Drugs Used to Treat Lower Respiratory Disease

Chapter 31Chapter 31

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Chapter 31

Lesson 31.1

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ObjectivesObjectives

• Identify the structures of the lower respiratory tract and their functions

• Describe the physiology of respirations• Compare the physiologic responses of the

respiratory system to emphysema, chronic bronchitis, and asthma

• Identify components of blood gases

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Objectives (cont’d)Objectives (cont’d)

• Cite nursing assessments used to evaluate the respiratory status of a patient

• Review the procedures for administration of medication by inhalation

• Implement patient education for patients receiving drug therapy for lower respiratory disease

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The Lower Respiratory Tract The Lower Respiratory Tract and the Alveoliand the Alveoli

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Common Lower Respiratory Common Lower Respiratory DiseasesDiseases

• Chronic obstructive pulmonary disease (COPD)

• Chronic airflow limitation disease (CALD)• Asthma• Chronic bronchitis• Emphysema

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Arterial Blood Gases (ABGs)Arterial Blood Gases (ABGs)

• Components pH – 7.35-7.45 PaCO2 – 35-45 mm Hg PaO2 – 80-100 mm Hg HCO3 – 21-28 mEq/L SaO2 (oxygen saturation) 95%

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Nursing AssessmentsNursing Assessments

• Obtain History, medications, description of current

symptoms • Perform

Respiratory assessment – percussion, auscultation, palpation, inspection

• Review Cardiovascular health, sleep pattern,

psychosocial health, laboratory and diagnostic data

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Administration of InhalantsAdministration of Inhalants

• Review with patients during each visit Demonstration of how to use the inhaler Exhale completely before inhaling Hold breath at least 10 seconds afterward Administer bronchodilator first, wait several

minutes, give steroid inhalant Rinse mouth after steroid medication

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Patient Education Patient Education and Health Promotionand Health Promotion

• Management principles rely on patient’s understanding of treatment Nutrition – well balanced diet, increase fluid

intake Exercise - adjust physical activity to reduce

fatigue Eliminate risk factors – stop smoking, avoid

irritants Proper administration of medications Use of peak flow meter and record readings

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Chapter 31

Lesson 31.2

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ObjectivesObjectives

• Distinguish the mechanisms of action of expectorants, antitussives, and mucolytic agents

• State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from expectorant, antitussive, and mucolytic therapy

• State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from sympathomimetic bronchodilator therapy

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Objectives (cont’d)Objectives (cont’d)

• State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from anticholinergic bronchodilator therapy

• State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from xanthine derivative therapy

• State the nursing assessments needed to monitor therapeutic response and the development of adverse effects from corticosteroid inhalant therapy

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Drug Therapy Drug Therapy for Lower Respiratory Diseasesfor Lower Respiratory Diseases

• Attempt to relieve symptoms of cough by liquefying thick secretions to prevent mucus plugs, or suppressing cough Expectorants Antitussives Mucolytic agents Bronchodilators Anti-inflammatory agents Immunomodulators

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Drug Class: ExpectorantsDrug Class: Expectorants

• Drug: guaifenesin (Robitussin)• Actions

Enhance output of respiratory tract fluid, decrease mucus viscosity, promote ciliary action

• Uses Relieve dry, nonproductive cough Treat symptoms of common cold, bronchitis,

laryngitis, pharyngitis, sinusitis

• Common adverse effects GI upset, nausea, vomiting

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Drug Class: Potassium IodideDrug Class: Potassium Iodide

• Drug: SSKI• Actions

Expectorant; stimulates increased secretions, making it easier to cough

• Uses Treat chronic pulmonary diseases such as

bronchial asthma, bronchitis, emphysema

• Common adverse effects Nausea, vomiting, diarrhea

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Drug Class: Saline SolutionsDrug Class: Saline Solutions

• Actions Hydrate mucus, reduce viscosity

• Uses Expectorant, administered by nebulization

• Common adverse effects None noted

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Drug Class: Antitussive AgentsDrug Class: Antitussive Agents

• Drugs Benzonatate (Tessalon Perles) Codeine Dextromethorphan (Robitussin, Delsym) Diphenhydramine (Diphen, Tusstat) Hydrocodone

• Actions Suppress cough center in brain

• Uses Suppress disruptive spasms

• Common adverse effects Dry mouth, drowsiness, constipation

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Drug Class: Mucolytic AgentsDrug Class: Mucolytic Agents

• Drug: acetylcysteine (Mucomyst)• Actions

Dissolve chemical bonds in mucus

• Uses Dissolve abnormally viscous mucus Treat chronic emphysema, emphysema with

bronchitis, asthmatic bronchitis, pneumonia

• Common adverse effects Nausea, vomiting

• Serious adverse effects Bronchospasm

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Drug Class: Beta-Adrenergic Drug Class: Beta-Adrenergic Bronchodilating AgentsBronchodilating Agents

• Actions Stimulate beta receptors within smooth muscle

of tracheobronchial tree

• Uses Reverse airway constriction Mainstay of all asthma therapy

• Serious adverse effects Tachycardia, palpitations, tremors,

nervousness, anxiety, restlessness, headache, dizziness, nausea and vomiting

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Drug Class: Anticholinergic Drug Class: Anticholinergic Bronchodilating AgentsBronchodilating Agents

• Drugs: ipratropium bromide (Atrovent), tiotropium bromide (Spiriva)

• Actions Produce bronchodilation

• Uses Long-term treatment of reversible

bronchospasm associated with COPD

• Common adverse effects Mouth dryness, throat irritation

• Serious adverse effects Tachycardia, urinary retention, exacerbation of

symptomsMosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Drug Class: Xanthine Derivative Drug Class: Xanthine Derivative Bronchodilating AgentsBronchodilating Agents

• Actions Act directly on smooth muscle of

tracheobronchial tree to dilate bronchi• Uses

Reverse airway constriction Treat acute and chronic bronchial asthma,

bronchitis, emphysema• Common adverse effects

Nausea, vomiting, epigastric pain, abdominal cramps

• Serious adverse effects Tachycardia, palpitations, tremors,

nervousness, restlessness, anxiety, headacheMosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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Drug Class: Respiratory Drug Class: Respiratory Anti-inflammatory AgentsAnti-inflammatory Agents

• Actions Inhibit inflammatory responses

• Uses For patients unresponsive to

sympathomimetic agents or xanthine derivatives

Prevent symptoms of asthma

• Common adverse effects Hoarseness, dry mouth

• Serious adverse effects Thrush

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Drug Class: Antileukotriene AgentsDrug Class: Antileukotriene Agents

• Drugs Montelukast (Singulair) Zafirlukast (Accolate)

• Actions Selective and competitive receptor antagonist

of cysteinyl leukotriene receptor• Uses

In combination with other drugs to treat asthma

• Common adverse effects Headache, nausea, dyspepsia

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Drug Class: Drug Class: Immunomodulator AgentImmunomodulator Agent

• Drug: omalizumab (Xolair)• Actions

Binds to circulating IgE antibodies inhibiting mast cell release of inflammatory chemicals

• Uses Treats moderate to severe persistent allergic

asthma• Common and serious adverse effects

Hypersensitivity, injection site reactions

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Miscellaneous Miscellaneous Anti-Inflammatory AgentsAnti-Inflammatory Agents

• Drug: cromolyn sodium (Intal)• Actions

Mast cell stabilizer; inhibits release of histamines and other mediators of inflammation

• Uses In combination with other agents to treat

severe bronchial asthma or allergic rhinitis• Common adverse effects

Oral irritation, dry mouth• Serious adverse effects

Bronchospasm, coughing

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