Respiratory Tract Drugs Lecture Notes PDF

DRUGS AFFECTING THE RESPIRATORY TRACT Texas Woman’s University Vy Wyatt, MS, RN, CNE OBJECTIVES 1. Compare and contrast the short-acting (rescue) and the long-term maintenance inhaled beta2-adrenergic agonists. 2. Recognize drugs used to treat asthma, airway inflammation, and bronchoconstrict...

DRUGS AFFECTING THE RESPIRATORY TRACT Texas Woman’s University Vy Wyatt, MS, RN, CNE OBJECTIVES 1. Compare and contrast the short-acting (rescue) and the long-term maintenance inhaled beta2-adrenergic agonists. 2. Recognize drugs used to treat asthma, airway inflammation, and bronchoconstriction in terms of mechanism of action, indications for use, major adverse effects, and nursing implications. 3. Implement the nursing process in the care of patients with asthma, airway inflammation, and bronchoconstriction 4. For the nasal decongestants, identify the prototype and describe the action, use, contraindications, adverse effects, and nursing implications. 5. For the antitussive agents, identify the prototype and describe the action, use, contraindications, adverse effects, and nursing implications. 6. For the expectorants, identify the prototype and describe the action, use, contraindications, adverse effects, and nursing implications. 7. For the mucolytics, identify the prototype and describe the action, use, contraindications, adverse effects, and nursing implications. 8. Recognize the concerns of using combination products to treat the common cold. 9. Implement the nursing process with patients receiving nasal decongestants, antitussives, expectorants, and mucolytic agents. REVIEW OF THE RESPIRATORY SYSTEM Lower tracts allow gas exchange As airways progress towards alveoli, they become smoother DRUGS FOR ASTHMA AND COPD ADMINISTERING DRUGS BY INHALATION • Advantages • delivers drugs directly to their site of action • systemic effects are minimized • relief of acute attacks is rapid METERED-DOSE INHALER MDI WITH SPACER RESPIMAT DRY-POWDER INHALER • Advantages • No propellant, just inhale • Disadvantages • Bulky, limited doses, expensive NEBULIZER NASAL SPRAY DRUGS FOR ASTHMA & COPD BRONCHODILATORS B eta Agonists (albuterol) A nticholinergics (ipratropium) Methylxanthines (theophylline) BRONCHODILATORS • Opens up the bronchioles to increase ventilation and gas exchange • Does not treat underlying inflammation BETA2-ADRENERGIC AGONISTS • Inhaled beta2 agonists most effective drugs for acute bronchospasm • Mechanism of action: sympathomimetic; activate beta2-adrenergic receptors 🡪 BRONCHODILATION COMPARISON OF BETA2-ADRENERGIC AGONIST ROUTES PO (long acting) Inhaled long-acting Inhaled short-acting Used on a fixed schedule for long-term control Used on a fixed schedule for long-term control Preferred over short acting for stable COPD PRN, can be used to stop ongoing attack, but cannot be used for prolonged prophylaxis (excess use is dangerous) albuterol (PO) salmeterol albuterol formoterol levalbuterol B ALBUTEROL • Fast acting RESCUE inhaler • Adverse effects: Tachycardia, angina, muscle tremor, anxiety, insomnia • Avoid taking with beta blocker (drugs for hypertension) and NSAIDs – can cause bronchospasms EPINEPHRINE • Also known as adrenaline • Used in acute attack of bronchoconstriction • Can be given by inhalation or subcutaneous route • Therapeutic rescue effects in 5 min A ANTICHOLINERGIC BRONCHODILATORS • Block muscarinic receptors in the bronchi, reduces bronchoconstriction & mucus secretion • Approved for COPD but used off-label for asthma ipratropium tiotropium • Adverse effects: cough, nervousness, nausea, gastrointestinal (GI) upset, headache, and dizziness, contraindicated in glaucoma, paradoxical bronchospasm has occurred M METHYLXANTHINES • Xanthines have similar chemical structure to caffeine theophylline Avoid cimetidine ciprofloxacin caffeine intake • Relaxes bronchial smooth muscles • Not commonly used anymore but may be prescribed for severe COPD/bronchitis as a second line drug if other prescribed medications are not working • Therapeutic rage: 5-15 mcg/mL • TOXIC: above 20 mcg/mL toxicity leads to seizures, tachycardia, dysrhythmia ANTI-INFLAMMATORY DRUGS