Pharmacology 12/12/22

DRUGS AFFECTING THE

RESPIRATORY SYSTEM Finals
Dr. Lolita Avanzado Trans 16

OUTLINE Sympathomimetics (Beta-adrenergic agonist)

I. Bronchodilators II. Drugs Affecting • Drugs that mimic the effects of the sympathetic nervous
Inflammation system.
• One of the actions is dilation of the bronchi with an
I. BRONCHODILATORS increased rate and depth of respiration
Bronchodilators or Anti-asthma • At therapeutic levels, the action of most sympathomimetics
• Medications used to facilitate respiration by dilating the are specific beta-receptors found in bronchi.
airways. • Other systemic effects:
• They are helpful in symptomatic relief or prevention of → Increased blood pressure, increased heart rate,
bronchial asthma and for bronchospasm associated with vasoconstriction, decreased renal and GI blood flow
COPD. (all actions of the sympathetic nervous system)
• Epinephrine
Asthma → The prototype drug; is the drug of choice for adults
• Characterized by reversible bronchospasm, inflammation, and children for the treatment of acute bronchospasm
and hyperactive airways. including that caused by anaphylaxis.
• Triggered by allergens or nonallergic inhaled irritants, or by • Adverse effects
factors such as exercise and emotions. → CNS: headache, restlessness
• Trigger causes an immediate release of histamine which → Cardiovascular: palpitation, tachycardia
results in bronchospasm in about 10 minutes. → Skin: pallor, local burning, and stinging sensation
• Later response 3-5 hours is cytokine-mediated
inflammation, mucus production and edema.
• Status asthmaticus is an extreme case of asthma.

Xanthines
• A theory suggests that xanthines work by directly affecting
the mobilization of calcium.
• Result to smooth muscle relaxation which increases the
vital capacity that has been impaired by the bronchospasm
or air trapping.
• Indications
→ Relief of symptoms or prevention of bronchial asthma
→ Reversal of bronchospasm associated with COPD Anticholinergics
• Adverse effects • Patients who cannot tolerate the sympathetic effects of
→ CNS: irritability, restlessness, dizziness sympathomimetics might respond to the anticholinergic
→ Cardiovascular: palpitation, life-threatening drugs ipratropium (Atrovent) and tiotropium (spirival)
arrhythmias • These drugs are not as effective as to sympathomimetics
→ Others: loss of appetite, fever flushing but can provide some relief to those patients who cannot
tolerate the other drugs
• Used as bronchodilators because of their effect on the
vagus nerve which is to block or antagonize the action of
the neurotransmitter acetylcholine at vagal-mediated
receptor sites
• By blocking the vagal effect, relaxation of smooth muscle in
the bronchi occurs leading to bronchodilation
• Adverse effects
→ CNS: dizziness, headache
→ GI: nausea, GI distress
→ CVS: palpitation
→ Respiratory: cough

Pharmacology Claudel 1 of 3
 II. DRUGS AFFECTING INFLAMMATION • They do not have immediate effects on the airways and are
Drugs Affecting Inflammation not indicated for treating acute asthma attack
• Second component of treating obstructive pulmonary
disorders; alter the inflammatory process that leads to Mast Cell Stabilizer
swelling and further airway narrowing • Prevent the release of inflammatory and broncho
• Effective treatment of asthma and COPD targets both constricting substances when the mast cells are stimulated
components to release these substances because of irritation or the
• These are the inhaled steroids, leukotriene receptors and a presence of antigen
mast cell stabilizer, w/c can affect both bronchodilation and • Cromolyn (nasal crom) is the only drug still available in this
inflammation class, only available over-the-counter form, and it is no
longer considered part of the treatment standards
Inhaled Steroids • Commonly used to prevent asthmatic attack
• Used to decrease the inflammatory response in the airway
• Increase airflow and facilitate respiration Lung Surfactant
• Inhaling the steroid tends to decrease the numerous • Are naturally occurring compound that reduce the surface
systemic effects that are associated with steroid use. tension within the alveoli, allowing expansion of the alveoli
• Indication for gas exchange
→ Prevention and treatment of asthma • Used to replace the surfactant that is missing in the lungs
→ Used as adjunctive therapy for asthma pts who do not of neonates with RDS
respond to traditional bronchodilators • Respiratory distress syndrome RDS is frequently seen in
• Adverse effects premature infants who are delivered before their lungs
→ CNS: irritability, headache have fully developed and while surfactant levels still very
→ Respiratory: rebound congestion, epistaxis, local low
infection • Nursing Considerations
• Nursing Considerations → Correct endotracheal tube placement—ensure proper
→ Not for immediate relief. placement of ET tube with bilateral chest movement
o Do not administer inhaled steroids to treat an and lung sounds to provide adequate delivery of the
acute asthma attack or status asthmaticus drug
→ Proper tapering of steroids. → Suction the infant sections, but do not suction for 2
o Taper systemic steroids carefully during the hours after administration of unless clinically
transfer to inhaled steroids; death have occurred necessary, to allow the drug time to work
from adrenal insufficiency with sudden withdrawal
→ Use decongestant drops before using to facilitate
penetration of the drug if nasal congestion is a
problem
→ Oral care.
o Have pt. rinse the mouth after using the inhaler
bec. this will help decrease systemic absorption
and decrease GI upset and nausea

