PHARMACOLOGY
S.Y. ‘23 - 24 | CAPARAS LANCE
1.0
1.1
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LESSON 6/ WEEK #10: DRUGS ACTING ON THE RESPIRATORY
SYSTEM
RESPIRATORY SYSTEM
FUNCTIONS
Oxygen Supplier. The job of the respiratory
system is to keep the body constantly supplied
with oxygen
Elimination. Elimination of carbon dioxide
Gas Exchange. The respiratory system organs
oversee the gas exchanges that occur between
the blood and the external environment
Passageway. Passageways that allow air to
reach the lungs
Humidifier. Purify, humidify, and warm incoming
air
Pharyngitis &
Laryngitis
Infections are mostly caused by popular
bacteria or viruses
Atelectasis
Breakdown of once-expanded alveoli,
can occur as a result of external
pressure on alveoli, such as pulmonary
tumor, pneumothorax, pleural effusion
Pneumonia
Inflammation of the lungs caused either
by bacterial or viral infiltration of the
tissue or by the aspiration of infectious
substances to the lower respiratory
tract
Bronchitis
Occurs when bacteria, viruses, or
foreign material affect the inner layer of
the bronchitis. There is an acute
inflammatory response at the site of the
infection
Bronchiectasis
Chronic condition affecting bronchi and
bronchioles. It is characterized by
bronchial dilation and chronic infection
and inflammation of the bronchial
passages
Obstructive
Pulmonary
Disease
Include asthma, cystic fibrosis, chronic
obstructive pulmonary disease, and
lung disease
2.0
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1.2
FREQUENT RESPIRATORY DISORDER
2.1
CONDITIONS
DESCRIPTION
Common Cold
Viruses enter the upper respiratory tract
tissues, induce the release of histamine
and prostaglandins, and cause
inflammatory reactions
Seasonal
Rhinitis
Allergic or seasonal rhinitis
(inflammation of the nasal cavity),
generally referred to as hay fever
Sinusitis
The epithelial lining of the sinus cavities
is inflamed
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BRONCHODILATORS
Antiasthmatics
Medications used to facilitate respiration byu
dilating the airways
Helpful in symptomatic relief or prevention of
bronchial asthma and for bronchospasm
associated with COPD
XANTHINES
Come from a variety of naturally occurring
sources. These drugs were once the main
treatment choices for asthma and bronchospasm
However, because they have a relatively narrow
margin of safety and interact with many other
drugs, they are no longer considered the
first-choice bronchodilators
BSN 2A | SEMESTER 1 | PHARMACOLOGY | LANCE CAPARAS
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CLASSIFICATION
XANTHINES
GENERIC
NAME
BRAND NAME
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Aminophylline
Truphylline
Caffeine
(generic)
Dyphylline
Dilor
Theophylline
Slo-Bid, Theo-Dur
Adverse Effects
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Therapeutic Actions
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A direct effect on the smooth muscles of the
respiratory tract, both in the bronchi and in the
blood vessels
A theory suggest that xanthines work by directly
affecting the mobilization of calcium within the
cell
They do this by stimulating two prostaglandins,
resulting in smooth muscle relaxation, which
increases the vital capacity that has been
impaired by the bronchospasm or air trapping
Xanthines also inhibit the release of
slow-reacting substance of anaphylaxis and
histamine, decreasing the bronchial swelling and
narrowing that occurs as a result of these two
chemicals
Indications
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CNS: Irritability, restlessness, dizziness
Cardiovascular: Palpitations, life-threatening
arrhythmias
Others: loss of appetite, fever, flushing
GU: Proteinuria
Respiratory: Respiratory arrest
Interactions
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2.2
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Nicotine. Nicotine increases the metabolism of
xanthines in the liver; xanthine dose must be
increased in patients who continue to smoke
while using xanthines
SYMPATHOMIMETICS
Drugs that mimic the effects of the sympathetic
nervous system
One of the actions of the sympathetic nervous
system is dilation of the bronchi with increased
rate and depth of respiration
CLASSIFICATION
Relief of symptoms or prevention of bronchial
asthma
Reversal of bronchospasm associated with
COPD
SYMPATHOMIMETICS
Contraindications and Cautions
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benefit to the mother clearly outweighs the
potential risk to the fetus
