This document discusses various respiratory agents used to treat respiratory diseases. It begins by introducing respiratory agents and their forms of administration. It then categorizes respiratory agents and discusses each category in further detail, including anti-asthmatic drugs, mucoactive agents, drugs for cough, and antibiotics. For anti-asthmatic drugs, it describes subclasses like bronchodilators, anti-inflammatory drugs, antihistamines, leukotriene inhibitors, and anti-IgE drugs. It provides examples, mechanisms of action, uses, side effects and nursing responsibilities for many of the discussed respiratory agents.
2. INTRODUCTION
Respiratory agents is a term used to describe a
wide variety of medicines used to relieve, treat, or
prevent respiratory diseases such
as asthma, chronic bronchitis, chronic
obstructive pulmonary disease (COPD),
or pneumonia.
Respiratory agents are available in many different
forms, such as oral tablets, oral liquids, injections or
inhalations.
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7. EPINEPHRINE:
It stimulates alpha and beta1as well as beta2
receptors.
It is an effective rapid acting bronchodilator when
injected S/C (0.4 mL of 1:1000 solution) or inhaled
as a microaerosol from a pressurised canister (320
mcg/ puff).
Adverse effects
Tachycardia,
Arrythmias
Worsening of angina pectoris.
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8. EPHEDRINE:
Used in asthma for longest time.
Longer duration and lower potency than
epinephrine.
Not much used nowadays due to development of
β2- selective agents.
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9. ISOPROTERENOL:
A potent bronchodilator , producing effect in 5
minutes.
Duration of action 60-90 minutes.
High doses associated with cardiac arrhythmias
leading to death.
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10. SELECTIVE BETA ADRENERGIC DRUGS:
Mechanism of action: They causes widening of
the airway by relaxing bronchial smooth muscles by
stimulate beta receptors.
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12. Indications/uses
Relieving the distress of asthma.
Bronchospasm or bronchoconstriction.
Contraindications/ Precautions.
Patient with uncontrolled arrythmias.
Prolonged use of albuterol may cause hypokalemia
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14. Drug interactions
(Beta) blocker antagonize the effects of adrenergic
agonists.
Prolonged use of theophylline cause additive
effects.
Nursing Responsibilities
Nurse should monitor the patient’s blood pressure,
pulse, respiratory rate, and breathing sounds.
Teach the patients that how to use inhalers.
Instruct the patient to avoid respiratory irritants,
such as smoke, dust, and strong smell.
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15. BRONCHODILATORS: METHYLXANTHINE
Mechanism of action: These drugs are weak CNS
stimulants that are powerful smooth muscle
relaxants thus they relax the smooth muscle of
bronchi. They also have diuretic effect.
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17. Indication/Uses
To treat and prevent bronchospasm.
To treat asthma, bronchitis, emphysema.
Contraindications/ Precautions
Hypersensitivity to any xanthine.
Infection or irritation of rectum or lower portion.
Give cautiously in neonates, in elderly patients,
heart disorders, hepatic disorders.
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19. DRUG INTERACTIONS
(beta) Blocker may antagonize the effects of
methylxanthines.
Erythromycin may increase the half life of
methylxanthines, and increasing the risk of
methylxanthines toxicity.
Rifampicin, phenobarbital phenytoin, cigarette
smoking and charcoal – broiled food may shorten
the half-life of drugs and reducing their
effectiveness.
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20. NURSING RESPONSIBILITIES
Nurse should assess for signs and symptoms of
toxicity.
Nurse also should know that therapeutic sr. level of
theophylline ranges from 10 to 20 mcg/ml.
Advise patients to decrease consumption of
xanthine – containing food and beverages.
To detect toxicity, nurse should monitor serum
drugs levels.
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22. MAST CELL STABILIZERS
Mast cell stabilizers works to prevent allergy cells
called mast cell from breaking open and releasing
chemicals that help to cause inflammation.
