respiratory drugs

the pathophysiology for asthma, chronic bronchitis, and allergic sinusitis are created by the same mechanism. Each cilia, whether in the nasal passage or the bronchi and bronchioles is attached to a goblet cell.

• to moisturize the air when we inhale, humidify by producing mucus
• to produce histamines, eosinophils, leukocytes, and leukotrienes to allergens and germs we inhale. i.e. smoke
• moisturize fine hairs known as cilia to keep inhaled particles from getting into our lungs through the nasal passage. the goblet cells produce mucous to catch these toxins prior to the lungs.

when the cilia are damaged, or the goblet cells are over-producing mucous and leukotrienes, the next reflex of the lungs is an inflammatory response, which produces leukocytes. As the cells swell, become inflmaed, and produce too much mucous, this makes the airway smaller. The next response or reflex of the lungs is to bronchospasm and cough these toxins out of the airway.

• nebulizer: misted treatment that you inhale.
• inhalation with MDI's (metered dose inhalers)
• oral medications to either prevent or treat inflammation that already exists.

steroids that suppress the inflammatory response.

prophylaxis and chronic inflammation (COPD)

• oral candidiasis
• dysphonia- hoarse voice
• long term therapy can cause thinning of the bones and adrenal insufficiency- suppressing the normal adrenalin secretion
• slowing the growth in children

• educate the client to rinse their mouth after using an inhaler or nebulizer
• if the inhaler is preventative teach the client to use it as ordered, usually bid
• if they are using a nasal spray, teach the client to use it aimed toward the side of the nasal passage not straight up, to get better effect on the cilia
• if the client is on high dose therapy, educate them to wean off their drugs slowly and not stop them suddenly so that the adrenal glands can start working again. If they stop suddenly they may have a rebound exacerbation of the inflammatory response.

• QVAR - beclamethasone inhaler bid
• Pulmicort- budenoside inhaler bid or "respules bid for nebulizer
• Aerobid - flunisolide inhalder bid
• Flovent - by inhaler or diskus bid
• asmacort- triamcinolone inhaler bid
• Nasacort- triamcinolone nasally bid
• Teach client to increase dose by 2 puffs or tid when they have a flare up.

• singulair (montelukast)- safest drug
• accolate (zafirlukast)
• intal (cromolyn)

• kast = mast cell inhibitors - keep the cells from producing leukotrienes and histamines, preventing inflammation in the airways.
• These are only used for prevention, not for acute corticosteroids for better effect.

monoclonal antibody class

Xolair (omalizumab) - decreases IgE

antibodies produced in lungs and responsible for allergic reactions.

only sub-q. very expensive imuno-suppressant, about $1,000 a dose, once a month, used for severe asthma that doesn't respond to other therapies.

immuno-suppressants

• client can become more vulnerable to bacterial infections, candidiasis, and accelerated growth of abnormal cells.
• TB and previous cancer diagnoses are contraindications to MAB's

• usually given orally or by inhalation as MDI's or nebulizers
• exception is epinephrine

bronchodilators have a benzene ring wihch stimulates the sympathetic B-2 receptors in the bronchial muscle cells, activating the "flight or fight" response

prevention of "athletic asthma" and treatment of acute inflammation, acute asthma attacks, and to prevent bronchospasms. Must be taken on a rigid schedule if used for prevention, as they only have a T1/2 of 2 hours

• albuterol MDI
• ** albuterol liquid PO has a longer T1/2

• increased heart rate
• hypertension
• dizziness
• anxiety or tremors
• "fight or flight" symptoms

naturally as herbal salts in nature coffee beans, coca leaves

• work by stimulating the sympathetic nervous receptors in smooth muscle. remember that not only the bronchials have these receptors but also the heart and bladder have smooth muscle.
• T1/2: 6 hours
• onset is rapid 15 minutes
• therapeutic index is narrow

