Drugs acting on the respiratory system

1. DRUGS ACTING ON
THE RESPIRATORY
SYSTEM
Mr Nkandu
Namwianga NTS

2. Introduction
The human respiratory system is a series
of organs responsible for taking in oxygen
and expelling carbon dioxide.
A complete lack of oxygen is known as
anoxia and a decrease in oxygen is
known as hypoxia.
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3. If hypoxia sets in for 4 to 6 minutes brain
cells are destroyed
It is against this background that you
must learn about drugs that act on the
respiratory system in order to serve lives
without causing any damage to the brain
cells.
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4. Namwianga NTS

5. 1. Antihistamines
Drugs used to suppress allergic reactions.
Also used to treat nausea and vomiting.
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6. Mode of action
When the body is exposed to allergens, it
releases histamines (mast cells).
Histamines attach to the cells in the body
and cause them to swell and leak fluid.
This causes the smooth muscles to
constriction in blood vessels & respiratory
& GI tracts.
Antihistamines prevent histamines
from attaching to the cells and
causing symptoms
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7. a) Promethazine hydrochloride
(phernegan)
Presentation
10mg, 25mg tablets; 25mg/ml
injection;5mg/5ml elixir.
Indication
Hay fever, urticaria, emergency treatment
of anaphylactic reactions, pre-operative
medication, sedation and nausea and
vomiting
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8. Dose
25-50mg .O.D P.O in adults.
25-50mg injection, maximum 100mg.
Side effects
drowsiness, sedation, headache,
psychomotor impairment, urinary retention,
dry mouth, blurred vision
Nursing implications
Warn patient that their ability to perform
activities that require high alertness may be
impaired.
Use with caution in epilepsy, BPH, glaucoma
and hepatic disease.
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9. b) Chlorpheniramine maleate
(Piriton /CRM)
Presentation
2mg, 4mg tablets; 2mg/5ml syrup;
10mg/ml injection.
Indication
Hay fever, urticaria, emergency treatment
of anaphylactic reactions.
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10. Dose
4mg q.i.d, maximum 24mg/day in adults.
Side effects
Dermatitis, tinnitus, transient hypertension
with injection, irritation, sedation
Nursing implications
As in promethazine hydrochloride
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11. c) Azatadine
Presentation
1 mg tablet
Indications :Same as Piriton
Dose
Adult 1 mg twice daily
Children: 1-12 years: 0.25-1 mg twice daily.
Side effects: same as Piriton
Nursing implications
As in promethazine hydrochloride
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12. d) Cetirizine (Zyrtec)
Dose
Adult; 10 mg daily
Children: 5 mg daily / 2.5 mg twice daily
(2-6 years)
Indications: same as Piriton
Side effects: same as Piriton
Nursing implications
As in promethazine hydrochloride
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13. 2. Bronchodilators
 A bronchodilator is a substance that
dilates the bronchi and bronchioles,
decreasing resistance in the respiratory
airway and increasing airflow to the lungs.
They are most useful in obstructive lung
diseases, of which asthma and chronic
obstructive pulmonary disease are the
most common conditions.
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14. Types of bronchodilators
The three types of prescription of
bronchodilator drugs are;
i. Adrenoceptor agonists which are selective
β2-agonists & other adrenoceptor agonists
(short- and long-acting),
ii.Xanthine derivatives
iii.Anti-muscarinic bronchodilators
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15. i) Beta 2-agonists
(adrenoceptor agonist) short
acting
They are called “reliever” or “rescue”
medicines because they stop asthma
symptoms very quickly by opening the
airways.
Selective beta2 agonists stimulate beta2
receptors in smooth muscle of the lung,
promoting bronchodilation, and thereby
relieving bronchospasms
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16. These are the best medications for
treating sudden and severe or new
asthma symptoms.
They work within 20 minutes and last four
to six hours.
They can be taken 15 -20 minutes ahead
of time before exposure to the stimulant.
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17. a) Salbutamol (Ventolin)
Presentation
2mg and 4mg tablets; 2mg/5ml syrup;
50mcg and 100mcg injection; aerosols
and nebulizers.
Indications
Asthma, reversible airway obstruction.
Dose
2mg to be taken 3-4 times a day,
maximum single dose 8mg.
Children: 1-2mg taken 3-4 times/day
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18. Side effects
Tachycardia, peripheral vasodilation,
tremors, headache, hypersensitivity
reaction.
Nursing implications
If patient also uses steroid inhaler, advise
to use steroid 5min after taking
salbutamol.
Use with caution in pregnancy and
breastfeeding patients.
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19. Do not administer drug to patients known
to react to it.
Tablets and aerosols may be used
concomitantly.
