2. RESPIRATORY MEDICATIONS.pdf

Respiratory Drugs PAUL ANDRE A. LUMIGUID RN MAN Instructor  Topics to discuss: Drugs for Upper Airways a. Antihistamines b. Decongestants c. Intranasal Steroids d. Antitussives e. Expectorants...

Respiratory Drugs PAUL ANDRE A. LUMIGUID RN MAN Instructor  Topics to discuss: Drugs for Upper Airways a. Antihistamines b. Decongestants c. Intranasal Steroids d. Antitussives e. Expectorants Drugs for Lower Airways a. Sympathomimetics b. Anticholinergics c. Xanthine Derivatives d. Leukotrine Receptor Agonists e. Mucolytics f. Steroids CMFiel  Respiratory Tract Upper Respiratory Tract nares, nasal cavity, pharynx, and larynx Lower Respiratory Tract trachea, bronchi, bronchioles, Air enters through the upper alveoli, and alveolar-capillary respiratory tract and travels to the lower respiratory tract, membrane where gas exchanges occur. CMFiel  Ventilation vs Respiration Ventilation and respiration are distinct terms and should not be used interchangeably. Ventilation is the movement of air from the atmosphere through the upper and lower airways to the alveoli. Respiration is the process whereby gas exchange occurs at the alveolar-capillary membrane. CMFiel  Phases of Respiration 1. Ventilation 2. Perfusion -Oxygen passes through the airways. With every inspiration, It involves blood flow at the air is moved into the lungs, alveolar-capillary bed. Perfusion and with every expiration, air is is influenced by alveolar transported out of the lungs pressure. For gas exchange to occur, the perfusion of each alveolus must 3. Diffusion be matched by adequate ventilation. Factors such as mucosal edema, secretions, and -movement of molecules from bronchospasm increase higher to lower concentrations, resistance to air flow and takes place when oxygen passes into the capillary bed to decrease ventilation and be circulated and carbon dioxide diffusion of gases. leaves the capillary bed and diffuses into the alveoli for ventilatory excretion. CMFiel  The chest cavity is a closed compartment bounded by 12 ribs, the diaphragm, thoracic vertebrae, sternum, neck muscles, and intercostal muscles between the ribs. The pleurae are membranes that encase the lungs. The lungs are divided into lobes; the right lung has three lobes, and the left lung has two lobes. The heart, which is not attached to the lungs, lies on the mid-left side in the chest cavity. CMFiel  Lung Compliance Lung compliance is the lung volume based on the pressure in the alveoli. This volume determines the lung’s ability to stretch. Factors that influence lung compliance include: (1) connective tissue (collagen and elastin) (2) surface tension in the alveoli, which is controlled by surfactant. Surfactant lowers the surface tension in the alveoli and prevents interstitial fluid from entering. lung compliance - chronic obstructive pulmonary disease (COPD) lung compliance - restrictive pulmonary disease. With low compliance, there is decreased lung volume resulting from increased connective tissue or increased surface tension. The lungs become “stiff,” and it takes greater-than-normal pressure to expand lung tissue. CMFiel  Bronchial Smooth Muscle The tracheobronchial tube is composed of smooth muscle whose fibers spiral around the tracheobronchial tube, becoming more closely spaced as they near the terminal bronchioles. Contraction of these muscles restrict airway. Parasympathetic- bronchoconstriction Sympathetic- bronchodilation Cyclic adenosine monophosphate (cAMP) in the cytoplasm of bronchial cells increases bronchodilation by relaxing the bronchial smooth muscles. CMFiel  common cold vs rhinitis vs allergic rhinitis Nasal Caused by Lasts for Symptoms secretions Runny or stuffy nose , Sore Common as long as 2 throat ,Cough ,Congestion, rhinovirus present Cold weeks Slight body aches or a mild headache ,Sneezing few days or Stuffy nose, Runny nose, Colds and Sneezing, Mucus (phlegm) in Rhinitis allergies up to four increase the throat (postnasal drip), weeks Cough pollen or a sneezing and coughing, a foreign As long as runny or blocked nose, itchy, Allergic substance you're red or watery eyes. Rhinitis increase itchy throat, mouth, nose and such as exposed to (hay fever) ears animal allergens dander CMFiel  Upper Respiratory Drugs CMFiel  Drugs for Upper Airways Intranasal Steroids Expectorants Antihistamines Decongestants Antitussives CMFiel  Upper respiratory infections (URIs) include the common cold, acute rhinitis, sinusitis, and acute pharyngitis. The common cold is the most prevalent type of URI. CMFiel  Antihistamines CMFiel  Antihistamines: 1st and 2nd Generation These two types of histamine receptors should not be confused. -compete with histamine for receptor sites Antihistamines decrease nasopharyngeal and prevent a histamine response secretions by blocking the H1 receptor. 