1. 28
Drugs Used to Treat Respiratory Conditions

2. Figure 28-1A The upper respiratory tract.

3. Figure 28-1B The lower respiratory tract.

4. Figure 28-2 Bronchioles and alveoli.

5. Asthma
Chronic disease caused by increased reactivity of the tracheobronchial tree to various stimuli
Affects about 16 million Americans
Classified according to cause: allergy, exercise-induced, or infections of respiratory tract

6. Figure 28-3 The effects of asthma on the bronchioles.

7. Isoproterenol
Isoproterenol (Isuprel) is often used to treat asthma in children.
However, this use is not a labeled indication for the drug.
Advise parents and children that saliva and sputum may appear pink after inhalation—this is normal.

8. Table 28-1 The Most Common Antiasthma Drugs

9. Table 28-1 (continued) The Most Common Antiasthma Drugs

10. Table 28-1 (continued) The Most Common Antiasthma Drugs

11. Table 28-1 (continued) The Most Common Antiasthma Drugs

12. Table 28-1 (continued) The Most Common Antiasthma Drugs

13. Table 28-1 (continued) The Most Common Antiasthma Drugs

14. Table 28-1 (continued) The Most Common Antiasthma Drugs

15. Bronchodilators Agents that widen the diameter of bronchial tubes:
Beta2-adrenergic agonists
Xanthines

16. Beta2-Adrenergic Agonists: Uses
Drugs of choice in acute bronchospasm; produce bronchodilation by relaxing smooth muscles of bronchial tree
Used to relieve bronchospasm of asthma, to treat bronchitis and other obstructive airway diseases

17. Beta2-Adrenergic Agonists: Adverse Effects
Restlessness
Headache
Dizziness
Palpitations
Insomnia
Nausea and vomiting
Anorexia
Tachycardia

18. Beta2-Adrenergic Agonists: Contraindications
Contraindicated in glaucoma, cardiogenic shock
Safety during pregnancy and lactation not established

19. Beta2-Adrenergic Agonists: Contraindications
Cautious use in older adults or debilitated patients; and in those with prostatic hypertrophy, hypertension, diabetes, hyperthyroidism, Parkinson’s disease, tuberculosis, and psychoneurosis

20. Beta2-Adrenergic Agonists: Patient Information
Instruct patients to not exceed dosage.
Advise patients to eat small, frequent meals to prevent nausea.
Instruct patients to report chest pain, dizziness, insomnia, weakness, tremors, irregular heartbeat, difficulty breathing, productive cough, or lack of therapeutic effects.

21. Xanthines: Uses
Drugs chemically related to caffeine that dilate bronchioles by relaxing smooth muscle
Used for prophylaxis and symptomatic relief of bronchial asthma and bronchospasm associated with chronic bronchitis and emphysema

22. Xanthines: Adverse Effects
Common: palpitations, tachycardia, flushing, hypotension, insomnia, nervousness, nausea and vomiting, diarrhea, tachypnea
Serious: respiratory arrest

23. Xanthines: Contraindications
Should not be given to patients with coronary artery disease, history of angina, or severe renal or liver impairments
Safety during pregnancy and lactation not established

24. Xanthines: Contraindications
Cautious use in children and older adults; those with hyperthyroidism, hypertension, peptic ulcer, prostatic hypertrophy, glaucoma, and diabetes

25. Xanthines: Patient Information
Advise patients to take at same time each day.
Instruct patients to avoid charbroiled food, limit caffeine intake, and avoid smoking.
Women should not breast feed while taking these drugs.

26. Corticosteroids: Uses
Mechanism of action believed to be diminished activation of inflammatory cells and increased production of anti-inflammatory mediators
Used to treat respiratory conditions such as nasal congestion and allergic conditions such as rhinitis and asthma

27. Corticosteroids: Adverse Effects
Irritation of mucous membranes
Headache
Pharyngitis
Epistaxis
Nausea and vomiting
Coughing

28. Corticosteroids: Contraindications
Contraindicated in children younger than 4 years
Cautious use in pregnancy and lactation, and in those with immune system infections, tuberculosis, herpes simplex, ulcers, and nasal surgery or trauma

29. Corticosteroids: Patient Information
Advise patients to avoid exposure to chickenpox or measles.

30. Leukotriene Inhibitors: Uses
Block synthesis of, or the body’s inflammatory response to, leukotrienes
Used in prophylaxis and treatment of chronic asthma or allergic rhinitis

