Kimberly Rose Barawid – Difficulty exhaling – pursed lip

BSN 2-D breathing

– “Pink Puffer”
Drugs Affecting the
Respiratory System Respiratory System Drugs
Bronchodilators and Other Respiratory Drugs COPD Drugs
Respiratory System Drugs • Long-term control
Lower Respiratory Tract Diseases – Antileukotrienes
• Asthma – cromolyn
• Emphysema – Inhaled steroids
• Chronic bronchitis – Long-acting β2-agonists
– Quick relief
Respiratory System Drugs – Intravenous systemic corticosteroids
Asthma – Short-acting inhaled β2-agonists
• Recurrent and reversible shortness of breath • Bronchodilators
• Airways become narrow as a result of: – β-adrenergic agonists
– Bronchospasm – Xanthine derivatives
– Inflammation & Edema of the – Anticholinergics
bronchial mucosa • Antileukotrienes
– Production of viscid mucus • Corticosteroids
• Alveolar ducts/alveoli remain open, but
airflow to them is obstructed Respiratory System Drugs
• Symptoms Bronchodilators: β-Agonists
– Wheezing • Large group, sympathomimetics
– Difficulty breathing • Used during acute phase of asthmatic
attacks
Respiratory System Drugs • Quickly reduce airway constriction
Asthma • Stimulate β2-adrenergic receptors
• Status asthmaticus throughout the lungs
– Prolonged asthma attack that does
not respond to typical drug therapy Respiratory System Drugs
– May last several minutes to hours Bronchodilators: β-Agonists
– Medical emergency Three types
Respiratory System Drugs  Nonselective adrenergics
Chronic Bronchitis – Stimulate α, β1 (cardiac), and β2
• Continuous inflammation of the bronchi (respiratory) receptors
and bronchioles – Example: epinephrine
• Often occurs as a result of prolonged  Nonselective β-adrenergics
exposure to bronchial irritants – Stimulate both β1 and β2 receptors
• Characterized by – Example: metaproterenol
– Hypoxemia – Selective β2 drugs
– Chronic productive cough – Stimulate only β2 receptors
– “Blue Bloater” – Example: albuterol (Proventil)

