respiratory system drugs.pptx
TRANSCRIPT
8/14/2019 RESPIRATORY SYSTEM DRUGS.pptx
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Arlyn C. Mendenilla
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Respiratory drugsThe respiratory system, extending
from the nose to the pulmonary
capillaries, performs the essentialfunction of gas exchange betweenthe body and its environment. In
other words, it takes in oxygen andexpels carbon dioxide.
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Antiasthmatic Drugs In 2002, the National Asthma Education and
Prevention Program updated guidelines for diagnosingand managing asthma.
Drugs are classified as long-term and quick reliefmedication with a stepwise approach to treatment.
Anticholinergic bronchodilators , antileukotrieneagonists, synthetic glucocorticoids, and mast cell
stabilizers are used for long term control of asthma.
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Antiasthmatic DrugsPrototype Related drugs Classification
Ipatropium (atrovent) Iotropium bromide(spiriva)
Anticholinergicbronchodilators andbeta2 antagonist
Ipatropium/albuterol
(combivent)
Combination
Anticholinergicbronchodilator
Zafirlukast (accolate) Zileuton (zyflo)Montelukast (sigulair)
Antileukotriene Antagonists
budesonide (pulmicort)
Beclomethasone(beclovent,
vanceril)Flunisolide (aerobid),fluticasone propionate(flovent, flonase)Mometasone furoate (elocon,nasonex)
Triamcinolone acetoride(azmacort, nasacort)
Synthetic
glucocorticoids
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Antiasthmatic DrugsPrototype Related drugs Classification
Salmeterol fluticasone(advair diskus)
Combinationgluciocorticoid and beta2antagonist
Cromolyn (Intal,nasalcrom)
Nedocromil (tilade) Mast cell stabilizers
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Mechanism of Action
Anticholinergic Bronchodilators
Antagonizes acetylcholine, which causes
bronchodilation; action is slow and prolonged.
Antileukotriene Antagonist
Block leukotriene-mediated bronchoconstrictionthat decreases bronchial edema and
inflammation seen in asthma.
Synthetic Glucocorticoids
Decrease inflammation and enhance beta-agonist activity.
Mast cells stabilizers
May inhibit release of histamine and othermediators of mast cells
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Therapeutic use
Anticholinergic Bronchodilators
Prevention of spasm in COPD.
Intranasal – allergic and non-allergic perennialrhinitis.
Antileukotriene antagonists
Indicated to decrease the severity and frequency of
asthma attacks, with improvement seen in about 1 week.
Synthetic Glucocorticoids
Treatment of chronic asthma
Used intranasally for treatment of seasonal allergies.Rhinitis not responsible to other decongestants.
Mast Cell Stabilizer
Prophylaxis of asthma. These are not used to treatacute asthma attacks.
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Adverse effects ansd side effects
Anticholinergic Bronchodilators
Pregnancy category B, except for Tiotropium
bromide (spiriva), which is category C. CNS: headache, nervousness, blurred vision
EENT: Sore throat, cough, dry mouth.
GI: GI irritation, nausea
Antileukotriene Antagonists
Pregnancy category B, although Zileuton (Zyflo)is a category.
CNS: Headaches, dizziness GI: Nausea, vomiting and diarrhea
Increased incidence of infection over age 55
Liver dysfunction
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Synthetic Glucocorticoids
Pregnancy category C
CNS: Dizziness, headache
EENT: Unpleasant taste, oral fungal infection,cough
GI: GI distress
Mast Cell Stabilizers Pregnancy category B
CNS: dizziness, headache
GI: unpleasant taste
resp: cough, bronchospasm, and throatirritation
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Drug interactions Anticholinergic bronchodilators
Additive Anticholinergic effects with concurrentuse of other anticholinergics .
Antileukotriene Antagonists Zileuton (Zylo)
Concurrent use with warfarin increases risk of bleeding Concurrent use with theophylline decrease zafirlukast
and Zileuton levels.
Zafirlukast (Accolate) Concurrent use with aspirin increases zafirlukast levels.
Concurrent use with erythromycin decreases zafirlukastlevels.
Zileuton (Zyflo) Concurrent use with Propanolol increases propranolol
levels.
