Respiratory agents Upper respiratory infections: 1. Colds prevalent, caused by rhinovirus RHINORRHEA, nasal congestion, cough 2.

. Acute rhinitis inflammation of mucous membranes of the nose 3. Sinusitis 4. Acute pharyngitis Drugs for upper respiratory problems Antihistamines -H1 blockers or H1 antagonist -complete with histamine for receptor sites preventing histamine response -rapidly absorbed in 15 minutes commonly used as cold remedies -can treat allergic rhinitis but not potent to combat anaphylaxis First generation causes drowsiness, dry mouth and other anti cholinergic properties (diphenhydramine) -decrease nasal itching and ticking that causes sneezing Second generation/ non sedating causes fewer anti cholinergic effects (loratidine, cetirizine) Major responses to anti cholinergic -Decrease GI motility -Decrease in secretions/ salivation -Dilation of pupils (mydriasis) -Increase in RR -Decrease bladder contraction Client teaching -give with food -avoid driving and alcohol -breastfeeding is not recommended -not recommended for patient with narrow angle glaucoma Nasal decongestant -sympathomimetic amines -stimulates the alpha adrenergic receptors to produce vascular constriction of the capillaries within nasal mucosa -frequent use can cause rebound nasal congestion

Systemic decongestants -alpha adrenergic agonist -relieve nasal congestion for longer period -ephedrine, Phenylephrine, neo- synephrine, phenylpropanolamine SE: increase BP and blood sugar, jittery and restless Intranasal glucocorticoids -effective for treating allergic rhinitis (rhinorrhea, sneezing, and congestion) -beclomethasone, budesonide, dexamethasone -can cause dryness of the nasal mucosa Antitusives -act on cough-control center suppress the cough reflex -used for nonproductive and irritating cough (dextromethorphan) - 3 types: narcotic, non narcotic, combination Expectorants -loosen bronchial secretions (guaifenesin) -HYDRATION is the best Sinusitis -systemic or nasal decongestant -fluids and rest Acute pharyngitis -antibiotics (except for viral pharyngitis) -saline gargles -lozenges -fluids -acetaminophen Effects of adrenergics at receptors Alpha 1 increase of heart contraction, vasoconstriction , increase BP, dilates pupils, decrease secretion Alpha 2 inhibits release of norepi, dilates blood vessels, decrease BP, mediate arteriolar and venous construction Beta 1 increase heart rate and force of contraction Beta 2 dilates bronchioles, GI and uterine relaxation

2 major categories of lower respiratory tract 1. Chronic obstructive pulmonary disease (COPD) Chronic bronchitis, bronchiectasis, emphysema and asthma 2. Restrictive pulmonary disease Pulmonary edema and fibrosis, bla bla Chronic bronchitis bronchial inflammation and excessive mucus secretion Bronchiectasis abnormal dilatation of bronchi and bronchioles Emphysema loss of fiber elastin network in the alveoli -enlarged alveoli Bronchial asthma characterized by periods of bronchospasm ir bronchoconstriction, wheezing, mucus secretion and dyspnea Chemical mediators: -histamines -cystokines -serotin -eosinophil chemotactic factor of anaphylaxis (ECF-A)

Drug for acute and chronic lower respiratory disorders Sympathomimetic : alpha 1 and beta 2 adrenergic agonist -increase cAMP; causing dilation of the bronchioles -albuterol (ventolin) selective beta 2 drug, effective for treatment and control of asthma with long -metaproterenol has some beta 1 effect but used as beta 2, for long term asthma treatment, frequently administered by inhalation Isoproterenol stimulates both beta 1 and beta 2 receptors, administered by inhalation or IV Epinephrine alpha 1, beta 1, and beta 2 agonist. Given SQ in acute bronchospasm caused by anaphylaxis. Elevates BP SE: epinephrine tremors, dizziness, HPN, tachycardia, palpitations Beta 2 adrenergics tremors, headaches, nervousness, increase PR and palpitations -may increase blood sugar level Anticholinergics -ipratropium bromide (atrovent, combivent) -treats asthma, few side effects -administered by aerosol, dilates bronchioles Methylxanthine (xanthine) derivatives -aminophylline, theophylline and caffeine -stimulates CNS and respiration, dilates coronary and pulmonary vessels and causes dieresis -increase cAMP

Theophylline toxicity with serum Concentration 20mcg/ml SE: hyperglycemia, decreased clotting time, leukocytosis SE of aminophylline (commonly use) -dizziness, flushing, hypotension, bradycardia and palpitations Leukotriene receptor antagonist and synthesis inhibitors -effective in reducing inflammatory symptoms of asthma, not used for acute asthma attack -zafirlukast, zileuton and montelukast Glucocorticoids -has anti inflammatory action -given if asthma is unresponsive to bronchodilator therapy -has synergistic effect if given with beta 2 agonist -MDI inhaler, tablet (prednisone) -IV (dexamethasone, hydrocortisone) -should be taken with food SE: fluid retention, skin thinning, increased blood sugar and impaired immune response Cromolyn and nedocromil -for prophylactic treatment of asthma, taken daily -only inhibits the release of histamine SE: cough and bad taste (common), rebound bronchospasm Mucolytics -liquefy and loosens thick mucous secretions (acetylcysteine) -bronchodilator should be given 5 mins before mucolytic SE: N&V, stomatitis and runny nose Antimicrobials -used if an infection results from retained mucus secretion