1. PTP 546 Module 7 Respiratory Pharmacology
Jayne Hansche Lobert, MS, RN, ACNS-BC, NP
Lobert

2. Respiratory Pharmacology
Antitussives
Ex: Dextromethorphan (Robitussin DM)
Action: inhibits cough by direct effect on brainstem; raises the cough threshold
Therapeutic Effect: reduces cough
Side Effect: retention of secretions related to cough suppression
Should not be used very often, as the body needs to cough.
Often used with codeine (opioide)
Lobert

3. Respiratory Pharmacology
Decongestants
Ex: Pseudoephedrine (Sudafed)
Can be used to make meth
Ex: Oxymetazxoline (Afrin)
Action: binds with alpha receptors in blood vessels of the nasal mucosa to stimulate vasoconstriction
Therapeutic Effect: reduces local congestion of nasal pathways
Side Effects: nervousness, increased blood pressure
Lobert

4. Respiratory Pharmacology
Antihistamines
Ex: Cetrizine (Zyrtec); Diphenhydramine (Benadryl), Loratadine (Claritin)
Action: blocks the action of histamine on upper respiratory tissues
Therapeutic Effect: treatment of allergic symptoms of sneeze, runny nose & tearing; treatment of allergic response
Side Effects: sedation, fatigue, dizziness, nausea,
Lobert

5. Respiratory Pharmacology
Expectorants & Mucolytics
Ex: expectorant: Guaifenesin (Robitussin)
Increases fluids in respiratory
Ex: mucolytic: Acetylcysteine (Mucomyst)
Decreases the viscosity by breaking chemical structures
Action: expectorants increases respiratory tract fluids  facilitate the production and ejection of mucus; mucolytics directly decrease the viscosity of secretions by breaking the chemical structure of mucus ejection of secretions
Therapeutic Effect: treatment of coughs associated with upper airway infections, etc.
Side Effects: rarely noted, dizziness, nausea
Want pts to max out on fluid in-take: DRINK WATER!
Lobert

6. Respiratory Pharmacology
Pharmacologic agents used to treat/prevent of diseases of airway obstruction (Asthma, Bronchitis, Emphysema)
Beta Adernergic Agonists
Xanthine Derivatives
Anticholinergics
Cromones Mast Cell Stabilizers
Glucocorticoids
Leukotriene Inhibitors
Lobert

7. Respiratory Pharmacology
Beta Adrenergic Agonists
Similar to fight or flight response: we need air, open up.
Ex: Short Acting Beta Agonist (SABA) Albuterol (Proventil)=inhaler
Ex: Long Acting Beta Agonist (LABA) Formoterol (Foradil); Salmeterol (Serevent)
Action: short or long acting stimulation of beta receptors  relaxation of bronchiole smooth muscles
Therapeutic Effect: prevents or inhibits airway obstruction in bronchospastic disease
Side Effects: nervousness, shaking, tremors, restlessness, tachycardia, palpitations, paradoxical bronchospasms
Lobert

8. Respiratory Pharmacology
Xanthine Derivatives
Ex: Theophylline (Theo-Dur); Aminophylline
Has a therapeutic window
Action: possible blocking of adensosine  smooth muscle relaxation; possible blocking of phosphodiesterase (PDE)  inhibition of inflammatory response
Therapeutic Effect: prevent bronchoconstriction in obstructive airway disease
Side Effects: toxicity that presents as nausea, irritability, restlessness
Lobert

9. Respiratory Pharmacology
Anticholinergics
Can’t spit, see, shit, pee
Ex: Ipratropium (Atrovent)= faster acting
Ex: Tiotropium (Spiriva)
Action: short or long acting muscarinic receptor blockers  reduction of acetylcholine induced bronchoconstriction
Therapeutic Effect: improves airway flow in bronchospastic diseases
Side Effects: constipation, dry mouth, blurred vision, urinary retention
Lobert

10. Respiratory Pharmacology
Cromones (Mast Cell Stabilizers)
Used for asthma prevention, not acute attack
Ex: Cromolyn Sodium (Intal)
Ex: Nedocromil Sodium (Tilade)
Action: inhibits the release of inflammatory mediators reduction of histamine and leukotrienes
Therapeutic Effect: prophylaxis; prevention of asthma attacks prior to activities that are known to precipitate an asthma attack (exercise, exposure to animal hair)
Side Effects: nasal and upper respiratory tract irritation following inhalation
Lobert

11. Respiratory Pharmacology
Leukotriene Inhibitors
Ex: Montelukast (Singular); Zafirlukast (Accolate)
Action: reduces the synthesis of leukotrienes or blocks the receptors for leukotrienes
Therapeutic Effect: management of the inflammatory component of bronchoconstrictive diseases
Side Effects: liver dysfunction noted rarely
Lobert

12. Respiratory Pharmacology
Glucocorticoids
Ex: Hydrocortisone (Cortef); Methylprednisolone (Medrol) (IV/Orally); Triamcinolone (Azamacort); Fluticasone (Flovent-inhaler)
Action: inhibit proinflammatory products (cytokines, prostaglandins, leukotrienes) while increasing antiinflammatory proteins
Therapeutic Effect: treatment of inflammation associated with hyperresponsive airways
Side Effects: gi bleed, dyspepsia, hyperglycemia, delayed wound healing, osteoporosis, fluid retention, hypertension, “moon face”, truncal obesity, back acne, buffalo hump, mood swings.
Lobert

13. Respiratory Pharmacology
Treatment of Cystic Fibrosis
Goal: Maintain airway patency
Pharmacologics
Bronchodilators
Mucolytics and Expectorants: break it up/cut the mucus
Glucocorticoids: decrease inflammation
Anti Infectives: proflective, prevents infection.
Others:
Lobert