Drugs & Respiratory System PDF

Drugs & Respiratory System Bronchodilators Beta 2-adrenergic agonists Functions (lungs) ❖treat symptoms associated with asthma and Supplies body tissues with O2 and eliminates chronic obstructive...

Drugs & Respiratory System Bronchodilators Beta 2-adrenergic agonists Functions (lungs) ❖treat symptoms associated with asthma and Supplies body tissues with O2 and eliminates chronic obstructive pulmonary disease (COPD) CO2 and exercise-induced asthma. Distributes air at the lungs via bronchi. ❖2 categories Performs gas exchange via the alveoli, the 1. short-acting exchange of gases O2 & CO2 occurs thru 2. long-acting. diffusion. Short-acting beta2-adrenergic agonists Drugs used to improve respiratory include symptoms are available in inhalation and albuterol (systemic, inhalation) systemic formulations bitolterol (systemic) levalbuterol (inhalation) These include: metaproterenol (inhalation) (BRONCHODILATORS) pirbuterol (inhalation) Beta2-adrenergic agonists terbutaline (systemic). Anticholinergics methylxanthines albuterol (AccuNeb, Proventil, Ventolin) (ANTIINFLAMMATORY AGENTS) -systemic, inhalation Corticosteroids (STEROID) -Inhalation- 0.5ml in 3ml of 0.9% NaCl in 5- leukotriene modifiers 15min. mast cell stabilizers levalbuterol (inhalation) Metaproterenol(inhalation) These include: -A& C >12yrs 2-4 inhalation as single dose, wait for 2mins before the 2nd dose PRN , use only Expectorants q3-4h to max-12 inhalation. Antitussives Pirbuterol (inhalation) decongestants Prevention: ❖ A & C >12yrs inhalation 2puffs q4-6h  ❖A &C ->12yrs inhalation MDI 2puffs 30-60min before exercise. Bronchospasm: Combination agents ❖ A & C >12yrs inhalation 2 puffs albuterol and ipratropium (Combivent) (1-3 mins apart) followed by 1puff not to exceed 12 inhalation/d A- (MDI) Inhale 2 puffs terbutaline (systemic). MDI-Contain asthma meds in a liquid form w/c the patient inhales a precise dose. Epinephrine ( Adrenalin) Budesonide and Formoterol A- SubQ 0.1 – 0.5ml of 1:1000 PRN formoterol and mometasone -IV- 0.1-0.25ml of 1:1000 w/ additional dilution. salmeterol and fluticasone C- SubQ- 0.01ml/kg of 1:1000 w/ additional dilution. Contraindications & Precautions -IV- 0.1mg or 10ml of 1:100,000 1. Patients w/ uncontrolled arrhythmias, hypertension, coronary artery disease or history Bitolterol mesylate (Tornalate) of stroke -A- inhalation 2puffs (1-3min apart) q6h, max- 2. Use cautiously in patients w/ diabetes, 12 inhalation/d hyperthyroidism or history of seizures. Long-acting beta2-adrenergic agonists Beta 2 adrenergic agonist-bronchodilator include Adverse Reactions albuterol (oral, systemic) 1. Anxiety, nervousness, tremors, palpitation, formoterol (inhalation) tachycardia, hypertension, arrhythmias, dry salmeterol (inhalation). mouth & bronchospasms formoterol (inhalation) 2. Albuterol- Hypokalemia in patients having dialysis. A & C >5yrs inhalation: inhale contents of 1 cap q12h 3. Long acting drugs –increase the severity of any asthma episodes. Long-acting beta2-adrenergic agonists Beta 2 adrenergic agonist-bronchodilator include Nursing Responsibilities ❖salmeterol (Serevent Diskus) 1. Monitor BP, pulse, respiratory rate & breath ❖Maintenance bronchodilator sounds. ❖A &C >12yrs inhalation MDI 2puffs q 12h 2. Administer the drug round the clock as ordered. ❖Prevention of exercise induced bronchospasm 3. Monitor respiratory status for development of Bronchospasm 4. Do not give long acting drug more often than ✔Metabolism- metabolized primarily by the prescribed, it can cause serious adverse effects liver. eg: death. ✔ Excretion- via urine 5. Do not administer during acute asthma Drug examples: attack. 1. Aminophylline- theophylline 6. If inhalation drug is ordered, teach patient A- PO LD (large dose) 4oomg then increase dose how to use it. according to body weight, Max- 24mg/kg/d 7. Instruct patient to maintain fluid of 2-3L/day IV- LD 6mg/kg over 30min, then 0.2-0.9mg/kg/h to make secretion less viscous. C- PO LD 7.5mg/kg then1mg/kg/h 8. Advise patient to consult a doctor before taking non prescription meds to prevent IV- 6mg/kg then 1mg/kg/h adverse drug interactions. Note –individual titration is based on serum 9. Instruct patient to avoid respiratory irritants theophylline levels. eg; smoke, dust & strong scents. Drug examples: 10. Discuss w/ the patient the importance of 2. Caffeine avoiding products containing coffee. 