1. Bronchodilators Lilley Pharmacology Text: Chapter 35
Original PPT modified by:
Anita A. Kovalsky, R.N., M.N.Ed.
Professor of Nursing
Original by: Professor Edwards,

4. Review of Glossary Terms: Lilley pg. 542
Alveoli:
Antigen:
Antibody:
Asthma Attack:
Bronchial Asthma:
Chronic Bronchitis:
Emphysema:
ADDITIONAL TERMS
Acute:
Exacerbation:

5. Diseases commonly treated with Bronchodilators
Asthma
COPD
Chronic Bronchitis
Emphysema

7. BRONCHODILATOR CLASSIFICATIONS
Bronchodilators:
Xanthines Derivatives
Beta-Agonists

8. Xanthine Derivatives (Refer to Prototype List in syllabus, pg. 19)
Prototype Drugs:
Theophylline- Theo-dur
Aminophylline

9. How Do These Drugs Work? Relieve Bronchoconstriction
Cause bronchodilatation

10. Mechanism of Action Cause bronchodilation by:
Increasing the levels of the energy producing substance called cAMP
Inhibiting PDE the enzyme that breaks down *cAMP….
Subsequently, this causes smooth muscle relaxation and broncchodilation; also inhibits release of chemical mediators such as histamine, etc.
*cAMP = cyclic adenosine monophosphate

11. Mechanism of Action contd.
Slow onset of action, so used more as preventative measure, however, also used as a continuous IV infusion to treat reversible bronchospasm in COPD clients who have an exacerbation of symptoms

12. Drug Effects
Relieve bronchopasms by causing airways to dilate, thereby improving air passage into and out of lungs
Stimulates CNS:
Increases contractility of heart (+ inotropic)
Increases heart rate (+chrontropic)
Increases cardiac output, thereby causing a….
Diuretic effect…what would cause this???????

13. Therapeutic Uses
Dilate airways in asthma, chronic bronchitis and emphysema
Adjunctive agent for treatment of pulmonary edema and dyspnea in left-sided heart failure by increasing cardiac output and increasing bloodflow to kidneys diuresis

14. Lab Diagnostics Cavanaugh Text: pg. 215
Aminophylline/Theophylline Levels:
10-18ug/ml WNL (within normal limits)
>20ug/ml TOXIC LEVEL

15. Side and Adverse Effects
Nausea
Vomiting
Anorexia
Gastroesophageal reflux
CARDIAC!!!!!!!! HIGH ALERT!!!!
Sinus Tachycardia
Palpitations
Ventricular Dysrhythmias
Hyperglycemia (transient)
Increased urinary output (transient)

16. Interactions Allopurinol Cimetidine Erythromycin Flu Vaccine
Oral Contraceptives
Need blood levels monitored closely

17. Available Theophylline Preparations
Oral
Parenteral
(aminophylline infusion)
Rectal

18. Prototype Drugs: (Brand name in parentheses)
Beta-Agonists or Sympathomimetic Bronchodilators (Refer to Prototype List in syllabus, pg Also listed in Lilley, pg. 548)
Prototype Drugs: (Brand name in parentheses)
- Albuterol (Proventil) Beta2 Selective
OTHERS:
-Ephedrine
-Epinephrine (Adrenalin, Primatene, Bronkaid)
-Terbutaline (Brethine)

19. When are Beta-Agonists used?
During acute phase of asthmatic attack
To quickly reduce airway constriction and cause bronchodilation
WHY ARE THEY CALLED AGONISTS????
AGONISTS or stimulators of SNS receptors----->
SYMPATHOMIMETIC ACTION
WHAT IS THE PRIMARY MECHANISM OF ACTION??
Imitate the effects of norepinephrine on receptors
Stimulate beta2-adrenergic receptors in the lungs causing dilation within the airways of the lungs (Example: Albuterol/Proventil)

20. Specific Receptors Refer to Lilley text, pg. 547
Nonselective adrenergic: stimulate the alpha, beta1 (cardiac), and beta2- (respiratory) receptors (Example: epinephrine)
Nonselective beta-adrenergic: stimulate both beta1 and beta2 receptors (Example: Isuprel)
Selective beta2: stimulate the beta2 receptors (Example: albuterol)

21. Drug Effects **SELECTIVE BETA2
Beta2 stimulation causes bronchodilation; also a decreased diastolic B/P, decreased K+ level

22. Mechanism of Action
Begins with specific receptors stimulated and ends with the dilation of airways
cAMP is activated when a beta2-adrenergic receptor is stimulated
Smooth muscles relax and airflow increased

23. Therapeutic Uses of Beta-Agonists
Pulmonary disorders for relief of bronchospasm
Nonselective: Used for hypotension and shock treatment and to relieve nasal congestion and stuffiness

24. Bronchodilators: Beta-Agonists Side Effects
Alpha-Beta Beta1 and Beta2 Beta2
(epinephrine) (isoproterenol) (albuterol)
Insomnia cardiac stimulation hypotension restlessness tremor vascular headache anorexia anginal pain cardiac stimulation vascular headache tremor vascular headache

25. Interactions
Beta-agonist with nonselective beta-adrenergic blocker (beta-blocker) antagonizes the bronchodilation effect!!!
Avoid MAO inhibitors

26. Available Selected Beta-Agonist PreparationsPO SC
Inhaler
Nebulizer IM

27. Nursing Considerations for Bronchodilators
Does the client have cardiac disease??
If so, which type of bronchodilator should be the drug of choice??
Does the client have diabetes??
If the client is receiving a xanthine, what blood levels should be monitored???

28. A client is receiving IV aminophylline for a severe exacerbation of COPD. Which of the following would you expect when evaluating for a therapeutic response to the medication? A. Drowsiness B. Increased heart rate C. Dilatation of bronchioles D. Increased respiratory rate

29. Which of the following side effects is associated with the use of xanthine derivatives? A. Bradycardia B. Palpitations C. Increase in appetite D. Constriction of bronchioles

30. Overview of Drugs Affecting the Respiratory System
Bronchodilators
Xanthine derivatives
Beta-agonists
Anticholinergics
Antileukotriene agents
Corticosteroids
Mast cell stabilizers

31. THE END