Respiratory System Drugs PDF

Drugs Affecting The Upper and Lower Respiratory System Prepared BY: Dr. YN, Dr. WA Edited by: Ms. Vanaja Muniswamy  Objectives 1. Describe pharmacokinetics, pharmacodynamics, pharmacotherapeutic, and adverse effects of the drugs affecting the respiratory system. 1. Identify the role of n...

Drugs Affecting The Upper and Lower Respiratory System Prepared BY: Dr. YN, Dr. WA Edited by: Ms. Vanaja Muniswamy  Objectives 1. Describe pharmacokinetics, pharmacodynamics, pharmacotherapeutic, and adverse effects of the drugs affecting the respiratory system. 1. Identify the role of nurses in drug administration of the respiratory drugs. AnHU  Dextromethorphan Pharmacotherapeutics Pharmacokinetics Pharmacodynamics non -productive Absorbed rapidly Opiate agonists cough from GI tract Suppress coughing forms: capsules, Onset : 15-30 minutes by directly affecting lozenges, syrups, Undergoes extensive the cough center in extended –released hepatic metabolism the medulla suspension, Exertion: renal , some chewable tablets drugs eliminated Ch unchanged, most eliminated as metabolites Gent  Dextromethorphan Precautions Side Effects Contraindicated in Drowsiness treating chronic coughs Dizziness resulting from asthma & Irritability emphysema Nausea Vomiting Patients with hepatic Constipation impairment. Overdose: Poisoning During pregnancy interater drag MACC  Dextromethorphan Maximizing Therapeutic Effects Minimising Side Effects Administer the drug evenly Safety precautions: side rails spaced intervals to maintain , ambulatory assistance blood levels of the drug at Assess respiratory status and steady state. movement of air Provide environmental Don’t Administer with control (appropriate lighting grapefruit or orange juice reduced noise, comfortable temperature to reduce sensory perceptual alteration and to aid relaxation.  Dextromethorphan Patient And Family Education Explain to patients the drug will quite a cough Emphasize on sedation, drowsiness, and impaired orientation. Avoid the drug if ever had reaction & in breast feeding, pregnant mothers. Cautions with patients on antidepressant as it may cause drug reactions Avoid OTC , alcohol as it may increase sedation Report chest tightness, shortness of breath as it indicates reaction to the drug  Cetirizine Antihistamine Pharmacotherapeutics Used to relieve symptoms of allergies. q T.at Block histamine release during inflammatory response to an antigen Effective for allergic rhinitis a Cetirizine ( Zyrtec) is effective in treating chronic idiopathic urticarial, perennial allergic rhinitis and seasonal allergic rhinitis It causes more sedation m than second generation antihistamines but less than first generation Can be used for children as young as 6 month It is excreted in human breast Qongestantd Drugs Affecting Lower Respiratory Tract  Mucolytic drugs Break down mucus and help the high-risk respiratory patient cough up thick, tenacious secretions to improve breathing and airflow  Acetylcysteine Pharmacotherapeutics liquefy thick tenacious secretions in patients with certain respiratory disorders who are unable to cough up the secretions (chronic airway limitation CAL, cystic fibrosis, pneumonia, TB). Patients with Atelectasis (collapse of the alveoli produces thick mucous secretion) During diagnostic bronchoscopy Suctioning in patients with tracheostomies. Used to prevent contrast-induced renal complications in high-risk patients ****Antidote for acetaminophen overdose,  Acetylcysteine Pharmacokinetics It is given by nebulizer (inhalation) or direct instillation. Onset of effect occurs within 1 minute, with a peak effect occurring within 5 to 10 minutes. It is metabolized in the liver and is excreted in the urine.  Acetylcysteine Pharmacodynamics It affect the mucoprotein in the respiratory secretions It splits disulfide bonds that are responsible for holding the mucous material together. The result is a decrease in the tenacity and viscosity of the secretions. This drug also protects liver cells from being damaged during episodes of acetaminophen toxicity. For best results, acetylcysteine is given within 8 to 10 hours after ingestion of acetaminophen. In its role in preventing contrast-induced nephropathy, acetylcysteine acts as an antioxidant and vasodilator.  