Lactation. Because the xanthines enter
breastmilk and could affect the baby, another
method of feeding the baby should be selected if
these drugs are needed during lactation
Comorbidities. Caution should be taken with
any patient with GI problems, coronary disease,
respiratory dysfunction, renal or hepatic disease,
alcoholism, or hyperthyroidism because these
conditions can be exacerbated by the systemic
effects of xanthines
Long-term Parenteral Use. xanthines are
available for oral and parenteral use; the
parenteral drug should be switched to oral form
as soon as possible because the systemic effects
of the oral form are less acute and more
manageable
Pregnancy. Although no studies are available of
xanthine effects on human pregnancy, they have
been associated with fetal abnormalities and
breathing difficulties at birth in animal studies, so
use should be limited to situations in which the
GENERIC
NAME
BRAND NAME
albuterol
Proventil
arformoterol
Brovana
ephedrine
(generic)
epinephrine
Sus-Phrine
formoterol
Foradil
indacaterol
Arcapta
isoetharine
(generic)
isoproterenol
Isuprel
levalbuterol
Xopenex
metaproterenol
Alupent
pirbuterol
Maxair
salmeterol
Serevent
terbutaline
Brethaire
BSN 2A | SEMESTER 1 | PHARMACOLOGY | LANCE CAPARAS
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Interactions
Therapeutic Actions
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At therapeutic levels, the action of most
sympathomimetics are specific to the
beta-receptors found in the bronchi
Other systemic effects include increased blood
pressure, increased heart rate, vasoconstriction,
and decreased renal and GI blood flow - all
actions off the sympathetic nervous system
Epinephrine, the prototype drug, is the drug of
choice for adults and children for the treatment of
acute bronchospasm, including that caused by
anaphylaxis; it is also available for inhalation
Indications
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CNS: Headache, restlessness
Cardiovascular: Palpitation, tachycardia
Skin: Pallor, local burning and stinging
GU: Decreased renal formation
Respiratory: Rebound congestion with nasal
inhalation
Misc: Fear, anxiety
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ANTICHOLINERGICS
Patients who cannot tolerate the sympathetic
effects of sympathomimetics might respond to
the anticholinergic drugs ipratropium (Atrovent)
and tiotropium (Spiriva)
These drugs are not as effective as the
sympathomimetics but can provide some relief to
those patients who cannot tolerate the other
drugs
CLASSIFICATION
ANTICHOLINERGICS
GENERIC
NAME
BRAND NAME
ipratropium
Atrovent
tiotropium
Sprival
Therapeutic Actions
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Underlying Conditions. These drugs are
contraindicated or should be used with caution,
depending on the severity of the underlying
condition, in conditions that would be aggravated
by the sympathetic stimulation, including cardiac
disease, vascular disease, arrhythmias, diabetes,
and hyperthyroidism
Pregnancy and Lactation. These drugs should
be used during pregnancy and lactation only if
the benefits to the mother clearly outweigh
potential risks to the fetus or neonate
Adverse Effects
2.3
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Long-acting treatment and prophylaxis of
bronchospasm and prevention of
exercise-induced bronchospasm in patients 2
years and older
Long-term maintenance treatment of
bronchoconstriction in COPD
Treatment of acute bronchospasm in adults and
children, although epinephrine is the drug of
choice
Treatment and prophylaxis of acute asthma
attacks in children more than 6 years old
Contraindications and Cautions
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Special precautions should be taken to avoid the
combination of sympathomimetic bronchodilators
with the general anesthetics
Cyclopropane and halogenated
hydrocarbons. Because these drugs sensitize
the myocardium to catecholamines, serious
cardiac complications could occur
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Anticholinergics are used as bronchodilators
because of their effect on the vagus nerve, which
assist to block or antagonize the action of the
neurotransmitter acetylcholine at vagal-mediated
receptor sites
By blocking the vagal effect, relaxation of smooth
muscle in the bronchi occurs, leading to
bronchodilation
Indications
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Maintenance and treatment of bronchospasm for
adults with COPD
Long-term, once-daily maintenance and