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Contraindication
Anticholinergic bronchodilators
Hypersensitivity to ipratropium, atropine andderivatives.
Propellant use to make inhaled ipratropium iscontraindicated in clients with peanut allergies
Antileukotriene Antacids
Hypersensitivity, breast feeding
Synthetic Glucocorticoids
Hypersensitivity Mast Cell Stabilizers
Hypersensitivity,
Status asthmaticus
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Nursing Implications All antihistamine
Monitor vital signs throughout
treatment Assess lung sounds and respiratory
function throughout treatment.
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Nursing Implications Anticholinergic bronchodilators
Administered by inhalation or intranasally Contact health care provider if severe
bronchospasm present so that an alternativemedication may be ordered.
If administered with other inhalationmedications, administer adrenergicbronchodilator first, followed by ipratropium,then corticosteroid, and wait 5 minutes betweenmedications.
Antileukotriene Antacids Available orally
Periodically monitor liver function studies
Monitor and report symptom
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Synthetic Glucocorticoids
monitor for adverse effects and report tohealth care provider.
Mast Cell Stabilizers
Available by inhalation or intranasally,ophthalmic use for allergy.
Do not administer during an acute asthma orstatus asthmaticus.
If taking before exercise or exposure to allergy,take at least 10 to 15 minutes before exposure.
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Patient Teaching
All antihistamine
Follow directions and use medications asordered.
Consult with health care provider before takingOTC medications or herbal remedies.
Do not discontinue without consulting withhealth care provider
do not double dose if a dose is missed.
For inhaled agents, use a spacer if recommendedby health care provider.
Teach client how to use meter dose inhalers.
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Patient teaching
Anticholinergic bronchodilators
Good mouth care, water, or hard candy helps to
decrease dryness. If symptoms do not improve within 30 minutes
after taking, contact health care provider ,.
Keep a record of number of inhalation instead of
floating canister in water to estimate how muchdrug is left in the canister.
Avoid getting drugs into the eyes.
Antileukotriene Antacids
Encourage follow-up with HCP for periodic liverfunction enzyme testing.
These drugs are used for prophylaxis and chronicasthma, but not acute asthma attacks.
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Patient teaching Report symptoms of Churg- Strauss syndrome to HCP.
Churg Strauss syndrome is more apt to occur when weaning from systemic steroids. Occurs rarely, but can belife threatening.
Take on an empty stomach.
Inhaled synthetic Glucocorticoids To prevent fungal infection, rinse mouth after taking
medication.
Rinse mouthpiece in warm water after each use.
If using inhaled synthetic glucocorticoids andbronchodilator, use the bronchodilator first, and wait 5minutes.
Inhaled synthetic glucocorticoids are not used to treatacute asthma attacks but should be continued if other
agents are used. A systemic glucocorticoids may be orderedduring an acute asthma attacks.
Contact health care provider if sore mouth or throat occurs
Allow 1 to 2 minutes between inhalations if a secondinhalation is ordered.
Use a spacer if recommended by health care provided.
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Bronchodilators DrugsBronchodilators dilate the bronchi and
bronchioles and include two classes ofdrugs:
Beta – agonists
Xanthine derivatives
The beta-agonist are also calledsympathomimetic bronchodilators.
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Bronchodilators DrugsPrototype drug Related drugs Drug classification
Epinephrine (adrenalin,
primatene, bronkaid)
Isoproterenol solution
(isuprel)Isoetharine HCL(bronkosol)Metraprorenol (alupent)
Beta-agonist
(sympathomimetics) Alpha-beta-agonist(epinephrine)beta-1-beta2-agonist(isoproterenol,isoetharine HCL &
metraproterenol)(non selective beta-agonist)
Albuterol (proventil, ventolin, volmax))
Bitolterol (tornalate)Formoterol (Foradil)
Levalbuterol (Xopenex)Pirbuterol (maxair)Salmeterol (serevent)Terbutaline (brethaire,bricanyl)
Beta 2 agonist
Theophylline (Theo-Dur,
Slo-bid)
Aminophylline (truphylline)
Dyphylline (dilor, lufyllin)
Xanthine derivatives
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Mechanism of Action Non selective Beta1 –Beta2-Agonist
Stimulate beta1 receptors in the heart and beta2receptors in the heart and lungs; relax bronchial
smooth muscle and dilates trachea and bronchi byincrease levels of cyclic adenosine monophosphate(cAMP)
Selective Beta2-Agonists Predominately stimulate the beta2 receptors in the
lungs and increase levels of cAMP, causingbronchodilators.
