DRUGS AFFECTING THE

RESPIRATORY SYSTEM
Jennifer S. Sentino, RN, MAN
Level II Instructor
• Antihistamines: are used to block the release or action of histamine- a
chemical mediator of inflammation that increases secretions and constricts
the air passageway.
• Antitussives: agents utilized to block the cough reflex.
• Drugs for COPD: this includes bronchodilators, inhaled steroids, Leukotriene
Receptor Blockers, and other anti -Asthma drugs.
• Decongestant: utilized to decrease the blood flow to the upper respiratory
tract and decrease the excessive production of secretions.
• Expectorant: used to decrease the viscosity of sputum to effectively
increase productive cough to clear the airways.
 ANTIHISTAMINES

• Also called H1 blockers or H1 antagonists, these are agents designed to

relieve respiratory symptoms and treat allergic conditions.
• Group according to “generations”
-first generation agents have greater anticholinergic effects and can cause
more sedation and drowsiness! Cause Drowsiness!
-second generation agents have fewer anticholinergic effects that is why they
cause less sedation.
• MODE Of ACTION
theses agents SELECTIVELY block the effects of histamine at the HISTAMINE-1 Receptor
sites in the target tissue by competing with histamine for receptor, decreasing the cellular
response. Have anticholinergic and antipruritic properties.
• USES: Rhinitis; Allergic sinusitis; uncomplicated urticaria and angioedema
• CONTRAINDICATION
a. Pregnancy and lactation
b. Impaired liver or kidney function
c. Fatal arrhythmias have been reported if some of these agents are given to patients with
a condition called prolonged QT intervals
• Side Effects:
❖CNS: drowsiness and sedation
❖Fatigue, dizziness, and disturbed coordination
❖Anticholinergic effect= drying of the respiratory mucus membrane, GI upset, arrhythmias,
dysuria, urinary retention.
❖Skin dryness
 NURSING RESPONSIBILITY
• Administer on empty stomach, or 1 hour before or 2 hours after meals to
increase the absorption.
• Give with food if GI upset occurs.
• Offer sugarless lozenges or hard candy to counteract dryness of the
mouth, Give frequent oral care.
• Provide safety measures if drowsiness occurs
• Allow the patient to void first before administering the drug.
 ANTITUSSIVES
• Suppresses the cough reflex on the MEDULLA OBLONGATA to suppress
cough of many respiratory conditions.
Benzonatate= narcotic antitussive (use in some procedures, e.g.
bronchoscopy, when coughing should be avoided)
Butamirate Citrate= non-narcotic
Codeine= narcotic
Dextromethorphan= non-narcotic
Hydrocodone= narcotic
• MOA
act directly on the MEDULLARY cough of the brain to depress the cough
reflex, but it DOES NOT SUPPRESS RESPIRATION. Dextromethorphan does
not depress respiration.
• USES: suppress a persistent, dry, or ineffective cough that prevents restful
sleep
• CONTRAINDICATION
NOT given to patients who had undergone thoracic and abdominal
surgeries because they need to cough to maintain airway patency.
precautions are instituted when given to patients with asthma,
emphysema, or COPD because an accumulation of secretions may occur.
• SIDE EFFECTS:
Respiratory: dryness of mucosal membranes, increased viscosity of secretions
CNS: Drowsiness. Dizziness and sedation
GIT: Nausea, constipation and dry mouth, GI upset
 NURSING RESPONSIBILITY

• Emphasize that the drug should be taken only at a specified time frame as
ordered.
• Provide other measures to relieve coughs such as providing humidified
oxygen, cool temperature, fluids, and use of lozenges.
• Provide health teachings as to drug name, dosage, and measures to handle
side effects.
• Caution that alcohol. Narcotics and sedatives-hypnotics can cause CNS
depression when used with antitussives.
 MUCOLYTICS
• Agents that break down mucous in order to help respiratory patients in coughing
up thick, tenacious secretions.
• Mucolytic Drugs: acetylcysteine, Dornase Alfa
• MOD:
work in the following ways: acetylcysteine affects the mucoproteins in the
respiratory secretions by splitting apart disulfide bonds that are responsible for
holding the mucus materials together.
Cautious should be used in cases of acute bronchospasms, peptic ulcers, and
esophageal varices (increased secretions can aggravate the problem)
• INDICATIONS: COPD, cystic fibrosis, pneumonia, tuberculosis, atelectasis
• SIDE EFFECTS: GIT= GI upset, stomatitis, irritation of the respiratory tract;
bronchospasm and rash
 NURSING RESPONSIBILITY

