Pangasinan State University

INSTITUTE OF NURSING
Bayambang Campus
Bayambang, Pangasinan

Written Report about

Drugs Affecting the Body System

(Respiratory System)

Group 3
De Guzman, Nervanz Christian D.
Encina, Camille Arra F.
Mancilla, Charise Jireh B.
Repalda II, Amado D.

BSN II-1
(A.Y. 2023-2024)

QUENNY ANNE Q. APIL, MAN

Instructor
 DRUGS ACTING ON THE RESPIRATORY SYSTEM

I. INTRODUCTION

The respiratory system plays the key role for breathing and keeping the right balance of gas
concentrations in our body to support homeostasis. This system has two parts: the upper and lower
respiratory systems.

• The upper part = which includes the nasal cavity, oral cavity, throat,
Pharynx and Larynx.
This provides a passage for air to be breathed in and out of the lungs,
but it also heats, humidifies and filters the air and is involved in
cough, swallowing and speech.
• The lower part = this includes the Trachea, Bronchi, Bronchioles,
and Alveoli – alveolar capillary membrane.
This pulls in air from the upper respiratory system, absorb the oxygen,
and release carbon dioxide in exchange.

THE LUNGS: These are vital organs in our respiratory system. They have tiny air sacs called alveoli
where the exchange of oxygen and carbon dioxide takes place. These oxygenate our blood and help
remove waste gases from our body.

MECHANISMS of RESPIRATION:
a. Ventilation = which oxygen passes through the airways.
b. Perfusion = involves blood flow at the alveolar-capillary bed. Perfusion is influenced by alveolar
pressure.
c. Diffusion = Gas molecules moves from higher to lower concentration.

THE PROBLEMS: Various issues can affect the respiratory system and make it challenging to
breathe. These issues include conditions like allergies, asthma, infections, lung diseases, and trauma
caused by environmental or physical factors.

THANKS TO MODERN TECHNOLOGY, we can address these problems by using medical

interventions, early detection systems, preventive measures, and various medications.
Furthermore, here are some drug classifications that are used on our respiratory system:

1|RESPIRATORY DRUGS
II. DRUGS AFFECTING RESPIRATORY SYSTEM

In this discussion, we'll delve into a variety of drug medications specifically created to either
prevent or alleviate common respiratory challenges. These treatments are generally focused on
enhancing your overall health and helping you breathe more comfortably in our world.

UPPER RESPIRATORY LOWER RESPIRATORY

I. Antihistamine I. Bronchodilators:
II. Antitussive (Xantines, Anticholinergic, Adrenergic agonists)
III. Expectorant II. Mucoactive Agents
III. Anti-Inflammatory agents
DRUGS OF THE UPPER RESPIRATORY SYSTEM

ANTIHISTAMINE – A substance that inhibits the physiological effects triggered by histamine,

commonly employed in managing allergic rhinitis. Divided into two subtypes: H1 (Allergies) and
H2(Gastro) blockers.
MOA: antihistamine that blocks histamine at H1 receptors, inhibits smooth muscle constriction in
blood vessels, the respiratory and GI tracts, and reduces capillary permeability, salivation, and tear
formation. This often used for treating cold symptoms, they are also effective in managing allergic
rhinitis.
Subtypes of H1 blocker antihistamine:
• +H1 blocker (1st generation) = crosses the blood-brain barrier, which results in drowsiness.
Prototype: Dipenhydramine (generic) = Benadryl (branded)
Indication: Common Cold, Respiratory Allergies, and Mild allergic reactions
Contraindication: Avoid alcohol and CNS depressants due to risk of sedation
Adverse fx: can cause anticholinergic effects (such as dry mouth, urinary retention, constipation
and blurred vision). Paradoxical effect of excitement in children. CNS depression or CNS
stimulation with excessive doses can occur, especially in children. Therefore, first-generation
antihistamines should be used with caution in the elderly.

