Drugs Acting On Respiratory System

DRUGS ACTING ON
RESPIRATORY SYSTEM
Unit 1, Module 6 Week 6
Intended Learning outcomes
• Upon completion of this unit, the learner should be able to:
1 Classify a list of respiratory system drugs according to action..
2. List uses, side effects and contraindications for bronchodilators and antitussives.
3. Explain appropriate patient education for those receiving respiratory system drugs.
4. Describe the action and uses of the antihistamine and decongestants.
5. List the side effects, contraindications and interactions of the antihistamines

and decongestants.
Concept (BRONCHODILATORS)
Breathing and coughing techniques – This will facilitate the removal of respiratory
secretions and optimize oxygen exchange.
Relaxation techniques – Since anxiety may result in respiratory difficulty, review
ways to alleviate anxiety such as music ad relaxation techniques
Evaluate heart rate and blood pressure – Teach client to monitor heart rate and BP
since an undesirable effect of these medications may be tachycardia, cardiac
arrhythmias and a change in blood pressure (Beta2, Adrenergic Agonists can cause
hypertension; methylxanthines can cause hypotension at theophylline level Less
30=35 mcg/ml
Arm identification – Recommend clients having asthmatic attacks to wear an ID
bracelet or tag.
Tremors – Evaluate client for tremors form these medications.
Have 8 or more glasses of fluids – Fluid will assist in decreasing the viscosity of
respiratory secretions.
Emphasize no smoking – Encourage the client to stop smoking under medical
supervision.
Action – Relaxes the smooth muscles of the bronchial tree, thereby relieving
bronchospasm and increasing the vital capacity of the lungs.
Indications – Used in the symptomatic treatment of acute respiratory conditions such
as asthma, as well as many forms of COPD
Classifications – Includes the sympathomimetic (adrenergic), the

parasymptholytics (anticholinergics) and the xanthine derivatives .
Sympathomimetics (adrenergics) – Potent bronchodilators that increase vital
capacity and decrease airway resistance. Work on the smooth muscle in the lungs
to cause relaxation. However, they also can affect the entire sympathetic nervous
system. May produce serious side effects and manufacturer’s directions should be
followed carefully regarding dosage and administration. The inhalation route of
administration is preferred to minimize systemic adverse effects.
Side effects - .Include potentiation of theophylline effects with increased risk of
toxicity, especially: GI – nausea, vomiting, decreased appetite; CNS stimulation –
nervousness, tremor, dizziness; Cardiac irregularities – tachycardia, palpitations,
arrhythmias, angina; hypertension, hyperglycemia.
Cautions – First administration, which should be observed by medical personnel for

hypersensitivity reactions; contacting physician if decreased effectiveness occurs;
close monitoring, if administering oral inhaled adrenergics with other oral inhaled
bronchodilators, for cardiovascular effects; Patients on beta-blocking drugs (Inderal)
will have a significant decrease in the effectiveness of adrenergic drugs; patients with
cardiovascular or kidney disorders, diabetes, seizure disorders or hyperthyroidism .
Parasympatholytics (anticholinergics) – Atrovent, achieve bronchodilation by
decreasing the chemical that promotes bronchospasm. Block the parasympathetic
nervous system and can cause drying of pulmonary secretions. Adequate hydrations
should be encourages to avoid mucus plugging.
Side effects – Cardiac effects – changes in heart rate, palpitations; CNS stimulation –
headache, drowsiness, dizziness, confusion, agitation; thickened secretions and mucus
plugging .
Cautions –Not indicated for patients with unstable cardiac status, history of heart
attacks, glaucoma, drug sensitivity or prostatic hypertrophy.
Drug – Tiotropium (Spiriva) similar to ipratropium., is administered daily (vs four
times daily from ipratropium), is more effective than ipratropium and may lead to a
reduction in the use of sympathomimetics for maintenance or rescue therapy.
Xanthines derivatives (theophylline and aminophylline) – cause bronchodilation. No
longer a first-line treatment, because individuals metabolize xanthines of different
rates, appropriate dosage must be determined by carefully monitoring the patient’s
response, tolerance, and blood concentration. For faster absorption, oral forms may be
taken with a full glass of water in an empty stomach, To reduce gastric irritation, take
with meals.
Side effects – GI distress – nausea, vomiting, epigastric pain, abdominal cramps,

