Respiratory System Drugs

Bronchodilators
β-adrenergic agonists

Corticosteroids
 Respiratory System Drugs
Bronchodilators: β-Agonists

Large group, sympathomimetics

Used during acute phase of asthmatic attacks

Quickly reduce airway constriction

Stimulate β2-adrenergic receptors throughout the

lungs
 Respiratory System Drugs
Bronchodilators: β-Agonists
Three types
 Nonselective adrenergics

 Stimulate α, β1 (cardiac), and β2 (respiratory) receptors

 Example: epinephrine
 Nonselective β-adrenergics

 Stimulate both β1 and β2 receptors

 Example: metaproterenol

 Selective β2 drugs

 Stimulate only β2 receptors

 Example: albuterol (Proventil)
 Respiratory System Drugs
Bronchodilators: β-Agonists
Mechanism of Action

 Begins at the specific receptor stimulated#

 Ends with the dilation of the airways

#Activation of β2 receptors activates cAMP,* which

relaxes smooth muscles of the airway and results in
bronchial dilation and increased airflow
*cAMP = cyclic adenosine monophosphate
 Respiratory System Drugs
Bronchodilators: β-Agonists
Indications

 Relief of bronchospasm related to asthma, bronchitis, and other

pulmonary diseases

 Useful in treatment of acute attacks as well as prevention

 Used in hypotension and shock

 Used to produce uterine relaxation to prevent premature labor

 Hyperkalemia—stimulates potassium to shift into the cell

 Respiratory System Drugs
β-Agonists: Adverse Effects

α-β (epinephrine)

 Insomnia
 Restlessness  Hyperglycemia
 Anorexia  Tremor
 Vascular headache  Cardiac stimulation
 Respiratory System Drugs
β-Agonists: Adverse Effects

β1 and β2 (metaproterenol)

 Cardiac stimulation

Vascular headache
 Tremor
 Hypotension
 Anginal pain
 Respiratory System Drugs
β-Agonists: Adverse Effects

β2 (albuterol)

 Hypotension or hypertension
 Vascular headache
 Tremor
 Respiratory System Drugs
β-Agonists - Nursing Implications
 Monitor for therapeutic effects
Decreased dyspnea
Decreased wheezing, restlessness, and anxiety
Improved respiratory patterns with return to normal rate and
quality
Improved activity tolerance

 Patients should know how to use inhalers

 Have patients demonstrate use of devices

 Monitor for adverse effects

 Respiratory System Drugs
β-Agonist Derivatives
Nsg Implications
 Albuterol, if used too frequently, loses its β2-specific actions at larger
doses
As a result, β1 receptors are stimulated, causing nausea, increased
anxiety, palpitations, tremors, and increased heart rate

 Take medications exactly as prescribed

 No omissions or double doses

 Report insomnia, jitteriness, restlessness, palpitations, chest pain, or

any change in symptoms
 Respiratory System Drugs
Corticosteroids
Anti-inflammatory!!!

Uses - chronic asthma/COPD exacerbations

Do not relieve acute asthmatic attacks S&S

Oral, IV (quick acting), or inhaled forms

Inhaled forms reduce systemic effects

May take several weeks before full
effects are seen
 Respiratory System Drugs
Corticosteroids
Mechanism of Action

Stabilize membranes of cells that release harmful

bronchoconstricting substances

Also increase responsiveness of bronchial smooth

muscle to β-adrenergic stimulation
 Respiratory System Drugs
Inhaled Corticosteroids

beclomethasone dipropionate
(Beclovent, Vanceril)

triamcinolone acetonide (Azmacort)

dexamethasone sodium phosphate (Decadron

Phosphate Respihaler)

fluticasone (Flovent, Flonase)

 Respiratory System Drugs
Corticosteroids - Indications

Treatment of bronchospastic disorders

that are not controlled by conventional bronchodilators

NOT considered first-line drugs for management of

acute asthmatic attacks or status asthmaticus
 Respiratory System Drugs
Corticosteroids - Adverse Effects
Pharyngeal irritation

Coughing

Dry mouth

Oral fungal infections

Systemic effects are rare because of the low doses used

for inhalation therapy
 Corticosteroids
Nursing Implications – Pt Education
 Contraindicated in patients with fungal infections, AIDS, TB

 Teach patients to gargle and rinse the mouth with lukewarm

water afterward to prevent the development of oral fungal
infections

 If a β-agonist bronchodilator and corticosteroid inhaler are both

ordered, the bronchodilator should be used several minutes
before the corticosteroid to provide bronchodilation before
administration of the corticosteroid