• +H1 blocker (2nd generation) = the non-sedating antihistamine; this do not cross the blood-brain
barrier to the extent that first-generation do and therefore do not cause drowsiness at standard
dosage levels. Has fewer drug interactions.
Prototype: Cetirizin (generic) = Zyrtec (branded)
Indication: Seasonal allergic rhinitis, Chronic urticaria, Perennial Allergic rhinitis
Contraindication: Avoid use if there is hypersensitivity to cetirizine or hydroxyzine.
Adverse fx: headache, nausea, vomiting, dysmenorrhea, and fatigue
Drug forms: available in various forms such as tablets, capsules, syrups, and topical creams

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INTERACTIONS:
• Monoamine inhibitor (MAOI) = Anticholinergic effects may be prolonged if
diphenhydramine is taken with a monoamine inhibitor.
• Ketoconazole/erythromycin = Interaction of fexofenadine with ketoconazole or
erythromycin may raise fexofenadine concentrations to toxic levels.
NURSING CONSIDERATIONS:
This medication is not safe for children under the age of 2 years without a healthcare
provider’s order.
NOTE: ZERO ALCOHOL INTAKE must be observed

ANTITUSSIVE – Prescription or over-the-counter drugs used for suppressing dry and persistent
coughs. It has three types: nonnarcotic, narcotic, or combination preparations.
MOA: Suppresses cough by depressing the cough center in the medulla oblongata or the cough
receptors in the throat, trachea, or lungs that effectively elevate the threshold for coughing This drug
aim to reduce the frequency and intensity of coughing, making it easier for individuals to rest and
recover from underlying conditions.
Drug forms: Oral syrups, Tablets, Capsules, Lozenges, ETR tablets, Liquid Gels, Prescription-
Based liquid formula
Indications: Antitussives are employed to alleviate dry, disruptive coughs that impede rest and sleep,
offering temporary relief from coughing, as well as minor throat and bronchial irritations caused by
the common cold, and may help relieve itchy, watery eyes.
Adverse effects: chest numbness, a chilly sensation, constipation, confusion, dizziness,
gastrointestinal upset, hallucinations, headache, nasal congestion, nausea, itching, sedation, skin
eruptions, vomiting, and nervousness.
Contraindications: This medication is not safe for children under 12, can be misused recreationally,
should not be taken with alcohol, and if you're using MAOIs or respiratory inhalers, consult your
doctor or pharmacist for guidance.
Prototype: Dextromethorphan (generic) = Rubitussin DM (branded)
Antidote: Naloxone (Narcan)
Interaction: Monoamine oxidase inhibitors (MAOI). Dextromethorphan should not be used with
MAOIs because hypotension, fever, nausea, myoclonic jerks, and coma could occur.
Nursing Consideration:
• Monitor patient response to the drug (control of non-productive cough).
• Monitor for adverse effects (respiratory depression, dizziness, sedation).

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 • Evaluate the effectiveness of the teaching plan.
• Monitor the effectiveness of other measures to relieve cough.
• This medication is not safe for children under the age of 4 years.

DECONGESTANT – provide short-term relief for a congested or stuffy nose (nasal congestion).
MOA: also called as sympathomimetic amine; stimulate the alpha-adrenergic receptors, producing
vascular constriction (vasoconstriction) of the capillaries within the nasal mucosa. This shrinks the
nasal mucous membranes and a reduction in fluid secretion.
Drug forms: Oral tablets, Capsules, Syrups, Nasal sprays, Nasal drops, Topical creams, Nasal
Inhalers
Indications: Relieve nasal obstruction due to inflammation.
Adverse effects: hypertension, dysrhythmia, dizziness, headache, insomnia, and restlessness. Some
patients may experience blurred vision, tinnitus, chest tightness, dry nose, and nasal congestion.
Contraindications: patients with severe hypertension, coronary artery disease (CAD), narrow-angle
glaucoma, and some antidepressant use. Also, use with caution in patients who have cardiac
dysrhythmias, hyperthyroidism, DM (diabetes mellitus), prostatic hypertrophy, and glaucoma
Prototype: Pseudoephedrine (generic) = Sudafed (branded)
Antidote: Acepromazine or Chlorpromazine
Nursing Considerations:
• This medication is not safe for children under the age of 4 years.

LOWER RESPIRATORY DRUGS

MUCOACTIVE AGENTS = encompasses various medications of addressing mucus-related
conditions/problems
EXPECTORANT – a mucoregulatory agent that help ease the symptoms of conditions such as colds
and flu, hay fever and other allergic reactions, catarrh and sinusitis.