31. Leukotriene Inhibitors: Adverse Effects
Arrhythmias
Dizziness
Anxiety
Headache
Euphoria
Dry mouth

32. Leukotriene Inhibitors: Contraindications
Contraindicated in those with severe asthma attacks, bronchoconstriction, status asthmaticus, or during lactation
Cautious use in children younger than 1 year, pregnancy, and patients with severe liver disease

33. Leukotriene Inhibitors: Patient Information
Instruct patients not to use for severe asthma attacks.

34. Oral Administration Advantage
The advantage of leukotrienes is oral administration.
Some patients (especially children) do not adhere to inhaled medication therapy.

35. Mast Cell Stabilizers: Uses
Inhibit release of bronchoconstrictors such as histamine from pulmonary mast cells
Used for prophylaxis of mild to moderate seasonal and perennial bronchial asthma and allergic rhinitis; prevention of exercise-related bronchospasm; prevention of acute bronchospasm

36. Mast Cell Stabilizers: Adverse Effects
Nausea and vomiting
Dry mouth
Throat irritation
Cough
Hoarseness

37. Mast Cell Stabilizers: Adverse Effects
Headache
Dizziness
Urticaria
Rash

38. Mast Cell Stabilizers: Contraindications
Contraindicated in patients with coronary artery disease or history of arrhythmias, dyspnea, acute asthma, and status asthmaticus; during pregnancy; or in children younger than 6 years
Cromolyn should be used cautiously in those with renal or hepatic dysfunction.

39. Mast Cell Stabilizers: Patient Information
Advise patients to gargle with water or to suck on lozenges after each treatment to reduce throat irritation, cough, and hoarseness.

40. Table 28-2 Major Types of Cough Suppressants

41. Antitussives: Uses
Opioids work by causing respiratory depression; nonopioids reduce activity of peripheral cough receptors and appear to increase threshold of central cough center
Opioids are used to suppress nonproductive cough; nonopioids offer temporary relief of cough spasms.

42. Antitussives: Adverse Effects
Difficulty breathing
Drowsiness
Rash
Itching
Dizziness
Nausea
Nervousness and restlessness

43. Antitussives: Contraindications
Contraindicated in asthma, emphysema, diabetes, heart disease, seizures, thyroid conditions, chronic bronchitis, and liver disease
Cautious use in pregnancy and lactation

44. Antitussives: Patient Information
Advise patients to call physician if coughing continues longer than 1 week or mucus is yellow.

45. Natural Expectorant
Wild cherry bark acts as an expectorant and a mild sedative. It is available in syrup or tincture forms.
It should not be used during pregnancy.

46. Opioids for Cough
Opioid analgesics are among most effective drugs used as cough suppressants: 15-mg doses are often sufficient.

47. Table 28-3 Expectorants and Mucolytics

48. Expectorants and Mucolytics: Uses
Work by lowering viscosity and facilitating removal of mucous secretions (acetylcysteine) or enhancing reflex outflow of respiratory tract fluids by irritating gastric mucosa (guaifenesin)
Used to treat bronchopulmonary disease and cystic fibrosis

49. Expectorants and Mucolytics: Adverse Effects and Contraindications
Common adverse effects: very few
Contraindicated in pregnancy and lactation
Guaifenesin may interact with heparin.

50. Expectorants and Mucolytics: Patient Information
Instruct patients to increase fluid intake.
Tell patients to report a persistent cough beyond 1 week.

51. Table 28-4 The Most Commonly Used Decongestants

52. Table 28-4 (continued) The Most Commonly Used Decongestants

53. Decongestants: Uses
Vasoconstricting agents that shrink swollen mucous membranes of nasal airway passage
Used for relief of nasal congestion due to common cold, upper respiratory allergies, and sinusitis

54. Decongestants: Adverse Effects
Nervousness and restlessness
Insomnia
Dizziness
Headache
Irritability

55. Decongestants: Contraindications
Diabetes
Heart disease
Uncontrolled hypertension
Hyperthyroidism
Prostatic hypertrophy
Concomitant use of other sympathomimetic drugs

56. Decongestants: Patient Information
Instruct patients to avoid taking oral decongestants with 2 hours of bedtime because they may act as stimulants.
Advise patients to discontinue and immediately report extreme. restlessness or signs of sensitivity
Women should not breast feed.