2 types of histamine receptors: Although antihistamines are commonly used as cold remedies, these agents can also treat H1 - When the H1 receptor is stimulated, allergic rhinitis. the extravascular smooth muscles— However, the antihistamines are not useful in including those lining the nasal cavity— an emergency situation such as anaphylaxis. are constricted. Most antihistamines are rapidly absorbed in H2 - With stimulation of the H2 receptor, 15 minutes, but they are not potent enough an increase in gastric secretions occurs, to combat anaphylaxis. which is a cause of peptic ulcer CMFiel First Dipenhydramine Generation -has been available for years and is Antihistamines frequently combined with other ingredients in cold remedy preparations. -Its primary use is to treat rhinitis. -cause drowsiness, dry mouth, and other anticholinergic symptoms, and decrease the nasal itching and tickling that cause sneezing -patients should be alerted not to drive or operate dangerous machinery when taking such medications -anticholinergic properties of most antihistamines cause dryness of the mouth and decreased secretions, making them useful in treating rhinitis caused by the common cold. CMFiel First Generation Antihistamines Dipenhydramine -it is sometimes used in sleep-aid -blocks the effects of histamine by competing products for and occupying H1 receptor sites. -It has anticholinergic effects and should not -also used as an antitussive to alleviate be used by patients with narrow-angle cough -can cause central glaucoma. nervous system (CNS) depression if taken with alcohol, narcotics, hypnotics, or barbiturates. most common side effects of first-generation antihistamines: drowsiness anticholinergic symptoms: dizziness dry mouth Fatigue urine retention disturbed blurred vision coordination wheezing CMFiel skin rashes CMFiel Second Generation Antihistamines -nonsedating antihistamines - cause fewer anticholinergic symptoms -cetirizine -fexofenadine have half-lives between 7 and 30 hours -loratadine -Azelastine (nasal spray) half-life of 22 hours CMFiel CMFiel  Warn patients to avoid driving a motor vehicle Patient Teaching and performing other dangerous activities if drowsiness occurs or until stabilized on the drug. for Antihistamines Advise patients to avoid alcohol and other central nervous system depressants. Encourage patients to take drugs as prescribed. Notify a health care provider if confusion or hypotension occurs. Teach patients on prophylaxis for motion sickness to take the drug at least 30 minutes before the offending event and also before meals and at bedtime during the event. Inform breastfeeding mothers that small amounts of drug pass into breast milk. Because children are more susceptible to the side effects of antihistamines (e.g., unusual excitement or irritability), breastfeeding is not recommended CMFiel while using these drugs.  Decongestants CMFiel  Nasal Nasal congestion results from dilation of Decongestants nasal blood vessels caused by infection, inflammation, or allergy. Nasal decongestants (sympathomimetic amines) stimulate the alpha-adrenergic With this dilation, a transudation of fluid receptors, producing vasoconstriction of into the tissue spaces occurs that results the capillaries within the nasal mucosa. in swelling of the nasal cavity. The result is shrinking of the nasal mucous membranes and a reduction in fluid secretion (runny nose). -administered by nasal spray or drops or in tablet, capsule, or liquid form. Frequent use of decongestants: result in tolerance and rebound nasal congestion, rebound vasodilation instead of vasoconstriction. Rebound nasal congestion is caused by CMFiel irritation of the nasal mucosa.  