ANTI-INFLAMMATORY DRUGS S teroids (beclomethasone) L eukotriene inhibitors (montelukast) Mast cell stabilizers (cromolyn) S SELECTED GLUCOCORTICOIDS I N H A L E D beclomethasone budesonide fluticasone propionate mometasone furoate (Asmanex, Nasonex) Prednisone (oral) P O methylprednisolone (oral & IV) S BECLOMETHASONE • Prophylaxis of chronic asthma • Management: Scheduled; not for PRN use • Adverse effects (inhaled) • Oropharyngeal candidiasis, hoarseness GLUCOCORTICOID/LONG-ACTING BETA2-ADRENERGIC AGONIST COMBINATION Fluticasone/salmeterol (Advair Diskus, Advair HFA) budesonide/formoterol (Symbicort) mometasone/formoterol (Dulera) ADJUVANT THERAPY TO REDUCE INFLAMMATION LEUKOTRIENE MODIFIERS montelukast (Singulair) - leukotriene receptor blocker • Used as 2nd line therapy (when inhaled glucocorticoid contraindicated) and as add-on therapy • Route is PO (slow acting) • May take up to 2 weeks to start working • Black Box Warning: neuropsychiatric events IMMUNOSUPPRESSANT MONOCLONAL ANTIBODIES • omalizumab • For severe allergic asthma • Inhibits IgE binding to IgE receptors on mast cells and basophils, reducing allergic response • Black Box Warning: Anaphylaxis with first injection, anaphylaxis occurrence more than one year after initial dose MAST CELL STABILIZER cromolyn sodium • Used when glucocorticoids contraindicated or ineffective • Not effective for acute attacks, used to prevent an attack • Administered by oral route, actuation or nebulizer DRUGS FOR URI ALLERGIC RESPONSE ANTIHISTAMINES • Oral antihistamines (histamine1 [H1] receptor antagonists) • Relieves sneezing, rhinorrhea, and nasal itching First Generation Antihistamines diphenhydramine (Benadryl) chlorpheneramine (Chlor-Trimeton) hydroxyzine (Vistaril, Atarax) Adverse effects: sedation Second Generation Antihistamines cetirizine (Zyrtec) loratadine (Claritin) Third Generation Antihistamines fexofenadine (Allegra) desloratadine (Clarinex) levocetirizine (Xyzal) GLUCOCORTICOIDS • Intranasal route beclomethasone budesonide fluticasone proprionate (Flonase) fluticasone furoate (Veramyst) mometasone (Nasonex) triamcinolone (Nasacort) • 90% of people respond with proper use • Suppresses congestion, rhinorrhea, sneezing, nasal itching, and erythema • Adverse effects: dry nasal mucosa and a burning or itching sensation. Sore throat, epistaxis, and headache. SYMPATHOMIMETICS (DECONGESTANTS) • Reduce nasal congestion by activating alpha1-adrenergic receptors on nasal blood vessels 🡪 vasoconstriction 🡪 decreased swelling & drainage Decongestant Routes pseudoephedrine (Sudafed) Oral phenylephrine (Neo-Synephrine) Drops, spray, oral oxymetazoline (Afrin) Spray SYMPATHOMIMETICS (DECONGESTANTS) ADVERSE EFFECTS • Rebound Congestion • Use topical agents for only 3-5 days • CNS stimulation • Cardiovascular • Widespread vasoconstriction can be dangerous for patients with hypertension, coronary artery disease, cardiac arrhythmias, cerebrovascular disease • Abuse • All products containing ephedrine and pseudoephedrine placed behind the counter COMBINATION DRUGS DRUGS FOR COUGH ANTITUSSIVES OPIOID ANTITUSSIVES codeine NON-OPIOID ANTITUSSIVES dextromethorphan (Delsym, Robitussin) hydrocodone (Hycodan) benzonatate (Tessalon, Zonatuss) Adverse effects: sedation, respiratory depression, death Adverse effects: nausea, drowsiness, rash, and difficulty breathing DRUGS FOR CONGESTION Expectorant EXPECTORANTS & MUCOLYTICS • Makes cough more productive by stimulating the flow of respiratory tract secretions • guaifenesin (Mucinex, Humibid) Mucolytic • Makes mucus more watery to make cough more productive • acetylcysteine (Mucomyst) by inhalation OTHER DRUG CLASSES THAT TREAT RESPIRATORY CONDITIONS Antibiotics Antiviral drugs Antifungals Diuretics Oxygen NURSING CONSIDERATIONS ▪ Establish a baseline for comparison ▪ Monitor oxygenation & respiratory status (lung sounds, SpO2, etc.) ▪ Encourage adequate fluid intake ▪ Elevate HOB ▪ Evaluate outcomes: improvement of symptoms ▪ Monitor for CV, sedation and other adverse effects REFERENCES Frandsen, G & Pennington, S.S. (2021). Abrams’ clinical dug therapy: Rationales for nursing practice (12th ed.). Philadelphia, PA: Wolters Kluwer.