3. Dyphylline (Dilor) Interactions A- PO 15mg/kg QID 4. When used w/ theophylline preparations causes additive effects. A- IM 250-500mg q6h 5. Use w/ beta adrenergic blockers decreases C- >6yrs PO 4-7mg/kg/d in 4 divided doses. drug’s Bronchodilating effects. ◼ Therapeutic serum theophylline range 10 6. Caffeine increases drug’s adverse effects. 20mcg/ml Methylxanthine Bronchodilators Indications: Mechanism of Action: 1. Prevent or treat bronchospasm. Produce bronchodilation by inhibiting cAMP 2. Treat asthma, bronchitis, emphysema (air breakdown & blocking adenosine receptors. sacs of the lungs are damage & enlarged causing dyspnea), & neonatal apnea. Pharmacokinetics: Contraindications & Precautions: ✔Absorption- absorbed rapidly & completely from the GIT. 1. Patients w/ status asthmaticus. ✔ Distribution- not well distributed in fat 2. Patients w/ xanthine hypersensitivity, peptic tissues, dosage is based on patient’s ideal or ulcer or untreated seizure disorders. actual body weight w/c is less. 3. To be used cautiously to elderly, neonates & 9. Grapefruit juice can increase the serum levels to those w/ heart diseases, hypoxemia (low O2 of theophylline increasing risk of toxicity. concentration in blood), hepatic disease, Nursing Responsibilities: hypertension, heart failure, alcoholism, during labor & breast feeding. 1. Assess s/s of toxicity eg; arrhythmias & seizures. 4. Aminophylline is contraindicated to patients who are hypersensitive to ethylenediamine & 2. Monitor serum drug levels to detect toxicity those w/ infection/irritation of the rectum or (therapeutic serum theophylline level should lower colon. range from 10-2omcg/ml). Adverse Reactions 3. Instruct patients to reduce consumption of xanthine-containing foods & beverages eg: cola, Headache, irritability, restlessness, anxiety, coffee, & chocolates to prevent toxicity. insomnia, dizziness, nausea, vomiting, abdominal cramping, epigastric pain, anorexia 3. Emphasize the importance of routine & diarrhea. laboratory studies to determine serum drug levels. Interactions: 1. Use w/ beta-adrenergic blockers partially antagonizes the effect of drug, altering the rate of metabolism & increasing the concentration. 2. Use w/ diuretics potentiates drug’s diuretic effects. 3. Use w/ sympathomimetics or cardiac glycosides potentiates drug’s adverse effects. 4. Phenobarbital, Phenytoin, Rifampicin, cigarette smoking & charcoaled foods may shorten drug’s half life-reducing its effectiveness. 5. Methylxanthine increases lithium clearance, reducing the effectiveness of the lithium. 6. Use w/ erythromycin may increase the drug’s half- life, increasing the risk of methylxanthine toxicity. 7. Smoking increases theophylline elimination & decreases the serum concentration & effectiveness. 8. Use w/ caffeinated beverages or caffeine like substances results in additive adverse reactions or s/s of methylxanthine toxicity.  TOPIC 2 CORTICOSTEROIDS 5. Cromolyn Sodium (Intal Aerosol Spray) A & C- >6yrs Intal MDI: 1 puff QID, Mechanism of action available; oral soln & powder, -prevent release of or counteract biochemical intranasal mediators (kinins, serotonin, histamine) that 6. Fluticasone ( Flonase, Flovent) cause the tissue inflammation responsible for edema & airway narrowing. A- 2 sprays daily or 1 spray BID -controls inflammation. C- >6yrs – 1 spray daily -widely use for arthritic conditions. 7. Methylprednisolone (Medrol, Solu-Medrol, Depo-medrol, sodium succinate) Pharmacokinetics A- PO 4-48mg/d in 1 or more divided doses 1. Absorption – rapidly absorbed thru IV, IM/IV – Succinate :10-40mg q4-6h poor systemic absorption after IM –Depo medrol -40-80mg/wk inhalation. 2. Distribution – not widely distributed 8. Prednisolone (Deltasone) into the tissues, high protein-bound. A- PO 5-60mg/d in divided doses 3. Metabolism – metabolized primarily by the liver. C- PO 0.1-0.15mg/kg/d in 2-4 divided doses 4. Excretion – eliminated thru the feces & urine. 