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Nursing Pharmacology: Respiratory drugs


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What are the two types of receptors for histamine?
H1 and H2
What does H1 receptors mediate?
1. smooth muscle contraction
2. dilation of capillaries
What does H2 receptors mediate?
1. exceleration of heart rate
2. exceleration of gastric secretions
What are the overall effects of histamine?
1. contriction of smooth muscle
(especially in the stomach and lungs).
2. Increase in body secretions.
3. vasodilation
4. Increase in capilary permeability.
5. Drop in BP
6. Edema
Name the 4 H2 antagonists or H2 blockers.
1. cimetidine
2. ranitidine
3. famotidine
4. nizatidine
What is the H1 antihistamines (H1 blockers) use for?
the treatment of allergies
Mechanism of Antihistamine
1. Acts by blocking the H1 receptors on the surface of basophils and mast cells.
2. Competes with histamine for the unoccuplied receptors.
**does not push off histamine that is already bound to a cell surface receptors.**
Indications of Antihistamine
1. Skin: wheal, flare formation, and iching.
2. Sesonal or perennial allergic rhinitis
3. Some symptom of common cold
What class of drugs is the action antihistamine similar to?
Side effects of Histamine
1. drowsiness
2. dry mouth
3. change in vision
4. difficulty urinating
5. constipation
Drugs that may interact with Fexofenadine.
erythromycin or ketoconazole
-may increase the level of Fexofenadine-
Drugs that may interact with antihistamine in general.
1. ketoconazole
2. cimetidine
3. erythromycin
4. loratadine
(may increase the concentration of loratadine there by increase the depressant effects)
Class of
cetirizine (Zertec)
H1 antihistamine
class of
desloratadine (Clarinex)
H1 antihistamine
class of
fexofenadine (Allegra)
H1 antihistamine
class of
loratadine (Claritin)
H1 antihistamine
class of and indications for
diphehydramine (Benadryl)
H1 antihistamine
1. allergic disorders
2. night time sleep aid
3. motion sickness
fexofenadine/psuedoephedrine (Allegra-D) is not recommended for person with...
1. hypertension
2. diabetes
3. ischemic heart disease
4. glaucoma
5. hyperthyroidism
6. renal impairedment
7. prostate disease
adverse effects of fexofeadine/psuedoepedrine
may stimulate the nervous system causing cardiac collapse.
class of fexofeadine/psuedoepedrine
H1 antihistamine
Class of cetirizine (Zyrtec)
and indication.
Anticholinergic: H1 antihistamine
treatment of year round allergies as well as seasonal allergies.
Antihistomine should be use in caution in clients with..
1. brochial asthma
2. increase intraoccular pressure
3. prostatic hypertrophy
4. elderly
What are the three group of nasal decongestants?
1. adrenergic (sympathomimetic)
2. anticholinergic (parasympatolytic)
3. topical corticosteroids (intranasal steroids)
Name the commonly used oral decongestant available OTC.
1. pseudoephedrine (Sudafed)
2. guaifenesin (Robintussin)
Name the commonly used nasal decongestant spray available OTC.
phenylephrine (Neo-Synephrine)
List the pros and cons of oral decongestant.
1. pro-longed decongestant effect.
2. no rebound congestion
1. delayed onset activities.
2. less potent than topical decongestant.
3. may affects vascular beds other than those in the nasal mucosa.
4. may also precipitate or agrravate high BP, cardiac arrhythmias, ischemic heart disease, DM, and hyperthyroidism.
List the pros and cons of topical decongestant.
1. produces potent decongestion effect.
2. prompt onset of action.
1. rebound congestion
2. adverse systemic effects such as elevation of BP and CNS stimulation may occurs if the decongestant drains through the nasal passage and swollowed by the client.
Name 5 adrenergic nasal inhalation decongestants.