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MOA: It reduce the viscosity of tenacious secretions by irritating the gastric vagal receptors that
stimulate respiratory tract fluid, thus increasing the volume but decreasing the viscosity of respiratory
tract secretions.
Drug form: Oral syrups, Tablets, Capsules, ETR tablets
Interaction: Found in many OTC cold remedies along with analgesics, antihistamines,
decongestants, and antitussives.
Indications: used for a productive cough and for loosening mucus from the respiratory tract.
Adverse effects: may cause a skin rash, headache, nausea, and vomiting
Considerations: Safe for all ages. Guaifenesin is only recommended for use during pregnancy and
breastfeeding when benefit outweighs the risk.
Prototype: Guaifenesin (generic) = Rubitussin (branded)
Nursing Considerations:
• The medication is safe for all ages. Guaifenesin is only recommended for use during
pregnancy and breastfeeding when benefit outweighs the risk.
• Hydration is the best natural expectorant

MUCOLYTICS – medications that break up mucus so you can clear it out of your lungs more easily.
They're used to treat cystic fibrosis, bronchiectasis and other lung conditions.
MOA: increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk
respiratory patients who are coughing up thick, tenacious secretions.
Drug forms: Oral tablets, capsules, syrups, nebulizer solutions, inhaler solution
Therapeutic effects: It safeguards liver cells during episodes of acetaminophen toxicity by restoring
hepatic glutathione levels and binding to a reactive hepatotoxic acetaminophen metabolite. In the
respiratory system, it acts on mucoproteins by breaking disulfide bonds that bind mucus materials,
leading to reduced thickness and stickiness in the secretions.
Indications: limited ability to move secretions, including postoperative patients with tracheostomies
for improved airway clearance and suctioning; clearing of secretions during diagnostic procedures
like diagnostic bronchoscopy; offers oral protection against acetaminophen toxicity for the liver, and
helps address atelectasis caused by thick mucus secretions.
Adverse effects: nausea, vomiting, loss of appetite, headaches, dizziness, runny nose, bronchospasm,
and skin rashes.
Contraindications: caution in situations involving acute bronchospasms, peptic ulcers, and
esophageal varices because the heightened secretions caused by this medication could potentially
worsen these conditions.
Prototype: Acetylcysteine (generic) = Mucomyst (branded)

5|RESPIRATORY DRUGS
 Interaction:
Nursing Considerations:
• Proper administration. Caution the patient not to use these drugs for longer than 1 week
and to seek medical attention if the cough persists after that time to evaluate for any
underlying medical condition and to arrange for appropriate treatment.
BRONCHODILATORS: (BAM! B-Beta2 agonist, A-Anticholinergic, M-Methyxanthines)
A type of medication that makes breathing easier. They do this by relaxing the muscles in the lungs
and widening the airways (bronchi). They often treat long-term conditions where the airways may
become narrow and inflamed. (COPD and Asthma)
Bronchodilators may be either:
Short-acting – used as short-term relief from sudden, unexpected attacks of breathlessness.
Long-acting – used regularly to help control breathlessness in asthma and COPD.

Nursing considerations:

• Evaluation of a patient using bronchodilators/antiasthmatics include the following:

✓ Monitor patient response to the drug (improved airflow, ease of respirations,
improved breathing).
✓ Monitor for adverse effects (CNS effects, increased pulse or blood pressure, GI upset,
dry skin, and mucous membranes)

BETA2- ADRENERGIC AGONISTS – a bronchodilator that is classified as sympathomimetic,

which increase cAMP (controlling ciliary beat frequency), causing dilation of the bronchioles.
MOA: stimulate beta-2 adrenergic receptors, leading to relaxation and dilation of bronchial airways
and certain blood vessels.
Administration: They are administered through a compact handheld inhaler, and alternative forms
like tablets or syrup may be accessible. In cases of sudden and severe symptoms, they can also be
administered via injection or nebulization, with a nebulizer, a device powered by a compressor,
converting liquid medication into a fine mist for inhalation through a mouthpiece or face mask,
facilitating the delivery of a higher medication dose.
Types: SABA (Short-Acting Beta2 Agonist), LABA (Long-Acting Beta2 Agonist), and ABA
(Alpha- and Beta-Adrenergic)
Indications: indicated for bronchodilation, with SABAs primarily used for acute relief of
bronchoconstriction and LABAs used for maintenance therapy to control symptoms in chronic
respiratory conditions. Whereas ABA is used for emergency scenarios, stimulating both adrenergic
receptors (alpha and beta).
Adverse effects: muscle tremor, excessive cardiac stimulation (Beta1), CNS stimulation. And, in
some prolong usage, electrolyte imbalances like low potassium levels

