Arlyn C.

Mendenilla

Respiratory drugs
The respiratory system, extending

from the nose to the pulmonary capillaries, performs the essential function of gas exchange between the body and its environment. In other words, it takes in oxygen and expels carbon dioxide.

Antiasthmatic Drugs
In

2002, the National Asthma Education and Prevention Program updated guidelines for diagnosing and managing asthma. Drugs are classified as long-term and quick relief medication with a stepwise approach to treatment. Anticholinergic bronchodilators , antileukotriene agonists, synthetic glucocorticoids, and mast cell stabilizers are used for long term control of asthma.

Antiasthmatic Drugs
Prototype Related drugs Classification

Ipatropium (atrovent)

Iotropium bromide (spiriva)

Ipatropium/albuterol (combivent)

Anticholinergic bronchodilators beta2 antagonist

Combination Anticholinergic bronchodilator Antileukotriene Antagonists

and

Zafirlukast (accolate)

Zileuton (zyflo) Montelukast (sigulair)

Beclomethasone(beclovent, Synthetic budesonide (pulmicort) vanceril) glucocorticoids Flunisolide (aerobid), fluticasone propionate (flovent, flonase) Mometasone furoate (elocon, nasonex) Triamcinolone acetoride (azmacort, nasacort)

Antiasthmatic Drugs
Prototype Related drugs
Salmeterol fluticasone (advair diskus) Cromolyn (Intal, nasalcrom) Nedocromil (tilade)

Classification
Combination gluciocorticoid and beta2 antagonist Mast cell stabilizers

A n t i a s t h m a t i c D r u g s

Mechanism of Action Anticholinergic Bronchodilators

Antagonizes acetylcholine, which causes bronchodilation; action is slow and prolonged.

Block leukotriene-mediated bronchoconstriction that decreases bronchial edema and inflammation seen in asthma.

Antileukotriene Antagonist

Synthetic Glucocorticoids

Decrease inflammation and enhance betaagonist activity. May inhibit release of histamine and other mediators of mast cells

Mast cells stabilizers

A n t i a s t h m a t i c D r u g s

Therapeutic use Anticholinergic Bronchodilators

Prevention of spasm in COPD. Intranasal allergic and non-allergic perennial rhinitis. Indicated to decrease the severity and frequency of asthma attacks, with improvement seen in about 1 week.
Treatment of chronic asthma Used intranasally for treatment of seasonal allergies. Rhinitis not responsible to other decongestants. Prophylaxis of asthma. These are not used to treat acute asthma attacks.

Antileukotriene antagonists

Synthetic Glucocorticoids

Mast Cell Stabilizer

A n t i a s t h m a t i c D r u g s

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
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

Antileukotriene Antagonists

A n t i a s t h m a t i c D r u g s

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 throat irritation

A n t i a s t h m a t i c D r u g s

Drug interactions Anticholinergic bronchodilators

Additive Anticholinergic effects with concurrent use of other anticholinergics .

Antileukotriene Antagonists

Zileuton (Zylo)

Concurrent use with warfarin increases risk of bleeding Concurrent use with theophylline decrease zafirlukast and Zileuton levels. Concurrent use with aspirin increases zafirlukast levels. Concurrent use with erythromycin decreases zafirlukast levels. Concurrent use with Propanolol increases propranolol levels.

Zafirlukast (Accolate)

Zileuton (Zyflo)

A n t i a s t h m a t i c D r u g s

Contraindication Anticholinergic bronchodilators

Hypersensitivity to ipratropium, atropine and derivatives. Propellant use to make inhaled ipratropium is contraindicated in clients with peanut allergies Hypersensitivity, breast feeding Hypersensitivity

Antileukotriene Antacids

Synthetic Glucocorticoids

Mast Cell Stabilizers

Hypersensitivity, Status asthmaticus

A n t i a s t h m a t i c D r u g s

Nursing Implications
All antihistamine

Monitor vital signs throughout treatment Assess lung sounds and respiratory function throughout treatment.

