Effects of Drugs on Respiratory Disorders
The Upper Respiratory Tract
The Lower Respiratory Tract
The Bronchioles and Alveoli
Asthma
Chronic disease caused by increased reactivity of the
tracheobronchial tree to various stimuli
Affects about 16 million Americans
Classified according to cause: allergy, exercise-
induced, or infections of respiratory tract
Asthma and the Bronchioles
Isoproterenol
Isoproterenol (Isuprel) is often used to treat asthma in
children
However, this use is not a labeled indication for the drug
Advise parents and children that saliva and sputum may
appear pink after inhalation—this is normal
Asthma Drugs
Asthma Drugs
Asthma Drugs
Asthma Drugs
Bronchodilators
Agents that widen the diameter of bronchial tubes:
Beta2-adrenergic agonists
Xanthines
Beta2-Adrenergic Agonists: Uses
Drugs of choice in acute bronchospasm; produce
bronchodilation by relaxing smooth muscles of
bronchial tree
Used to relieve bronchospasm of asthma, to treat
bronchitis and other obstructive airway diseases
Beta2-Adrenergic Agonists:
Adverse Effects
Restlessness
Headache
Dizziness
Palpitations
Insomnia
Nausea and vomiting
Anorexia
Tachycardia
Beta2-Adrenergic Agonists:
Contraindications
Contraindicated in glaucoma, cardiogenic shock
Safety during pregnancy and lactation not established
Cautious use in older adults or debilitated patients; and
in those with prostatic hypertrophy, hypertension,
diabetes, hyperthyroidism, Parkinson’s disease,
tuberculosis, and psychoneurosis
Beta2-Adrenergic Agonists:
Patient Information
Instruct patients to not exceed dosage.
Advise patients to eat small, frequent meals to prevent
nausea.
Instruct patients to report chest pain, dizziness,
insomnia, weakness, tremors, irregular heartbeat,
difficulty breathing, productive cough, or lack of
therapeutic effects.
Xanthines
Uses
Drugs chemically related to caffeine that dilate
bronchioles by relaxing smooth muscle
Used for prophylaxis and symptomatic relief of
bronchial asthma and bronchospasm associated with
chronic bronchitis and emphysema
Adverse Effects
Common: palpitations, tachycardia, flushing,
hypotension, insomnia, nervousness, nausea and
vomiting, diarrhea, tachypnea
Serious: respiratory arrest
Xanthines
Contraindications
Should not be given to patients with coronary artery disease,
history of angina, or severe renal or liver impairments
Safety during pregnancy and lactation not established
Cautious use in children and older adults; those with
hyperthyroidism, hypertension, peptic ulcer, prostatic
hypertrophy, glaucoma, and diabetes
Patient Information
Advise patients to take at same time each day.
Instruct patients to avoid charbroiled food, limit caffeine
intake, and avoid smoking.
Women should not breast feed while taking these drugs.
Corticosteroids
Uses
Mechanism of action believed to be diminished activation of
inflammatory cells and increased production of anti-
inflammatory mediators, which reduces production of mucus
and decreases edema
Used to treat respiratory conditions such as nasal congestion
and allergic conditions such as rhinitis and asthma
Adverse Effects
Irritation of mucous membranes
Headache
Pharyngitis
Epistaxis
Nausea and vomiting
Coughing
Corticosteroids:
Contraindications
In children younger than 4 years
Cautious use in pregnancy and lactation, and in those
with immune system infections, tuberculosis, herpes
simplex, ulcers, and nasal surgery or trauma
Patient Information
Advise patients to avoid exposure to chickenpox or
measles
Leukotriene Inhibitors
Uses
Block synthesis of, or the body’s inflammatory response to,
leukotrienes
Used in prophylaxis and treatment of chronic asthma or
allergic rhinitis
Adverse Effects
Arrhythmias
Dizziness
Light-headedness
Anxiety
Headache
Euphoria
Dry mouth
Leukotriene Inhibitors
Contraindications
In those with severe asthma attacks, bronchoconstriction,
status asthmaticus, or during lactation
Cautious use in children younger than 1 year, pregnancy, and
patients with severe liver disease
Patient Information
Instruct patients not to use for severe asthma attacks.
Oral Administration Advantage
The advantage of leukotrienes is oral administration.
Some patients (especially children) do not adhere to
inhaled medications.
Mast Cell Stabilizers
Uses
Inhibit release of bronchoconstrictors such as histamine from
pulmonary mast cells
Used for prophylaxis of mild to moderate seasonal and
perennial bronchial asthma and allergic rhinitis; prevention of
exercise-related bronchospasm; prevention of acute
bronchospasm
Adverse Effects
Nausea and vomiting
Dry mouth
Throat irritation
Cough
Hoarseness
Headache
Dizziness
Urticaria
Rash
Mast Cell Stabilizers
Contraindications
In patients with coronary artery disease or history of
arrhythmias, dyspnea, acute asthma, and status
asthmaticus; during pregnancy; or in children younger
than 6 years
Cromolyn should be used cautiously in those with renal
or hepatic dysfunction.
Patient Information
Advise patients to gargle with water or to suck on
lozenges after each treatment to reduce throat irritation,
cough, and hoarseness
Cough Suppressants
Antitussives
Uses
Opioids work by causing respiratory depression; nonopioids
reduce activity of peripheral cough receptors and appear to
increase threshold of central cough center.
Opioids are used to suppress nonproductive cough;
nonopioids offer temporary relief of cough spasms.
Adverse Effects
Difficulty breathing
Drowsiness
Rash
Itching
Dizziness
Nausea
Nervousness and restlessness
Antitussives
Contraindications
In asthma, emphysema, diabetes, heart disease, seizures,
thyroid conditions, chronic bronchitis, and liver disease.
Cautious use in pregnancy and lactation
Patient Information
Advise patients to call physician if coughing continues
longer than 1 week or mucus is yellow.
Natural Expectorant
Wild cherry bark acts as an expectorant and a mild
sedative. It is available in syrup or tincture forms.
It should not be used during pregnancy
Opioids for Cough
Opioid analgesics are among most effective drugs
used as cough suppressants: 15-mg doses are often
sufficient.
Expectorants and Mucolytics
Expectorants and Mucolytics: Uses
Work by lowering viscosity and facilitating removal of
mucous secretions (acetylcysteine) or enhancing reflex
outflow of respiratory tract fluids by irritating gastric
mucosa (guaifenesin)
Used to treat bronchopulmonary disease and cystic
fibrosis
Expectorants and Mucolytics:
Adverse Effects and Contraindications
Common adverse effects: very few
Contraindicated in pregnancy and lactation.
Guaifenesin may interact with heparin.
Expectorants and Mucolytics:
Patient Information
Instruct patients to increase fluid intake.
Tell patients to report a persistent cough beyond 1
week.
Decongestants
Decongestants: Uses
Uses
Vasoconstricting agents that shrink swollen mucous
membranes of nasal airway passage
Used for relief of nasal congestion due to common cold,
upper respiratory allergies, and sinusitis.
Adverse Effects
Nervousness and restlessness
Insomnia
Dizziness
Headache
Irritability
Decongestants
Contraindications
Diabetes
Heart disease
Uncontrolled hypertension
Hyperthyroidism
Prostatic hypertrophy
Concomitant use of other sympathomimetic drugs
Patient Information
Instruct patients to avoid taking oral decongestants with 2
hours of bedtime because they may act as stimulants
Advise patients to discontinue and immediately report
extreme restlessness or signs of sensitivity.
Women should not breast feed