9. Traimcinolone (Azmacort, kenacort, Aristocort, kenalog) Drug Examples: A- PO 4-48mg/d in2-4divided doses 1.) Beclomethasone (Beconase, Vancenase, Vanceril) Topical prep- cream & ointment A- 1-2 puffs/sprays BID-QID Indications: C- 6-12yrs, 1-2 sprays BID-QID 1. Beclomethasone – treat chronic bronchitis 2.) Budesonide (Pulmicort, Rhinocort) 2. Budesonide, Dexamethasone, A&C- >6yrs, 2 sprays BID or 4 sprays in the Flunisolide, & Traimcinolone- control morning. bronchial asthma in patients with steroid-dependent asthma. 3.) Decadron Phosphate Respihaler 3. Budesonide & Cromolyn Sodium- Treat A- 2 sprays BID or TID allergic rhinitis, adjunctive tx for severe C- 5-12yrs, 1-2 sprays BID perennial asthma, & prophylactic tx for exercise-induced asthma. 4.) Flunisolide (Aerobid) A- 2 sprays BID-TID C- 6-14yrs, 1 spray TID or 2 sprays BID Contraindication & Precautions: 5. Instruct patient on the proper use & care of inhaler & spacer. 1. Contraindicated to patients w/ acute bronchospasm. 6. Don’t abruptly discontinue but tapered the drug. 2. Use w/ extreme caution in patients w/ clinical tuberculosis or viral respiratory Leukotriene Receptors Modifiers infections, systemic infections, Mechanism of Action hypertension, diabetes, peptic ulcer or glaucoma. ◼ Selectively compete for leukotriene receptor sites thereby blocking Adverse reaction: inflammatory action that causes the s/s 1. Mouth irritation of asthma. 2. oral candidiasis – (or thrush infection Indications: on the mucosa of the mouth cause by ◼ Prophylactic & long term tx of candida albincan/yeast fungi) bronchial asthma in adults & children, 3. upper respiratory infections Montelukast approved for children as young as 12 months. Interactions: Pharmacokinetics 1. Hormonal contraceptives, Ketoconazole & macrolide antibiotics increase the ◼ Absorption- rapidly absorbed in the GIT activity of corticosteroids. ◼ Distribution- highly protein bound 2. Barbiturates, cholestyramine, & ◼ Metabolism- metabolized by the liver phenytoin decrease the effectiveness of corticosteroids. ◼ Excretion- excreted in the urine & feces Nursing Responsibilities: Drug examples: 1. Instruct patients receiving 1. Montelukast (Singulair) bronchodilator & corticosteroids inhaler to use the bronchodilator several A- PO 10mg daily @ bedtime minutes before the corticosteroids, to C- 6-14yrs PO 5mg daily @bedtime ensure penetration of the corticosteroids into the airways. C-2-5yrs 4mg daily @ bedtime 2. Give oral medicines w/ food to 2. Zafirlukast (Accolate) minimize GIT upset. A- P.O. 20mg BID 1hr before or 2hrs 3. Instruct patient to rinse mouth after after meal (12 yrs & adults) using inhaled steroids. 7-12yrs 10mg BID 4. Inform patients, receiving Cromolyn 3. Zileuton (Zyflo) that this drug is ineffective during acute bronchospasm attacks, & frequent use A- PO 600mg QID over a prolonged period decrease the C- >12yrs PO 600mg QID severity or frequency of attacks. Contraindications & Precautions: 3. Concurrent use of erythromycin & theophylline may decrease the 1. Not use for tx of status asthmaticus or effectiveness of the these drugs. acute asthma attacks. 4. Phenobarbital & rifampicin decrease 2. Patients w/ previous allergy to the bioavailability & effects of leukotriene modifiers. Montelukast when together. 3. Used cautiously in pregnant women. Nursing Intervention: Adverse Effect: 1. Monitor respiration for rate, depth, 1. Headache rhythm, & type. 2. dizziness 2. Monitor lung sounds for rhonchi, wheezing or rales. 3. nausea 3. Observe lips & fingernails for cyanosis. 4. diarrhea 4. Monitor drug therapy for effectiveness, 5. abdominal pain observe for side effects. 6. generalized fatigue 5. Provide adequate hydration. Fluids aids 7. Possible Churg-Strauss syndrome In in loosening secretions. patients who are decreasing oral 6. Monitor liver function test; AST & ALT – steroid dose while using Zafirlukast. may be elevated w/ Zafirlukast & 8. nasal congestion Montelukast. 