Xanthine derivatives Increase cAMP causing brochodilation
Also have diuretic and positive inotropic andchronotropic effects and cause gastric acid secretionand CNS stimulation.
Xanthine contains caffeine, so caffeine intake shouldbe minimized.
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Therapeutic Use Beta-Agonists
Bronchial asthma, bronchitis, bronchospasm, andother pulmonary disease.
Alpha-Beta-Agonist Also used to treat hypotension and shock
Selective Beta2-Agonist Also used to treat hyperkalemia
Bitolterol (Tornalate) Has a long onset of action and use for prophylaxis of
bronchospasm in clients over age 12.
Formoterol (Foradil) Used for maintenance treatment of asthma and prophylaxis
of bronchospasm in clients over age 5 with reversibleobstructive airway disease.
Also used to prevent exercise-induced bronchpspasm inclients over age 12.
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Selective Beta2-Agonist
Isoproterenol (Isuprel)
Also indicated for heart block, shock, and ventriculardysrhythmias.
Salmeterol (Serevent) Has a long-onset of action and indicated for
maintenance therapy of asthma, prevention ofbronchospasm in selected clients over age 4 withreversible airway disease, and prevention of exercise-induced asthma.
Xanthine Derivatives
Prevention and treatment of bronchial asthma,bronchitis, and COPD
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Adverse effects and side effects Non selective beta1-beta2-agonist
Pregnancy category C
CV: palpitation, tachycardia, hypertension, andcardiac arrest
CNS: anxiety, tremors, insomia, dizziness, andheadache.
Endocrine: hyperglycemia
GI: nausea and vomiting Selective beta2-agonists
Pregnancy category c except terbutaline (brethare,bricanyl), which is category B.
CV: palpitation, hypertension
CNS: tremors, nervousness, restlessness, headacheand insomia
Endocrine: hyperglycemia
GI: nausea and vomiting
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Adverse effects and side effects
Xanthine derivatives
Pregnancy category C
CV: tachycardia, dysrhythmias, and palpitations
CNS: anxiety, headache, insomnia, seizures, andtremors.
GI: anorexia, nausea, vomiting and cramps
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Drug interactions
All bronchodilators
Concurrent use with sympathomimetic canincrease cardiac and CNS stimulation.
Beta-agonists
Concurrent use with monoamino oxidaseinhibitors (MAOIs) may cause hypertensivecrisis.
Concurrent use of beta-blockers may antagonizetherapeutic effects.
Increased risk of hypokalemia if taken withpotassium-sparing diuretics.
Concurrent use with caffeine may causestimulation effects.
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Drug interactions Xanthine derivatives
Increase theophylline levels with concurrent useof allopurinol, benzodiazepines cimetidine,erythromycin, oral contraceptives, influenza
vaccine, interferon, beta-blockers, andcorticosteroids.
Nicotine may increase metabolism and decreaseeffectiveness of xanthines.
Contraindications All brochodilators
Hypersensitivity
Beta-agonist and xanthine derivatives tachydyrhythmias
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Nursing Implications
All Bronchodilators
Monitor vital signs
Assess lung sounds
Encourage fluids unless contraindicated.
Careful monitoring of the elderly as they aremore susceptible to adverse reactions.
Beta-agonist
Available by inhalation
Albuterol, metaproterenol, and also availableorally.
Isoproterenol (Isupril) is also available IV and SL.
N i I li ti ( t’)
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Nursing Implications (cont ) Terbutaline is also available SC. Oral medication can be given with food to decrease GI
effects. Monitor cardiac status and report changes to health care
provider. xanthine derivatives
Available PO, parenterally, or rectally Give over 24 hours to maintain therapeutic levels. Monitor theophyline levels: therapeutic range 10.0 to 20.0
mcg/ml Use an infusion pump and give slowly when administered
IV. IV rate should not exceed 20 to 25 mg/min. Wait 4 to 6 hours after IV therapy is discontinued before
giving first dose orally. Monitor I & O Monitor for drug toxicity and notify health care provider if
toxicity occurs. Oral drug can be given with food if GI effects occur. Clients with cardiac history should be monitored for EKG
changes or chest pain.
