Drugs Acting on

Respiratory System
By: Levi Posadas, R.N.
 The respiratory system is essential for survival. It brings oxygen into
the body, allows for the exchange of gases, and leads to the expulsion
of carbon dioxide and other waste products.
 The normal functioning of the respiratory system depends on an
intricate balance of the nervous, cardiovascular, and musculoskeletal
systems.
 Numerous conditions can affect the respiratory tract and interfere with
the body’s ability to ensure adequate oxygenation and gas exchange.
 General Function:
The major function of the respiratory system is to:
 Deliver oxygen to the body
 Remove Carbon Dioxide in the cells
through the process of Respiration

Gas exchange from

air to blood, & blood to
body cells.
Protector of the systemic circulation by
filtering debris/particles.
Anatomy & Physiology
Respiratory System is composed of 2 Parts:

Upper Respiratory Tract

Lower Respiratory Tract

Upper Respiratory Tract

This is known as the

upper airway, warms
and filters inspired
air.
Lower Respiratory Tract

This accomplish gas

exchange
Lungs
 The lungs are paired elastic
structures enclosed in the
thoracic cage.
 Primary organ of the
respiratory system.
 It delivers oxygen to the body
through the process of
respiration.
2 Process happening in Respiration:
1. Inhalation
 To breathe in
2. Expiration
 To breathe out
 Pleura
 It is a membrane that lined the lungs & thoracic cage

 Visceral Pleura
 Covers the lungs
 Parietal Pleura
 Covers the thoracic cage
Alveoli
 The functional Unit of
the lungs.
 It is where the
process of
respiration happens.
Drugs Acting on the Upper
Respiratory System

Drugs that affect the respiratory

system work to keep the
airways open and gases moving
efficiently.
 ANTITUSSIVES

 These are drugs that suppress the cough reflex.

Many disorders of the respiratory tract, including the
common cold, sinusitis, pharyngitis, and pneumonia,
are accompanied by an uncomfortable,
unproductive cough. Persistent coughing can be
exhausting and can cause muscle strain and further
irritation of the respiratory tract.
 Therapeutic Actions and Indications

 The traditional antitussives which act directly on the

medullary cough center of the brain to depress the cough
reflex.
 All of these drugs are indicated for the treatment of
nonproductive cough.
Pharmacokinetics

 Dextromethorphan are rapidly absorbed, metabolized in

the liver, and excreted in urine. They cross the placenta
and enter breast milk. Benzonatate is metabolized in
the liver and excreted in urine. These drugs should not
be used in pregnancy and lactation
Contraindications and Cautions
 Antitussives are contraindicated in 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.
 Careful use is recommended for patients with asthma and emphysema
because cough suppression in these patients could lead to an
accumulation of secretions and a loss of respiratory reserve.
 Patients who need to drive or to be alert should use dextromethorphan
with extreme caution because these drugs can cause sedation and
drowsiness. These drugs should not be used during pregnancy and
lactation because of the potential for adverse effects on the fetus or baby,
including sedation and CNS depression.
 Adverse Effects
 Traditional antitussives have a drying effect
on the mucous membranes and can
increase the viscosity of respiratory tract
secretions. Because they affect centers in
the brain, these antitussives are associated
with CNS adverse effects, including
drowsiness and sedation.
 Their drying effect can lead to nausea,
constipation, and complaints of dry mouth
 The locally acting antitussives are
associated with gastrointestinal (GI) upset,
headache, feelings of congestion, and
sometimes dizziness.
Drug–Drug Interactions

 Dextromethorphan should not be used with

monoamine oxidase (MAO) inhibitors; hypotension,
fever, nausea, myoclonic jerks, and coma could
occur.
Nursing Consideration
 Assess for possible contraindications or cautions: any history of allergy to any
component of the drug or drug vehicle to avoid allergic reactions.
 Monitor temperature to evaluate for possible underlying infection.
 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
 Monitor for adverse effects (respiratory depression, dizziness, sedation).
 Evaluate the effectiveness of the teaching plan (patient can name drug, dosage,
adverse effects to watch for, specific measures to avoid them, and measures to
take to increase the effectiveness of the drug).
 Monitor the effectiveness of other measures to relieve
ANTIHISTAMINES
 It blocks the release or action of histamine, a chemical
released during inflammation that increases secretions and
narrows airways.
 Antihistamines are found in multiple OTC preparations that
are designed to relieve respiratory symptoms and to treat
allergies. When choosing an antihistamine, the individual
patient’s reaction to the drug is usually the governing factor.
 Therapeutic Actions & Indications
 The antihistamines selectively block the effects of histamine at the
histamine-1 receptor sites, decreasing the allergic response.
 Antihistamines are used for the relief of symptoms associated with
seasonal and perennial allergic rhinitis, allergic conjunctivitis,
uncomplicated urticaria, and angioedema.
 Other uses that are being explored include relief of exercise- and
hyperventilation-induced asthma and histamine-induced
bronchoconstriction in asthmatics. They are most effective if used before
the onset of symptoms.
Pharmacokinetics