6|RESPIRATORY DRUGS
 Contraindications: Hypersensitivity, cautious to patient with cardiac disease, vascular disease,
arrhythmias, diabetes, and hyperthyroidism.
Prototype:
SABA: Albuterol (Generic) = Ventolin HFA (Branded)
LABA: Salmeterol (Generic) = Advair Diskus (Branded)
ABA: Epinephrine (Generic) = Adrenaline (Branded)
Nursing Considerations:
• Monitor respiratory rate, oxygen saturation, and lungs sounds before and after
administration. If more than one inhalation is ordered, wait at least 2 minutes between
inhalations.
• Use a spacer device to improve drug delivery, if appropriate.

On the flipside: There is also a Beta2 Antagonist which are called as Beta blockers = to where they
have a constricting effect on bronchial airways and blood vessels, leading to decreased heart rate and
reduced blood pressure. Not recommended for patient with asthma or COPD due to its effects that
may worsen the condition.

ANTICHOLINERGIC – a bronchodilator that targets the parasympathetic nerve endings located

at the submucosal glands of the lungs.
MOA: It inhibits the activity of acetylcholine at muscarinic receptors (mAChRs), which are
distributed throughout multiple organs and tissues such as the heart, lungs, gastrointestinal tract, and
glands. This inhibition of acetylcholine, a neurotransmitter within the parasympathetic nervous
system, results in the blocking of parasympathetic nerve signals and leads to various physiological
effects within the body.
Administration: available in oral, intranasal, and intravenous forms
Indications: COPD, Asthma, IBS, Diarrhea, Overactive bladder, Parkinson’s disease: Temors and
Dystonia, and motion sickness
Adverse effects: dry mouth, blurred vision, constipation, urinary retention, confusion, and increased
heart rate. These side effects are a result of the inhibition of parasympathetic functions.
Contraindications: Cautious use in patients with glaucoma, urinary retention and certain heart
conditions.
Prototype: Tiotropium (generic) = Spiriva (branded)
Antidote: physostigmine salicylate
Nursing Considerations: Ensure proper administration of the drug to ensure effective use and
decrease the risk of adverse effects. Monitor patient response (e.g., blood pressure, ECG, urine
output) for changes that may indicate need to adjust dose.

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 METHYLXANTINE DERIVATIVES – bronchodilators used to treat asthma, and stimulate the
central nervous system (CNS) and respiration, dilate coronary and pulmonary vessels, and cause
diuresis.
MOA:
Phosphodiesterase Inhibition = inhibits phosphodiesterase enzymes, particularly
phosphodiesterase type 3 and type 4. This leads to increased levels of cyclic adenosine
monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), resulting in bronchodilation,
relaxation of smooth muscle, and anti-inflammatory effects in the airways.
Adenosine Receptor Antagonism = antagonize adenosine receptors, which can lead to
bronchodilation and central nervous system stimulation.
Release of Endogenous Epinephrine = They stimulate the release of endogenous epinephrine,
leading to bronchodilation and increased heart rate.
Administration: orally in the form of tablets, capsules, or liquid preparations. Intravenous forms,
such as aminophylline, may be used for acute situations.
Indications: Asthma, COPD, Apnea of Prematurity, and Cardiac Arrhythmias
Adverse effects: Nausea, vomiting, headache, palpitations, and nervousness. Toxicity can be seen
with seizures, arrhythmias, and gastrointestinal disturbances.
Contraindications: Hypersensitivity, medication tolerance, cardiac arrhythmias, seizure disorders,
and peptic ulcers.
Prototype: Theophylline (generic) = Elixophyllin (branded)
Nursing Considerations: Patients should be sure to take medications as prescribed at appropriate
intervals. They should avoid irritants and drink fluids to help thin secretions.Patients will need
serum blood levels tested every six to twelve months.

