1. Drugs Used to Treat Lower Respiratory Disease
Chapter 31
Drugs Used to Treat
Lower Respiratory Disease
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2. Chapter 31
Lesson 31.1
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3. Objectives
Identify the structures of the lower respiratory tract and their functions
Describe the physiology of respirations
Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis, and asthma
Identify components of blood gases
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4. Objectives (cont’d)
Cite nursing assessments used to evaluate the respiratory status of a patient
Review the procedures for administration of medication by inhalation
Implement patient education for patients receiving drug therapy for lower respiratory disease
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5. The Lower Respiratory Tract and the Alveoli
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6. Common Lower Respiratory Diseases
Chronic obstructive pulmonary disease (COPD)
Chronic airflow limitation disease (CALD)
Asthma
Chronic bronchitis
Emphysema
Respiratory diseases are divided into two types: obstructive and restrictive.
Obstructive airway diseases are asthma and acute bronchitis.
Restrictive airway diseases are chronic bronchitis and emphysema.
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7. Arterial Blood Gases (ABGs)
Components
pH –
PaCO2 – mm Hg
PaO2 – mm Hg
HCO3 – mEq/L
SaO2 (oxygen saturation) 95%
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8. Nursing Assessments Obtain Perform Review
History, medications, description of current symptoms
Perform
Respiratory assessment – percussion, auscultation, palpation, inspection
Review
Cardiovascular health, sleep pattern, psychosocial health, laboratory and diagnostic data
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9. Administration of Inhalants
Review with patients during each visit
Demonstration of how to use the inhaler
Exhale completely before inhaling
Hold breath at least 10 seconds afterward
Administer bronchodilator first, wait several minutes, give steroid inhalant
Rinse mouth after steroid medication
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10. Patient Education and Health Promotion
Management principles rely on patient’s understanding of treatment
Nutrition – well balanced diet, increase fluid intake
Exercise - adjust physical activity to reduce fatigue
Eliminate risk factors – stop smoking, avoid irritants
Proper administration of medications
Use of peak flow meter and record readings
Describe ways to prevent infections.
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11. Chapter 31
Lesson 31.2
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12. Objectives
Distinguish the mechanisms of action of expectorants, antitussives, and mucolytic agents
State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from expectorant, antitussive, and mucolytic therapy
State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from sympathomimetic bronchodilator therapy
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13. Objectives (cont’d)
State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from anticholinergic bronchodilator therapy
State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from xanthine derivative therapy
State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from corticosteroid inhalant therapy
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14. Drug Therapy for Lower Respiratory Diseases
Attempt to relieve symptoms of cough by liquefying thick secretions to prevent mucus plugs, or suppressing cough
Expectorants
Antitussives
Mucolytic agents
Bronchodilators
Anti-inflammatory agents
Immunomodulators
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15. Drug Class: Expectorants
Drug: guaifenesin (Robitussin)
Actions
Enhance output of respiratory tract fluid, decrease mucus viscosity, promote ciliary action
Uses
Relieve dry, nonproductive cough
Treat symptoms of common cold, bronchitis, laryngitis, pharyngitis, sinusitis
Common adverse effects
GI upset, nausea, vomiting
Used in combination with other agents to aid in making a nonproductive cough more productive.
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16. Drug Class: Potassium Iodide
Drug: SSKI
Actions
Expectorant; stimulates increased secretions, making it easier to cough
Uses
Treat chronic pulmonary diseases such as bronchial asthma, bronchitis, emphysema
Common adverse effects
Nausea, vomiting, diarrhea
Patients should notify the prescriber if taking any other medications containing potassium.
Concurrent use of humidification in patients taking expectorants helps to decrease the viscosity of secretions.
Long-term use may result in goiter; thyroid function tests are important.
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17. Drug Class: Saline Solutions
Actions
Hydrate mucus, reduce viscosity
Uses
Expectorant, administered by nebulization
Common adverse effects
None noted
Commonly given to pediatric patients who cannot take antihistamines or cough suppressants.
Therapeutic outcome: moisturized mucous membranes for less irritation from dryness.
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18. Drug Class: Antitussive Agents
Drugs
Benzonatate (Tessalon Perles)
Codeine
Dextromethorphan (Robitussin, Delsym)
Diphenhydramine (Diphen, Tusstat)
Hydrocodone
Actions
Suppress cough center in brain
Uses
Suppress disruptive spasms
Common adverse effects
Dry mouth, drowsiness, constipation
Should be used for nonproductive cough only.