1. *naphazoline (Privine)* alpha-adrenergic vasoconstrictor
2. tetrahydrozoline (Tyzine Pediatric Drops)
3. oxymetazoline (Afrin)
4. phenylephrine (Neo-Synephrine, Sinex)
5. ephedrine (Pretz-D)
ephedrine (Pretz-D)
nasal inhalation decongestant
naphazoline (Privine)
nasal inhalation decongestant
oxymetazoline (Afrin)
nasal inhalation decongestant
(Neo-Synephrine, Sinex)
nasal inhalation decongestant
Name two adrenergic inhalation decongestion used orally.
1. desoxyephedrine (Vicks inhaler)
2. propylhexedrine (Benzedrex inhaler)
What is the indications for inhaled intranasal steroids and anticholinergic agents?
used prophylactically to prevent nasal congestion in patient with chronic upper respiratory symptoms.
**do not cause rebound congestion**
Name commonly used intranasal steroids.
1. Beconase**
2. Flonase**
3. Vancenase
4. Pullmicort
5. Rhinocort
6. Nasacort
7. nasalide
8. Turbuhaler
What is the mechanism of adrenergic nasal decongestant agents?
-shrink engorged nasal mucosal membranes and relieve nasal stuffiness by stimulating the Alpha1-adrenergic nerve receptors in vascular smooth muscles.
-Thereby constricting the small arterioles that supply the structures of the upper respiratory tract, primarily the blood vessle surrounding the nasal sinuses.
-reduces flow and allows for drainage.
What is the mechanism of nasal steroids decongestant agents?
nasal steroid are aimed at the inflammatory response elicited by the invading organisms (viruses and bacteria) or antigens. Steroids exert their antiinflammatory effect by causing these cells to be turned off rendered unresponsive.
Indications for nasal decongestants.
1. acute or chronic bronchitis
2. common cold
3. sinusitis
4. hay fever
5. allergies
6. reduces swelling of the nasal passages
7. facilitate visualization of the nasal and pharyngeal membranes before sugery or diagnostic procedures.
Contraindications for
adrenergic nasal decongestant.
1. drug allergy
(Adrenergic drugs)
2. narrow-angle-glaucoma
3. uncontrolled cardiovascular disease
4. diabetes
5. thyroid dysfunction
6. prostatitis
Side effects/ Adverse reaction for nasal decongestants.
1. nervousness
2. insomnia
3. palpitation
4. tremor
intranasal steroids:
1. mucosal irritaion
2. mucosal dryness
Systematic effects of nasal decongestants.
1. headache
2. nervousness
3. dizziness
Interactions for nasal decongestants.
1. sympathomimetic drugs and sympathomimetic nasal decongestants are more likely to cause toxicity when given together.
2. MAOIs may result in additive pressor effects (i.e. raising BP) when given with sympathomimetic nasal decongestion.
What should the nurse monitor for when client is using
intranasal steroid products?
1. developement of nasal irritation and dryness
2. systemic steroid effects such as:
- fluid retension
- weight gain
- menstrual irregularities
- muscle weakness
- increase suceptibility to fracture and infection.
- decrease effetiveness of immunization due to steroidal effects.
What is Cromolyn Sodium
drug use in the tratment of allergic rhinitis.
Class & Mechanism of cromolyn sodium
-Antiallergic Agent & Antiasthmatic drug (prophylactic)
-inhibits histamine release and other chemical agents liberated as a result of allergic response by stabilizing mast cells.
What is that advange of saline nose drop?
1. non habit forming
2. can be use more often during the day than most decongestants
3. inexpensive
Name 5 commonly use expectorants.
1. ammonium chloride
2. guaifenesin* (Robitussin, Guiatuss, Humibid)
3. potassium iodine* (SSKI)
4. iodinated glycerol* (Iophen, Organidine)
5. terpin hydrate
Class and Mechanism of
(Robitussin, Guiatuss, Humibid)
-Reflex stimulation:
loosening and thinning of the respiratory tract;
-secretions occurs in response to an irritation of the GI tract produced by the drug.
