Level I

  1. Beta-2 adrenergic agonists
    • Mechanism of Act: activate sympathetic nervous system, which relaxes bronchial smooth muscle resulting in bronchodilation
    • Therapeutic Effects: Bronchodilation
    • Indications: Asthma, COPD-for bronchospasm, exercise induced bronchospasm
    • Side Effects: common H/A, dizziness, tremor, nervousness, throat irritation, tachycardia, arrhythmias, hypokalemia, hyperglycemia, paradoxical bronchoconstriction
  2. Anticholinergics
    Ipratropium Atrovent
    Tiotropium Spiriva
    • Mechanism of Act: Blocks parasympathetic nervous system resulting in bronchodilatiion
    • Therapeutic Effects: Bronchodilation
    • Indications: COPD, Asthma
    • Side Effects: rarely - dry mouth, GI distress, headache, anxiety
  3. Methylxanthine
    • Long term maintenance
    • Mechanism of Act: inhibits phosphodiesterase, producing increase tissue concentration of cyclic adenosine monophosphate cAMP, increased levels of cAMP result in bronchodilation, CNS stimulation, positive inotropic & chronotropic effects
    • Therapeutic: Bronchodilation
    • Indications: Asthma, COPD, unlabeled - unlabeled respiratory/myocardial stimulant in premature infant apnea
    • SE: nervousness, tremors, dizziness, H/A, N/V, anorexia; tachycardia, dysrhythmias, hypotension, seizures, circulatory failure, respiratory arrest
  4. Anti-Inflammatory Agents
    Systemic Corticosteroids/Glucocorticoids
    Prednisone (PO)
    Methylprednisolone (IV)
    • Mechanism of Act: decrease activation of inflammatory cells and increase production of anti-inflammatory mediators
    • Therapeutic: Suppress inflammation, modify normal immune response
    • Indications: Asthma, COPD - 6hrs
    • SE: hyperglycemia, hypokalemia, hypocalcemia, decreased immune response= higher risk for infections, long term use - wt gain from edema, monitor mood changes-depression & irritability, suppression of adrenal glands
  5. Inhaled Corticosteroids
    Beclomethasone Beconase AQ, Qvar
    Budesonide, Pulmicort
    Triamcinolone Azmacort
    • Preferred
    • Mechanism of Act: potent, locally acting anti-inflammatory and immune modifier. reduces bronchial hyper-responsiveness
    • Therapeutic: decrease frequency and severity of sthma attacks, improves asthma symptoms, takes 2-3 days of use to be effective
    • Indications: maintenance of asthma
    • SE: hoarsness, dry mouth, cough, sore throat, orpharyngeal candidiasis, hypercorticism, hypersensitivity reactions
  6. Mast Cell Stabilizer
    Cromolyn intal
    nedocromil sodium Tilade
    • Mechanism of Act: inhibits the release of histamine from the mast cells
    • Therapeutic: prevent asthma attacks in people w/ bronchial asthma, prevent bronchospasm
    • Indications: useful only in prophylaxis to prevent bronchospasm, helps to prevent exercise induced asthma, may allow reduced dosage of bronchodilators & corticosteroids, Asthma, COPD
    • SE: nausea, sneezing, nasal stinging, throat irritation, unpleasant taste, anaphylaxis, angioedema, bronchospasm - not common
  7. Leukotriene Modifiers-
    Leukotriene Receptor Antagonists-
    Zafirlukast accolate
    Montelukast singulair
    Leukotriene Synthesis Inhibitors Zileuton zyflo
    • Mechanism of Act: antagonizes the effects of Leukotrienes, which are components of slow-reacting substance of anaphylaxis, substance mediate following - airway edema, smooth muscle constriction, altered cellular activity, result is decrease inflammatory process that is part of asthma
    • Therapeutic: decreased frequency and severity of asthma
    • Indication: long term control agent in the management of asthma