treatment of bronchospasm associated with
COPD in adults
Contraindications and Cautions
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Comorbidities. Caution should be used in any
condition that would be aggravated by the
anticholinergic or atropine-like effects of the drug,
such as narrow-angle glaucoma, bladder neck
obstruction or prostatic hypertrophy, and
conditions aggravated by dry mouth and throat
BSN 2A | SEMESTER 1 | PHARMACOLOGY | LANCE CAPARAS
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Pregnancy and Lactation. These drugs are not
usually absorbed systematically, but as with all
the drugs, caution should be used in pregnancy
and lactation because of the potential for adverse
effects on the fetus or nursing baby
Allergy. The use of ipratropium or tiotropium is
contraindicated in the presence of known allergy
to the drug or to soy products or peanuts to
prevent hypersensitivity reactions
Adverse Effects
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CNS: Headache, dizziness
Cardiovascular: Palpitations
GI: nausea, gastrointestinal distress
Respiratory: Cough
Misc: Nervousness
NURSING RESPONSIBILITY:
Bronchodilators
➢ Relieve GI upset. Administer oral drug with food
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or milk to relieve GI irritation if GI upset is a
problem
Monitor drug response. Monitor patient
response to the drug (e.g. relief of respiratory
difficulty, improved airflow) to determine the
effectiveness of the drug dose and to adjust dose
as needed
Provide comfort. Provide comfort measures
including rest periods, quiet environment, dietary
control of caffeine, and headache therapy as
needed to help the patient cope with the effects of
drug therapy
Provide follow-ups. Provide periodic follow-up,
including blood tests, to monitor serum
theophylline levels
Individual drug response. Reassure patient that
the drug of choice will vary with each individual;
these sympathomimetics are slightly different
chemicals and are prepared in a variety of delivery
systems; a patient may have to try several
different sympathomimetics before the most
effective one is found
Proper administration and dosage. Advise the
patient to use the minimal amount needed for the
shortest period necessary to prevent adverse
effects and accumulation of drug levels
Proper use of sympathomimetics. Teach the
patients who use one of these drugs for exerciseinduced asthma to use it 30-60 minutes before
exercising to ensure peak therapeutic effects
when they are needed
Use of adrenergic blockers. Alert the patient that
long-acting adrenergic blockers are not for use
during acute attacks because they are
slower acting and will not provide the necessary
rescue in a state of acute bronchospasm
Increase oral fluid intake. Ensure adequate
hydration and provide environmental controls
such as the use of a humidifier, to make the
patient more comfortable
➢ Encourage voiding. Encourage the patient to
void before each dose of medication to avoid
urinary retention related to drug effects
➢ Small, frequent meals. Provide small, frequent
meals and sugarless lozenges to relieve dry
mouth and Gi upset
➢ Use of inhalator. Review the use of inhalator with
the patient; caution the patient not to exceed
12 inhalations in 24 hours to prevent serious
adverse effects
➢ Educate the patient. Provide thorough patient
teaching, including the drug name and prescribed
dosage measures to help avoid adverse effects,
warning signs that may indicate problems, and the
need for periodic monitoring and evaluation, to
enhance patient knowledge about drug therapy
and to promote compliance
➢ Provide patient support. Offer support and
encouragement to help the patient cope with the
disease and the drug regimen
3.0
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Drugs that liquefy the lower respiratory tract
secretions. They are used for the symptomatic
relief of respiratory conditions characterized by a
dry, nonproductive cough
CLASSIFICATION
EXPECTORANT
GENERIC
NAME
guaifenesin
BRAND NAME
Mucinex
Therapeutic Actions
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Enhances the output of respiratory tract fluids by
reducing the adhesiveness and surface tension
of these fluids, allowing easier movement of the
less viscous secretions
Indications
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Symptomatic relief of respiratory conditions
characterized by a dry, nonproductive cough
Contraindications and Cautions