Side effects of
(Robitussin, Guiatuss, Humibid)
1. stomach upset
2. nausea
What expectorant is not approved by the FDA?
Ammonium Chloride
Class and Mechanism of iodinated glycerol and potassium iodine
act by direct stimulation of the secretory glands in the respiratory tract.
Class and Mechanism of Ipecac syrup.
stimulate the flow of gastric and respiratory tract secretions.
Usage of Ipecac syrup
1. low dosage (0.25-1) expectorant
2. high dosage (15ml) potent emetic
Class and Mechanism of
Terpin hydrate
-act by stimulating the secretory glands directly to increase natural respiratory tract secretions.
Name two main indications of
1. relief of productive cough.
2. Supression of coughs caused by chronic paranasal sinusitis.
What are the contraindications for expectorants?
1. drug allergy
2. hyperkalemia
(for potassium contanning expectorant)
what are the side effects of expectorant?
1. nausea
2. vomiting
3. GI upset
Iodine= above + rash hypersensitivity
List 2 drugs interations that may occur with the use of expectorant.
1. Iodinated product + lithium or antithyroid drugs = hypothyroidism
2. Iodinated product + potassium-sparing diuretics = hyperkalemia
Name the 3 narcotic antitussive agents.
1. codine phosphate
2. hydrocodone bitartrate
2. guaifenesin and codine (Robitussin A-C)
Describe the MOA of narcotic antitussive agents.
supress the cough reflex through a direct action on the cough center in the CNS.
List the side effects of narcotic antitussive:
Codine & Hydrocodone
1. sedation
2. nausea
3. vomiting
4. lightheadedness
5. constipation
List interaction that may occurs with narcotic antitussive:
Codine & Hydrocodone
potentiate the effects of:
1. other opiods
2. general anesthetics
3. tranquilizers
4. sedative or hypnotics
5. tricyclic antidepressants (TCAs)
6. MAOIs
7. alcohol
8. other CNS depressants
narcotic antitussive must be use in great caution with:
1. preexisting pulmonary distress
2. those using psychotropic agents
3. sedative-hypnotics
4. alcohol
5. other CNS depression
List the three non-narcotic antitussive agents.
1. benzonatate (Tessalon)
2. dextromethorphan HBr* (benylin DM, Robitussin DM)
3. diphenhydramine HCl (Benedryl)
Mechanism of
dextromethorphan HBr
(Benylin DM, Robitussin DM)
acts on the cough center inthe medulla, but does not cause respiratory depression, analgesia, or dependence.
Mechanism of
benzonatate (Tessalon)
acts by providing local anesthetic action, which impairs sensation of the stretch receptors located in the respiratory tract, thereby interfering with the cough reflex.
Side effects of
dextromethorphan HBr
(Benylin DM, Robitussin DM)
1. dizziness
2. drowsiness
3. nausea
side effects of
benzonatate (Tessalon)
1. dizziness
2. headache
3. sedation
4. nausea
5. constipation
6. pruritus
7. nasal congestion
side effects of
diphenhydramine (Benedryl)
1. sedation
2. dry mouth
3. and other anticholigic effects
Interaction for nonnarcotic antitussin:
dextromethorphan HBr
(Benylin DM, Robitussin DM)
dextromethorphan may potentiate the serotonergic effects of MAOIs and thus concurrent administration is contraindicated.
Decribe the mechanism of brochodilation caused by sympathomimetic agents.
when the Beta 2 receptors of mast cells is stimulated by sympathomimetic agents, there is an increase in the formation of cyclic AMP. cAMP is associated with smooth muscle relaxation and bronchodilation.
Sympathomimetic agent => B2 => cAMP => bronchodilation.
Give 2 examples of commonly used sympathomimetic bronchodilators:
1. albuterol (Proventil, Ventolin)
2. terbutaline sulfate (Brethaire, Brethene, Bricanyl)
What should clients taking sympathomimetic bronchodilators be monitored for?
