U5 Oxygenation Drugs PDF - NCM106 Pharmacology Lecture

13/10/2024 U5 Oxygenation Drugs NCM106 Pharmacology Lecture 1 Contents of this cluster Drugs in Managing Oxygenation Problems will cover: Classify prototype respiratory, cardiovascular & CNS drugs according to their pharma...

13/10/2024 U5 Oxygenation Drugs NCM106 Pharmacology Lecture 1 Contents of this cluster Drugs in Managing Oxygenation Problems will cover: Classify prototype respiratory, cardiovascular & CNS drugs according to their pharmacologic & therapeutic effects. Discuss specific mechanism of action. Identify appropriate indication, contraindication, side-effects, adverse effects, other effects. Identify nursing responsibilities. Identify appropriate health education. Identify appropriate evaluation criteria to assess client’s response. 2 1  13/10/2024 01 Drugs acting on Respiratory System 3 Drugs acting on Upper Respiratory Tract 4 2  13/10/2024 Antitussives o Suppress the cough reflex - Particular for uncomfortable, nonproductive cough o Act directly on the medullary cough center o Rapidly absorbed, metabolized in the liver, & excreted in the urine o Codeine & hydrocodone are narcotics o C/I: people who need cough to maintain airway, pregnancy & lactation o A/E: CNS adverse effects, including drowsiness & sedation o Drug interaction: MAO inhibitors → hypotension, fever, nausea 5 Decongestants o Decrease the overproduction of secretions by causing local vasoconstriction to the upper respiratory tract o Frequent or prolonged use ➔ rebound congestion (technically called Rhinitis medicamentosa) o Usually, adrenergics or sympathomimetics o Topical nasal decongestants are for nasal congestion - almost immediate onset with less systemic effects - A/E: local stinging, burning o Topical steroid decongestants are for allergic rhinitis o Oral decongestants shrink the nasal mucous membrane (stimulating the o 1receptors in the nasal mucous membranes) →  airway alpha-adrenergic o Generally, well absorbed (20-45 minutes) - A/E: anxiety, tenseness, restlessness, tremors, hypertension, arrhythmias, sweating, & pallor 6 3  13/10/2024 Antihistamines o Block the release or action of histamine o inflammation  secretions & narrows airways o With antipruritic effects o First-generation have greater anticholinergic effects (drowsiness) while second-generation is less-sedating (individual variances noted) o Well absorbed orally (1-3 hrs); generally metabolized in the liver, with excretion in the feces & urines o A/E: drying of the respiratory & GI mucous membranes, GI upset & nausea, arrhythmias, dysuria, urinary hesitancy, & skin eruption & itching associated with dryness 7 Expectorant o Increase productive cough ➔ clear the airways - liquefy lower respiratory tract secretions ➔  viscosity of secretions ➔  adhesiveness & surface tension ➔ easier to cough up  coughing o Rapidly absorbed (30 minutes) o A/E: GI symptoms (e.g., nausea, vomiting, anorexia); headache, dizziness, or both; occasionally, a mild rash o Should not be taken more than a week 8 4  13/10/2024 Mucolytics o Increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients o Acetylcysteine - splits disulfide bonds (responsible for holding the mucus material together) ➔  viscosity of secretions o Dornase Alfa - separate extracellular DNA from proteins ➔ selectively break down respiratory tract mucus A/E: GI upset, stomatitis, rhinorrhea, bronchospasm, & occasionally a rash 9 Drug action sites 10 5  13/10/2024 Drugs acting on Lower Respiratory Tract 11 Bronchodilators o Facilitate respiration by dilating the airways (Antiasthmatics) o For bronchial asthma or bronchospasm (COPD) o Xanthines ‘-phylline’ - Direct effect on the smooth muscles of the respiratory tract, both in the bronchi & in the blood vessels - Narrow margin of safety o Sympathomimetics - dilation of the bronchi with increased rate & depth of respiration - Epinephrine is the drug of choice (acute bronchospasm) o Anticholinergics ‘-ium’ - Block the action of neurotransmitter Ach at vagal-mediated receptor sites causing relaxed smooth muscles (COPD) o 12 6  13/10/2024 Antiinflammatory o Increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients o Inhaled steroids - effective for bronchospasm - leads to  swelling & promotion of beta-adrenergic activity - A/E: sore throat, hoarseness, coughing, dry mouth, pharyngeal & laryngeal fungal infections o Leukotriene receptor antagonists - selectively & competitively block (‘-kast’) or antagonize receptors for the production of leukotrienes ➔ block S/Sx of asthma - rapidly absorbed from the GIT - use cautiously in patients with hepatic or renal impairment 13 Immune modulators o Antibodies as add-on maintenance therapy for moderate- severe asthma o ‘-mab’ o Do not have immediate effects o Benralizumab - binds to interleukin-5 receptor expressed on eosinophils & basophils → apoptosis o Omalizumab - binds to IgE receptors on mast cells, basophils & dendritic cells →  IgE-mediated inflammation. o Mepolizumab & reslizumab - bind to inhibit interleukin-5 (cytokine that facilitates growth & activation of the eosinophils) o Dupilumab - binds to cells that have a receptor shared by interleukin-4 & interleukin-13. 14 7  13/10/2024 P cromolyn Mast Cell Stabilizer o Prevents the release of inflammatory & bronchoconstricting substances (like histamine) when mast cells are stimulated to release these substances because of irritation or the presence of an antigen. o It is no longer part of the treatment standards because of the availability of more specific & safer drugs. o Used to treat the symptoms of mastocytosis. o Mastocytosis is a rare condition caused by too many mast cells in the body. o S/Sx: abdominal pain, nausea, vomiting, diarrhea, headache, flushing or itching of skin, or hives. 15 Lung Surfactants o Naturally occurring compounds or lipoproteins containing lipids & apoproteins that reduce the surface tension within the alveoli’ o ‘-tant’ o Replace surfactant in the lungs of neonates with Respiratory distress syndrome (RDS) o Instilled directly into the trachea & begin to act immediately on instillation o No contraindications 16 8  13/10/2024 Drug action sites 17 Resources Burchum, J.R., Rosethal, L.D. (2019). Lehne’s Pharmacology for nursing care 10th edition. Missouri, USA: Elsevier Inc. Johnson, Nachole. (2017). Pharmacology mnemonics for the family nurse practitioner. USA: Nachole Johnson & ReNursing Publishing Company. Karch, A.M. (2017). Focus on nursing pharmacology Seventh edition. Philadelphia, USA: Wolters Kluwer. Karch, A. M., Tucker, R. G. (2020). Focus on nursing pharmacology Eighth edition. Philadelphia, USA: Wolters Kluwer. McCuistion, L.E., Vuljoin-Dimaggio, K., Winton, M.B., Yeager, J.J. (2023). Pharmacology A patient-centered nursing process approach 11th edition. Missouri, USA: Elsevier. Tucker, Rebecca G. (2023). Karch’s Focus on nursing pharmacology Ninth edition. Philadelphia, USA: Wolters Kluwer. 18 9