    • SE: H/A, nausea, diarrhea, live toxicity (Zileuton), increased AST
  8. Antimicrobials
    Method of Action: Destroy the cell wall, prevent viral replication through reduction of enzymes the virus needs to reproduce
  9. Vancomycin
    • Mechanism of Act: binds to bacterial cell wall, resulting in cell death
    • Therapeutic: bactericidal, target trough concentrations 5-15 mcg/mL
    • Indications: infections, staphylococcal, Group A beta strep, C-diff
    • SE: N/V, anaphylaxis, superinfections, nephrotoxicity, ototoxicity, red-man syndrome
    • Nursing Implications: monitor peak/trough after 3rd dose - obtain peak 1hr after end of infusion, trough levels prior to 4th dose, trough levels obtained w/in 30min before the nxt scheduled dose
    • Patient teaching: take oral Vanco as directed, take full coures, N/V, rash, vertigo; hearing loss-tinnitus, unusual colored urine, decreased urine output
  10. Gentamycin
    • Mechanism of Act: inhibits protein synthesis in bacteria at level of 30S ribosome
    • Therapeutic: bactericidal action, trough - <2mcg/mL, Peak 5-8mcg/mL
    • Indications: treatment of gram negative infections, staphy when penicillin's contraindicated
    • SE: pain/inflammation at injection site, rash, fever, nausea, diarrhea, dizziness, tinnitus, anaphylaxis, nephrotoxicity, irreversible ototoxicity, superinfections
    • Nursing Implications: levels should be drawn around the 3rd or 4th dose to allow the drug to reach steady-state, peak levels should be drawn 30 minutes after the end of infusion, trough levels should be drawn immediately before the nxt dose
    • Patient teaching: take exactly as directed by the physician, full course, N/V, rash, vertigo hearing loss-tinnitus, unusual colored urine, decreased urine output
  11. Cephalosporin
    • Mechanism of Act: cell wall inhibitor
    • Therapeutic: antibacterial
    • Indications: most effective against gram+, more potent/broader spectrum against gram-, broader than 2nd, effective against organismsthat have developed resistance to earlier cephalosporins, enters cerebrospinal fluid to treat CNS infections
    • SE: diarrhea, abdominal cramping, nausea, fatigue, rash, pruritus, pain at injection site, oral/vaginal candidiasis, pseudomembranous colitis, nephrotoxicity, anaphylaxis
  12. Penicillins
    • Mechanism of Act: works by disrupting theĀ  cell walls
    • Therapeutic: antibacterial
    • Indications: Gram+, pneumonia, meningitis, skin, bone, joint infections, blood/valve infections, gas gangrene, tetanus, anthrax, sickle cell anemia in infants
    • SE: rash, pruritis, diarrhea, nausea, fever, drowsiness, anaphylaxis - angioedema, circulatory collapse, cardiac arrest, nephrotoxicity
  13. Flouroquinolones
    Cipro, levaquin, moxifloxacin
    • Mechanism of Act: affect DNA synthesis by inhibiting two bacterial enzymes: DNA gyrase & topoisomerase IV (bacteriocidal)
    • Therapeutic: antibacterial
    • Indications: respiratory infections, GI & GU tracts, some skin & soft tissue infections
    • SE: D/V, diarrhea, H/A, restlessness, pain and inflammation at infection site, local burnings, stinging, corneal irritations, anaphylaxis, tendon rupture, superinfections, photosensitivity, pseudomembranous colitis, seizure, peripheral neuropathy, hepatotoxicity
  14. H1 Receptor Antagonists
    Benadryl, phenergan, Tavist, Dimetap, Zyrtec, Allegra, Claritin
    • Mechanism of Act: selectively blocks the action of histamine at the H1 receptor, thus alleviating allergic symptoms
    • Therapeutic: treatment of allergies
    • Indication: relief of allergy symptoms
