Drugs used on respiratory system

Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.

1. Drugs used on Respiratory System Mr. Dipti Sorte

2. Anti-Asthmatic Drugs Classified as: Bronchodilators: Anticholinergic. Mast cell stabilizers Corticosteroids. Anti-histamines. Adrenergic Agonist or sympathomimetics. Methylxanthines.

3. Bronchodilators: Adrenergic agonist or sympathomimetics Mechanism of action: They causes widening of the airway by relaxing bronchial smooth muscles by stimulate beta receptors.

4. Drug examples & Doses S. No. Drugs Doses 1 Salbutamol 2-4 mg orally 2 Terbutaline 5mg orally. 3 Formoterol 80 mcg B.D. orally 4 Albuterol 200-400 mcg inhaled every 6 hrly .

5. Indications/uses Relieving the distress of asthma. Bronchospasm or broncho -constriction.

6. Contraindications/ Precautions. Patient with uncontrolled arrythmias. Prolonged use of albuterol may cause hypokalemia.

7. Adverse Effects Nervousness. Anxiety. Tremor. Headache. Palpitations. Tachycardia. Arrhythmias.

8. Drug interactions ꞵ (beta) blocker antagonize the effects of adrenergic agonists. Prolonged use of theophylline cause additive effects.

9. Nursing Responsibilities Nurse should monitor the patient’s blood pressure, pulse, respiratory rate, and breathing sounds. Teach the patients that how to use inhalers. Instruct the patient to avoid respiratory irritants, such as smoke, dust, and strong smell.

10. Bronchodilators: Methylxanthine Mechanism of action : These drugs are weak CNS stimulants that are powerful smooth muscle relaxants thus they relax the smooth muscle of bronchi. They also have diuretic effect.

11. Drug examples & Doses S. No. Drugs Doses 1 Theophylline 200-400 mg TDS orally. 2 Etiophylline 250 mg TDS IV/IM 3 Aminophylline 250-500mg TDS IV slow.

12. Indication/Uses To treat and prevent bronchospasm. To treat asthma, bronchitis, emphysema.

13. Contraindications/ Precautions Hypersensitivity to any xanthine. Infection or irritation of rectum or lower portion. Give cautiously in neonates, in elderly patients, heart disorders hepatic disorders.

14. Adverse effects Headache. Anxiety. Nausea. Seizures. Abdominal Cramping. Diarrhea. Respiratory arrest. Irritability. Insomnia. Vomiting. Peptic ulcer. Epigastric pain. Tachycardia.

15. Drug interactions ꞵ (beta) Blocker may antagonize the effects of methylxanthines. Erythromycin may increase the half life of methylxanthines, and increasing the risk of methylxanthines toxicity. Rifampicin, phenobarbital phenytoin, cigarette smoking and charcoal – broiled food may shorten the half-life of drugs and reducing their effectiveness.

16. Nursing Responsibilities Nurse should assess for signs and symptoms of toxicity. Nurse also should know that therapeutic sr. level of theophylline ranges from 10 to 20 mcg/ml. Advise patients to decrease consumption of xanthine – containing food and beverages. To detect toxicity, nurse should monitor sr drugs levels.

17. Anticholinergic – Already Explained

18. Mast cell Stabilizers – Introduction Mast cell stabilizers works to prevent allergy cells called mast cell from breaking open and releasing chemicals that help to cause inflammation. They are not effective once the allergic reaction has occurred and mediators are released from mast cells. So they are useless during asthmatic attack. They are used in the prophylaxis of asthma.

19. Mechanism of action They inhibit mast cell activity, thus prevent the release of allergic mediators like histamine, serotonin, prostaglandins, cytokines. These chemical are essential for an inflammation and allergic reactions.

20. Drug examples and Doses S. No. Drug Doses 1 Cromolyn sodium 20mg 4times a day (Nebulization solution) 2 Sodium cromoglicate 20mg 6hrly 3 Ketotifen 1-2mg OD or BD

21. Indication / uses Prevent asthma symptoms from occurring or prophylaxis to asthmatic attack. To decrease inflammation or bronchospasm. To decrease allergic reactions. Rhinitis/conjunctivitis.

22. Contraindications/ precautions Hypersensitivity. Precautiously with renal dysfunction, hepatic dysfunction. Lactation, Cardiac arrhythmias.

23. Adverse effects Throat irritations. Nasal irritations. Wt. Gain. Headache. Drowsiness. Dry mouth. Dizziness.

24. Drug interactions Not reported

25. Nursing Responsibilities Nurse should monitor drugs adverse reactions. Instruct patients that this drug is not effective in an acute attack. Nurse should instruct the patient how to use metered – dose inhaler or nebulizer. If more than one inhalation is ordered, advise patient to wait 1-2 minutes before taking second puff. If the parents is also receiving an inhaled bronchodilator, advise the patient to use bronchodilators first to open the airways and then wait approximately 5min before using cromolyn sodium to maximize its effectiveness.