Instruct patient to use aerosol form of
drug 15min before exercises.
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20. b) Terbuline
Presentation
Oral tablet, Inhaler 2.5mg / dose (MDI); 5mg
/ dose ( Turbuhaler)
Dose
5-7.5 mg two times daily
Side effects
Tachycardia, peripheral vasodilation, fine
tremors, headache, hypersensitivity reaction.
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21. • Nursing Implication
• Administer with caution in clients with
Hyperthyroidism, cardiovascular disease,
arrhythmias, hypotension.
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22. ii) Beta 2-agonists long
acting
These are long-term medications taken
routinely in order to control and prevent
bronchoconstriction.
They are not intended for fast relief.
These medications may take longer to
begin working, but relieve airway
constriction for up to 12 hours.
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23. Commonly taken twice a day with an anti-
inflammatory medication (corticosteroid),
they maintain open airways and prevent
asthma symptoms, particularly at night.
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24. a) Formoterol
Presentation
Inhaler 4.5mcg / dose
Inhaler 9mcg / dose
Dosage
Dose adult: Inhaler 4.5mcg / dose
Children: Same as adult
Adverse effects: Tachycardia and
palpitations, Headache, Tremor
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25. b) Salmeterol
Presentation
Inhaler 25mcg / dose (MDI); 50 mcg /
dose
Dosage
Dose adult: 50-100 mcg twice daily; 50
mcg twice
Children: Same as adult
Side effects: same as Formoterol
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26. Xanthine derivatives
This is another class of bronchodilators
Xanthine derivatives includes drugs;
a. Theophylline
b. aminophylline
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27. a) Theophylline
Presentation
Tablet 200mg,300mg ,Capsule 50mg 100
mg
Indications
Reversible airway obstruction
Severe cases of asthma or those that are
difficult to control.
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28. Dose
Adult: 7-12 mg/ kg / day in two divided
doses
Children:10-16 mg / kg / day in two divided
• Side effect: tachycardia, palpitations, GI
disturbance, headache, insomnia, convulsion
if given rapidly by IV
• Nursing implications:
• Administer slowly via IV
• Always check the patients vitals
• Administer with caution in patients with PUD
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29. b) Aminophylline
Presentation
100mg tabs;25mg/ml injection.
Indication:
bronchospasms, severe acute asthma.
Dose
100-300mg 3-4 times daily P.O in adults. 250-
500mg (5mg/kg) I.v slowly (over 20min).
Maintenance 500mg in 5% Dextrose infusion
given 8 hourly over 24 hours .
Humidified oxygen through a mask 3lts/min
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30. Side effects
nausea, headache, tachycardia, insomnia,
arrhythmias and convulsions if given
rapidly by IVF, GIT disturbances.
Nursing implications
Give intravenous drug very slowly.
Relieve GIT symptoms by giving oral drug
with full glass of water at meals.
Inform elderly patients that dizziness is
common adverse effect.
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31. Anti-Muscarinic
• Provide short-term relief in chronic
asthma, but short-acting beta2 agonists
act more quickly and are preferred.
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32. ipratropium bromide
• Indications: reversible airways
obstruction, particularly in chronic
obstructive pulmonary disease; rhinitis
• Dose . By aerosol inhalation, 20–40
micrograms, 3–4 times daily. and through
nebulization.
• Side-effects: Dry mouth, tachycardia,
palpitation.
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33. Nursing implication
• Give the pt some water to drink to avoid
dry mouth.
• Monitor vitals to R/o tachycardia
• Observe for any hypersensitivity reactions
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34. Corticosteroids
Corticosteroids are used to provide relief
for inflamed areas of the body.
They lessen swelling, redness, itching and
allergic reactions.
They are used as part of treatment for a
number of different diseases such as
allergies, asthma etc.
Beclomethasone is an example of the
corticosteroid that is used in respiratory
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35. Beclomethasone Dipropionate
(Becotide)
Presentation
Aerosol, 50 micrograms/metered dose
Indications
Chronic airways obstruction, especially in
Asthma not controlled by Bronchodilators
Dose
1 to 2 puffs three to four times a day .
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36. • Child; 50 - 100mcg (1 - 2 puffs of 50mcg
metered inhaler) 2 –4 times a day.
• Side effect:
• hoarseness and candidiasis of mouth and
throat ,skinreaction including rash and
angioedema.
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37. Namwianga NTS

38. Expectorants
These drugs are used to assist in the
removal of secretions or exudate from the
trachea, bronchi, or lungs.
M.O.A
They act by liquefying viscid mucus or
mucopurulent exudates.
They are used in the treatment of coughs
to help expel these exudates and
secretions.