• theophylline (aminophylline)
• theodur- XR- time release PO
• forms: can be given PO, or rectally as maintenance
• give IV for severe respiratory failure
• dose: adult loading dose is 5mg/Kg IV or PO
• warnings: Drug levels must be monitored every day and 30 minutes after giving IV loading dose.
• Therapeutic dose: 10-15 mcg/ml

• drug toxicity: nausea, vomiting, seizures, flushing, tachycardia, dysrythmias
• due to sympathetic stimulation: insomnia and irritability, uriniary frequency and dehydration, tachycardia and hypertension, rare: aminophylline : induced psychosis

• monitor drug levels and assess for toxic side affects
• listen to lung sounds - still wheezing?
• monitor oxygen saturation, heart rate and blood pressure constantly if giving IV, patient needs to be on heart monitor
• hydration for bladder spasms and possible dehydration
• accurate intake and output

• atrovent (Ipratopium) also in combivent
• spiriva (tiotropium) 24 hour inhaler

• these drugd are anti-cholinergics which work by blocking the parasympathetic nervous system, thereby blocking brinchospasms. Atrovent is also used nasally to dry up excess mucous. ex allergic rhinitus.
• These drugs are typically used for COPD patients. By blocking the parasympathetic nervous system, they act on the unconcious act of bronchospasm. specially useful in combination with beta aderenergics because of their synergistic properties.
• Good for those who wheeze at the site of a nurse or doctor.

the stimulation of the goblet and mast cells due to routine or seasonal allergens, recognized by the bodys B-cells. Allergies can range from a runny nose, a cough, to an anaphylactic experience.

the same as asthma. overstimulation of mucoid production, inflammation, and chronic congestion

first line antihistamines

benadryl, also a anti-chollinergic so it has a drying effect and sedative effect.

GI drugs, mild antihistimines

less sedation

• oral medications:
• zyrtec
• allegra/alavert
• claritin
• xyzal
• nasal sprays: usually one in each nostril every 5-6 hours
• astelin
• astapro
• topical singulair for the nose:
• patanase

nose bleed and headache

in nasal sprays and work to prevent allergic rhinitus but not for acute infections.

• beconase AQ (aqueous)
• rhinocort
• omnaris
• flonase
• veramyst
• nasonex

• clean the top of your inhaler weekly
• dont use if nasal drainage changes from clear to colored, steroids can enhance the growth of bacterium
• use twice a day as ordered, to prevent flare ups. if one type doesnt work another might.

nasalcrom (cromolyn sodium)

• are less than other sprays.
• safe enough for 2 year olds.
• takes longer to work. up to 2 weeks.

antihistamines and decongestants.

stimulating the symathetic blood vessels and in the nares, causing constriction and shrinking the vessels.

• get a stuffy nose
• have polyps
• or deviated septums which swell and sinuses cant drain properly.

they can be used for allergies, common colds, and sinusitis infections

• tachycardia
• nervousness, insomnia
• hypertension
• "fight or flight"

people on anti-hypertensives = stroke

• topical (nasally) work faster and the client can become dependent on them.
• oral forms: these are the basis of meth

• phenylephrine
• ephedrine
• pseudophedrine

anti-cough medicines

• hydrocodone
• codeine
• oxycodone

dependence on the medication

suppressing the CNS, cough relfex

• dextromethorphan (benadryl)
• tessalon perles (tetracaine derivative)

suppressing the cough mechanism, but in different ways. may also be slightly sedating.

breaks up mucous

interacts with the mucous to make it more watery.

a nebulizer inhaler

• bronchospasm
• tastes and smells like rotton eggs

sulfa allergies

• most OTC are antihistamines with or without decongestants.
• anlagesics with caffeine
• anti-tussives with or without antihistamines and decongenstants
• OTC drugs are not approved for childer under 2 years old and may be dangerous.
• when the cold is over the toothbrush needs to be disinfected or a new one bought.
• do not use antihistamines to sedate children
• if you are on other meds see your PCP first