They are not effective once the allergic reaction has
occurred and mediators are released from mast
cells. So they are useless during asthmatic attack.
They are used in the prophylaxis of asthma.
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23. MECHANISM OF ACTION
They inhibit mast cell activity, thus prevent the
release of allergic mediators like histamine,
serotonin, prostaglandins, cytokines. These
chemical are essential for an inflammation and
allergic reactions.
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27. Drug interactions
Not reported
Nursing Responsibilities
Nurse should monitor drugs adverse reactions.
Instruct patients that this drug is not effective in an acute
attack.
Nurse should instruct the patient how to use metered –
dose inhaler or nebulizer.
If more than one inhalation is ordered, advise patient to
wait 1-2 minutes before taking second puff.
If the parents is also receiving an inhaled bronchodilator,
advise the patient to use bronchodilators first to open
the airways and then wait approximately 5min before
using cromolyn sodium to maximize its effectiveness.
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28. Anti-Inflammatory Drugs (Cortico-steroids)
These drugs have antiinflammatory as well as
antiallergic actions thus they are effective in
bronchial asthma.
Mechanism of action
They prevent the release of or counteract the
bronchial mediators (Kinins, serotonin, Histamine)
that cause tissue inflammation responsible for
edema and airway narrowing.
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31. Contraindications/precautions
Acute bronchospasm.
Use cautiously in patients who are
immunosuppressed and in those taking prednisone
or other corticosteroids.
Use very cautiously in patients with viral respiratory
infections.
Adverse effects
Hoarseness.
Candida infections.
Oropharyngeal irritation.
Bronchospasm after inhalation of dry powder.
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32. Drug interaction
Generally Not reported but can be find drug
specific.
Nursing Responsibilities
Nurse should instruct the patient to rinse his mouth,
after using inhaled steroids.
Nurse should teach the patient to:
Use bronchodilators several minutes before
glucocorticoid inhaler.
Rinse mouth after using inhaled steroids.
Use and care for inhaler properly
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33. ANTIHISTAMINES
Antihistamines are the drugs used in the treatment
od allergic disorders and some other conditions.
Mechanism of action
These drugs block the effect of histamine and its
receptors. They also provide some sort of sedation.
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38. INDICATIONS/USES
Allergic reactions (Hay fever, Vasomotor rhinitis
urticaria, asthma, Anaphylaxis).
Because of their anticholinergic actions they are
used as antiemetics and useful in motion sickness.
As hypnotics, Mild sedative/anxiolytics.
Parkinsonism.
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40. ADVERSE EFFECTS
Drowsiness in common.
Delirium.
Convulsions
Due to anticholinergic effect
Urinary retention.
Constipation.
Dryness of mouth.
Blurring of vision. .
Severe toxicity may causes death to cardiac and
respiratory failure.
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41. NURSING RESPONSIBILITIES
Antihistamines are best given in the evening since
all antihistamines cause drowsiness.
Advise to patient not to drive vehicle or do not
operate machinery.
Advise to patient to avoid sedative such as alcohol
or sedative hypnotics.
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42. LEUKOTRIENE INHIBITORS:
They act against one of the inflammatory
components of asthma and provide protection
against bronchoconstriction when taken before
exercise or exposure to allergen or to cold air.
Examples of leukotriene inhibitors include
montelukast and zafirlukast
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43. Side effects
Abdominal pain
Thirst
Headache
Hyperkinesia (in young children)
Cautions
Should not be used for the treatment of acute
asthma attacks
Caution in pregnancy and breastfeeding
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44. ANTI IMMUNOGLOBULIN E (ANTI-IGE)
Action by blocking immunoglobulin E,which causes of
inflammation in allergic asthma.
Anti-IgE therapy is only available by prescription. Unlike
other asthma medications, it is not administered by pill
or by inhaler. It needs to be injected once every two or
four weeks by a doctor or other trained healthcare
professional.
Example is omalizumab (Xolair®).