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39. a) Ammonia and ipecacuanha
Indication: Productive cough
Dose
10-20ml 3-4 times a day
Side effects: nausea and vomiting
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40. b) Guaifenesin
Indication
Presence of mucous in the respiratory
tract.
Dose
100-400 mg qid P.O every 4 to 6 hours.
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41. Antitussives
Antitussives are drugs that suppress
coughing, possibly by reducing the activity
of the cough centre in the brain.
Antitussive agents are used to relieve dry
cough by specifically inhibiting or
suppressing the act of coughing.
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42. Codeine phosphate
Presentation
15mg/5ml codeine phosphate, paeds
3mg/5ml codeine phosphate.
Indication
dry painful cough
Dose
5-10ml 3-4 times a day
Side effects -Respiratory depression in
overdose, constipation, drowsiness.
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43. Dextromethorphan
It is used to control non-productive
coughs by soothing minor throat and
bronchial irritations.
Dose
10 to 30 mg every 6 to 8 hours.
Indications and side effects
same as codeine
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44. Diphenhydramine
Presentation
10 mg/ 5ml
Dose
25 mg q4h, Max: 150 mg daily
Indications and side effects
same as codeine
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45. Nursing alerts of Antitussives
You must observe for excessive
suppression of the cough reflex (inability
to cough effectively when secretions are
present).
This is a potentially serious adverse effect
because retained secretions may lead to
lungs collapse, pneumonia, hypoxia and
respiratory failure
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46. Decongestants
Drugs that relieve nasal congestion in the
upper respiratory tract.
• Mode of action
• Decongestants stimulate the alpha
adrenergic receptors , thus producing
vascular constriction of capilaries in the
mucosa
• This results in shrinking of the nasal
mucous membranes and reduction in the
fluid secretion
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47. a) Ephedrine Hydrochloride
Presentation: nasal drops, 0.5%
Indication: Nasal congestant
Administration: Instil 1-2 drops into
each nostril when required
Side-effects: Local irritation, after
excessive use tolerance with diminished
effect, rebound congestion
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48. b) Oxymetazoline
Indication
Nasal congestion.
Presentation
Nasal Drops 0.025% 20 ml
Dose: Children/adults
2-3 sprays BD
Adverse effects
Restlessness, irritability, anxiety and
insomnia
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49. c) Phenylephrine
Presentation
Nasal Drops 0.5% 10 ml
Dose Adult
Several drops
Adverse effects
Restlessness, irritability, anxiety and
insomnia
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50. Nursing considerations of
decongestants
Overuse of topical nasal decongestants can
cause rebound congestion, meaning that the
congestion can be worse with the use of drug.
To minimise this, drug therapy should be
discontinued gradually.
The patient’s blood pressure and pulse should
be assessed before a decongestant is
administered
Inform the patient that nasal burning and
tingling sensation.
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51. Oxygen
Therapeutic agent prescribed for
hypoxaemic patients to increase alveolar
oxygen tension and reduce effort
breathing to maintain the necessary
arterial oxygen tension.
Oxygen should always be administered to
patients by bubbling it through water
(humidified).
Oxygen is supplied in metallic cylinder
painted black and whiter.
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52. Methods of oxygen
administration
• Lets discuss the methods
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53. Methods of oxygen
administration
1. Nasal cannula - this consists of two small
plastic tubes, or prongs, that are placed in
both nostrils.
2. Face mask - which fits over the patient’s
nose and mouth?
3. Trans-tracheal - Small tube inserted into
the patient’s windpipe through the front of
the neck.
4. Tent – 02 is administered through the tent
the Pt is Put in tent then supply it with O2
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54. Face mask
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55. Sources of oxygen therapy
The main type’s sources for oxygen therapy
are;
1. Liquid storage
Liquid oxygen is stored in chilled tanks until
required, and then allowed to boil (at a
temperature of 182.96 °C)) to release oxygen
as a gas.
This is widely used in hospitals due to their
high usage requirements, but can also be
used in other settings.
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56. 2. Compressed gas storage
The oxygen gas is compressed in a gas
cylinder, which provides a convenient
storage
Large oxygen cylinders hold 6,500 litres
and can last about two days at a flow rate
of 2 litres per minute.
A small portable cylinder holds 170 litres
and can last 4–6 hours.
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57. Oxygen cylinders
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58. 3. Instant usage
The use of an electrically powered oxygen
concentrator or a chemical reaction based
unit can create sufficient oxygen for a
patient to use immediately.
These units are widely used in home and
hospitals in airplanes and space stations.
It has the advantage of continuous supply
without the need for additional deliveries
of bulky cylinders.
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59. Oxygen concentrator
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