26. Anti-Inflammatory Drugs (Cortico-steroids) These drugs have anti-inflammatory as well as anti-allergic actions thus they are effective in bronchial asthma.

27. Mechanism of action They prevent the release of or counteract the bronchial mediators (Kinins, serotonin, Histamine) that cause tissue inflammation responsible for edema and airway narrowing.

28. Drug example and dose S. No Drugs Doses 1 Prednisolone 5-60mg per day in divided dose. 2 Beclomethasone Dipropionate 100 μ gm (microgram) 6hrly by aerosol inhalation. 3 Budesonide 400 μ gm (microgram) daily in divided dose. 4 Fluticasone 100-250 μ gm (microgram) BID by aerosol 5 Betamethasone Valerate 200 μ gm (microgram) 6hrly by aerosol.

29. Indication/uses Chronic bronchitis. Allergic Rhinitis. Respiratory inflammatory disorders. Bronchial asthma. Prophylaxis in exercise induced asthma. Allergic reaction.

30. Contraindications/precautions Acute bronchospasm. Use cautiously in patients who are immunosuppressed and in those taking prednisone or other corticosteroids. Use very cautiously in patients with viral respiratory infections.

31. Adverse effects Hoarseness. Candida infections. Oropharyngeal irritation. Bronchospasm after inhalation of dry powder.

32. Drug interaction Generally Not reported but can be find drug specific.

33. Nursing Responsibilities Nurse should instruct the patient to rinse his mouth, after using inhaled steroids. Nurse should teach the patient to: Use bronchodilators several minutes before glucocorticoid inhaler. Rinse mouth after using inhaled steroids. Use and care for inhaler properly.

34. Antihistamines Antihistamines are the drugs used in the treatment od allergic disorders and some other conditions.

35. Mechanism of action These drugs block the effect of histamine and its receptors. They also provide some sort of sedation. There are four types of antihistamines drugs. Highly sedatives. Moderate sedatives. Mild sedatives. Non sedatives.

36. Drug Example & Doses S. No Drugs Doses Highly Sedative 1 Diphenhydramine 25-50mg 2 Promethazine 25-50mg 3 Hydroxyzine 25-50mg Moderate Sedatives 4 Medizine 25-50mg 5 Buclizine 25-50mg 6 Phenivamine 25-50mg 7 Cyproheptadine 4mg

37. contd S. No. Drugs Doses Mild Sedatives 8 Chlorpheniramine 2-4mg 9 Cyclizine 50mg 10 Triprolidine 2.5-5mg Non Sedatives 11 Astemizole 10mg 12 Cetrizine 10mg 13 Lovatadine 10mg 14 Fexofenadine 120-180mg

38. Indications/Uses Allergic reactions (Hay fever, Vasomotor rhinitis urticaria, asthma, Anaphylaxis). Because of their anticholinergic actions they are used as antiemetics and useful in motion sickness. As hypnotics, Mild sedative/anxiolytics. Parkinsonism.

39. Contraindications/precautions Hypersensitivity. Lactation. Hypokalemia. Neonate. Coma. Special precautions in acute asthma and pregnancy, elderly, epilepsy.

40. Adverse effects Drowsiness in common. Dryness of mouth. Blurring of vision. Due to anticholinergic effect Urinary retention. Constipation. Delirium. Convulsions. Severe toxicity may causes death to cardiac and respiratory failure.

41. Nursing Responsibilities Antihistamines are best given in the evening since all antihistamines cause drowsiness. Advise to patient not to drive vehicle or do not operate machinery. Advise to patient to avoid sedative such as alcohol or sedative hypnotics.

42. Mucolytics These drugs reduced the viscosity of sputum that leads to easily expel the sputum.

43. Mechanism of action Decrease mucous viscosity by breaking or altering mucoproteins present in sputum.

44. Drug example & Doses S No. Drugs Doses 1 Acetylcysteine 2.5 ml of 10-20% solution given by inhalation or nebulization 2 Bromhexine 8-16 mg TDS.

45. Indications/uses To treat abnormal viscid, or thick and hard mucus. As an antidote for acetaminophen overdose (acetylcysteine).

46. Contraindications/precautions Hypersensitivity to these drugs. Cautiously in elderly, pregnant or breast feeding mothers.

47. Adverse effects Stomatitis. Drowsiness. Bronchospasm. Nausea/vomiting. Severe rhinorrhea.

48. Drug interactions Activated charcoal decreases acetylcysteine effectiveness. Incompatible with chlortetracycline, erythromycin, amphotericin B, Hydrogen peroxide.

49. Nursing Responsibilities To assess the airway and maintain it patent. Provide suction if needed. Assess the pattern breath sounds, cough, and bronchial secretions. Advise patient to maintain a fluid intake of 2-3litres/day. Warn the patient about the rotten egg smell of acetylcysteine.