A n t i a s t h m a t i c D r u g s

Nursing Implications Anticholinergic bronchodilators

Administered by inhalation or intranasally Contact health care provider if severe bronchospasm present so that an alternative medication may be ordered. If administered with other inhalation medications, administer adrenergic bronchodilator first, followed by ipratropium, then corticosteroid, and wait 5 minutes between medications. Available orally Periodically monitor liver function studies Monitor and report symptom

Antileukotriene Antacids

A n t i a s t h m a t i c D r u g s

Synthetic Glucocorticoids monitor for adverse effects and report to health care provider. Mast Cell Stabilizers Available by inhalation or intranasally, ophthalmic use for allergy. Do not administer during an acute asthma or status asthmaticus. If taking before exercise or exposure to allergy, take at least 10 to 15 minutes before exposure.

A n t i a s t h m a t i c D r u g s

Patient Teaching All antihistamine

Follow directions and use medications as ordered. Consult with health care provider before taking OTC medications or herbal remedies. Do not discontinue without consulting with health care provider do not double dose if a dose is missed. For inhaled agents, use a spacer if recommended by health care provider. Teach client how to use meter dose inhalers.

A n t i a s t h m a t i c D r u g s

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 much drug is left in the canister. Avoid getting drugs into the eyes.
Encourage follow-up with HCP for periodic liver function enzyme testing. These drugs are used for prophylaxis and chronic asthma, but not acute asthma attacks.

Antileukotriene Antacids

A n t i a s t h m a t i c D r u g s

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 be life threatening. Take on an empty stomach. To prevent fungal infection, rinse mouth after taking medication. Rinse mouthpiece in warm water after each use. If using inhaled synthetic glucocorticoids and bronchodilator, use the bronchodilator first, and wait 5 minutes. Inhaled synthetic glucocorticoids are not used to treat acute asthma attacks but should be continued if other agents are used. A systemic glucocorticoids may be ordered during an acute asthma attacks. Contact health care provider if sore mouth or throat occurs Allow 1 to 2 minutes between inhalations if a second inhalation is ordered. Use a spacer if recommended by health care provided.

Inhaled synthetic Glucocorticoids

Bronchodilators Drugs
Bronchodilators dilate the bronchi and

bronchioles and include two classes of drugs: Beta agonists Xanthine derivatives The beta-agonist are also called sympathomimetic bronchodilators.

Bronchodilators Drugs
Prototype drug Epinephrine (adrenalin, primatene, bronkaid) Related drugs Isoproterenol solution (isuprel) Isoetharine HCL (bronkosol) Metraprorenol (alupent) Drug classification Beta-agonist (sympathomimetics) Alpha-beta-agonist (epinephrine) beta-1-beta2-agonist (isoproterenol, isoetharine HCL & metraproterenol) (non selective betaagonist) Beta 2 agonist

Albuterol (proventil, ventolin, volmax))

Bitolterol (tornalate) Formoterol (Foradil) Levalbuterol (Xopenex) Pirbuterol (maxair) Salmeterol (serevent) Terbutaline (brethaire, bricanyl)

Theophylline (Theo-Dur, Aminophylline (truphylline) Xanthine derivatives Slo-bid) Dyphylline (dilor, lufyllin)

B r o n c h o d i l a t o r s

Mechanism of Action Non selective Beta1 Beta2-Agonist

Stimulate beta1 receptors in the heart and beta2 receptors in the heart and lungs; relax bronchial smooth muscle and dilates trachea and bronchi by increase levels of cyclic adenosine monophosphate (cAMP)
Predominately stimulate the beta2 receptors in the lungs and increase levels of cAMP, causing bronchodilators. Increase cAMP causing brochodilation Also have diuretic and positive inotropic and chronotropic effects and cause gastric acid secretion and CNS stimulation. Xanthine contains caffeine, so caffeine intake should be minimized.

D r u g s

Selective Beta2-Agonists

Xanthine derivatives

B r o n c h o d i l a t o r s

Therapeutic Use Beta-Agonists

Bronchial asthma, bronchitis, bronchospasm, and other pulmonary disease.