Respiratory System Drugs Respiratory System Drugs

Emphysema
 Air spaces enlarge as a result of the
destruction of alveolar walls
 The surface area where gas exchange takes
place is reduced
 Effective respiration is impaired
 Characterized by:
– Increased paCO2 - respiratory
acidosis
Bronchodilators: β-Agonists
Mechanism of Action
• Begins at the specific receptor
stimulated#
• Ends with the dilation of the airways
– #Activation of β2 receptors activates
cAMP,* which relaxes smooth
muscles of the airway and results in
 bronchial dilation and increased – Sputum production
airflow – Allergies
*cAMP = cyclic adenosine – History of respiratory problems
monophosphate – Other medications
Respiratory System Drugs Respiratory System Drugs
Bronchodilators: β-Agonists β-Agonists - Nursing Implications
Indications • Monitor for therapeutic effects
• Relief of bronchospasm related to asthma, – Decreased dyspnea
bronchitis, and other pulmonary diseases – Decreased wheezing, restlessness,
• Useful in treatment of acute attacks as well and anxiety
as prevention – Improved respiratory patterns with
• Used in hypotension and shock return to normal rate and quality
• Used to produce uterine relaxation to – Improved activity tolerance
prevent premature labor – Patients should know how to use
• Hyperkalemia—stimulates potassium to inhalers and MDIs
shift into the cell – Have patients demonstrate use of
devices
Respiratory System Drugs • Monitor for adverse effects
β-Agonists: Adverse Effects
α-β (epinephrine) Respiratory System Drugs
• Insomnia β-Agonists - Patient Education
• Restlessness • Patients should be encouraged to have a
• Anorexia good state of health
• Vascular headache – Avoid exposure to conditions that
• Hyperglycemia precipitate bronchospasms
• Tremor (allergens, smoking, stress, air
• Cardiac stimulation pollutants)
– Adequate fluid intake
Respiratory System Drugs – Compliance with medical
β-Agonists: Adverse Effects treatment
β1 and β2 (metaproterenol) – Avoid excessive fatigue, heat,
• Cardiac stimulation extremes in temperature, caffeine
• Tremor – Patients to get prompt treatment
• Anginal pain for flu or other illnesses
• Vascular headache • Patients to get vaccinated against
• Hypotension pneumonia and flu
• Check with their physician before taking any
Respiratory System Drugs medication, including OTCs
β-Agonists: Adverse Effects • Teach patients to take bronchodilators
β2 (albuterol) exactly as prescribed
• Hypotension OR hypertension
• Vascular headache Respiratory System Drugs
• Tremor β-Agonist Derivatives
Nsg Implications
Respiratory System Drugs • Albuterol, if used too frequently, loses its
β-Agonists Nursing Implications β2-specific actions at larger doses
• Thorough assessment before beginning – As a result, β1 receptors are
therapy stimulated, causing nausea, increased
– Skin color anxiety, palpitations, tremors, and
– Baseline vital signs increased heart rate
– Respirations (should be between • Take medications exactly as prescribed
12 and 24 breaths/min) – No omissions or double doses
– Respiratory assessment, including
PO2
 • Report insomnia, jitteriness, restlessness, – caffeine, theobromine, and
palpitations, chest pain, or any change in theophylline
symptoms – Only theophylline is used as a
Inhalers: bronchodilator
Patient Education • Synthetic xanthines:
• For any inhaler prescribed, ensure that the (IV) theophylline (Aminophylline)
patient is able to self-administer the (oral) theophylline (Elixophyllin, Theo-Dur)
medication
– Provide demonstration and return Respiratory System Drugs
demonstration Bronchodilators
– Ensure the patient knows the correct Xanthine Derivatives
time intervals for inhalers • Increase levels of energy-producing
– Provide a spacer if the patient has cAMP
difficulty coordinating breathing – This is done competitively inhibiting
with inhaler activation phosphodiesterase (PDE), the
– Ensure that patient knows how to enzyme that breaks down cAMP
keep track of the number of doses (cAMP = cyclic adenosine
in the inhaler device monophosphate)
• Result:
– decreased cAMP levels, smooth
Respiratory System Drugs muscle relaxation,
Anticholinergics bronchodilation, and increased
Mechanism of Action airflow
• Acetylcholine (ACh) causes bronchial – cardiovascular stimulation:
constriction and narrowing of the airways increased force of contraction and
• Anticholinergics bind to the ACh receptors, increased heart rate, resulting in
preventing ACh from binding increased cardiac output and
• Result: increased blood flow to the kidneys
– bronchoconstriction is prevented (diuretic effect)
– airways dilate
• ipratropium bromide (Atrovent) and Respiratory System Drugs
tiotropium (Spiriva) Bronchodilators
• Slow and prolonged action Xanthine Derivatives
• Used to prevent bronchoconstriction • Dilate of airways in asthma, chronic
• NOT used for acute asthma bronchitis, and emphysema
exacerbations! • Mild to moderate cases of acute asthma
• Adjunct drug in the management of
COPD
Respiratory System Drugs • Not used as frequently due to:
Anticholinergics – potential for drug interactions
Adverse effects – variables related to drug levels in
• Dry mouth or throat the blood
• Nasal congestion Xanthine Derivatives:
• Heart palpitations Adverse Effects
• Gastrointestinal distress • Nausea, vomiting, anorexia
• Headache • Gastroesophageal reflux during sleep
• Coughing • Sinus tachycardia, extrasystoles,
• Anxiety palpitations, ventricular dysrhythmias
• Transient increased urination
No known drug interactions Xanthine Derivatives
Respiratory System Drugs Nursing Implications
Bronchodilators • Contraindications: history of PUD or GI
Xanthine Derivatives disorders
• Plant alkaloids: • Cautious use: cardiac disease
 • Timed-release preparations should not be • Decrease neutrophil and leukocyte
crushed or chewed (causes gastric infiltration to the lungs, preventing
irritation) inflammation
• Report to physician:
– Palpitations Nausea
Vomiting Respiratory System Drugs
– Weakness Dizziness Chest Antileukotrienes – Indications
pain • Prophylaxis and chronic treatment of
– Convulsions asthma in adults and children older than
• Interactions with cimetidine, oral age 12
contraceptives, allopurinol, certain • NOT meant for management of acute
antibiotics elevate serum xanthine blood asthmatic attacks
levels • montelukast (Singulair)
• Nicotine & caffeine potentiate cardiac – is approved for use in children
effects ages 2 and older, and for treatment
• St. John’s wort increases metabolism = of allergic rhinitis
decrease blood levels
Respiratory System Drugs
Respiratory System Drugs Antileukotrienes: Adverse Effects
Antileukotrienes zileuton (Zyflo) zafirlukast (Accolate)
• Also called Headache Headache
leukotriene receptor antagonists (LRTAs) Dyspepsia Nausea
• Newer class of asthma drugs Nausea Diarrhea
Currently available drugs Dizziness Liver dysfunction
• montelukast (Singulair) Insomnia
• zafirlukast (Accolate) Liver dysfunction
• zileuton (Zyflo)
Respiratory System Drugs Montelukast (Singulair) has fewer adverse
Antileukotrienes effects
• Leukotrienes
– substances released when a trigger, Respiratory System Drugs
such as cat hair or dust, starts a series Nursing Implications – Pt Ed
of chemical reactions in the body • Ensure that the drug is being used for
– cause inflammation, chronic management of asthma, not acute
bronchoconstriction, and mucus asthma
production • Teach the patient the purpose of the
– Result: coughing, wheezing, therapy
shortness of breath • Improvement should be seen in about 1
week
Respiratory System Drugs • Check with physician before taking any
Mechanism of Action OTC or prescribed medications—many
• Antileukotriene drugs drug interactions
– prevent leukotrienes from attaching • Assess liver function before beginning
to receptors on cells in and in therapy
circulation • Medications should be taken every night
• Inflammation in the lungs is blocked on a continuous schedule, even if
• Asthma symptoms are relieved symptoms improve
By blocking leukotrienes:
• Prevent smooth muscle contraction of the Respiratory System Drugs
bronchial airways Corticosteroids
• Decrease mucus secretion • Anti-inflammatory!!!
• Prevent vascular permeability • Uses - chronic asthma/COPD
exacerbations
• Do not relieve acute asthmatic attacks S&S
 • Oral, IV (quick acting), or inhaled forms Corticosteroids
• Inhaled forms reduce systemic effects Nursing Implications – Pt Education
– May take several weeks before full • Teach patients
effects are seen – to monitor disease with a peak flow
Respiratory System Drugs meter
Corticosteroids – use of a spacer device to ensure
Mechanism of Action successful inhalations
• Stabilize membranes of cells that release – keep inhalers and nebulizer
harmful bronchoconstricting substances equipment clean after uses
• Also increase responsiveness of bronchial – Tapering doses of oral
smooth muscle to β-adrenergic corticosteroids
stimulation

Respiratory System Drugs

Inhaled Corticosteroids
• beclomethasone dipropionate
(Beclovent, Vanceril)
• triamcinolone acetonide (Azmacort)
• dexamethasone sodium phosphate
(Decadron Phosphate Respihaler)
• fluticasone (Flovent, Flonase)

Respiratory System Drugs

Corticosteroids – Indications
• Treatment of bronchospastic disorders
that are not controlled by conventional
bronchodilators
• NOT considered first-line drugs for
management of acute asthmatic attacks
or status asthmaticus

Respiratory System Drugs

Corticosteroids - Adverse Effects
• Pharyngeal irritation
• Coughing
• Dry mouth
• Oral fungal infections
• Systemic effects are rare because of the low
doses used for inhalation therapy
Corticosteroids
Nursing Implications – Pt Education
• Contraindicated in patients with psychosis,
fungal infections, AIDS, TB
• Teach patients to gargle and rinse the
mouth with lukewarm water afterward to
prevent the development of oral fungal
infections
• If a β-agonist bronchodilator and
corticosteroid inhaler are both ordered, the
bronchodilator should be used several
minutes before the corticosteroid to
provide bronchodilation before
administration of the corticosteroid