50. Decongestants A Decongestant drugs used to relieve nasal congestion in upper respiratory tracts.

51. Mechanism of action Decongestants are sympathomimetic drugs that act by stimulating the α (alpha) – adrenergic receptors. The decongestant effect due to vasoconstriction of the blood vessel in the nose sinuses etc. the vasoconstriction effect reduces swelling or inflammation and mucous formation in the nasal passage and make it easier to breath.

52. Drug examples and doses S. No. Drugs Doses 1 Oxymetazoline hydrochloride 0.05% solution or nasal spray. 2 Phenylephrine hydrochloride 10 mg 3 Pseudoephedrine hydrochloride 60 mg.

53. Indications /uses For temporary relief of nasal congestion due to common cold. Hay fever. Sinusitis. Upper respiratory tract allergens. To promote nasal and sinus drainage.

54. Contraindications/precautions Hypersensitivity to these drugs. MAO (Monoamine oxidase) inhibiters drugs therapy. Use cautiously in older age patient they are more likely to experience adverse reaction. Nasal contestant should not be used for more than three days, and oral decongestant should not used more than 7days because prolonged use will result in rebound congestion.

55. Adverse Effects Arrhythmias. Tachycardia. Insomnia. Palpitation. Hypertension. Drowsiness. Hypersensitivity reactions including rash, urticaria.

56. Drug interactions If given with other sympathomimetic amines may increase central nervous system stimulation. If given with MAO inhibiters may cause severe hypertension.

57. Nursing Responsibilities Nurse should assess adverse effect of drugs. Monitor pulse rate, BP, and ECG. Advise patient not to share the container with other people and not allow the tip of the container to touch the nasal passage to avoid contamination.

58. Drugs for cough The drug which used in cough are: Antitussive. Expectorants. Bronchodilators.

59. Antitussives (Cough center suppressant) Opioids – Codeine, pholcodine. Non opioids – Noscapine, dextromethorphan. Antihistamine – Chlorpheniramine diphenhydramine.

60. Expectorants Bronchial secretion enhances – sodium or potassium citrate, potassium iodide, ammonium chloride. Mucolytes – bromhexine ambroxol, acetylcysteine.

61. Bronchodilators – already explained Salbutamol, Terbutaline.

62. Antitussives – Introduction They are used to suppress dry cough mostly because their aim to control rather than eliminate cough. These are also called cough center suppressants.

63. Mechanism of action These are the drugs that act in the CNS to increase threshold of cough center.

64. Drug example & Doses S. No Drugs Doses 1 Codeine (Opioids) 15-60mg up to every 4 hrs 2 Noscapine (Non opioids) PO 15-30 mg itramin maleate 3 Dextromethorphan (Non opioids) 10-30mg PO 4-8hrs max. 120/day 4 Chlorpheniramine (Antihistamine) 4 mg PO 4-6 hrly 5 Diphenhydramine (Antihistamine) 25 mg PO 4hrly not to exceed 150 mg / day.

65. Indications/uses Dry & unproductive cough. Allergic cough. Spasmodic cough.

66. Adverse Effects Constipation. Drowsiness. Dryness of mouth. Irritability. Ataxia. Respiratory depression in higher doses. Addiction. Vertigo. Nausea, Headache.

67. Contraindication/precautions Respiratory Depression. Asthmatics. Convulsion disorder. Contraindicate while driving. Obstructive airway disease.

68. Nursing Responsibilities Assess the side effects or adverse reaction during the therapy. Special precaution should be keep in mind before drug administration. Advise to patient not to driving after taken opioids drugs such as codeine pholecodiene .

69. Expectorants – Introduction These drugs help in removal of secretions of respiratory tract and mucolytic agents produce liquification of mucous making expectoration easier.

70. Mechanism of action They increase bronchial secretions or reduce its viscosity, sodium and potassium citrate increase bronchial secretion by salt action also these drugs stimulate gastric mucosa or directly acting on mucous membrane of lungs to increase the secretion of mucous.

71. Indications/uses Chronic productive cough. Thick mucous production. Combinations with antitussives drugs for relieving cough.

72. Adverse effect Allergic reactions / hypersensitivity. Rhinorrhea. Lacrimation. Gastric irritation.

73. Contraindication/precautions History of peptic ulceration. Asthmatic patients. Severe hepatic or renal function.

74. Drug interactions They may increase the risk of bleeding when use with anticoagulants.

75. Nursing Responsibilities Advise to take plenty of fluid during this therapy to easier removal of thick mucous. Assess the adverse effects.

76. References Dr. P.K. Panwar, Essentials of pharmacology for nurses, AITBS pub. 2017, India, Pg no. 49 – 62. Dr. Suresh k sharma , Textbook of pharmacology, pathology & genetics for nurses, Jaypee pub. 2016 India Pg no 161 – 205. Tara v. Shanbhag , Smita shenoy , Pharmacology preparation manual for undergraduate, Elsevier pub. 2014. Pg no. 226 – 257. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barlet pub 2010 India, Pg no 225-258. Govind s. Mittal, Pharmacology at a glance, Paras medical book pub. 2009 India 18 – 19. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India 1 st edition, Pg no 92 – 98.