1. changes in cardiac function
2. changes in BP
3. CNS stimulations such as insomnia, nervousness, anxiety, tremor, and GI disturbances.
List contraindications for sympathomimetic bronchodilators.
Client on sympathomimetic bronchodilators should not use:
1. MAO inhibitors
2. tricyclic antidepressants
3. antihisamine
4. sodium levothyroxine
Describe the mecahinism of Xanthine Bronchodilators.
The agent interfere with the action of phosphodiesterase, an enzyme that breaks down cyclic AMP to inactive product. An increase in intracellular cAMP leads to brochodilation.
Xanthine x=> PhDR x=> cAMP => bronchodilation
Give 3 classes of Xanthan.
1. caffeine
2. theophylline
3. theobromine
List side effects of Xanthine.
1. tachycardia
2. dysrhythmias
3. diuresis
Name 4 example of Xanthine bronchodilator drugs.
*generic name ends with "phylline"*
1. aminophylline
2. dyphylline
3. oxtriphylline
4. theophylline
what is the rate of administration for aminophylline?
not exceed 25mg/min using a contiuous IV infusion pump.
What should the client who are taking Xanthine bronchodilator drugs be monitored for?
stimulation of CNS:
1. insomnia
2. hyperexcitability
3. potential for seizure activity
What is the therapeutic range for theophylline and when should it be taken?
10-20 mcg/mL
1-2 hours after immediate acting
about 4 hours after sustained-release
List the side effects of Xanthine bronchodilator drugs.
1. nausea
2. vomiting
3. anorexia
Others: gasstrointestinal reflux, sinus tachycardia, ventricular dysrhythmias, increase urination, hyperglycemia.
How do you treat an overdose of Xanthine bronchodilator drugs.
with syrup of ipecac
List drugs that will interact with Xanthine bronchodilator drugs
1. allopurinol
2. cimetidine
3. erythromycin
4. flu vaccine
5. contraceptives
list the indications for Xanthine bronchodilator drugs
1. acute asthma
2. chronic bronchitis
3. emphysema
List contraindication to Xanthine bronchodilator drugs
1. drug allergy
2. cardiac dysrhythmias
3. seizure
4. hyperthyroidism
5. peptic ulcers
Name three leukotriene receptor antagonists.
1. zafirlukast (Acculate)
2. montelukast (Singular*)
3. zileuton
Classificaion of
montelukast (singular)
leukotriene receptor antagonists: antileukotriene
Mechanism of leukotriene receptor antagonists
Act by bloking leukotriene-mediated bronchoconstriction.
Indications of leukotriene receptor antagonists
1. chronic stable asthma
2. exercise-induced asthma attacks
3. allergies
**not for acute asthma attack**
Side effects of leukotriene receptor antagonists.
1. headache
2. drowsiness
3. fatique
4. GI diturbances
5. liver dysfunction
What are some cautions for client taking leukotriene receptor antagonists?
clients taking zafirlukast (Acculate) who are also taking Warfarin should be monitored to adjust the anticoagulant as needed.
What is the only anticholinergic drug use as a brochodilators?
ipratropium bromide (Atrovent)
Mechanism of
ipratropium bromide (Atrovent)
antagonize the action of acetylcholine, thereby resulting in bronchodilation.
Contraindications of
ipratropium bromide (Atrovent)
clients with glaucoma
Side effects of zafirlukast (Acculate)
1. headache
2. nausea
3. diarrhea
What are the adverse effects of
ipratropium bromine(Atrovent)
1. dry mouth or throat
2. GI distress
3. headache
4. coughing
5. anxiety
What is the contraindications of
ipratropium bromide (Atrovent)
hypersensitivity to atropine or any of its derivatives
What is a mucolytic agent?
agent that reduces the thickness and the stickiness of pulmonary secretions so that removal by ciliary action and cough is facilitated and pulmonary ventilation can be improved.
Name the most commonly used mucolytic agent.
acetylcysteine (Mucomyst)
Class and mechainism of
acetylcysteine (Mucomyst)
mucolytic agent
it breaks down chemical bond resposible for the high viscosity of mucus.
