pharm respiratory drugs

Histamine is released from mast cells and basophils when an allergen enters the body.  This causes itching, increased mucous secretion and nasal congestion.  H1 receptor antagonists block histamine from reaching the H1 Receptors so histamine cannot be produced

• PO
• IV
• IM

• Drowsiness
• Paradoxical excitation
• Anticholinergic effects -slow things down

• Prostatic Hypertrophy - BPH
• GI Obstruction- because it slows things down
• Narrow Angle Glaucoma-increased pressure in the eye

• Alcohol
• Opiates
• Other OTC cold Med

• Anticholinergic effects
• QRS widening

• Motion sickness
• Insomnia
• Parkinson's disease
• Skin Rashes

only work better because they are newer and people have not developed a tolerance to them as much as the older ones

• sprayed directly into the nose to decrease the secretion of inflammatory mediators, reduce edema, and cause mild vasoconstriction
• Decreases the inflammation in the nose and helps the person feel less congested

Intranasal

usually a metered spray device that limits the amount per spray and makes the dose consistent

no serious adverse effects when given intranasally, but may give systemic effect if large amounts are swallowed

• Sensitivity
• Know bacterial, fungal, viral or parasitic infection

• patient has infection
• Steroids will increase the infection

Nasal Decongestants

sympathomimetics

Activate alpha adrenergic receptors in the autonomic nervous system

used only for nasal congestion, sometime combined with antihistamine for sneezing, tearing eyes

• PO
• Intranasal

• intranasal = rebound congestion (can occur within 3 days of regular use of Afrin)
• stinging or dryness

• PO = no rebound congestion but it is slower onset to work
• can cause HTN, CNS Stimulation, tachycardia, nervousness

• HTN
• Heart Disease

limited for nasal

PO - CNS Stimulants

COUGH SUPPRESSANTS

reduces the thickness of secretions so that they can be removed by coughing

breaks down the chemical structure of mucous to loosen it

opiate or non-opiate

suppress the cough reflex

used for dry hacking cough

PO

• Opiate based = Drowsiness, Dizziness
• Non-Opiate Based = GI upset

• asthma
• excessive bronchial secretions

• MAOIs
• CNS Depressants

Works like local anesthetic by anesthetizing stretch receptors in the lungs

Cannot be chewed or crushed, it will numb whatever it touches

Makes the bronchial secretions thinner and increase mucous flow

PO

None

Breaks down the chemical structure of mucus to loosen it up and make it easier to remove by coughing

(Mycomyst)

• Vomiting
• Bronchosparm

Inhaled Insulin

Asthma (because the bronchospasms)

• Breath Sounds
• Respiratory Status
• Vitals
• Allergies

• Ineffective airway
• ineffective breathing pattern
• disturbed sleep process
• risk for injury
• risk for falls

• increased fluid intake (help thin secretions)
• monitor fever
• monitor dizziness, drowsiness
• report changes in severity or frequency of cough
• changes in mucus
• educate-limit the use of nasal sprays
• educate-blow nose...nasal spray...spit out spray that drains in mouth

brings in O2 removes CO2

chronic pulmonary disease with inflammatory and bronchospasm components

effect 20 million people

intense breathlessness, coughing and gasping for air

(wheezing caused by inflammation, air trying to be forced through airways)

• Quick Relief: short immediate acting beta 2 adrenergic agonists, anticholinergic or systemic corticosteroids
• Long Acting: long acting beta 2 adrenergic agonists, methylxanthines and immunomodulators (more SE because large amount inhaled at one time)

activates beta 2 receptors found on the smooth muscles of the lung, which relaxes bronchial smooth muscles resulting in bronchodilation

PO, Inhaled, IV

• Headache
• Tremor
• Nervousness
• Tachycardia
• Dysrhythmias
• Tolerance

• Cardiac History
• HTN
• Black Box Warning: LABAs

• Beta Blockers (counter act each other)
• MAOI (increases BP when given together)
• CNS Stimulants

Blocks sympathetic nervous system and causes bronchodilator

LONG ACTING

bronchodilators that act similar to caffeine

can be given PO, IV

Rarely used anymore becaused safer drugs are available

• Nervousness
• Insomnia
• CNS Stimulation
• Dysrhythmias

Cardiac History

• Dampen the activation of inflammatory cells and increases production of anti-inflammatory mediators
• Reduce bronchial hyperresponse to allergens
• Mostly used for prevention
• LONG ACTING

Administer after bronchodilator (to open airway)

Should Not be used during asthma attack (it will not work)

• Thrush (because the steroid sits in the mouth)
• Hoarseness
• Dry Mouth
• Systemic effects are rare unless it is swallowed

educate patient to brush teeth or rinse mouth after to prevent the steroid for sitting in the mouth

Growth in Pediatric Patients (must measure frequently)

There are no known interactions when inhaled

leukotriene is mediator of immune response it promotes edema, inflammation, and bronchoconstriction

Blocks leukotriene receptors

LONG ACTING and can take 1 week to start working

PO, Inhalation

• minimal
• headache
• cough
• nasal congestion

• patients older than 65
• patients with Liver damage

• inhibit mast cells from releasing histamine
• reduces inflammation

• Nasal Congestion
• Throat Irritation
• Bitter unpleasant taste

• Health history
• Asthma triggers
• Vitals
• Pulmonary function

• impaired gas exchange
• ineffective tissue perfusion
• anxiety
• activity intolerance

• provide instruction regarding immediate acting vs long acting
• increase fluids
• reduce allergens
• rinse mouth to prevent thrush
• teach to use spacers if needed
• always use bronchodilator before steroid
• rinse inhaler and spacer daily