Acetylcysteine Contraindications and Precautions Patients with hypersensitivity to the drug Use with caution in h/o respiratory compromise Caution in patients with asthma IV administration in serious hepatic disease ( serum concentration) Oral form may induce vomiting (Esophageal Varices/hepatic ulcer) Pregnancy category B Bronchospasm  Acetylcysteine d Adverse Effect Inhaled acetylcysteine may induce bronchospasm, bronchoconstriction, chest tightness, a burning feeling in the upper airway, and rhinorrhea, stomatitis less common adverse effects are fever, chills, drowsiness, IV acetylcysteine may induce anaphylactic reactions such as angioedema, chest tightness, rash, hypotension, and tachycardia.  Acetylcysteine Nurses’ Role During Drug Administration Assess vital sign and evaluate the skin Acetylcysteine should be avoided during pregnancy and lactation. Inhaled acetylcysteine is administered under the supervision of a respiratory therapist or specially trained nurse. Patients receiving acetylcysteine for contrast-induced nephrotoxicity or acetaminophen overdose must be closely monitored.  Acetylcysteine Maximizing Therapeutic Effects Minimizing Side Effects Administer an inhaled beta Inform the patient that agonist before administering nebulization may produce an acetylcysteine, to dilate the initially disagreeable odor, bronchial tree and enable the drug may irritate the the drug to permeate the face and will make it feel entire tree. sticky and uncomfortable. Monitor for any buildup of Establish a routine for the drug in the mask from pulmonary hygiene to evaporation eliminate secretions as To mask the taste dilute oral efficiently as possible. acetylcysteine with any diet  Acetylcysteine Patient and family education Inhaled acetylcysteine will help to get rid of mucus in the lungs. Don’t take this drug without the assistance of a respiratory therapist Warn not to take any other drugs without their provider’s approval Not to drink alcohol while taking this drug Teach all aspects of pulmonary hygiene. Encourage other methods of keeping secretions loose (Drinking plenty of fluids, Use humidifier, avoiding dry or smoke-filled areas. Nebulization may produce a transient disagreeable odor. Wipe the face with water to remove residual drug after administration by face mask (WHY?)  Brandodilatersig Albuterol (Ventolin) Pharmacotheraputics Bronchodilators are drugs used to facilitate respiration by dilating the airways. Managing CAL (chronic airway limitation) and asthma  Albuterol (Ventolin) Pharmacokinetics Can be administered orally (Tablet, liquid) and by inhalation. Oral inhalation by mdi or nebulization, Bronchodilation occurs I in 5 to 15 minutes, after which albuterol is absorbed over several hours from the respiratory tract. 80% to 100% of a dose excreted by kidneys within 72 hours. 10% may be eliminated in feces. Orally in tablet or liquid form, bronchodilation occurs within 30 minutes. The kidneys excrete 75% of a dose within 72 hours as metabolites, and 4% may be found in feces.  Albuterol (Ventolin) Pharmacodynamics Beta agonists (sympathomimetics) There are two types of beta receptors: Beta-1(heart)& beta-2 (lung). Albuterol is beta-2 agonist. It selectively stimulates receptors of smooth muscle in the Fleetamusclatanosso lungs, the uterus, and the vasculature that supplies skeletal muscle. Main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, airway resistance, facilitates mucus drainage  Albuterol (Ventolin) Adverse Effect The most common adverse: Throat irritation, Palpitations, Sinus tachycardia, anxiety, Tremor, and Increased blood pressure. digi Rarely, serious adverse effects rd Such as bronchospasm, urticaria, or angioedema may occur. tachycardia or palpitations, anxiety, tremors, headache, insomnia Overuse of albuterol may induce rebound bronchoconstriction,  Albuterol (Ventolin) Role Of The Nurses Perform the cardiac and respiratory systems assessment. Evaluate the pregnancy status of female patients, because it can interfere with uterine contractility as a result of its beta adrenergic–mediated relaxant effects on smooth muscle. Oral albuterol tablets and extended-release tablets are not recommended for children younger than 6 years of age Liquid albuterol is not recommended for children younger than 2 years of age. Assess the patient’s intake of caffeine ( coffee, tea, soda, cocoa, candy, and chocolate). Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Assess for use of over-the-counter medications (pain relievers, appetite suppressants, cold medicines as they contain caffeine)  Atrovent Anticholinergic Inhaled anticholinergic drugs are considered first-line treatment for patients with CAL whose symptoms have become persistent. Anticholinergic agents diminish the effect of acetylcholine, the terminal neurotransmitter in the parasympathetic nervous system. In the respiratory system, use of inhaled anticholinergic drugs stops the bronchoconstriction that is caused by stimulation of the parasympathetic nervous system. Ipratropium bromide (atrovent) is the prototype  Ipratropium Bromide: Atrovent Pharmacotherapeutic Ipratropium bromide is used for maintenance treatment of bronchospasm associated with: 1. Asthma, 2. Bronchitis, 3. Pulmonary emphysema.  