What are the methods of administration of
acetylcysteine (Mucomyst)
1. nebulization: tent, facemask, or mouthpiece
2. direct instillation of the solution into an intratracheal catheter.
What are some of the dos donts concerning with the administration of
acetylcysteine (Mucomyst)
1. should not be mixed with many drugs
2. should not touch iron, copper, and ruber.
3. should be made to use only glass, plastic, aluminum, or stainless steel part.
What are the adverse effects associated with
acetylcysteine (Mucomyst)
development of bronchospasm as a result of the aerosol administration.
Usage of:
cromolyn sodium and nedicromil sodium
1. prophylactic treatment of bronchial asthma in client who require long-term therapy to control their disease.
2. those whose asthma attacks follow a predictable pattern.
Mechanism of:
cromolyn sodium and nedicromil sodium
inhibits the release of histamine and other substances from sensitized mast cells.
How is cromolyn sodium and nedicromil sodium administer?
poorly absorbed from the gastrointestinal, so they are generally adminitered by inhalation as a solution to be inhale by a nebulizer.
Contraindication for:
cromolyn sodium and nedicromil sodium
1. acute asthma attack
2. status asthmaticus
side effects of:
cromolyn sodium and nedicromil sodium
1. cough
2. bronchospasm
What are some nursing implication for:
cromolyn sodium and nedicromil sodium?
1. properly instruct client on the method of administration
2. impressed the client with the need for adhering to the prescribed regiment.
When is cromolyn administer by orally?
in the treatment of mastocytosis becuse cromolyn dose exert a local action in the mast cells w/i the GI tract.
When is corticosteroid use in the respiratory system?
prophylactic treatment of bronchial asthma.
mechanism of corticosteroid
produce an antiinflammatory effects by decrease the number of inflammatory cells in the respiratory tract, which leads to decrease bronchoconstriction.
What are some common corticosteroid inhaler drugs use in the treatment of asthma?
*most generic name ends with "sone"*
1. beclomethasone* (Beclovent, Vanceril)
2. flunicasone (Flonase*, Flovent)
Side effets/Adverse reaction of corticosteroids inhalers.
1. GI distress
2. cough
3. dizziness
4. headache
5. bad taste in your mouth
6. oral fugal infection (candidiasis)
What the two example of mast cell stablizers?
1. cromolyn
2. nedocromil
What is the mechanism of cromolyn and nedocromil?
indirect-acting agents because they prevent the release of various intracelluar chemical mediators that cause brochospasm, as oppose to blocking the receptors for these substances.
What is the use for
cromolyn and nedocromil?
used as adjuncts to the overall management of Pt. with asthma and are used solely for prophylaxis, not for acute asthma attacks.
What are the side/adverse effects of
cromolyn and nedocromil?
1. coughing
2. sore throat
3. rhinitis
4. bronchospasm
other includes: taste chages, dizziness, and headache.
What is the class, action, and uses of cyproheptadine?
-exerts a local anesthetic action
-treatment of pruritus
Class and uses of:
cyclizine, trimeprazine, methdilazine, meclizine, and promethazine.
*generic name ends with "zine"*
-preventing or countering
motion sickness as well as
nasea and vomiting.
Name the three antihistamine that are currently available in US, and are similar in chemicle structure to phenothiazine antipsychotic agents.
1. trimeprazine
2. methdilazine
3. promethazine
These three agents are contraindicated in what types of clients? trimeprazine, methdilazine, promethazine
1. comatose
2. sensitive to phenothiazine drugs
3. hepatic disorders
4. CNS depression (due to barbiturates, narcotic analgesics, or alcohol)
Class, mechanism, effects of:
astemizole (Hismanal)
cetirizine HCl (Zyrtec)
loratadine (Claritin)
fexofenadine (Allegra)
-H1 antihistamine
-specific in blocking peripheral H1 histamine receptors.
-result in lower incident of sedation.

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