• Instruct patient to avoid combining with other drugs in the nebulizer to

avoid the formation of precipitates.
• The drug can be administered via nebulizers with the drug diluted with
sterile water.
• Remind the patient that the drug may irritate the respiratory mucosa.
• Provide health teaching including drug name and prescribed dosage.
• Have suction machine available.
 DRUGS FOR COPD

• Bronchodilators such as adrenergic and xanthines- are used to assist in

opening the narrowed airways.
• Steroids: to decrease inflammation
• Leukotriene modifiers- reduce inflammation in the lung tissue
• Cromolyn sodium and nedocromil- act as anti-inflammatory agents by
suppressing the release of HISTAMINE from the mast cells.
• Expectorants- to assist in loosening secretions from the airway.
• Antibiotics- to prevent serious complications from bacterial infection.
 BRONCHODILATORS

• Used to facilitate respiration by dilating the airways.

• Helpful in symptomatic relief or prevention of bronchial asthma and
bronchospasm associated with COPD.
• The bronchodilators are:
a. Xanthines
b. Sympathomimetics (beta-agonist)
c. Anticholinergics
d. Inhaled steroids
 BRONCHODILATORS- XANTHINES
• Were once the main choice for treatment of Asthma and bronchospasm
• Xanthines include:
- Aminophylline
- Caffeine
- Dyphilline
- Oxytripylline
- Pentoxyfilline
- Theophylline
• MOA: have a direct effect on the smooth muscles of the respiratory tract, both
those on the bronchi and the blood vessels.
• It stimulates the CNS such that respiration is stimulated, coronary arteries dilate
and pulmonary arteries dilate with an additional effect of diuresis.
• USES:
✓Symptomatic relief or prevention of bronchial asthma and reversal of
bronchospasm associated with COPD.
✓Unlabeled uses include stimulation of respiration in Cheyne-stoke
respiration.
✓Treatment of apnea and bradycardia in premature infants.
• SIDE EFFECTS:
- Related to theophylline levels in the blood ( 10-20ug/ml). Should be
monitored to avoid severe side effects.
- Cimetidine can cause an increased level
- GI upset, anorexia, vomiting, gastric pain, nausea, irritability, and
tachycardia to seizures, brain damage, and even death.
- Rapid IV administration of theophylline can cause dizziness, flushing,
severe HYPOTENSION, bradycardia, and palpitation.
 NURSING RESPONSIBILITY
• Monitor V/S and note for the BP and HR because there may be HYPOTENSION and
tachycardia.
• Administer oral drugs with food or milk to relieve GI irritation
• Monitor patient response to the drug= relief of respiratory difficulty and improved
airflow.
• Provide comfort measures, including rest period, quiet environment, dietary
control of caffeine, and headache therapy as needed, to help the patient cope with
the effects of drug therapy.
• Provide adequate hydration.
• Don’t crush enteric-coated and sustain-released tablets.
• Encourage to stop smoking.
• Provide periodic follow-up including blood tests to monitor serum theophylline
level.
 BRONCHODILATORS- SYMPATHOMIMETICS
• These are drugs that mimic the effects of the sympathetic nervous system.
• One of the action of SNS is dilation of the bronchi and increased rate and
depth of respiration.
• MOA:
✓Most sympathomimetics used as bronchodilators are beta2- selective
adrenergic agonists.
✓Act to increase the concentration of cellular cAMP (cyclic adenosine
monophosphate) leading to dilation of the bronchioles.
• USES:
➢Asthma and other allergic conditions
➢Bronchospasms in reversible obstructive airway diseases such as acute and
chronic asthma and chronic bronchitis.
➢Effective in preventing exercise-induced bronchospasms.
➢Used also in preterm labor.
• CONTRAINDICATION
contraindicated or used with caution depending on the severity of the
underlying condition, in conditions that would be aggravated by the
sympathetic stimulation.
such conditions include CARDIAC ARREST, VASCULAR DISEASE,
ARRHYTHMIAS, DIABETES, and HYPERTHYROIDISM. PREGNANCY AND
LACTATION.
• SIDE EFFECTS
CNS STIMULATION= tremors, headache, nervousness
GI= GI Upset
CARDIO= cardiac arrhythmias, HPN, tachycardia, palpitations,
vasoconstriction
RESPI= bronchospasm, sweating, pallor, flushing
Hyperglycemia, Urinary Retention
• DRUG INTERACTION
a. Anticholinergics= aggravates glaucoma
b. Antidiabetic= hyperglycemic effect of epinephrine may increase the need
for insulin.
c. Beta-adrenergic Blocking Agent= causes bronchial constriction
d. Digitalis Glycoside= may cause cardiac arrhythmias
 NURSING RESPONSIBILITY