9. fever 7. Provide pulmonary therapy by chest clapping & postural drainage as needed 10. rash 8. Administer Zafirlukast 1 hours before or Churg-Strauss syndrome — also known as 2 hrs. after meals for best absorption. eosinophilic granulomatosis (gran-u-loe-muh- TOE-sis) with polyangiitis (pol-e-an-jee-I-tis) —is 9. Montelukast is best absorbed when a disorder marked by blood vessel given at night. inflammation. This inflammation can restrict Antitussives blood flow to vital organs and tissues, sometimes permanently damaging them ◼ Acts on the cough-control center in the medulla to suppress the cough reflex. Interactions: ◼ Cough is a protective way to clear the 1. Warfarin used w/ Zafirlukast may result airway of secretions or any foreign in increased bleeding, monitor matters. prothrombin time closely & adjust warfarin dose accordingly. Three types of antitussives: 2. Calcium-channel blockers & 1. Narcotic cyclosporine increase the effect of 2. Non narcotic Zafirlukast & cause toxicity.  3. Combination w/ other agent A- PO 5-10mg q4-6hrs, max 15mg/day Pharmacokinetics: C- 1.25mg q4-6hrs, 0.6mg/kg/d in 3-4 divided doses not to exceed ◼ Dextromethorpan is available in 10mg/single dose. numerous cough & cold remedies in syrup form/ liquid Chewable capsules &. Non opioid antitussive (non productive cough) lozenges 2.1. Benzonatate (Tessalon) ◼ Absorption- thru GIT A- PO 100mg TID or q4hrs, max 600mg/d ◼ Distribution- unknown C- 6yrs 1 spray daily sinus congestion, and sneezing. Because it contains pseudoephedrine. 3. Oxymetazoline HCl (Afrin) Indications: A & C > 6yrs: 0.05% gtt or spray; 2-3gtt or 1-2 sprays in each nostrils BID 1. Temporary relief of nasal congestion due to common cold, hay fever or other C- 2-5yrs (0.025% gtt only): 2-3gtt BID URT allergies & sinusitis. (q10- 12h) 2. Promote nasal or sinus drainage. 4. Fluticasone (Flonase, Flovent) 3. Hay fever- also known as allergic A- 2 sprays daily or 1 spray BID rhinitis, is a common condition that C- >6yrs 1 spray daily shows signs and symptoms similar to a cold with sneezing, congestion, runny 3. Oxymetazoline HCl (Afrin) nose and sinus pressures. A & C > 6yrs: 0.05% gtt or spray; 2-3gtt 4. Sinusitis- inflammation of mucous or 1-2 sprays in each nostrils BID membrane of 1 or more maxillary, C- 2-5yrs (0.025% gtt only): 2-3gtt BID frontal, ethmoid, or sphenoid sinuses. (q10- 12h) Contraindications & Precautions: 4. Phenylephrine HCl (Neo-Synephrine, Sinex) 1.Contraindicated to patients taking MAO A: soln (0.25-1%): 2-3gtt or 1-2 sprays in inhibitors & those hypersensitive to drug’s each nostrils q4h ingredients. C- 6-12 yrs: soln (0.25%): 1-2gtt or spray Taken with MOA may increase each nostril q4h possibility to cause hypertension & cardiac dysrhythmias (abnormal rhythm). C- 6months- 5yrs soln (0.125-0.16%): 1-2 gtt in each nostril q4h 2. Used cautiously in patient 60yrs up (adverse effect) patient w/ thyroid disease, 5. pseudoephedrine hydrochloride (Sudafed, cardiovascular disease, coronary artery disease, Decofed) hypertension, intraoccular pressure or peripheral vascular disease & those w/ difficulty A- PO : 60mg q4-6h in voiding due enlarge prostate. Pedia- PO 6-12yrs 30mg q4-6h 3. Pseudoephedrine contraindicated to PO 2-5yrs- 15mg q4-6h hypertensive patient due to the risk of cardiac arrest. PO 3-12mons 3gtt/kg q4-6h 6. pseudoephedrine sulfate (Drixoral) –nasal spray 6mg/120mg. Adverse effects: 1. Decongestants can make client jittery, nervous or restless. 2. Usage of nasal decongestants longer than 5 days could result to rebound nasal congestion (instead of nasal membrane constrict, vasodilation occurs causing stuffy nose & nasal congestions). 3. Arrhythmias, palpitations, tachycardia, bradycardia, hypotension, headache, light- headedness, drowsiness, insomnia. Interactions: 1. Pseudoephedrine may increase the effect of beta-blockers. 2. When taken w/ MAO inhibitors , decongestants may increase possibility of hypertension or cardiac dysrhythmias. Nursing Responsibilities: 1. Inform client to avoid large amount of caffeine (coffee & tea), it can increase restlessness & palpitations caused by decongestants. 2. Teach client the proper method of using inhaler, sprays or drops. 3. Instruct client not to share the container w/ other person & not to allow the tip of the container to touch the nasal passage to avoid contamination. 4. Inform client not to used the drug more than 5 days to prevent toxicity (rebound congestion).