ANTI-INFLAMMATROY AGENTS: SML?! = S-steroids, M- Mast Cell Stabilizers, and L-LT

modifiers,
GLUCOCORTICOIDS (STEROIDS) - contain synthetic versions of cortisol, a hormone produced
naturally by the adrenal glands. They are used for their anti-inflammatory and immunosuppressive
properties. A medication used for episodes of asthma attacks.
MOA: binding to glucocorticoid receptors, influencing gene expression and regulating various
metabolic, immunologic, and inflammatory processes in the body. It reduces inflammation by
suppressing the immune response and inhibiting the production of inflammatory mediators, such as
prostaglandins and cytokines.
Administration: can be administered orally (as tablets or liquids), topically (as creams or ointments
for skin conditions), by inhalation (for respiratory conditions), or through injections (e.g., intra-
articular for joint inflammation).

8|RESPIRATORY DRUGS
Indications: Inflammatory disease, Allergic Reaction and Asthma, Autoimmune Diseases, COPD,
Sarcoidosis, Interstitial lung disease and used as Cancer treatments.
Adverse and side effects: Long term effects may cause side effects of headache, euphoria,
confusion, sweating, hyperglycemia, insomnia, nausea, vomiting, weakness, and menstrual
irregularities; and adverse effects of depression, peptic ulcer, loss of bone density and development
of osteoporosis, and psychosis.
NOTE: when oral and IV steroids are used for prolonged periods, electrolyte imbalance, fluid
retention (puffy eyelids, edema in the lower extremities, moon face, weight gain), hypertension,
thinning of the skin, purpura, abnormal subcutaneous (fat) distribution, hyperglycemia, and impaired
immune response are likely to occur.
Contraindications: hypersensitivity to the medication, significant hepatic impairment, and active
systemic fungal infections
Prototype: beclomethasone (generic) = Qvar (branded)
Nursing Consideration: Administer drug daily at 8 to 9 AM to mimic normal peak diurnal
concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis (HPA).

MAST CELL STABILIZERS - prevent and manage allergic reactions and related conditions by
stabilizing mast cells, which are a type of immune cell involved in allergic responses.
MOA = Prevents mast cells from degranulating and releasing histamine and other inflammatory
mediators when exposed to allergens or triggers. By stabilizing mast cells, these medications reduce
the allergic response, including symptoms such as itching, swelling, and bronchoconstriction.
Administration: nasal sprays or eye drops for allergic rhinitis and conjunctivitis. For asthma, they
can be administered via inhalation.
Indication: Allergic rhinitis and conjunctivitis, and Asthma
Adverse effect: Rash, itching/swelling, severe dizziness, trouble breathing.
Contraindication: Hypersensitivity
Prototype:
Cromolyn sodium (Gastrocrom): Available in various forms, including nasal sprays and eye drops
for allergic rhinitis and conjunctivitis, and inhaled preparations for asthma.
Nedocromil (Tilade,Alocril): Used in the treatment of allergic conjunctivitis and asthma.
NURSING CONSIDERATIONS:
✓ Current symptoms, vital signs, lung sounds as needed Monitor symptoms and
effectiveness of treatment
✓ Wash hands before self-administering
✓ Maintenance therapy; do not use medication to stop an acute attack
✓ Can take 1–2 weeks or more for symptom relief
✓ Rinse and gargle after administration
✓ Clean equipment after use
✓ Blow nose before instillation

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 ✓ Clean spray nozzle after use
✓ Avoid touching dropper to eye, fingers, other surfaces
✓ Do not wear soft contact lenses