Systemic Advantage: -relieves nasal congestion for a longer Decongestants period than nasal decongestants; -also known as alpha-adrenergic however, long-acting nasal agonists decongestants are now available -available in tablet, capsule, and liquid Disadvantage: form -nasal decongestants usually act -used primarily for allergic rhinitis, promptly and cause fewer side effects including hay fever and acute coryza than systemic decongestants. (profuse nasal discharge). -ephedrine SE and AR: -phenylephrine, -low with topical preparations such as nose drops -can make a patient jittery, nervous, or restless -oxymetazoline(Afrin) -Use for as little as 3 days could result in rebound -pseudoephedrine nasal congestion -blood pressure and blood glucose levels can CMFiel increase  Systemic Decongestants -ephedrine -phenylephrine -oxymetazoline(Afrin) -pseudoephedrine CMFiel  Intranasal Steroids CMFiel  Intranasal -These drugs may be used alone or in combination with an H1 antihistamine. Glucocorticoids -The spray should be directed away -effective for treating allergic rhinitis from the nasal septum, and the because they have an anti-inflammatory patient should sniff gently. With action, thus decreasing the allergic continuous use, dryness of the nasal rhinitis symptoms of rhinorrhea, mucosa may occur. sneezing, and congestion -undergoes rapid deactivation after -Beclomethasone absorption -Budesonide -Dexamethasone -Most allergic rhinitis is seasonal; -Flunisolide therefore the drugs are for short-term -Fluticasone use unless otherwise indicated by the -Mometasone health care provider. -Triamcinolone CMFiel  Intranasal -Beclomethasone -Budesonide Glucocorticoids -Dexamethasone -Flunisolide -Fluticasone -Mometasone -Triamcinolone CMFiel  Antitussives CMFiel Antitussives Guaifenesin, a nonnarcotic antitussive, is widely used in OTC cold remedies. -act on the cough-control center in the medulla to suppress the cough reflex Dextromethorphan is available in numerous cold and cough remedy -The cough is a naturally protective way to preparations in syrup or liquid form, clear the airway of secretions or any chewable capsules, and lozenges. collected material. -A sore throat may cause coughing that increases throat irritation. -If the cough is nonproductive and irritating, an antitussive may be taken.. types of antitussives: a. Non-opioid b. opioid c. combination preparations CMFiel  Expectorants CMFiel Expectorants -Hydration is the best natural expectorant. -loosen bronchial secretions so they can be -When taking an expectorant, patients eliminated by coughing should increase fluid intake to at least 8 glasses per day to help loosen mucus. -They can be used with or without other pharmacologic agents. -Expectorants are found in many OTC cold remedies along with analgesics, antihistamines, decongestants, and antitussives. -The most common expectorant in such preparations is guaifenesin. CMFiel CMFiel  Teach patients about proper use of nasal sprays and proper use of “puff” or squeeze products. Patient Teaching Caution patients not to use more than one or two puffs four to six times a day for 5 to 7 days, because rebound congestion can occur with overuse. Advise patients to read labels on OTC drugs and to check with a health care provider before taking cold remedies. This is especially important when taking other drugs or when a patient has a major health problem such as hypertension or hyperthyroidism. Also, acetaminophen may be in many products, promoting an overdose. Inform patients that antibiotics are not helpful in treating common cold viruses. However, they may be prescribed if a secondary infection occurs. CMFiel  Tell patients to maintain adequate fluid intake. Fluids liquefy bronchial secretions to ease Patient Teaching elimination with coughing. Teach patients not to take a cold remedy before or at bedtime. Insomnia may occur if it contains a decongestant. Encourage patients to get adequate rest. Inform patients that common cold and flu viruses are transmitted frequently by hand-to-hand contact or by touching a contaminated surface. Cold viruses can live on the skin for several hours and on hard surfaces for several days. Advise patients to avoid environmental pollutants, fumes, smoking, and dust to lessen irritating cough. CMFiel  Lower Respiratory Drugs CMFiel  Drugs for Lower Airways Anticholinergics Mucolytics Steroids Sympathomimetics Xanthine Derivatives Leukotrine Receptor Agonists CMFiel  Sympathomimetics CMFiel Sympathomimetics: Alpha- and Beta2 -Adrenergic Agonists For bronchospasm associated with chronic asthma or COPD, selective beta2-adrenergic -increase cAMP, causing dilation of the agonists are given by aerosol or as a tablet. bronchioles. In an acute bronchospasm -These drugs act primarily on the beta2 caused by anaphylaxis from an allergic receptors, therefore side effects are less reaction, severe than those of epinephrine, which acts on alpha1 , beta1 , and beta2 receptors. -the nonselective sympathomimetic epinephrine— an alpha1 , beta1 , and beta2 agonist—is given subcutaneously to promote