Alpha-Beta-Agonist

D r u g s

Also used to treat hypotension and shock

Also used to treat hyperkalemia Bitolterol (Tornalate)

Selective Beta2-Agonist

Has a long onset of action and use for prophylaxis of bronchospasm in clients over age 12.
Used for maintenance treatment of asthma and prophylaxis of bronchospasm in clients over age 5 with reversible obstructive airway disease. Also used to prevent exercise-induced bronchpspasm in clients over age 12.

Formoterol (Foradil)

B r o n c h o d i l a t o r s

Selective Beta2-Agonist

Isoproterenol (Isuprel)

Also indicated for heart block, shock, and ventricular dysrhythmias.

D r u g s

Salmeterol (Serevent)

Has a long-onset of action and indicated for maintenance therapy of asthma, prevention of bronchospasm in selected clients over age 4 with reversible airway disease, and prevention of exerciseinduced asthma.

Xanthine Derivatives Prevention and treatment of bronchial asthma, bronchitis, and COPD

B r o n c h o d i l a t o r s

Adverse effects and side effects Non selective beta1-beta2-agonist

D r u g s

Pregnancy category C CV: palpitation, tachycardia, hypertension, and cardiac arrest CNS: anxiety, tremors, insomia, dizziness, and headache. Endocrine: hyperglycemia GI: nausea and vomiting
Pregnancy category c except terbutaline (brethare, bricanyl), which is category B. CV: palpitation, hypertension CNS: tremors, nervousness, restlessness, headache and insomia Endocrine: hyperglycemia GI: nausea and vomiting

Selective beta2-agonists

B r o n c h o d i l a t o r s

Adverse effects and side effects Xanthine derivatives

D r u g s

Pregnancy category C CV: tachycardia, dysrhythmias, and palpitations CNS: anxiety, headache, insomnia, seizures, and tremors. GI: anorexia, nausea, vomiting and cramps

B r o n c h o d i l a t o r s

Drug interactions All bronchodilators

Concurrent use with sympathomimetic can increase cardiac and CNS stimulation. Concurrent use with monoamino oxidase inhibitors (MAOIs) may cause hypertensive crisis. Concurrent use of beta-blockers may antagonize therapeutic effects. Increased risk of hypokalemia if taken with potassium-sparing diuretics. Concurrent use with caffeine may cause stimulation effects.

D r u g s

Beta-agonists

B r o n c h o d i l a t o r s

Drug interactions Xanthine derivatives

D r u g s

Increase theophylline levels with concurrent use of allopurinol, benzodiazepines cimetidine, erythromycin, oral contraceptives, influenza vaccine, interferon, beta-blockers, and corticosteroids. Nicotine may increase metabolism and decrease effectiveness of xanthines.

Contraindications All brochodilators

Hypersensitivity tachydyrhythmias

Beta-agonist and xanthine derivatives

B r o n c h o d i l a t o r s

Nursing Implications All Bronchodilators

D r u g s

Monitor vital signs Assess lung sounds Encourage fluids unless contraindicated. Careful monitoring of the elderly as they are more susceptible to adverse reactions. Available by inhalation Albuterol, metaproterenol, and also available orally. Isoproterenol (Isupril) is also available IV and SL.

Beta-agonist

 Nursing Implications (cont)

B r o n c h o d i l a t o r s

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. 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.

xanthine derivatives

D r u g s

B r o n c h o d i l a t o r s

Patient teaching All bronchodilators

Check with health care provider taking OTC medications and herbal remedies. Take exactly as prescribed and do not double up on missed doses. Report adverse effects such as feeling jittery, palpitations, chest pain, restlessness, insomnia, or other symptoms to health care provider. Take oral medication with meals to decrease GI upset. 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 to health care provider. Avoid tobacco use as nicotine increases the metabolism of xanthines.

Beta-agonists

D r u g s

Xanthines

B r o n c h o d i l a t o r s

D r u g s

Meter-dose inhalaler Instruct client on proper use of MDI. If taking a bronchodilator 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 of medication.