    • SE: anticholinergic, dry mouth, eyes, mouth, nose & throat, H/A, hypotension, dizziness, urinary retention, thickening of bronchial secretions, N/V, confusion, blurred vision, paradoxical excitation, sedation, hypersensitivity reactions, hypotension, extrapyramidal symptoms, agranulocytosis, respiratory depression
    • Nursing Implications: monitor VS, monitor for urinary retention, avoid alcohol, driving, admin w/ food or milk
  15. Nasal Decongestant/Spray
    adrenergic, anticholinergic, non-glucocorticoid
    Afrin, neo-synephrine
    • Mechanism of Act: produces vasoconstriction in the respiratory tract mucosa
    • Therapeutic: nasal drying/ decongestant
    • Indications: nasal congestion, allergic conditions
    • SE: rebound effect (worsening nasal congestion), produces few systemic effects because almost none of drug is absorbed into circulation
    • Nursing Implications: no longer than 3 days
  16. Nasal Decongestant/Sprays
    Flonase, nasonex, beconase, nasacort
    • Mechanism of Act: decrease the secretion of inflammatory mediators, reduce tissue edema & cause mild vasoconstriction
    • Therapeutic: decrease in symptoms of allergic rhinitis
    • Indications: seasonal allergic rhinitis & other chronic nasal inflammatory conditions
    • SE: mild nasal irritation and dryness, local fungal infection, sneezing, H/A
    • Nursing Implications: monitor degree of nasal stuffiness, amt & color of nasal discharge, and frequency of sneezing
    • Patient teaching: maximal response may take 2-3 weeks
  17. Oral Decongestants
    adrenergic, anticholinergic, actifed, sudafed
    • Mechanism of Act: produces vasoconstriction in the respiratory tract mucosa
    • Therapeutic: nasal drying/decongestant
    • Indications: Nasal congestion, allergic conditions
    • SE: nervousness, insomnia, H/A, dry mouth, HTN, CNS excitation, tremors, dysrhythmias, tachycardia, difficulty in voiding
    • Nursing Implications: Admin at least 2 hrs before bedtime to minimize insomnia
    • Patient Teaching: Do not use w/ MAOI, HTN, Heart disease, glaucoma
  18. Expectorants
    mucinex, robitussin
    • Mechanism of Act: reduces viscosity of tenacious secretions by increasing respiratory tract fluid
    • Therapeutic: mobilization & subsequent expectoration of mucus
    • Indication: management of cough associated w/ viral upper respiratory tract infections.
    • SE: drowsiness, H/A, GI upset, no serious adverse effects
    • Nursing Implications: full glass of water, do not chew or crush, encourage adequate fluid intake (thins secretions), encourage cough & deep breath
  19. Mucolytics
    acetylcysteine mucomyst
    • Mechanism of Act: directly loosens thick, viscous bronchial secretions, breaks down the chemical structure of mucus molecules
    • Therapeutic: mucolytic, antidote
    • Indications: inhalation - management of conditions associated w/ thick viscid mucus secretions (cystic fibrosis), emergency of management of acetaminophen overdose
    • SE: bronchospasms, N/V, stomatitis, runny nose
    • Nursing Implications: give via nebulizer, bronchodilator often given 5 min before mucolytic, do not mix w/ another med
  20. Antitussives
    opioid-codeine, hycodan
    nonopioid-benadryl tablet or syrup
    • Mechanism of Act: acts on cough control center in medulla to suppress cough reflex
    • Therapeutic: suppression of dry hacking cough that interferes w/ sleep
    • Indication: antitussive
    • SE: respiratory depression, constipation, dizziness, drowsiness, sedation, GI irritation, nausea, hypotension
    • Nursing Implications: assess lung sounds, cough, RR, HR, BP, admin with food/milk, may cause drowsiness, orthostatic hypotension, excitation in peds & elderly
Card Set
Level I
Level I Respiratory Drugs