anorexia or diarrhea; CNS stimulation – nervousness, insomnia, irritability, headache,
tremors, seizures (can be fatal); cardiac effects – palpitation, tachycardia, arrhythmias,
especially with rapid IV administration, urinary frequency (mild diuresis);
hyperglycemia .
Cautions –Cardiovascular, kidney. Pulmonary or liver dysfunction; diabetes, peptic
ulcer or glaucoma; children and older adults – more prone to toxicity; IV injection –
must be done slowly; patients undergoing influenza immunization or who have
influezxa; pregnancy and lactation.
Interactions - Cimitide, allopurinol, erythromycin, oral contraceptives, calcium
channel blockers and beta-blockers which increase theophylline levels; smoking,
barbiturates, phenytoin and rifampin which decrease theophylline effectiveness.
Patient education – Following the written directions on the package very carefully
regarding dosage and administration because of the danger of serious side effects;
watching closely for cardiac irregularities or CS stimulation )e.g. nervousness, tremor,
dizziness, confusion, headache) and reporting these symptoms to the physician
immediately; other side effects possible with adrenergics and xanthines, for example
gastric distress, insomnia or hyperglycemia; drinking adequate fluids to prevent mucus
plugging, especially with anticholinergics; avoiding any new medication, including
OTC without consulting the physician first because of the danger of serious
complications; many interactions are possible; avoiding changing brands of medicine
without consulting the physician or pharmacist. .
Expectorants and mucolytics
Expectorants – (guaifenesin and others) Increase secretions, reduce viscosity and help
to expel sputum.
Mucolytics (acetylcysteine – Mucomyst) liquefy pulmonary secretions
Side effects – expectorants: Nausea and vomiting, diarrhea; runny nose; drowsiness,
dizziness and headache.
Contraindications – Patients with persistent or chronic cough; some asthmatic (prone
to bronchospasm); cardiovascular disease and hypertension, especially with
combination products; pregnancy or lactation.
Drugs – Mucolytic: acetylcysteine (Mucomyst); Expectorant: guaifenesin
(Mucinex, Robitussin) .
Antitussives
Medications to prevent coughing in patients not requiring a productive cough.
Coughing a reflective mechanism, helps eliminate secretions from the respiratory
tract.
Side effects – expectorants: Nausea and vomiting, diarrhea; runny nose; drowsiness,
dizziness and headache.
Contraindications – Patients with persistent or chronic cough; some asthmatic (prone
to bronchospasm); cardiovascular disease and hypertension, especially with
combination products; pregnancy or lactation.
Drugs – Mucolytic: acetylcysteine (Mucomyst); Expectorant: guaifenesin
(Mucinex, Robitussin) .
Antihistamines
Action – Blocks histamine release at H1 receptors.
Indications – Upper respiratory allergic disorders; anaphylactic reactions; blood
transfusion reactions; acute urticaria; motion sickness.
Undesirable effects – Depression, sedation, dry mouth, GI upset, bronchospasm,
thickening of secretions, (anticholinergic effects), arrhythmias.
Other specific Information – Alcohol, CNS depressants may increase CNS

depressant effect. Ketoconazole may alter metabolism of antihistamine. Increased
levels and possible toxicity with ketoconazole, erythromycin when given with
fexofenadine. Avoid MNP inhibitors
Interventions – Monitor vital signs, intake and output. If secretions are thick, use a
humidifier.
Antihistamines
Patient education – Instruct client to take with food; drink a minimum of 8 glasses pf
fluid per day. Advise to do frequent mouth care; may use sugarless gum, lozenges or
candy. Notify provider if confusion or other undesirable effects occur. Instruct client not
to drive or operate machinery if drowsiness occurs or until response to drug has been
determined. For prophylaxis of motion sickness, recommend taking 30-60 minutes
before travelling. Avoid alcohol and other depressants.
Evaluation – Client will have improvement of histamine-associated (i.e. rhinitis,

