Kuntarti, SKp, MBiomed

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Drugs affecting the Respiratory

Systems

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Anatomy & Physiology of

respiratory
1. The Upper respiratory tract

nares, nasal cavity, pharynx,& larynx

2. The Lower respiratory tract

trachea, bronchi, bronchioles, alveoli,

& alveolar-capillary membrane

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Ventilation & Respiration

Ventilation
is the movement of air from the
atmosphere through the upper & lower
airways to the alveoli
Respiration
the process whereby gas exchange
occurs at the alveolar-capillary membrane

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Phases of respiration
1.

Ventilation
in which oxygen passes through the airways

2.

Perfusion
in which blood from the pulmonary circulation is
adequate at the alveolar-capillary bed

3.

Diffusion of gases
in which oxygen passes into the capillary bed to be
circulated and carbon dioxide leaves the capillary bed &
diffuses into the alveoli for ventilatory excretion

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Lung compliance
1.
2.

Connective tissue (collagen & elastin)

Surface tension in the alveoli (by surfactant)

Control of respiration

Chemoreceptors changes of concentration of O2,

CO2, H+
*

The central chemoreceptors: in the medulla near the

respiratory center & cerebrospinal fluid (by: CO2 & pH)
* Peripheral chemoreceptors: in the carotid & aortic bodies (by:
changes of oxygen levels)

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Bronchial smooth muscle

Contraction constricts the airway

* The vagus nerve (parasympathetic nervous
system) acetylcholine bronchoconstriction
* The sympathetic nervous system epinephrine
bronchodilatation

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Common manifestations of
respiratory disease

Sneeze
- caused by a foreign body or irritant; inflammation
- the early stages of a cold
- requires no medication; a steroidal nasal spray for
prophylactic
- Sodium cromoglycate for prophylactically in the control
of allergic rhinitis by topical inhalation (Hopkins, 1992)

Sputum
- purulent (by infection); frothy (by pulmonary edema);
bloodstained (by haemoptysis); tenacious (by cystic
fibrosis or mucous plugging)
- Expectorants to liquefy mucus

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Common manifestations of
respiratory disease

Noisy breathing
- Stridor is a rasping sound heard predominantly in
inspiration
- a cough that is caused by inflammation of the mucosa of
the larynx, trachea, & bronchi, with narrowing of the
subglottic area (by virus)
- Medication: moist inhalations, nebulized steroids &
adrenalin

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Drugs affecting the Respiratory

Systems

Drugs for asthma

1. anti-inflammatory agents
2. bronchodilators
Drugs for rhinitis, cough, & colds
1. nasal decongestans
2. antihistamines
3. anti-inflammatory agents
4. antitussives
5. Expectorants & mucolytics

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Asthma

common in children & adults

characteristic signs: breathlessness,
tightness in chest, wheezing, dyspnea, &
cough
chronic inflammatory disorder of the
airway  a reaction to allergens
symptoms of asthma: combination of
inflammation & bronchoconstriction

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Drugs for asthma

2 main pharmacologic class:
1. Anti-inflammatory agents: glucocorticoids &
cromolyn
2. Bronchodilators: beta2 agonists

most antiasthmatic drugs can be administered by

inhalation, caused:
- therapeutic effects are enhanced (by delivering drugs directly
to their site of action)
- systemic effects are minimized
- relief of acute attacks is rapid

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Bronchodilator & antiasthma

Sympathomimetics/Beta2-Adrenergic agonist
- Examples: epinephrine, isoproterenol, isoetharine,
albuterol, terbutaline, ephedrine
- Use/ mechanism of action: treat asthma, bronchitis,
& emphysema by stimulating beta2 receptors in bronchial
smooth muscle to produce bronchodilatation, & thereby
relieve bronchospasm

- Adverse effect:
CNS: restlessness, anxiety, dizziness,headache,
insomnia; Cardiovascular: palpitations, cardiac
arrhythmias, tachycardia, hypertension, cerebrovascular
accidents, angina; GI: nausea, severe vomiting, diarrhea

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Sympathomimetics

Adverse effect:
Skin: local necrosis & tissue sloughing from
extravasated intravenous catecholamines

Contraindication:cardiovascular diseases,
phenochromacytoma, hypertension

Precaution: hyperthyroidism, diabetes, & pregnancy

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Glucocorticoids (steroid)

Examples: dexamethasone, betamethasone, prednison

Use/mechanism of action: steroids reduce symptoms of
asthma by suppressing inflammation (decreased synthesis
& release of inflammatory mediators; decreased
infiltration & activity of inflammatory cells; decreased
edema of the airway mucosa)
Adverse effect: inhalation oropharingeal candidiasis &
dysphonia (hoarseness & speaking difficulty); oral (in
prolonged therapy adrenal suppression, osteoporosis,
hyperglycemia, peptic ulcer disease, & suppression of
growth (in young patients)

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Glucocorticoid

Contraindication: systemic fungal

infections; individuals receiving live-virus
vaccines
Cautions: pediatric, pregnant & breast
feeding woman

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Cromolyn/ Mast cell stabilizers

Examples: Cromolyn, Nedocromyl

Use/ mechanism of action: Cromolyn suppresses
inflamation by stabilizing the cytoplasmic
membrane of mast cells, thereby preventing
release of histamine & other mediators. Cromolyn
inhibits eosinophils, macrophages & other
inflammatory cells
Adverse effects: cromolyn is the safest of all
antiasthmatic medications, the most common
reactions are wheezing, coughing & unpleasent
taste