Antihistamines
Also known as H1 antagonist and directly compete

with histamine for specific Antihistamine are categorized as

1.

receptor

sites.

2.

1st generation which include the chemical classes of alkylamines, ethanolamines, ethylenedilamines, phenothiazines, piperidines. 2nd generation or non sedating agents. Sedation is a problem seen with first generation antihistamines.

 Prototype drug
A n t r i h i s t a m i n e
Diphenhydramnie (benadryl)

Related drug Clemastine (Tavist) Dimenhydrinate (Dramamine) Trimethobenzamide HCL (arrestin, benzacot, tigan, ) Bronphineramine (Dimetane) Chlorpeniramine (chlor-trimeton) Dexchlorpheniramine (polaramine)

Classificaton First generations antihistamine Traditional antihistamines (ethanolamines) Alkylamines

D r u g s a

There is no prototype

Tripelennamine (Pyribenzamine)

Ethylenediamines

Buclizine (Bucladin-S) Phenothiazines Meclizine (Antivert) Cyclizine (marezine) Promethazine (phenergan) Trimeprazine (Temaril)


A n t i h i s t a m i n e

Prototype

Related drugs Azatadine (optimine) Cyproheptadine (PERIACTIN) Hydroxyzine (Atarax), vistaril, others

c;lassification Piperidines

D r u g s

Loratidine (claritine)

Azelastine (Astelin) Cetirizine (Zyrtec) Fexofenadine(alle gra)

2nd generation antihistamines Nonsedating histamines

A n t i h i s t a m i n e

D r u g s

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 reduces or prevents sedation. 2nd generation antihistamines have a longer duration of action and fewer anticholinergic effects than 1st generation antihistamines Therapeutic use Rhinitis, allergic, colds, nausea, adjunctive therapy of anaphylaxis, motion sickness, vertigo, Parkinsons disease and a sleep aid (first generation)

A n t i h i s t a m i n e

Adverse effects All antihistamines

D r u g s

Anticholinergic effects: first generation antihistamines; dry mouth dilated pupils urinary retention, tachycardia, and constipation: 2nd generation have minimal effects. CNS: sedation in 1st generation Derm : photosensitivity Blurred vision GI: dry mouth, GI upset, diarrhea, or constipation GU: urinary retention

A n t i h i s t a m i n e

D r u g s

First generation Antihistamines and second generation antihistamines. Pregnancy category B, although azelastine, brompheniramine, cyclizine, promethazine, and hydroxyzine, triamethobenzamide HCL, vistaril and others are category C. Unclassified pregnancy category are triplennamine 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.

A n t i h i s t a m i n e

D r u g s

Drug interactions Concurrent use with alcohol or other CNS depressants, antidepressants, kava-kava, valeria, and chamomile may cause additive CNS depression. Concurrent use with MAOIs can intensify antihistamine effects Concurrent use of erythromycin or ketoconazole with loratidine and fexofenadine increases concentrations of loratidine and foxefenadine.

A n t i h i s t a m i n e

D r u g s

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 to allergy test. When anti histamine are used as sleep aid, they should be given at least 2o minutes before bedtime. Antihistamine used for motion sickness should be given at least 30minutes before exposure to situations that may cause motion sickness.

A n t i h i s t a m i n e

D r u g s

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 minimize anticholinergic effects of dry mouth. Wear sunscreen and protective gear to prevent photosensitivity As many of these drugs are available OTC, take as directed.

Decongestant Drugs
Decongestant are used to decrease nasal congestion

caused by stimulation of the alpha1-adrenergic receptors 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 prolonged and less potent effects while topical decongestants produce rapid and potent effects.


