5 respiratory agents

8/7/2019 5 Respiratory Agents

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by:

Cirilo Albert Hicban

RN, RM


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Upper Respiratory Infections:

1. Colds prevalent

RHINORRHEA

2. Acute Rhinitis

3. Sinusitis

4. Acute Pharyngitis


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Drugs for Common Upper Respiratory

Problems

Antihistamines

H1 blockers or H1 antagonist

compete with histamine for receptor sites

preventing histamine responserapidly absorbed in 15 minutes, commonly used as

cold remedies

can treat allergic rhinitis but not potent to combat

anaphylaxis


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Antihistamines

First Generation causes drowsiness, dry mouth and

other anti-cholinergic properties (diphenhydramine)

- decreases nasal itching and tickling that causes

sneezing

Second Generation/ Non-Sedating causes feweranti-cholinergic effects (loratidine, cetirizine)


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Give with food

Encourage client to avoid driving and

alcohol

Breastfeeding is not recommendedwhile using the drugs


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Nasal Decongestants

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 agonistrelieve nasal congestion for a longer period

(ephedrine, phenylephrine, neo- synephrine)


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Side Effects:

increases BP and blood sugar,

jittery and restless


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Intranasal Glucocorticoids

effective for treating allergic rhinitis (rhinorrhea,

sneezing and congestion)

Beclomethasone, Budesonide, Dexamethasone

can cause dryness of the nasal mucosa

for short-term use only


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Antitusives

act on cough-control center to suppress the

cough reflex

used for nonproductive and irritating cough

(Dextromethorphan)

3 types: narcotic, non narcotic, combination


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Expectorants

loosens bronchial secretions (Guaifenesin)

HYDRATION is the best expectorant


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EFFECTS OF ADRENERGICS AT

RECEPTORS

ALPHA1 - force of heart contraction,

vasoconstriction, BP, dilates pupils,

secretion

ALPHA2 inhibits release of norepi,

dilates bld vessels, BP, mediate

arteriolar and venous constriction

BETA1 - HR and force of contraction

BETA2 dilates bronchioles, GI and

uterine relaxation


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2 Major Categories of Lower

Respiratory Tract Disorders:

1. Chronic Obstructive Pulmonary

Disease (COPD)

Chronic bronchitis, Bronchiectasis,Emphysema and Asthma

2. Restrictive Pulmonary Disease

Pulmonary edema and fibrosis,

pneumonitis, Lung tumors, Thoracic

deformities


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Drugs for Acute and Chronic Lower Respiratory

Disorders

Sympathomimetics: Alpha-and Beta2-AdrenergicAgonists

increases cAMP, causing dilation of the bronchioles

Albuterol (Ventolin) selective beta2 drug, effective for

treatment and control of asthma with long duration of actionMetaproterenol has some beta1 effect but used primarily

as beta2, for long-term asthma treatment, frequently

administered by inhalation, onset of action is more rapid by

inhalation


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Isoproterenol stimulates both beta1 and beta2 receptors,

administered by inhalation or IV, with short action

Epinephrine alpha1, beta 1 and beta 2 agonist. Given SQ in

acute bronchospasm caused by anaphylaxis

SE: Epinephrine - tremors, dizziness, HPN, tachycardia,

palpitations)

Beta2 adrenergics - tremors, headaches, nervousness,

increase PR and palpitations. May increase blood

sugar level


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Anticholinergics

Ipratropium bromide (Atrovent, Combivent), used to

treat asthma, few side effects, administered by aerosol,combined with Albuterol Sulfate will treat chronic

bronchitis

dilates bronchioles


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Methylxanthine (Xanthine) Derivatives

Aminophylline, theophylline and caffeine. Stimulates

CNS and respiration, dilate coronary and pulmonaryvessels and causes diuresis.

Theophylline Toxicity with serum concentration

>20mcg/ml


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Leukotriene Receptor Antagonist and Synthesis

Inhibitors

effective in reducing the inflammatory symptoms ofasthma, not used for acute asthma attack. Zafirlukast,

Zileuton and Montelukast


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Glucocorticoids (Steroids)

has anti-inflammatory action

given if asthma is unresponsive to bronchodilator

therapy

have synergistic effect if given with beta2 agonist

MDI inhaler, tablet (Prednisone), IV(Dexamethasone, Hydrocortisone)

should be taken with food

SE: fluid retention, skin thinning, increased bloodsugar and impaired immune response

eyelids, lower extremeties, face


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Mucolytics

liquefy and loosens thick mucous secretions

(Acetylcysteine)

bronchodilator should be given 5mins before

mucolytic

SE: nausea and vomiting, stomatitis and runnynose


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Cromolyn and Nedocromil

for prophylactic treatment of asthma, taken daily

not a bronchodilator only inhibits the release of

histamine

SE: cough and bad taste (common), rebound

bronchospasm


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Antimicrobials

used if an infection results from retained mucus

secretions


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5 respiratory agents

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