Ipratropium Bromide: Atrovent Pharmacokinetics Administered by oral inhalation (MDI or nebulizer) or intranasal spray. Onset of action occurs between 15 and 30 minutes; Action peaks in 1 to 2 hours and lasts 4 to 5 hours. Is not readily absorbed into the systemic circulation after inhalation either from surface of the lung or from the GI tract. Approximately 50% of the absorbed drug is excreted unchanged in the urine. After intranasal dosing, less than 20% of an ipratropium dose is absorbed from the nasal mucosa into the systemic circulation. Metabolism of intranasal ipratropium bromide is the same as that of the inhaled drug.  Ipratropium Bromide: Atrovent Pharmacodynamics  oIpratropium Bromide: Atrovent Adverse Effect More commonly induce cough, hoarseness, throat irritation, or dyspepsia. The classic anticholinergic adverse effects: dry mouth, constipation, urinary retention, and blurred vision Paradoxical acute bronchospasm that can be life threatening in some patients. Serious, but rare, adverse effect: anaphylactic reaction. (urticaria; angioedema of the tongue, lips, and face; maculopapular rash; bronchospasm; laryngospasm; pruritus; and oropharyngeal edema).  Ipratropium Bromide: Atrovent Role of the Nurse Perform a baseline respiratory examination. Should be used during pregnancy only when the benefits to the mother outweigh the possible risk to the fetus. Can be used with lactating mother because minimal amounts of inhaled ipratropium reach breast milk It has not been established in infants or in children < 5 years Patient should stop smoking because smoking causes vasoconstriction, the opposite of the action of ipratropium. As albuterol, are the drugs of choice for acute symptoms, ipratropium may still be delivered during exacerbations of asthma.  Ipratropium Bromide: Atrovent Patient and Family Education 5 Juotattack Advise patients that ipratropium is used prophylactically to reduce the frequency and severity of future asthma attacks. Advise patients to avoid using ipratropium if they have a History of allergy to soybeans, legumes, or soya lecithin. Remind patients that ipratropium must be taken daily, despite the absence of symptoms of asthma. Remind patients that overuse of ipratropium may induce Adverse effects or increase their intensity. Teach patients to use an MDI  Theophylline Pharmacotherapeutics Pharmacokinetics Bronchodilators (don’t work Given orally or mm as rapidly as beta-adrenergic intravenously. When given agonist drugs). orally, it is well absorbed, is indicated for symptomatic with peak effects in 2 hours; relief or prevention of It lasts from 4 to 8 hours. bronchial asthma & reversal The drug is metabolized in of bronchospasm associated the liver and excreted in the with cal. urine.  Theophylline Pharmacodynamics Theophylline has a direct effect on the smooth muscles of the respiratory tract, both those in the bronchi and those in the blood vessels. It is believed that bronchodilation is caused by inhibiting phosphodiesterase smoothmuscle broncho Theophylline also increases the force of contraction of SEE diaphragmatic muscles to draw more air into the lungs.  Theophylline Adverse Effect At serum levels less than 20 mcg/ ml, adverse effects are uncommon. At serum levels of 20 to 25 mcg/ml, the most common adverse effects are GI symptoms of nausea, vomiting, and diarrhea and cns effects of headache, insomnia, and irritability. At serum levels exceeding 30 mcg/ml, adverse effects such as hyperglycemia, hypotension, arrhythmias, seizures, brain damage, and even death may occur.  Theophylline Adverse Effect General Side effect: CNS : irritability (especially in children), restlessness, muscle twitching. GI: loss of appetite, hematemesis, and gastroesophageal reflux. Cardiovascular: palpitations, tachycardia, and circulatory failure. Respiratory: tachypnea. Genitourinary: Urinary retention in men with prostate enlargement and diuresis.  