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Methylxanthines

Examples: Theophylline, aminophylline,

dyphylline
Use/ mechanism of action: theophylline produces
bronchodilatation by relaxing smooth muscle of
the bronchi, the most probable mechanism is
blockade of receptors for adenosine.
Adverse effects: theophylline has a narrow
therapeutic range, & hence dosage must be
carefully controlled; at plasma levels > 20g/ml :
nausea, vomiting, diarrhea, insomnia, restlesness,
dysrhythmia & convulsion

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Anticholinergic/ muscarinic antagonist

Examples: atropine, ipatropium bromide

(atrovent)
Use/ mechanism of action: by blocking
muscarinic cholinergic receptors in bronchi, &
thereby promotes bronchodilatation
Adverse effects: dryness of oropharynx, cough

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Drugs for rhinitis

Rhinitis: an inflammation of the nasal

mucous membranes
Symptoms: sneezing, rhinorrhea, nasal
itching, & nasal congestion
Allergic & non-allergic
Drugs: (1) nasal decongestants (2)
antihistamines (3) intranasal antiinflammatory

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Nasal decongestants

Examples: phenylephrine, phenylpropanilamine (ppa)

Use/ mechanism of action: by stimulating alpha1adrenergic receptors on smooth muscle of nasal
blood vessels  vasocontriction  shrinkage of
swollen membranes nasal drainage; topical
administration more rapid & intense than oral
administration
Adverse effects: rebound congestion; CNS
stimulation; cardiovascular effects widespread
casoconstriction
Contraindication & caution: hypertension & CAD

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Antihistamines (H1-receptor antagonist)

Examples: diphenhydramine, chlorpheniramine,

promethazine, azatadine (1st generation), terfenadine,
astemizole, loratadine (2nd generation)
Use/ mechanism of actions: these agents can relieve
sneezing, rhinorrhea, & nasal itching by blocking H1
receptor & thereby preventing the actions histamines
at these sites
Adverse effects: sedation (1st generation), cardiac
dysrytmia, dizzines, nausea, vomiting,constipation,
dry mouth

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Drugs for cough & cold

Cough: a complex reflex involving the

central & pheripheral nerve systems &
muscles of respiration can be initiated by
irritation of the bronchial mucosa
(+): remove foreign matter & excess
secretions from the bronchial tree
(-): deprive us of comfort & sleep

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Common cold: an acute upper respiratory

infection of viral origin
Symptoms: rhinorrhea, sneezing, cough,
sore throat, headache, malaise,& myalgia
Combination cold remedias, 2 or more of:
1. nasal decongestants
2. antitussives
3. analgesic
4. antihistamines
5. caffeine

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Antitussive agents

Examples: opioid  codeine, hydrocodone; nonopioid dextromethorpan hydrobromide (DMP)

Use/ mechanism of action: suppress coughing by
altering response threshold of cough center in the
medulla or peripherally by inhibiting pulmonary
stretch, thus decreasing impulses to the cough
center

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Antitussive agents

Adverse effects:
- Codeine: impaired alertness or coordination,
hypersensitivity, dependence; toxic reactions: euphoria,
hyperactivity, nystagmus, uncoordinated movements,
stupor, shallow breathing
- DMP: drowsiness & GI upset; toxic reaction: miosis,
bradycardia, tachycardia, hypotension, narcosis, seizures,
circulatory collapse

Contraindication: pregnancy, lactation, known

hypersensitivity

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Antitussive agents

Precautions: benign prostatic hypertrophy, debilitation,

thoracotomy, laparotomy, history of drug abuse

Drug interactions:
- DMP and MAO (monoamine oxidase) inhibitors:
excitation, hyperpyrexia
- narcotic/opioid antitussive with MAO inhibitors,
alcohol, & other CNS depressants: potentiation of CNS
depressive effects

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Expectorants agents

Examples: ammonium chloride, guaifenesin/glyceryl

guaiacolate (GG)

Use/ mechanism of action:facilitate expulsion of

mucus by reducing adhesiveness and surface tension of
mucus

Precaution:liver and renal insufficiency

Adverse effects:
- GG: drowsiness, nausea, vomiting

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Mucolytic agents

Examples: bromhexin, ambroxol, acetilcistein,

hypertonic saline

Use/ mechanism of action: enhance mucolysis by

altering molecular composition of mucus, reducing

viscosity; ambroxol: stimulate surfactant production of
premature infant with respiratory distress syndromes

Precaution: gastric ulcer

Adverse effects:
- bromhexin: nausea, serum transaminase level
- acetilcistein: bronchial spasm, nausea, vomiting,
stomatitis, haemoptysis

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Nursing diagnosis
1.

2.

3.

Ineffective airway clearance related to

mucus accumulation manifested by cough &
ronchi
Risk for infection related to build up of
respiratory secretions
Risk for injury related to CNS depression

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Nursing implementation

Administration procedures
* Increase fluid intake of client taking expectorant

Daily monitoring & measurements

* Monitor client taking codeine for signs of respiratory depression

Client teaching
1. Explain to client the importance of increasing fluid intake when
taking expectorant
2. Encourage patient who is confined to bed and taking expectorant to
turn, breathe deeply, & cough every 2 hours
3. Warn client taking a narcotic antitussive not to drink alcohol
4. Caution client that prolonged use of codeine may cause
dependence
5. Show client how to use and clean nebulizer for acetylcystein
administration

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Nursing evaluation
Client shows:

Absence of coughing.

Improved ability to cough up mucus.

No signs or symptoms of infection
(Cardinal signs).

No signs of excessive CNS depression.

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