Side Effects
The most common side effects of anti-IgE therapy are:
skin irritation or reaction at the site of the injection, and
respiratory tract infections (e.g., common cold).
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45. MUCOACTIVE AGENT
Mucoactive agents are a class of drugs which aid
in the clearance of mucus from the upper and lower
airways, including the lungs, bronchi, and trachea.
Mucoactive drugs include expectorants, mucolytics,
mucoregulators, and mucokinetics.
These medications are used in the treatment
of respiratory diseases that are complicated by the
oversecretion of mucus.
The drugs can be further categorized by
their mechanism of action
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46. TYPES
Expectorants – increase airway water or the
volume of airway secretions
Mucolytics – thin (reduce the viscosity of) the
mucus
Mucokinetics – increase transportability of mucus
by cough
Mucoregulators – suppress underlying
mechanisms of mucus hypersecretion
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47. MUCOLYTICS
These drugs reduced the viscosity of sputum that
leads to easily expel the sputum.
Mechanism of action
Decrease mucous viscosity by breaking or altering
mucoproteins present in sputum.
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49. Indications/uses
To treat abnormal viscid, or thick and hard mucus.
As an antidote for acetaminophen overdose
(acetylcysteine).
Contraindications/precautions
Hypersensitivity to these drugs.
Cautiously in elderly, pregnant or breast feeding
mothers.
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51. NURSING RESPONSIBILITIES
To assess the airway and maintain it patent.
Provide suction if needed.
Assess the pattern breath sounds, cough, and
bronchial secretions.
Advise patient to maintain a fluid intake of 2-
3litres/day.
Warn the patient about the rotten egg smell of
acetylcysteine.
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52. DECONGESTANTS
A Decongestant drugs used to relieve nasal
congestion in upper respiratory tracts.
Mechanism of action
Decongestants are sympathomimetic drugs that act
by stimulating the α (alpha) – adrenergic receptors.
The decongestant effect due to vasoconstriction of
the blood vessel in the nose sinuses etc. the
vasoconstriction effect reduces swelling or
inflammation and mucous formation in the nasal
passage and make it easier to breath.
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54. INDICATIONS /USES
For temporary relief of nasal congestion due to
common cold.
Hay fever.
Sinusitis.
Upper respiratory tract allergens.
To promote nasal and sinus drainage.
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55. CONTRAINDICATIONS/PRECAUTIONS
Hypersensitivity to these drugs.
MAO (Monoamine oxidase) inhibiters drugs
therapy.
Use cautiously in older age patient they are more
likely to experience adverse reaction.
Nasal contestant should not be used for more than
three days, and oral decongestant should not used
more than 7days because prolonged use will result
in rebound congestion.
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57. Drug interactions
If given with other sympathomimetic amines may
increase central nervous system stimulation.
If given with MAO inhibiters may cause severe
hypertension.
Nursing Responsibilities
Nurse should assess adverse effect of drugs.
Monitor pulse rate, BP, and ECG.
Advise patient not to share the container with other
people and not allow the tip of the container to
touch the nasal passage to avoid contamination.
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61. ANTITUSSIVES
They are used to suppress dry cough mostly
because their aim to control rather than eliminate
cough. These are also called cough center
suppressants.
Mechanism of action
These are the drugs that act in the CNS to increase
threshold of cough center.
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64. NURSING RESPONSIBILITIES
Assess the side effects or adverse reaction during
the therapy.
Special precaution should be keep in mind before
drug administration.
Advise to patient not to driving after taken opioids
drugs such as codeine pholecodiene.
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65. EXPECTORANTS
These drugs help in removal of secretions of
respiratory tract and mucolytic agents produce
liquification of mucous making expectoration easier.
Mechanism of action
They increase bronchial secretions or reduce its
viscosity, sodium and potassium citrate increase
bronchial secretion by salt action also these drugs
stimulate gastric mucosa or directly acting on
mucous membrane of lungs to increase the
secretion of mucous.