 The antihistamines are well absorbed orally, with an

onset of action ranging from 1 to 3 hours. They are
generally metabolized in the liver, with excretion in
feces and urine. These drugs cross the placenta and
enter breast milk
Contraindications and Cautions
 Antihistamines are contraindicated during pregnancy or lactation
unless the benefit to the mother clearly outweighs the potential
risk to the fetus or baby.
 They should be used with caution in renal or hepatic impairment,
which could alter the metabolism and excretion of the drug.
 Special care should be taken when these drugs are used by any
patient with a history of arrhythmias or prolonged QT intervals
because fatal cardiac arrhythmias have been associated with the
use of certain antihistamines and drugs that increase QT
intervals, including erythromycin.
Adverse Effects

 The adverse effects most often seen with antihistamine use are
drowsiness and sedation although second-generation
antihistamines are less sedating in many people.
 The anticholinergic effects that can be anticipated include drying of
the respiratory and GI mucous membranes, GI upset and nausea,
arrhythmias, dysuria, urinary hesitancy, and skin eruption and
itching associated with dryness.
Drug–Drug Interactions

 Drug–drug interactions vary among the

antihistamines; for example, anticholinergic effects
may be prolonged if diphenhydramine is taken with a
monoamine inhibitor, and the interaction of
fexofenadine with ketoconazole or erythromycin may
raise fexofenadine concentrations to toxic levels.
 Nursing Consideration
 Assess respirations and adventitious sounds to monitor drug effects.
 Evaluate liver and renal function tests to monitor for factors that could affect the metabolism
or excretion of the drug.
 Administer drug on an empty stomach, 1 hour before or 2 hours after meals, to increase the
absorption of the drug; the drug may be given with meals if GI upset is a problem.
 Provide safety measures as appropriate if CNS effects occur to prevent patient injury.
 Caution the patient to avoid alcohol while taking these drugs because serious sedation can
occur.
 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.
 Monitor for adverse effects (skin dryness, GI upset, sedation and drowsiness, urinary
retention, thickened secretions, glaucoma).
 EXPECTORANTS

 It increase productive cough to clear the airways. They

liquefy lower respiratory tract secretions, reducing the
viscosity of these secretions and making it easier for the
patient to cough them up.
 Expectorants are available in many OTC preparations,
making them widely available to the patient without advice
from a health care provider. Currently, the only available
expectorant is guaifenesin
Therapeutic Actions and Indications

 Guaifenesin 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.
 The result of this thinning of secretions is a more
productive cough and thus decreased frequency of
coughing.
 Pharmacokinetics

 It is rapidly absorbed, with an onset of 30

minutes and a duration of 4 to 6 hours.
 Contraindications

 This drug should not be used in patients with a known

allergy to the drug to prevent hypersensitivity
reactions.
 It should be used with caution in pregnancy and
lactation because of the potential for adverse effects
on the fetus or baby and with persistent coughs, which
could be indicative of underlying medical problems.
 Adverse Effects
 The most common adverse effects associated with expectorants
are GI symptoms (e.g., nausea, vomiting, anorexia). Some patients
experience headache, dizziness, or both; occasionally, a mild rash
develops.
 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.
 These drugs should not be used for more than 1 week; if the
cough persists, encourage the patient to seek health care.
 Nursing Consideration
 Assess respirations and adventitious sounds to evaluate the respiratory
response to the drug effects.
 Advise the patient to take small, frequent meals to alleviate some of the
GI discomfort associated with these drugs.
 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.
 Monitor for adverse effects (skin rash, GI upset, CNS effects).
 Assess for possible contraindications or cautions: any history of allergy
to the drug
 MUCOLYTICS
 It increase or liquefy respiratory secretions to aid
the clearing of the airways in high-risk respiratory
patients who are coughing up thick, tenacious
secretions.
 Patients may be suffering from conditions such as
chronic obstructive pulmonary disease (COPD),
cystic fibrosis, pneumonia, or tuberculosis.
Therapeutic Actions & Indications

 Acetylcysteine is used orally to protect liver cells

from being damaged during episodes of
acetaminophen toxicity because it normalizes
hepatic glutathione levels and binds with a reactive
hepatotoxic metabolite of acetaminophen.
Pharmacokinetics

 The medication may be administered by nebulization

or by direct instillation into the trachea via an
endotracheal tube or tracheostomy.
 Acetylcysteine is metabolized in the liver and
excreted somewhat in urine. It is not known whether
it crosses the placenta or enters breast milk.
Dornase alfa has a long duration of action, and its
fate in the body is not known.
Contraindications & Cautions

 Caution should be used in cases of acute

bronchospasm, peptic ulcer, and esophageal varices
because the increased secretions could aggravate
the problem.
 There are no data on the effects of the drugs in
pregnancy or lactation.
Adverse Effects

Adverse effects most commonly associated

with mucolytic drugs include GI upset,
stomatitis, rhinorrhea, bronchospasm, and
occasionally a rash.
 Nursing Consideration
 Assess for possible contraindications or cautions: any history of allergy to the drugs and the
presence of acute bronchospasm, which are contraindications to the use of these drugs.
 Avoid combining with other drugs in the nebulizer to avoid the formation of precipitates and
potential loss of effectiveness of either drug.
 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
 Monitor for adverse effects (CNS effects, skin rash, bronchospasm, and GI upset).
 Monitor the effectiveness of comfort and safety measures and compliance with the regimen.
 Offer support and encouragement to help the patient cope with the disease and the drug
regimen.
 NOTE:
Mucolytics work to break down mucus to aid high risk
respiratory patients in coughing up thick, tenacious
secretions.
Dornase alfa is specific for the treatment of patients
with cystic fibrosis, which is characterized by a thick,
tenacious mucus production that can block airways.