Patient teaching
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Patient teaching All bronchodilators
Check with health care provider taking OTC medicationsand herbal remedies.
Take exactly as prescribed and do not double up on misseddoses.
Beta-agonists Report adverse effects such as feeling jittery, palpitations,
chest pain, restlessness, insomnia, or other symptoms tohealth care provider.
Take oral medication with meals to decrease GI upset. Xanthines
Avoid caffeine, as caffeine acts as xanthine during therapy. Take with food if GI upset occurs. Do not chew or crush enteric coated or sustained release
products. Report adverse effects such as palpitations, chest pain,
nausea, vomiting, weakness, dizziness, or other sx tohealth care provider.
Avoid tobacco use as nicotine increases the metabolism ofxanthines.
M d i h l l
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Meter-dose inhalaler
Instruct client on proper use of MDI. If taking abronchodilator and steroid, take the
bronchodilator first to open up the airways,followed by the steroid.
Fast-acting bronchodilators, such as albuterol,should be taken before slower or longer acting
brochodilators, such as salmetrol. If taking a beta-agonist with an anticholinergic
take the beta-agonist before taking the Anticholinergic, ipratropium.
Canister contains measured doses ofmedication.
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Antihistamines
Also known as H1 antagonist and directly compete with histamine for specific receptor sites. Antihistamine are categorized as
1. 1st
generation which include the chemical classes ofalkylamines, ethanolamines, ethylenedilamines,phenothiazines, piperidines.
2. 2nd generation or non sedating agents. Sedation is aproblem seen with first generation antihistamines.
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Prototype drug Related drug Classificaton
Diphenhydramnie(benadryl)
Clemastine (Tavist)Dimenhydrinate(Dramamine)
TrimethobenzamideHCL (arrestin,benzacot, tigan, )
First generationsantihistamineTraditional
antihistamines(ethanolamines)
There is no prototype Bronphineramine(Dimetane)
Chlorpeniramine(chlor-trimeton)Dexchlorpheniramine(polaramine)
Alkylamines
Tripelennamine(Pyribenzamine)
Ethylenediamines
Buclizine (Bucladin-S)Meclizine (Antivert)Cyclizine (marezine)Promethazine(phenergan)
Trimeprazine (Temaril)
Phenothiazines
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Prototype Related drugs c;lassification Azatadine(optimine)Cyproheptadine(PERIACTIN)Hydroxyzine
(Atarax), vistaril,others
Piperidines
Loratidine(claritine)
Azelastine(Astelin)Cetirizine (Zyrtec)
Fexofenadine(allegra)
2nd generationantihistaminesNonsedating
histamines
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Mechanism of action H1 blockers block the effects of histamine by
competing for H1 receptor site. 2nd generation, non sedating antihistamines do
not cross the blood brain barrier,which reducesor prevents sedation.
2nd
generation antihistamines have a longerduration of action and fewer anticholinergiceffects than 1st generation antihistamines
Therapeutic use
Rhinitis, allergic, colds, nausea, adjunctivetherapy of anaphylaxis, motion sickness, vertigo, Parkinsons disease and a sleep aid (firstgeneration)
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Adverse effects
All antihistamines
Anticholinergic effects: first generation
antihistamines; dry mouth dilated pupils urinaryretention, tachycardia, and constipation: 2nd generation have minimal effects.
CNS: sedation in 1st generation
Derm : photosensitivity Blurred vision
GI: dry mouth, GI upset, diarrhea, orconstipation
GU: urinary retention
First generation Antihistamines and second
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First generation Antihistamines and secondgeneration antihistamines. Pregnancy category B, although azelastine,
brompheniramine, cyclizine, promethazine,and hydroxyzine, triamethobenzamide HCL, vistaril and others are category C.
Unclassified pregnancy category aretriplennamine and trimeprazine.