conjunctivitis, motion sickness, etc) with not undesirable effects from the medication.
Drugs – azatadine (Opimine); azelastine (Astelin); brompheniramine (Dimetapp);

buclizine (Buladin-S); cetirizine (Zyrtec); chlorpheniramine (Clor-Trimeton); clemastine
(Tacist); cycline (Mazenine); cyproheptadine (Periactin); diphenhydramine (Benadryl0;
fexofenadine (Allegra); hydroxyzine (Atarax, Vistaril); loratidine (Claritin); meclizine
(Antivert); promethazine (Phenergin); tripelennamine (PBZ).
Antihistamines
Patient education – Instruct client to take with food; drink a minimum of 8 glasses pf
fluid per day. Advise to do frequent mouth care; may use sugarless gum, lozenges or
candy. Notify provider if confusion or other undesirable effects occur. Instruct client not
to drive or operate machinery if drowsiness occurs or until response to drug has been
determined. For prophylaxis of motion sickness, recommend taking 30-60 minutes
before travelling. Avoid alcohol and other depressants.
Evaluation – Client will have improvement of histamine-associated (i.e. rhinitis,

conjunctivitis, motion sickness, etc) with not undesirable effects from the medication.
Drugs – azatadine (Opimine); azelastine (Astelin); brompheniramine (Dimetapp);

buclizine (Buladin-S); cetirizine (Zyrtec); chlorpheniramine (Clor-Trimeton); clemastine
(Tacist); cycline (Mazenine); cyproheptadine (Periactin); diphenhydramine (Benadryl0;
fexofenadine (Allegra); hydroxyzine (Atarax, Vistaril); loratidine (Claritin); meclizine
(Antivert); promethazine (Phenergin); tripelennamine (PBZ).
Decongestants - phenylephrine
(Neosynephrine)
Action – Constrict blood vessels in the respiratory tract, resulting in shrinkage of swollen
mucous membranes and helping to open nasal airway passages. Oral and nasal
decongestants should be used only on a short-term basis because rebound congestion
may occur within a few days. Frequently combined with antihistamines, analgesics,
caffeine and/or antitussives. Many of these products are available over the counter and
by combining several drugs, the possibility of adverse side effects is increased, especially
without adequate medical supervision..
Side effects – Anxiety, nervousness, tremor, seizures; palpitations, hypertension,

headache, cerebral hemorrhage; reduced cardiac output and reduced urine output..
Decongestants - phenylephrine
(Neosynephrine)
Contraindications – Cardiovascular disorder; hyperthyroid or diabetes older adults –
especially those with glaucoma or BPH; pregnancy and lactation.
Interactions – Potentiation of adverse side effects with other adrenergics, ergot,
tricyclics, MAOIs..
Patient education – Using decongestants for only a few days to avoid rebound
congestion. Avoiding when cardiac or thyroid conditions or diabetes are present.
Discontinuing with side effects such as nervousness, tremor, palpitations or
headache. Avoiding combining with any other medication without consulting
physician.

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What are the classifications of bronchodilators discussed?

What are some side effects of bronchodilators?

DRUGS ACTING ON

4. Describe the action and uses of the antihistamine and decongestants.

5. List the side effects, contraindications and interactions of the antihistamines

Classifications – Includes the sympathomimetic (adrenergic), the

Cautions – First administration, which should be observed by medical personnel for

Side effects – GI distress – nausea, vomiting, epigastric pain, abdominal cramps,

Other specific Information – Alcohol, CNS depressants may increase CNS

Evaluation – Client will have improvement of histamine-associated (i.e. rhinitis,

Drugs – azatadine (Opimine); azelastine (Astelin); brompheniramine (Dimetapp);

Evaluation – Client will have improvement of histamine-associated (i.e. rhinitis,

Drugs – azatadine (Opimine); azelastine (Astelin); brompheniramine (Dimetapp);

Side effects – Anxiety, nervousness, tremor, seizures; palpitations, hypertension,

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