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Allergy. This drug should not be used in patients
with a known allergy to the drug to prevent
hypersensitivity reactions
Pregnancy or Lactation. This drug should be
used with caution in pregnancy and lactation
because of the potential adverse effects on the
fetus or baby
Cough. This drug should not be used with
persistent coughs, which could be indicative of
an underlying medical problem
BSN 2A | SEMESTER 1 | PHARMACOLOGY | LANCE CAPARAS
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Adverse Effects
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4.0
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CNS: Headache, dizziness
Underlying cough: the most important
consideration in the use of these drugs is
discovering the cause of the underlying cough;
prolonged use of the OTC preparations could
result in the masking of important symptoms of a
serious underlying disorder
GI: nausea, vomiting, anorexia
Respiratory: Rhinorrhea, bronchospasm
Skin: Rash
Drugs that suppress the cough reflex
Act on the cough-control center in the medulla to
suppress the cough reflex; if the cough is
nonproductive and irritating, an antitussive may be
taken
GENERIC NAME
BRAND NAME
benzonatate
Tessalon
codeine
codeine
dextromethorphan
Benylin
hydrocodone
Hycodan
Acts directly on the medullary cough center of the
brain to depress the cough reflex
Because they are centrally acting, they are not
the drugs of choice for anyone who has a head
injury or could be impaired by central nervous
system depression
Indications
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Local anesthetic on the respiratory passages,
lungs, and pleurae, blocking the effectiveness of
the stretch receptors that stimulate a cough reflex
For relief of moderate to moderately severe pain
For the treatment of dry cough, drug withdrawal
syndrome, opioid type drug dependence, and
pain
Contraindications and Cautions
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Adverse Effects
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CNS: Drowsiness and Sedation
GI: nausea, constipation, dry mouth, GI upset
Interactions
Monoamine Oxidase Inhibitors (MAOI).
Dextromethorphan should not be used with
MAOIs because hypotension, fever, nausea,
myoclonic jerks, and coma could occur
NURSING RESPONSIBILITY: Antitussive
Therapeutic Actions
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ANTITUSSIVES
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ANTITUSSIVE
CLASSIFICATION
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Asthma and Emphysema. Patients with asthma
and emphysema are contraindicated because
cough suppression could lead to accumulation of
secretions and a loss of respiratory reserve
Addiction. Patients who are hypersensitive to or
have a history of addiction to narcotics; codeine
is a narcotic and has addiction potential
Sedation. Patients who need to drive or be alert
should use codeine, hydrocodone, and
dextromethorphan with extreme caution because
these drugs can cause sedation and drowsiness
Pregnancy. Patients who are pregnant and
lactating, because of the potential for adverse
effects on the fetus or baby, including sedation
and CNS depression
➢ Prevent overdose. Ensure that the drug is not
taken any longer than recommended to prevent
serious adverse effects and severity respiratory
tract problems
➢ Assess the underlying problem. Arrange for
further medical evaluation for coughs that persist
or are accompanied by high fever, rash, or
excessive secretions; To detect the underlying
cause of coughing, and to arrange for appropriate
treatment of the underlying problem
➢ Provide other relief measures from cough.
These nursing interventions may include
humidifying the room, providing fluids, use of
lozenges, and cooling room temperature
➢ Educate the patient. Provide thorough patient
teaching, including the drug name and prescribed
dosage, measures to help avoid adverse effects,
warming signs that may indicate problems, and
the need for periodic monitoring and evaluation, to
enhance patient knowledge about drug therapy
and promote compliance
➢ Provide emotional support. Offer support and
encouragement to help the patient cope with the
disease and the drug regimen
Patent Airways. Patients who need to cough to
maintain the airways (e.g. postoperative patients
and those who have undergone abdominal or
thoracic surgery) to avoid respiratory distress
BSN 2A | SEMESTER 1 | PHARMACOLOGY | LANCE CAPARAS
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