• Instruct the client on the correct use of the inhaler or nebulizer

• Instruct the client to use the bronchodilator inhaler before the steroid
inhaler.
• Teach patients who use one of these drugs for exercise-induced asthma to
use it 30-60 minutes before exercising to ensure peak therapeutic effect
when they are needed.
• Monitor client for adverse effects.
• Assess vital signs
• Instruct client to stop smoking to preserve lung function.
BRONCHODILATORS- ANTICHOLINERGICS
• USES:
a. Prevent or reverse bronchospasm in client with asthma
b. Maintenance therapy of reversible airway obstruction due to COPD
c. Management of rhinorrhea
• ADVERSE EFFECT:
a. dizziness, headache, nervousness
b. Blurred vision, sore throat
c. Epistaxis, nasal dryness or irritation
d. Bronchospasm, cough
e. Hypotension, palpitations
f. Gastric irritation, nausea
• CONTRAINDICATION: acute bronchospasm; glaucoma; urinary retention;
pregnancy; children under 5 years of age.
• DRUG INTERACTION: potential toxicity to fluorocarbon if used with other
inhalation bronchodilators having a fluorocarbon propellant.
• NURSING RESPONSIBILITIES
✓Assess for allergies
✓Assess respiratory status
✓Instruct the client of the proper use of the inhaler, nebulizer, or nasal spray
✓Instruct the client to rinse the mouth after inhaler use
✓Encourage sugarless gums or candy to minimize dry mouth.
• TYPES:
- Atropine
- Ipratropium (Atrovent)
 BRONCHODILATORS- INHALED STEROIDS
• Found to be a very effective treatment for bronchospasm
• Agents include:
- Beclomethasone= given via MDI Inhaler
- Flunisolide
- Triamcinolone
- Dexamethasone= given IV, orally not inhaled.
- Prednisone and prednisolone
• ACTIONS AND INDICATIONS:
❖ inhaled steroids are used to decrease the inflammatory response in the
airway.
❖In an airway swollen and narrowed by inflammation and swelling, this action will
increase airflow and facilitate respiration.
❖When administered into the lungs by inhalation, steroids decrease the
effectiveness of the inflammatory cells.
❖This has 2 effects
- Decreased swelling associated with inflammation
- Promotion of beta-adrenergic receptor activity= which may promote smooth
muscle relaxation and inhibit broncho-constriction.
• CONTRAINDICATION
➢Inhaled corticosteroids are not for emergency use and not for use during an acute
attack asthma attack or status asthmaticus.
➢Pregnancy and lactation
• ADVERSE EFFECT
Respiratory= sore throat, hoarseness, coughing, dry mouth, and pharyngeal and
laryngeal fungal infections.
If patient does not administer the drug appropriately or develops lesions that allow
absorption of the drug, the systemic side effects associated with steroids may occur.
 NURSING RESPONSIBILITY
• Do not administer the drug to treat an acute asthma attack or status
asthmaticus as these drugs are not intended for the treatment of acute
attack.
• Taper systemic steroids carefully during the transfer to inhaled steroids;
deaths have occurred from renal insufficiency with sudden withdrawal.
• Have the patient use decongestant drops before using the inhaled steroids
to facilitate penetration of the drug if nasal congestion is a problem,
• Have the client rinse the mouth after using the inhaler as this will help
decrease systemic absorption and decrease GI upset and nausea.
• Monitor the patient for any signs of respiratory infection; continued use
during acute infection can lead to serious complications related to the
depression of the inflammatory and immune responses.
 LEUKOTRIENE RECEPTOR ANTAGONIST
• USES:
❖Indicated as an adjunct therapy for the prophylaxis and chronic treatment of
asthma.
❖Either block the leukotrienes released in response to the allergen (zafirlukast), or
inhibit leukotriene formation (zileuton).
• ADVERSE REACTIONS:
a. headache, dizziness, weakness
b. Churg-Strauss syndrome (blood vessel inflammation)
c. Elevated liver enzyme, drug-induced hepatitis
d. Arthralgia, back pain, myalgia
• CONTRAINDICATION: not bronchodilators and are not used to treat acute asthma
attacks.; lactation
• DRUG INTERACTION: warfarin (coumadin)- need to be adjusted in dose
• TYPES:
Zafirlukast (accolate)
Zileuton (Zyflo)
NURSING INTERVENTION:
✓Assess respiratory status
✓Monitor effectiveness
✓Monitor liver enzymes
 CROMOLYN
• Administered by INHALATION is a drug that is frequently used in the
treatment of asthma.
• A mast cell stabilizer.
• MOA:
-it works at the cellular level to inhibit the release of histamine (released from
mast cells in response to inflammation or irritation) and inhibits the release of
SRSA (slow reacting substance of anaphylaxis)
-inhaled from a capsule and may not reach its peak effect for 1 week.
- Recommended for the treatment of chronic bronchial asthma, exercised-
induced asthma, and allergic rhinitis.
• CONTRAINDICATION:
a. Cannot be used during an acute attack
b. Allergy to seafood
c. Pregnant and lactating mothers or children under the age of 6 years.
• ADVERSE EFFECT:
❖Swollen eyes, headache, dry mucosa, and nausea
❖Careful patient management can help to make drug-related discomfort
tolerable.
 NURSING RESPONSIBILITY

