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Respiratory agents

Upper respiratory infections:

1. Colds prevalent, caused by rhinovirusRHINORRHEA, nasal congestion, cough

2. Acute rhinitis inflammation of mucous membranes of the nose3. Sinusitis4. 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

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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 1increase heart rate and force of contraction

Beta 2dilates bronchioles, GI and uterine relaxation

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2 major categories of lower respiratory tract

1. Chronic obstructive pulmonary disease (COPD)Chronic bronchitis, bronchiectasis, emphysema and asthma

2. Restrictive pulmonary diseasePulmonary 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

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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