bronchodilation and elevate blood pressure -Epinephrine is administered in emergency situations to restore circulation and increase airway patency SE: tremors, dizziness, hypertension, tachycardia, heart palpitations, cardiac CMFiel dysrhythmias, and angina Sympathomimetics: Sympathomimetics: ALBUTEROL (beta2-adrenergic) METAPROTERENOL -effective for treatment and control of -has some beta1 effect but is primarily used asthma by causing bronchodilation with a as a beta2 agent long duration of action SE: tremors, headaches, -It can be administered orally or by nervousness, increased pulse inhalation with a metered-dose inhaler rate, and palpitations (high (MDI) or a nebulizer. doses). -The effective inhalation drug dose is less than it would be by the oral route, and there are also fewer side effects using this route. CMFiel CMFiel CMFiel albuterol formoterol levalbuterol metaproteremol CMFiel  Anticholinergics CMFiel Anticholinergic: Tiotropium is an anticholinergic drug used -block the action of acetylcholine for maintenance treatment of bronchospasms associated with COPD. -Acetylcholine is a neurotransmitter, or a chemical messenger. It transfers signals -This drug is administered by inhalation only between certain cells to affect how your with the HandiHaler device (dry-powder body functions. capsule inhaler). -Patients should discard any capsules that are opened and not used immediately. -HandiHalers should be washed with warm water and dried. common adverse effects of tiotropium: dry mouth, constipation, vomiting, dyspepsia, abdominal pain, depression, insomnia, headache, CMFiel joint pain, and peripheral edema. CMFiel Anticholinergic: The combination is more effective and has a ipratropium bromide is used to treat longer duration of action than either agent asthmatic conditions by dilating the used alone. bronchioles. These two agents combined increase the Unlike other anticholinergics, ipratropium FEV1 , the index used to evaluate asthma bromide has few systemic effects. It is and obstructive lung disease and the administered by MDI. patient’s response to bronchodilator therapy. The combination of ipratropium bromide with albuterol sulfate is used to treat COPD. CMFiel CMFiel  Xanthine Derivatives CMFiel Methylxanthine Derivatives: The second major group of bronchodilators used to treat asthma is the methylxanthine (xanthine) derivatives, which include aminophylline, theophylline, and caffeine. Xanthines also stimulate the central nervous system (CNS) and respiration, dilate coronary and pulmonary vessels, and cause diuresis. Because of their effect on respiration and pulmonary vessels, xanthines are used in the treatment of asthma. CMFiel Methylxanthine Derivatives: THEOPHYLLINE Theophylline was once used as the first- line drug for treating patients with chronic -relaxes the smooth muscles of the bronchi, asthma and other COPDs. However, bronchioles, and pulmonary blood vessels theophylline use has declined sharply by inhibiting the enzyme because of a potential danger of serious phosphodiesterase, resulting in an increase adverse effects—including dysrhythmias, in cAMP, which promotes bronchodilation convulsions, and cardiorespiratory collapse—and efficacy has not been found to be greater than that of beta agonists or -has a low therapeutic index and a narrow glucocorticoids. desired therapeutic range (5-15 mcg/mL) To decrease the potential for side effects, patients -serum or plasma theophylline should not take other concentration level should be monitored xanthines while taking frequently to avoid severe adverse effects. theophylline. Toxicity is likely to occur when the serum level is greater than 20 mcg/mL. CMFiel  -Because of the diuretic effect of xanthines, including theophylline, patients should avoid caffeinated products such as coffee, tea, cola, and chocolate, and they should increase fluid intake. -Rapid IV administration of aminophylline, a theophylline product, can cause dizziness, flushing, hypotension, severe bradycardia, and palpitations. -To avoid severe adverse effects, IV theophylline preparations must be administered slowly via an CMFiel infusion pump.  