LEUKOTRIENE MODIFIERS - a chemical mediator that inhibits/targets leukotriene D4 (LTD4)

in the body, helping to reduce inflammation and improve respiratory symptoms. These modifiers are
LT receptor antagonists and LT synthesis inhibitors that is used for asthma attacks.
MOA:
LT receptor antagonist = blocks the action of leukotrienes after they have been produced and
released. By binding to LT receptors, LT receptor antagonists prevent LT from attaching to and
activating their target cells.
LT synthesis inhibitors = inhibits the enzyme 5-lipoxygenase, which is responsible for the
production of leukotrienes from arachidonic acid. By blocking this enzyme, leukotriene synthesis
inhibitors reduce the formation of leukotrienes, thereby limiting their availability for binding to
receptors and exerting their effects.
Administration: orally in the form of tablets or granules. They are usually taken once daily.
Indication: Asthma, allergic rhinitis, Exercise-Induced Bronchoconstriction (EIB)
Adverse effects: headache, gastrointestinal disturbances, and, rarely, neuropsychiatric effects like
mood changes or sleep disturbances.
Contraindications: Hypersensitivity, peptic ulcer disease, seizure disorders, cardiac arrhythmias,
smokers, and chronic clearance disorder
Prototypes:
LTRA = Montelukast (Generic) = Singulair (Branded)
LTSI = Zileuton (Generic) = Zyglo (Branded)
NURSING CONSIDERATIONS:
✓ Do not use for acute asthma attacks
✓ Take montelukast two hours before exercise if prescribed for exercised induced
bronchoconstriction
✓ Oral granules: take within 15 minutes of opening packet
✓ Can be taken directly or with a tablespoon of applesauce or ice cream
✓ Take zafirlukast on an empty stomach
✓ Take zileuton with food
✓ Report symptoms of hepatotoxicity, neuropsychiatric problems
✓ Continue taking as prescribed even in absence of symptoms

10 | R E S P I R A T O R Y D R U G S
 DRUG PROTOTYPES/SAMPLES

Drug Class Generic Branded Suffix

H1 blocker Doxylamine Unisom®
(1st generation) Dipenhydramine Benadryl
H1 blocker Azelastine Dymista® “-ine”
(2nd generation) Cetirizine Zyrtec®
Loratadine Claritin®
Antitussive Dextromethorphan Robitussin DM
hydrobromide None
Codeine Demazin and Codral
Hydrocodone Vicodin® and Lortab®
Decongestant Pseudoephedrine Sudafed and Galpseud
Tetrahydrozoline Visine None
Naphazoline Naphcon-A, Opcon-A, and Visine-A
Expectorant Guaifenesin Mucinex, Bidex400, and Organidin
NR None
Bronchodilators Levalbuterol Xopenex® (inhaler)
SABA Albuterol /Salbutamol Ventolin, Proventil HFA, ProAir
Respiclick
Bronchodilators Fluticasone/ Salmeterol Advair Diskus, Airduo Respiclick,
LABA (No brand name for powder
inhalation drugs) “-erol”
Formoterol Symbicort, Fostair, Atock, Foradile
Olodaterol Striverdi Respimat
Bronchodilators Epinephrine Adrenalin® None
ABA
Bronchodilators Tiotropium Spiriva (R/x drug)
Anticholinergic/ Ipratropium bromide Atrovent, and Atrovent HFA “nacine”
Muscarinic Atropine Atropen® “ium”
antagonist
Bronchodilators Aminophylline Norphyl, Phyllocontin, Truphylline
Xanthine Theophylline Uniphyl and Theocron
derivatives Caffeine NoDoz, Vivarin, Enerjets, Lucidex “-phylline”
Mucolytics Acetylcysteine Mucomyst
Carbocisteine Mucodyne “-eine”

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 Ambroxol Mucobrox, Mucosolvan
Leukotriene Zafirlukast Accolate
Modifiers Zirleuton Zyflo, Zyflo CR “-lukast”
Montelukast Singulair
Mast cell Cromolyn Na Gastrocrom None
stabilizer Nedocromil Tilade
Glucocorticoids Beclomethasone Qvar
Dexamethasone Decadron, Solurex, Baycadron “-asone”
Prednisone Rayos and Deltasone® “-sone”
Beta Blocker Propanolol Inderal “-olol”

REFERENCES

Access anytime anywhere | Cleveland Clinic. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/

Chippewa Valley Technical College. (2023, January 12). Fundamentals of Nursing Pharmacology -
1st Canadian Edition. Pressbooks. https://opentextbc.ca/nursingpharmacology/

DrugBank Online | Database for drug and drug target info. (n.d.). DrugBank.
https://go.drugbank.com/

McCuistion L. E. (2021). Pharmacology : a patient-centered nursing process approach (New Edition

(2nd & subsequent) / 10th). W.B. Saunders Company

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