Antitussives
• Persistent coughing can be exhausting and can cause
muscle strain and further irritation of the respiratory tract
• Many disorders are accompanied by an uncomfortable,
unproductive cough
• Coughing is naturally protective way to clear the airway of
secretions or any collected materials, and antitussives
prevent these actions
• Acts on the cough-control center in the medulla to suppress
the cough reflex; if the cough is nonproductive and irritating
• Indications
Leukotriene Receptor Antagonist (suffix “lukast”) → Local anesthetic on the respiratory passages, lungs
• Selectively and competitively block (zafirlukast, and pleurae, blocking the effectiveness of the stretch
montelukast) or antagonize (zileuton) receptors to produce receptors that stimulate a cough reflex
leukotrienes D4 and E4 → For the treatment of dry cough, drug withdrawal
• As a result, these drugs block many of the signs and syndrome, opioid type drug dependence and pain
symptoms of asthma, such as neutrophil and eosinophil • Contraindication and Caution
migration, neutrophil and monocyte aggregation, leukocyte → Asthma and emphysema
adhesion, increased capillary permeability, and smooth
muscle concentration.
Pharmacology Drugs Affecting the Respiratory System 2 of 3
 obecause cough suppression could lead to • Selectively block the effect of histamine at the histamine 1
accumulation of secretions and loss of respiratory receptor sites, decreasing the allergic response
reserve • It block the release or action of histamine, a chemical
→ Addiction released during inflammation that increases secretion and
o pt. who are hypersensitive to or have a history of narrow airways
addiction to narcotics; codeine is a narcotic and • They are found in multiple OTC preparations that are
has addiction potential designed to relieve respiratory symptoms and treat
→ Sedation allergies
o pts who need to drive or be alert should use • First generation antihistamines have greater anticholinergic
codeine, hydrocodone and dextromethorphan effects with resultant drowsiness, a person who needs to
with extreme caution because these drugs can be alert should be given one of the second generation, less
cause sedation and drowsiness sedating antihistamines
• Indications
III. DECONGESTANTS → Relief symptoms of seasonal and perennial allergic
Decongestants rhinitis, allergic conjunctivitis, uncomplicated urticarial
• Decrease the overproduction of secretions by causing local and angioedema
vasoconstriction to the upper respiratory tract → Relief of nausea and vomiting associated with motion
• This vasoconstriction leads to the shrinking of swollen sickness. Ex. Meclizine or bonamine
mucus membranes and tends to open clogged nasal • First generation antihistamine
passages, providing the relief from discomfort of a blocked → Promethazine hydrochloride (Phenergan), Meclizine (
nose and promoting drainage of secretions and improve bonamine), Benadryl, Chlorphenamine maleate
airflow • Second generation antihistamine (non-drowsy or non-
sedating)
Topical Nasal Decongestant → Cetirizine (verlix), Loratadine (allerta), Levocetirizine
• Imitate the effects of the sympathetic nervous system to (Xyzal), Fexofenadine (Allegra)
cause vasoconstriction, leading to decreased edema and
inflammation of the nasal membranes Expectorant
• Relieves the discomfort of nasal congestion that • Are drugs that liquefy the lower respiratory tract secretions,
accompanies the common cold, sinusitis, and allergic reducing the viscosity of these secretions and making it
rhinitis easier to cough them up
→ Ex: ephedrine, oxymetazoline, phenylephrine, • They are used for the symptomatic relief of respiratory
xylometazoline, tetrahydrozoline conditions characterized by dry, nonproductive cough
• Ex. Guaifenesin (Rubitusin)
Topical Nasal Steroid Decongestants
• Their anti-inflammatory action results from their ability to Mucolytics
produce a direct local effect that blocks many of the • Increase or liquefy respiratory secretions to aid the clearing
complex reaction responsible for the inflammatory of the airways in high-risk respiratory pts. Who are
response coughing up thick, tenacious secretions
• Treatment of seasonal allergic rhinitis in pts who are nor • Affects the mucoproteins in the respiratory secretions by
obtaining a response with other decongestants or splitting apart disulfide bonds that are responsible for
preparation holding the mucus material together
→ Ex: dexamethasone like Decadron, fluticasone like • The result is a decrease in the tenacity and viscosity of the
Flovent, triamcinolone as Azmacort, flunisolide as secretions
Aerobid • Patients may be suffering from conditions such as COPD,
cystic fibrosis, pneumonia, or tuberculosis
Oral Decongestants
• Acetylcysteine is used orally to protect the liver from
• Decrease nasal congestion related to common cold, acetaminophen toxicity
sinusitis, and allergic rhinitis
• Ex. Carbocisteine (solmux, robikids, loviscol)
• Shrink the nasal mucous membrane by stimulating the
• Acetylcysteine (Flumucil)
alpha-adrenergic receptors in the nasal mucous
• Ambroxol HCL (mucosolvan)
membranes
• This shrinkage result in a decrease in membrane size
promoting drainage of the sinuses and improving airflow
• Ex: pseudoephrine like Sudafed decofed, beclomethasone
such as Beclovent, budesonide like Pulmicort
• Sinutab non drowsy relieves sinus and nasal congestion
and Claritin-D for allergy and congestion

Antihistamines

Pharmacology Drugs Affecting the Respiratory System 3 of 3