1. Respiratory Medications
NUR 154
Pharmacotherapeutics

2. Upper Respiratory Disorders
Allergic Rhinitis - Nasal mucosa react to allergen.
S/S: Sneezing, rhinorrhea (runny nose), nasal itching, watery eyes, congestion
Medication Management
Drug therapy: Antihistamines are the drugs of choice
Benadryl, Claritin
Common S.E.’s: Sedation, dry mouth, urinary retention, constipation (anticholinergic S.E.’s), Insomnia, nervousness, irritability

3. Lower Respiratory Disorders
Obstructive
Narrowed air passages
Increased turbulence (secretions)
Increased resistance to air flow
S/S = bronchospasm, edema, inflammation, excessive mucous secretion
Examples:
Chronic obstructive pulmonary disease or COPD
Asthma
Bronchitits
Cystic fibrosis

4. Lower Respiratory and Related Medications
Expectorants
Liquefy mucous by stimulating secretion of lubricant fluids in larger airways
Can increase effectiveness of ciliary action and coughing
Guaifenesin (Robitussin)
Used in acute coryza (common cold), bronchitis, pharyngitis, sinusitis, laryngitis, COPD
Used in combination with other resp. agents, such as bronchodilators, decongestants, and antihistamines
Therapeutic Outcome
Reduced frequency of nonproductive cough, increased expectoration of phlegm.

5. Lower Respiratory and Related Medications
Antitussive Agents
Suppress cough center in brain
Used to suppress bothersome dry, hacking, nonproductive cough
***NOT normally used to suppress productive cough***
Codeine is the “gold standard”
Usu. low doses, short duration of use to avoid long-term dependence
Causes resp. depression in higher doses
Side Effects: Drowsiness, sedation, constipation; enhanced CNS depression with other like agents, such as alcohol, sedatives, antihistamines, phenothiazines
Dextromethorphan
Does not cause respiratory depression or dependence!
Drug of choice for children – Is in many OTC meds

6. Lower Respiratory & Inhalant Medications
Beta-adrenergic Bronchodilators
Stimulation of beta receptors relaxes smooth muscle of bronchi; if non-selective, stimulate beta receptors of heart muscle
S.E.’s: Tachycardia, palpitations, nervousness, tremors; N/V
Notify MD of an increase of 20 or > beats per minute
Mainstay of asthma therapy and COPD
*Ideally – should wait ten minutes between inhalations
Common types: Albuterol (acute); Serevent (nonacute);

7. Lower Respiratory & Inhalant Medications
Anticholinergic Bronchodilators - Atrovent
Blocks cholinergic receptors in bronchial smooth muscle, with minimal anticholinergic side effects
S.E.’s: Dry mouth and throat irritation, should resolve in ~ 1st – 2nd week of use.
Mainstay of asthma and COPD treatment; oftentimes combined in nebulizer treatment with Albuterol
*If more than 1 inhaler is ordered, you administer corticosteroids to open bronchial before administering other inhalers.

8. Respiratory Anti-inflammatory Medications
Corticosteroids – Advair disk, Flovent
Smooth muscle relaxation and decrease inflammation.
P.O., IV (Prednisone or methylprednisone) or Inhalants – Flovent is a traditional aerosol inhalant
Advair is dry powder inhalant (DPI)
for asthma, or COPD
Side effects
Inhalant – oral thrush, dysphonia (spacer, gargle, and rinse after each use)
P.O. or IV use: Increased susceptibility to infections, hyperglycemia, mood swings, delayed wound healing
Never d/c these drugs abruptly, as they cause adrenal suppression of pt.’s own cortisol production. Always taper gradually!

9. Lower Respiratory and Related Medications
Xanthine Derivatives – Aminophylline, Theophylline
Relaxes smooth muscle of airways
Acute management – IV administration
Side effects: GI upset (^ gastric acid), tachy, palpitations, nervousness
This category can inhibit the effects of Beta Blockers and lithium
Chronic management – Oral medication, such as Theodur

10. Lower Respiratory and Related Medications
Leukotriene Inhibitors – Zafirlukast (Accolate)
Inhibit inflammatory mediators which trigger asthma, thereby reducing potential for edema, increased mucous and airway constriction
These are not bronchodilating agents
Do not use for acute attacks!
S.E.’s: HA, nausea – subsides with continued therapy
Take with food or milk.
*Increases effects of theophylline and warfarin!
Monitor closely and expect decreased doses of these other meds

11. Lower Respiratory and Related Medications
Acetylcysteine (Mucomyst)
Inhalant which liquefies and reduces viscosity of mucous secretions
Used in emphysema, COPD, bronchiectasis and pneumonia clients
Allows easier removal of secretions by coughing, percussion and postural drainage
Wash client’s face and hands after administration to reduce chance for irritation.
S.E.’s: N/V (drug has a rotten egg smell), bronchospasm.
Do not administer concurrently with antibiotics
**This Drug is also given orally as the antidote to Tylenol overdose**

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