Contraindication Hypersensitivity
Lactation
Clients with lower respiratory tract disease Acute asthma attacks
Cautious use with bladder neck obstruction,narrow angle glaucoma and stenosing peptic
ulcer.
D i t ti
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Drug interactions
Concurrent use with alcohol or other CNSdepressants, antidepressants, kava-kava,
valeria, and chamomile may cause additiveCNS depression.
Concurrent use with MAOIs can intensifyantihistamine effects
Concurrent use of erythromycin orketoconazole with loratidine and fexofenadineincreases concentrations of loratidine andfoxefenadine.
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Nursing implications Give PO; some antihistamines may also be given
SC, IM, IV, PR, or topically. Azelastine Asteline is available as nasal and
opthalmic agent. Monitor VS Assess lung sounds, secretions, and allergy
symptoms Unless contraindicated, encourage fluid intake If client is undergoing allergy testing, discontinue
antihistamine use for atleast 4 days before testing,as antihistamine may decrease skin response toallergy test.
When anti histamine are used as sleep aid, theyshould be given at least 2o minutes before bedtime.
Antihistamine used for motion sickness should begiven at least 30minutes before exposure tosituations that may cause motion sickness.
Patient teaching
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Patient teaching Avoid driving or operating heavy machinery.
Avoid alcohol and taking other CNS
depressants. If possible take at bedtime to avoid daytime
sedation.
Inform health care provider and dentist if
taking antihistamines. Take with food to decrease GI upset
Encourage fluids and hard candy to minimizeanticholinergic effects of dry mouth.
Wear sunscreen and protective gear to preventphotosensitivity
As many of these drugs are available OTC, takeas directed.
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Decongestant Drugs Decongestant are used to decrease nasal congestion
caused by stimulation of the alpha1-adrenergicreceptors on the nasal blood vessels, which causes vasoconstriction, in turn shrinking mucous membrane
and relieving congestion. Decongestant are available orally and topically. Oral
decongestants have a delayed onset with prolongedand less potent effects while topical decongestants
produce rapid and potent effects.
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Prototype drug Related drugs Drug classificationEphedrine (Pretz-D) Naphazoline (privine)
Oxymetazoline (afrin)Phenylephrine(neoSynephrine,Coricidin, others)
Pseudo-ephedrine hcl(sudafed, dorcol,decofed)Tetrahydrozoline(Tyzine) Xylometazoline
(otrivin)
Decogestants(sympathomimetics)
Mechanism of Action
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Mechanism of Action Causes vasoconstriction through the stimulation of
the alpha1 adrenergic receptors on the nasal blood vessel causing shrinkage of the nasal membranes.
Therapeutic use Congestion seen with acute or chronic rhinitis,
sinusitis and colds.
Adverse effects and side effects. Pregnancy category C CV: hypertension, palpitations, and tachycardia,
dyspnea seen more frequently with oral agents
CNS: stimulation, headache, nervousness,
restlessness, seen more frequently with oral agents GI: N&V
Other: rebound congestion with topical agents,fever
Drug Interaction
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Drug Interaction Concurrent use with other sympathomimetic can
increase toxicity.
Concurrent use with MAOIs can causehypertensive crisis.
Contraindications Hypersensitivity
Hypertension (oral use)
CAD (oral use)
Nursing implications Many decongestants are OTC agents
Monitor vital signs and assess lung sounds andcongestion periodically throughout the therapy.
Monitor for hypertension, palpitations, ortachycardia and report symptoms to health careprovider.
P ti t T hi
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Patient Teaching
Avoid concurrent use of OTCs and herbal remedies without consulting health care provider.
Avoid caffeine while taking decongestants. May cause cardiac or CNS stimulation, such as
palpitations, restlessness, or insomnia. Report sx toHCP.
Take exactly as directed Topical decongestants should not be taken for more
than 3 to 5 days to avoid rebound decongestion
Contact HCP if sx persist for more than a week or if
rash occurs. Encourage fluids unless contraindicated.
Avoid taking near bedtime to prevent insomni.
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Antitussive Drugs Antitussive drugs suppress or inhibit coughing. They
are typically used to treat dry, non-productive coughs.