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66. Indications/uses
Chronic productive cough.
Thick mucous production.
Combinations with antitussives drugs for relieving
cough.
Adverse effect
Allergic reactions / hypersensitivity.
Rhinorrhea.
Lacrimation.
Gastric irritation.
Contraindication/precautions
History of peptic ulceration.
Asthmatic patients.
Severe hepatic or renal function.
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67. Drug interactions
They may increase the risk of bleeding when use
with anticoagulants.
Nursing Responsibilities
Advise to take plenty of fluid during this therapy to
easier removal of thick mucous.
Assess the adverse effect
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68. INHALATIONAL DRUG DELIVERY DEVICES
The majority of puffers need to be washed regularly
to avoid blockage
The recommended frequency of washing ranges
from daily to monthly, depending on the device.
Refer to the specific product information for
directions.
Patients should shake the device every time before
using it.
If there appears to be very little liquid inside the
canister when shaken, it is time to replace it
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70. TECHNIQUE IN THE USE OF MDIS
Check patient technique and demonstrate the correct
technique (if necessary) at every opportunity. It has
been shown that there is deterioration in technique
within two months of correct demonstration.
The device should be held upright with the mouthpiece
at the bottom. This allows an accurate dose to be
dispensed into the actuator valve.
Deposition of the drug from the inhaler to the airway is
achieved by coordinating the actuation of the puffer and
inhalation of the aerosol mist.
Starting at the end of a normal expiration, the puffer
should be actuated once at the same time as a slow
deep inspiration through the mouth is undertaken. At the
completion of the slow deep inspiration, the breath
should be held for approximately 10 seconds.
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71. TYPES
There are two techniques which are both
satisfactory if performed well:
Closed mouth – where the lips are sealed
around the mouthpiece of the MDI.
Open mouth – where the inhaler is held up to 6
cm away from the mouth.
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73. Inhalation of aerosol from the spacer should
commence as soon after actuation as possible
to minimise deposition in the spacer and loss of
the drug.
One actuation of MDI per inhalation is
recommended.
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74. TECHNIQUE IN THE USE OF SPACER DEVICE
The proper use of a spacer is as follows:
Shake the MDI before use.
Insert MDI, mouthpiece down, into the spacer.
Actuate the MDI.
Inhale slowly and deeply from the spacer (starting as
soon after actuation as possible).
Hold breath for 10 seconds.
Two modifications of the use of spacer devices may be
applicable for children:
Take four to six tidal breaths to inhale the aerosol.
Use a face mask adapter to inhale from the spacer (for
infants and young children).
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75. CARE OF SPACER DEVICES
Spacers should be washed before initial use and at
least monthly thereafter.
Use kitchen detergent mixed with warm water.
Leave to drain (without rinsing) and allow to dry
before use.
A cloth should not be used to dry the spacer as this
can produce an electrostatic charge causing drug
particles to adhere to the walls of the spacer.
Before using the spacer, it should be ‘primed’ by
actuating three to five doses of the drug. This
minimizes fluctuations in inhaled doses due to
variation in electrostatic charge.
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76. REFERENCES
Dr. P.K. Panwar, Essentials of pharmacology for nurses,
AITBS pub. 2017, India, Pg no. 49 – 62.
Dr. Suresh k sharma, Textbook of pharmacology,
pathology & genetics for nurses, Jaypee pub. 2016 India
Pg no 161 – 205.
Tara v. Shanbhag, Smita shenoy, Pharmacology
preparation manual for undergraduate, Elsevier pub.
2014. Pg no. 226 – 257.
Marilyn Herbert – Ashton, Nancy Clarkson,
Pharmacology, Jones & Barlet pub 2010 India, Pg no
225-258.
Govind s. Mittal, Pharmacology at a glance, Paras
medical book pub. 2009 India 18 – 19.
Madhuri Inamdar, Pharmacology in nursing, Vora
medical pub. 2006 India 1 st edition, Pg no 92 – 98 76
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