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19. Drug Class: Mucolytic Agents
Drug: acetylcysteine (Mucomyst)
Actions
Dissolve chemical bonds in mucus
Uses
Dissolve abnormally viscous mucus
Treat chronic emphysema, emphysema with bronchitis, asthmatic bronchitis, pneumonia
Common adverse effects
Nausea, vomiting
Serious adverse effects
Bronchospasm
Can also be used to treat Tylenol toxicity.
Concurrent use of a bronchodilator may be necessary to prevent bronchospasm.
Therapeutic outcome: improved airway flow.
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20. Drug Class: Beta-Adrenergic Bronchodilating Agents
Actions
Stimulate beta receptors within smooth muscle of tracheobronchial tree
Uses
Reverse airway constriction
Mainstay of all asthma therapy
Serious adverse effects
Tachycardia, palpitations, tremors, nervousness, anxiety, restlessness, headache, dizziness, nausea and vomiting
For specific drugs, see Table 31-5.
Used in conditions of chronic and acute asthma, bronchitis, emphysema.
Therapeutic outcome: easier breathing with reduced wheezing.
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21. Drug Class: Anticholinergic Bronchodilating Agents
Drugs: ipratropium bromide (Atrovent), tiotropium bromide (Spiriva)
Actions
Produce bronchodilation
Uses
Long-term treatment of reversible bronchospasm associated with COPD
Common adverse effects
Mouth dryness, throat irritation
Serious adverse effects
Tachycardia, urinary retention, exacerbation of symptoms
Used in combination with beta adrenergic bronchodilators.
Best used for prophylaxis and maintenance and not for acute attacks.
Tiotropium longer in duration of action than ipratropium.
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22. Drug Class: Xanthine Derivative Bronchodilating Agents
Actions
Act directly on smooth muscle of tracheobronchial tree to dilate bronchi
Uses
Reverse airway constriction
Treat acute and chronic bronchial asthma, bronchitis, emphysema
Common adverse effects
Nausea, vomiting, epigastric pain, abdominal cramps
Serious adverse effects
Tachycardia, palpitations, tremors, nervousness, restlessness, anxiety, headache
For specific drugs, see Table 31-5.
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23. Drug Class: Respiratory Anti-inflammatory Agents
Actions
Inhibit inflammatory responses
Uses
For patients unresponsive to sympathomimetic agents or xanthine derivatives
Prevent symptoms of asthma
Common adverse effects
Hoarseness, dry mouth
Serious adverse effects
Thrush
For specific drugs, see Table 31-6.
Aerosols enhance effects of beta-adrenergic bronchodilators and have a direct effect on smooth muscle relaxation.
Oral hygiene following inhalation is recommended and can prevent fungal infections.
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24. Drug Class: Antileukotriene Agents
Drugs
Montelukast (Singulair)
Zafirlukast (Accolate)
Actions
Selective and competitive receptor antagonist of cysteinyl leukotriene receptor
Uses
In combination with other drugs to treat asthma
Common adverse effects
Headache, nausea, dyspepsia
Not bronchodilators; given orally. Should not be used to treat acute episodes of asthma.
The cysteinyl leukotriene receptor is the one that leukotriene D4 and E4 stimulates to trigger asthma symptoms.
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25. Drug Class: Immunomodulator Agent
Drug: omalizumab (Xolair)
Actions
Binds to circulating IgE antibodies inhibiting mast cell release of inflammatory chemicals
Uses
Treats moderate to severe persistent allergic asthma
Common and serious adverse effects
Hypersensitivity, injection site reactions
Administered as a subcutaneous injection given every 2 or 4 weeks.
Patients must have a minimum 12-year history of asthma and a positive skin test to airborne allergens and symptoms that are not adequately controlled with inhaled corticosteroids.
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26. Miscellaneous Anti-Inflammatory Agents
Drug: cromolyn sodium (Intal)
Actions
Mast cell stabilizer; inhibits release of histamines and other mediators of inflammation
Uses
In combination with other agents to treat severe bronchial asthma or allergic rhinitis
Common adverse effects
Oral irritation, dry mouth
Serious adverse effects
Bronchospasm, coughing
Used for prophylactic management of bronchospasms and asthma.
Also used just before exposure to conditions or substances that cause bronchospasm (wheezing or difficulty in breathing).
Will not help an asthma or bronchospasm attack that has already started.
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