Leukotriene Receptor Antagonists and Synthesis Inhibitors CMFiel Leukotriene Receptor Antagonists and Synthesis Inhibitors These drug groups are not Leukotriene (LT) is a chemical mediator that recommended for treatment of acute can cause inflammatory changes in the lung. asthmatic attacks, rather they are used for exercise-induced asthma. The cysteinyl leukotrienes promote an increase in eosinophil migration, mucous Three leukotriene modifiers: production, and airway wall edema that a. zafirlukast results in bronchoconstriction. b. zileuton c. montelukast LT receptor antagonists and LT synthesis inhibitors, called leukotriene modifiers, are effective in reducing the inflammatory symptoms of asthma triggered by allergic and environmental stimuli. CMFiel Leukotriene Receptor Antagonists and Synthesis Inhibitors zafirlukast was the first drug in the class of leukotriene modifiers. zileuton is a leukotriene synthesis inhibitor. -acts as an leukotriene receptor -It decreases the inflammatory process and antagonist, reducing the inflammatory decreases bronchoconstriction. process and decreasing bronchoconstriction -has a short half-life of 1 to 2.3 hours. -administered orally -absorbed rapidly Montelukast (leukotriene receptor -has a moderate to moderately long antagonist) has a short half-life of 2.7 to 5.5 half-life hours and is considered safe for use in -usually given twice a day children 2 years of age and older. CMFiel CMFiel CMFiel  Patient Teaching: Advise patients that if an allergic reaction occurs (i.e., rash, urticaria), the drug should be Leukotriene Receptor discontinued and a health care provider should be notified. Antagonists Monitor hepatic function tests periodically. Warn patients that black or green tea and guarana taken with montelukast and zafirlukast may cause increased stimulation. Encourage patients to stop smoking. Discuss ways to alleviate anxiety (relaxation techniques, music). Advise patients who have frequent or severe asthmatic attacks to wear an identification bracelet or a MedicAlert tag. CMFiel  Patient Teaching: Encourage patients contemplating pregnancy to seek medical advice before taking montelukast. Leukotriene Receptor Caution patients and their significant others not to Antagonists open oral granule packets until they are ready to use them. After opening a packet, the dose must be administered within 15 minutes. If mixed with baby formula or an approved food (applesauce, carrots, rice, or ice cream), do not store for future use. Advise patients with known aspirin sensitivity to avoid a bronchoconstrictor response by avoiding aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) while taking montelukast. Encourage patients to inform a health care provider if short-acting inhaled bronchodilators are needed more often than usual with montelukast. CMFiel  Mucolytics CMFiel Mucolytics Acetylcysteine is administered by nebulization for bronchopulmonary disorders. With one -act as detergents to liquefy and loosen important exception, this drug should not be thick, mucous secretions so they can be mixed with other drugs. expectorated When patients with asthma or hyperactive airway disease produce increased secretions that obstruct bronchial airways, acetylcysteine may be administered as an adjunct to a bronchodilator, but these are not mixed together; the bronchodilator should be given 5 minutes before the mucolytic. Side effects: nausea and vomiting, stomatitis (oral ulcers), and “runny nose.” -may be diluted in soft drinks to minimize the risk of vomiting. CMFiel  Glucocorticoids CMFiel Glucocorticoids (Steroids) Glucocorticoids can be given using the following -members of the corticosteroid family methods: MDI inhaler: Beclomethasone -used to treat respiratory disorders, Tablet: Dexamethasone, prednisone particularly asthma Intravenous: Dexamethasone Inhaled glucocorticoids are not helpful in -These drugs have an anti-inflammatory treating a severe asthmatic attack because it action and are indicated if asthma is may take 1 to 4 weeks for an inhaled steroid unresponsive to bronchodilator therapy or if to reach its full effect. the patient has an asthmatic attack while on maximum doses of theophylline or an When maintained on inhaled glucocorticoids, adrenergic drug. asthmatic patients demonstrate an improvement in symptoms and a decrease in asthmatic attacks. -It is thought that glucocorticoids have a synergistic effect when given with a beta2 Inhaled glucocorticoids are more effective for agonist. controlling symptoms of asthma than are beta2 agonists, particularly in the reduction of CMFiel bronchial hyperresponsiveness.  Beclomethasone Dexamethasone Side effects associated with orally inhaled glucocorticoids are generally local (e.g., throat irritation, hoarseness, dry mouth, coughing) rather than prednisone systemic. CMFiel  Thanks! Do you have any questions? CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik. CMFiel