquefy mucous by stimulating secretion of lubricant

fluids in larger airways Can increase effectiveness of ciliary action and coughing

– Guaifenesin (Robitussin) Used in acute coryza (common cold), bronchitis, pharyngitis,

sinusitis, laryngitis, COPD Used in combination with other resp. agents, such as

bronchodilators, decongestants, and antihistamines

– Therapeutic Outcome Reduced frequency of nonproductive cough, increased

expectoration of phlegm.

Lower Respiratory and Related MedicationsLower Respiratory and Related Medications Antitussive Agents

– Suppress cough center in brain Used to suppress bothersome dry, hacking, nonproductive

cough– ***NOT normally used to suppress productive cough***

– Codeine is the “gold standard” Usu. low doses, short duration of use to avoid long-term

dependence Causes resp. depression in higher doses Side Effects: Drowsiness, sedation, constipation; enhanced

CNS depression with other like agents, such as alcohol, sedatives, antihistamines, phenothiazines

– Dextromethorphan Does not cause respiratory depression or dependence! Drug of choice for children – Is in many OTC meds

Lower Respiratory & Inhalant MedicationsLower Respiratory & Inhalant Medications

Beta-adrenergic Bronchodilators – Stimulation of beta receptors relaxes smooth

muscle of bronchi; if non-selective, stimulate beta receptors of heart muscle

S.E.’s: Tachycardia, palpitations, nervousness, tremors; N/V

– Notify MD of an increase of 20 or > beats per minute

– Mainstay of asthma therapy and COPD *Ideally – should wait ten minutes between inhalations

– Common types: Albuterol (acute); Serevent (nonacute);

Lower Respiratory & Inhalant MedicationsLower Respiratory & Inhalant Medications

Anticholinergic Bronchodilators - Atrovent– Blocks cholinergic receptors in bronchial smooth muscle,

with minimal anticholinergic side effects – S.E.’s: Dry mouth and throat irritation, should resolve in ~

1st – 2nd week of use.

Mainstay of asthma and COPD treatment; oftentimes combined in nebulizer treatment with Albuterol

*If more than 1 inhaler is ordered, you administer corticosteroids to open bronchial before administering other inhalers.

Respiratory Anti-inflammatory MedicationsRespiratory Anti-inflammatory Medications Corticosteroids – Advair disk, Flovent

– Smooth muscle relaxation and decrease inflammation.– P.O., IV (Prednisone or methylprednisone) or Inhalants –

Flovent is a traditional aerosol inhalant– Advair is dry powder inhalant (DPI)

for asthma, or COPD

– Side effects Inhalant – oral thrush, dysphonia (spacer, gargle, and rinse after

each use) P.O. or IV use: Increased susceptibility to infections,

hyperglycemia, mood swings, delayed wound healing Never d/c these drugs abruptly, as they cause adrenal suppression of

pt.’s own cortisol production. Always taper gradually!


Xanthine Derivatives – Aminophylline, Theophylline– Relaxes smooth muscle of airways– Acute management – IV administration – Side effects: GI upset (^ gastric acid), tachy, palpitations,

nervousness– This category can inhibit the effects of Beta Blockers and

lithium– Chronic management – Oral medication, such as Theodur


Leukotriene Inhibitors – Zafirlukast (Accolate)– Inhibit inflammatory mediators which trigger asthma,

thereby reducing potential for edema, increased mucous and airway constriction

These are not bronchodilating agents– Do not use for acute attacks!

– S.E.’s: HA, nausea – subsides with continued therapy Take with food or milk.

– *Increases effects of theophylline and warfarin! Monitor closely and expect decreased doses of these other meds


Acetylcysteine (Mucomyst)– Inhalant which liquefies and reduces viscosity of

mucous secretions Used in emphysema, COPD, bronchiectasis and pneumonia

clients Allows easier removal of secretions by coughing, percussion

and postural drainage Wash client’s face and hands after administration to reduce

chance for irritation. S.E.’s: N/V (drug has a rotten egg smell), bronchospasm.

– Do not administer concurrently with antibiotics

– **This Drug is also given orally as the antidote to Tylenol overdose**

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respiratory medications nur 154 pharmacotherapeutics

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