• Instruct the client on the proper use of the drug.

• Inform the client that optimal response to cromolyn may take 2 months of
daily use.
• Instruct the client that the drug must be used even when free of clinical
manifestation.
• Administer with inhalation---poorly absorbed when taken orally
• Hold and notify the physician if bronchospasm or severe cough occurs.
 DRUGS FOR TUBERCULOSIS
• A combination of drugs is used to kill or inhibit the growth of mycobacteria.
• USES:
Chemotherapy to treat pulmonary or miliary tuberculosis.
• All drugs are hepatotoxic
• ADVERSE REACTION
a. Optic neuritis (swelling damages the optic nerve)
b. Skin rash
c. Red-orange color urine, saliva, tears, and feces (rifampicin)
d. Thrombocytopenia
e. Hepatotoxicity
f. GI upset, nausea and vomiting
 NURSING RESPONSIBILITY
• Obtain a sputum sample before starting the drugs.
• Instruct the client on the importance of adherence to the drug regimen for the
entire time (6-12months)
• Inform the client that a noninfectious state occurs after 1-2 weeks of continuous
therapy.
• Administer on an empty stomach.
• Encourage the patient to maintain an adequate nutritional status.
• Inform the client that yearly follow-ups are necessary.
• Monitor liver function.
• Instruct to avoid alcohol while on therapy to reduce the risk of hepatotoxicity
• Monitor the client on streptomycin for 8th cranial nerve damage (vestibulocochlear)
• Administer vitamin B6 (pyridoxine) in conjunction with INH to prevent peripheral
neuritis.
 ANTITUBERCULOSIS DRUGS

• TYPES:
❑ ethambutol
❑Rifampicin
❑Isoniazid (INH)
❑streptomycin