Theophylline Precautions & Contraindication It is contraindicated during: pregnancy; newborns of mothers who used theophylline exhibit tachycardia, jitteriness, and withdrawal apnea. Assess older men for enlargement of the prostate gland  Theophylline Role of Nurse Screen the patient for any hypersensitivity to xanthines , peptic ulcer, active gastritis, coronary artery disease, hypothyroidism, renal or hepatic disorders, pregnancy, and lactation. Monitor patients with cardiac problems closely during theophylline therapy as it may cause palpitations, tachycardia, and elevated blood pressure. Assess smoking as it may decrease serum theophylline levels Theophylline elimination is decreased by a high-carbohydrate, low-protein diet. Caffeine (beverages, such as coffee, tea, and cola, chocolate), can increase effect of theophylline.  Theophylline Role of Nurse Keep serum levels at 10 to 20 mcg/ml, which is the optimal therapeutic level. Never infuse theophylline rapidly; rapid infusion may cause hypotension, arrhythmias, syncope, or even death.  Theophylline Patient and Family Health Education Avoid taking theophylline: If allergic to it , have reactions to caffeine, or breast-feeding. Instruct patients about things that can interfere with their drug concentrations (Diet, OTC drugs, and smoking). Instruct patients to avoid consuming large quantities of caffeine-containing foods (Chocolates) or beverages(e.G., Coffee, cola, and tea) while taking theophylline Advise patients to ingest small, frequent meals if GI distress occur.  Anti-inflammatory agents Inhaled glucocorticoid steroids: are the most effective anti-inflammatory drugs available for managing respiratory disorders. It potent for an exacerbation of CAL or asthma that occurs despite the use of inhaled steroids Fluticasone used in managing rhinitis, asthma and CAL. Available for nasal inhalation oral inhalation High dose fluticasone is associated with suppression of the HPA axis Approved to use for over 4 years children It is a pregnancy category C drug  Mast Cell Stabilizers Vasoactive substance such as histamine, serotonin, bradykinin and leukotrienes are located within the mast cell. Cromolyn Sodium When mas cell ruptures these substance cause an inflammatory response such as bronchial constriction which accounts for the symptoms of an acute asthma  Cromolyn Sodium Pharmacotherapeutics Pharmacokinetics Used as a prophylactic agent Can be administered orally for in treating mild to moderate a systemic effect treat asthma and acute mastocytosis bronchospasm induced by No systemic absorption when exercise, environmental used intranasal or pollutants and known ophthalmic administration antigens 10% of inhaled cromolyn Nasal Crom: Used to treat reaches the lungs allergic rhinitis 98% of the drug is eliminated unchanged in feces Crolom: Used for allergic Minimal amounts of the drug conjunctivitis cross the placenta or enter Table 35.8 breast milk  Cromolyn Sodium Pharmacodynamics Cromolyn sodium is an anti-inflammatory agent that works at the surface of the mast cell to inhibit mas cell rupture and degranulation after contact with an antigen Consequently it prevents the release of histamine and SRS-A, mediators of type I allergic reactions It reduce the release of inflammatory leukotrienes These effect is produce by inhibiting calcium influx  Cromolyn Sodium Adverse Effects Most common adverse effect is bronchospasm, throat irritation, and cough Nausea and vomiting , bloating, abdominal cramps and flatulence can be experience by patient with lactose intolerance Intranasal cromolyn spray can produce sneezing and nasal irritation  Cromolyn Sodium Role of the Nurse Evaluate for previous adverse effects before administration Perform baseline physical assessment for eyes, nose ,throat and lung sounds Note whether the patient is pregnant or lactating Monitor patient with lactose intolerance Patient with exercise induced bronchospasm to take this med 15-20 minutes before exercise  Cromolyn Sodium Patient and Family Education Cromolyn should not be taken by any one who has a hypersensitivity to this drug Emphasize that cromolyn is only useful as prophylaxis (NOT for managing acute symptoms) Should be used for 15-20 minutes to be taken before engaging in any exercise.  Leukotriene Receptor Antagonists Leukotrienes are inflammatory mediators that are powerful bronchoconsitrictors and vasodilators Monteleukast It is similar to zafirlukast in its mechanism of action It is one daily dosage It can be used in children 2 years and older It does not inhibit hepatic clearance of drugs metabolized enzymes Leukotriene receptor antagonists (Montelukast) Leukotrienes are inflammatory mediators that are powerful bronchoconstrictors and vasodilators Montelukast It is similar to zfirlukast in its mechanism of action It is one daily dosage It can be used in children 2 years and older It does not inhibit hepatic clearance of drugs metabolized enzymes