D e c o n D g s t r g s e u
Prototype drug Ephedrine (Pretz-D) Related drugs Naphazoline (privine) Oxymetazoline (afrin) Phenylephrine (neoSynephrine, Coricidin, others) Pseudo-ephedrine hcl (sudafed, dorcol, decofed) Tetrahydrozoline (Tyzine) Xylometazoline (otrivin) Drug classification Decogestants (sympathomimetics)

a
n t

D e c o n D g s t r g s e u

a
n t

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

D e c o n D g s t r g s e u

a
n t

Drug Interaction Concurrent use with other sympathomimetic can increase toxicity. Concurrent use with MAOIs can cause hypertensive crisis. Contraindications Hypersensitivity Hypertension (oral use) CAD (oral use) Nursing implications Many decongestants are OTC agents Monitor vital signs and assess lung sounds and congestion periodically throughout the therapy. Monitor for hypertension, palpitations, or tachycardia and report symptoms to health care provider.

D e c o n D g r

e u
s g t a n s

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 to HCP. 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.

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 are opiods and non-opioids. Prescriptions antitussives are usually indicated when OTC preparations have not been effective.

Antitussive Drugs
Prototype Dextromethorphan (Vicks formula 44, Robitussin DM) Diphenhydramine (benylin, benadryl) Codeine (Dimetane-DC, Tussar SF) Related drugs Drug classification Non-opioid antitussives Benzonanate (tessalon) There is no related drugs at this time Hydrocodone (hycodan) Non-opioid antitussives Locally acting Antitussive antihistamine Opioid antitussive

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 opiods antitussives . 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.

Antitussive Drugs
Therapeutic use Symptomatic relief for non-productive coughs or in situations 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

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

 Interactions Non-opioid antitussives

Antitussive Drugs

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

 Contradictions All antitussives

Antitussive Drugs

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

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.

Antitussive Drugs
Patient Teaching Avoid concurrent use of OTCs and herbal remedies without consulting with physician. Use an antitussive for a dry, nonproductive cough. Avoid driving or operating heavy machinery while taking antitussives 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.

Expectorant Drugs
Expectorants stimulate the flow of the respiratory tract

secretions, 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 popular expectorant. Expectorant can be given as a single agent or in combination with other drugs.

Expectoraants
Prototype Guaifenesin (robitussin,others) Related Drugs There are no related drugs Drug classification Expectorants

Acetylcysteine (Mucomyst)
Dornase alfa (pulmozyme)

Mucolytics (antidote: acetaminophen Tylenol) Cystic fibrosis drug

Expectorants
Mechanism of action Expectorants

Reduces viscosity of secretions by increasing respiratory tract fluid, which mobilizes and allows for expectoration of mucus. Also indirectly irritates the GIT, which can cause N&V Decreases viscosity of pulmonary secretions. Split links in the respiratory mucoprotein molecules into smaller, more soluble, and less viscous strands. In acetaminophen (tylenol) overdose, it alters hepatic metabolism to decrease liver injury.

Mucolytics

Expectorants
Therapeutic use Expectorants

Relief of coughs associated with viral upper respiratory tract infactions

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
Adverse effects and sideeffects Expectorants

Pregnancy category C GI: GI upset, N&V Pregnancy category B CNS: dizziness, drowsiness GI: Nausea, stomatitis, hepatotoxicity, unpleasant odor (sulfur in drug may smell like rotten eggs) Resp: bronchospasm, hemoptysis, rhinorrhea Resp: cough pharyngitis, wheezes Other: conjunctivitis, chest pain

Mucolytics

Dornase alfa

Expectorants
Interactions
Expectorants

Non significant Acetylcysteine contains hydrogen sulfide and will discolor iron, copper and harden rubber.

Mucolytics

Expectorants
Contraindications All expectorants and Mucolytics

Hypersensitivity Some guaifenesin-containing products contain alcohol and should be avoided by recovering alcoholics

Expectorants

Mucolytics

Status asthmaticus and increased ICP Dornase alfa hypersensitivity

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 endotracheal tube 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 in eliminating 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

Expectorants
Nursing implications (cont) Dornase alfa

Store in refrigerator and protect from light Review use of nebulizer Give immediately, if 24 hours or less. Monitor liver function test, electrolytes, BUN, acetamenophen levels, and cardiac function Oral use: can be given with water and use within an hour.

Antidote use of mucomyst

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 recovering

alcoholics 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

Thanks for listening

Happy Vacation Guys