There are two categories of Antitussive; they areopiods and non-opioids.
Prescriptions antitussives are usually indicated whenOTC preparations have not been effective.
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Antitussive Drugs
Prototype Related drugs Drug classification
Dextromethorphan(Vicks formula 44,Robitussin DM) Benzonanate (tessalon)
Non-opioid antitussives
Non-opioid antitussives
Locally actingDiphenhydramine(benylin, benadryl)
There is no related drugsat this time
Antitussive antihistamine
Codeine (Dimetane-DC,Tussar SF)
Hydrocodone (hycodan) Opioid antitussive
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Antitussive Drugs
Mechanism of Actions Nonopioid Antitussives
Suppress the cough reflex through direct action to the cough center.They do not cause addiction nor CNS depression like the opiodsantitussives . They are available OTC.
Non-opioid antitussives (locally acting) Anesthetize or numb the stretch receptors and keep the cough reflex
being stimulated in the medulla. Available only by prescription.
Antitussive antihistamines Antagonize histamine effects at H receptor sites, CNS depressant
and anticholinergic effects, and suppress cough.
Opioid antitussives Narcotic analgesics available by prescription only. Suppress the
cough reflex through direct action to the medullary cough center, with analgesic effect.
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Antitussive Drugs Therapeutic use
Symptomatic relief for non-productive coughs or insituations when coughing may be harmful.
Adverse effects and sideeffects Non-opioid antitussives
Pregnancy category unknown CNS: dizziness, drowsiness
GI: Nausea
Non-opioid antitussives (Locally acting) Pregnancy category C
CNS: dizziness, headache, and sedation Derm: pruritus
EENT: Nasal Congestion
GI: constipation, Nausea
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Antitussive Drugs Antitussive antihistamines
Pregnancy category B CNS: drowsiness, anticholinergic effects, headache and
dizziness GI: dry mouth, anorexia, constipation, and diarrhea Derm: Photosensitivity
Opioid antitussives Pregnancy category C CV: Hypertension CNS: confusion, sedation, and headache GI: constipation, nausea and vomiting GU: urinary retention Resp: respiratory depression
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Antitussive Drugs Interactions
Non-opioid antitussives Concurrent use with MAOIs may cause serotonin syndrome Additive CNS depression with alcohol, antihistamines and antidepressants,
sedative/hypnotics and opiods.
Non-opioid antitussives (locally acting) Additive CNS depression with alcohol, antihistamines and sedative/hypnotics and
opiods.
Antitussive antihistamine Additive CNS depression with alcohol, antihistamines and antidepressants,
sedative/hypnotics and opiods. Additive anticholinergic effects with TCA, disopyramide, or quinidine. MAOIs intensify and prolong anticholinergic effects of antihistamine.
opioid antitussives Pregnancy category C
CV: hypertension CNS: confusion, sedation, and headache GI: constipation, nausea and vomiting GU: urinary retention Resp: respiratory depression
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Antitussive Drugs Contradictions
All antitussives Hypersensitivity Should not be used for chronic productive cough
Non-opioid antitussives Clients taking MAOIs May contain alcohol and should be avoided by recovering alcoholics
Non-opioid antitussives (locally acting) Cross sensitivity to benzonatate or related compounds.
Antitussive – antihistamines Acute asthma attacks Lactation Liquid products may contain alcohol and should be avoided by
recovering alcoholics.
Opioid antritussives Clients with severe respiratory disorders or respiratory depression Seizure disorders Increased intracranial pressure
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Antitussive Drugs Nursing Implications
All antitussives Administered orally
Assess lung sounds, cough and type and amount of sputum
Non-opioid antitussives Do not gives immediately after administering to prevent dilution of
drug. Shake oral suspensions before giving.
Non-opioid antitussives (locally acting) Instruct client to chew capsule, as a benzonate from capsules may
cause a local anaesthetic effect and choking
Opioid antitussives Assess for constipation
Antidote: nalaxone (narcan)
Prolonged use can lead to physical or psychological dependence.
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Antitussive Drugs Patient Teaching
Avoid concurrent use of OTCs and herbal remedies withoutconsulting with physician.
Use an antitussive for a dry, nonproductive cough.
Avoid driving or operating heavy machinery while takingantitussives as they may cause drowsiness.
Encourage fluid intake unless contraindicated
Avoid drinking fluids for at least 30 minutes after taking an
antitussive Contact health care provider if cough persists for more than a
week, or if a rash, fever, or persistent headache occurs.
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Expectorant Drugs
Expectorants stimulate the flow of the respiratory tractsecretions, which makes the cough more effective.Mucolytics work directly on mucus to make it more watery, which makes more productive.
Guafenesin (Robitussin) is a widely used and popularexpectorant.
Expectorant can be given as a single agent or incombination with other drugs.
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ExpectoraantsPrototype Related Drugs Drug classification
Guaifenesin(robitussin,others)
There are no relateddrugs
Expectorants
Acetylcysteine(Mucomyst)
Dornase alfa(pulmozyme)
Mucolytics(antidote: acetaminophenTylenol)
Cystic fibrosis drug
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Expectorants
Mechanism of action Expectorants
Reduces viscosity of secretions by increasing respiratory tractfluid, which mobilizes and allows for expectoration of mucus.
Also indirectly irritates the GIT, which can cause N&V
Mucolytics
Decreases viscosity of pulmonary secretions. Split links in therespiratory mucoprotein molecules into smaller, more soluble,and less viscous strands.
In acetaminophen (tylenol) overdose, it alters hepaticmetabolism to decrease liver injury.
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Expectorants
Therapeutic use Expectorants
Relief of coughs associated with viral upper respiratory tractinfactions
Mucolytics Adjunct treatment of thick tenacious mucus in cystic fibrosis
and bronchopulmonary disease
Antidote for acetaminophen toxicity
Dornase alfa used for management of cystic fibrosis
Expectorants
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Expectorants Adverse effects and sideeffects
Expectorants Pregnancy category C
GI: GI upset, N&V
Mucolytics
Pregnancy category B CNS: dizziness, drowsiness
GI: Nausea, stomatitis, hepatotoxicity, unpleasant odor (sulfurin drug may smell like rotten eggs)
Resp: bronchospasm, hemoptysis, rhinorrhea
Dornase alfa
Resp: cough pharyngitis, wheezes
Other: conjunctivitis, chest pain
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Expectorants
Interactions
Expectorants
Non significantMucolytics
Acetylcysteine contains hydrogen sulfide
and will discolor iron, copper andharden rubber.
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Expectorants
Contraindications All expectorants and Mucolytics
Hypersensitivity
Expectorants
Some – guaifenesin-containing products contain alcohol andshould be avoided by recovering alcoholics
Mucolytics
Status asthmaticus and increased ICP
Dornase alfa hypersensitivity
E t t
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Expectorants Nursing implications
All expectorants and mucolytics Assess lung sounds and cough including: type, frequency, and
characterestics.
Expectorants Hypersensitivity
Acetylcysteine (mucomyst)
Available by inhalation via nebulizer, instillation via endotrachealtube or orally Monitor vital signs Encourgae coughing after administration Suction if indicated after treatment Maintain good oral hygiene
Percussion and good postural drainage may assist client ineliminating secretions Administer treatment at least 30 minutes to 1 hour before meals to
prevent nausea Use within 48 hours after opening and store in refrigerator
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Expectorants Nursing implications (cont)
Dornase alfa
Store in refrigerator and protect from light
Review use of nebulizer Antidote use of mucomyst
Give immediately, if 24 hours or less.
Monitor liver function test, electrolytes, BUN, acetamenophenlevels, and cardiac function
Oral use: can be given with water and use within an hour.
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Patient teaching Avoid concurrent use of OTCs and herbal medicines without
consulting with physicians. Dispose of tissues and secretions properly. Cough effectively by splitting up, taking several slow deep breaths
before coughing. Encourage fluid intake to help liquefy secretions, unless
contraindicated. Report fever, cough, headache, or other symptoms lasting longer than 1
week to health care provider. Guaifenesin
Liquid product may contain alcohol and sugar and recoveringalcoholics and diabetic clients should avoid use.
Acetylcyteine Has a charecteristic rotten egg odor due to release of hydrogen sulfide Use good oral hygiene during therapy
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