This document discusses antihistamines, decongestants, antitussives, expectorants, and bronchodilators used to treat respiratory conditions. It covers the mechanisms of action, indications, nursing implications, and side effects of these drug classes. Inhalers and their proper use are also reviewed. The document concludes with a chapter about antitubercular drugs used to treat tuberculosis.

1. CHAPTER 36
Antihistamines, Decongestants,
Antitussives, and Expectorants

2. Antihistamines
 H1 antagonists are commonly referred to
as antihistamines
◦ Examples: diphenhydramine (Benadryl),
loratadine (claritin)
 Antihistamines have several properties
◦ Antihistaminic
◦ Anticholinergic
◦ Sedative

3. Antihistamines:
Mechanism of Action
 The binding of H1 blockers to the
histamine receptors prevents the adverse
consequences of histamine stimulation
◦ Vasodilation
◦ Increased GI and respiratory secretions
◦ Increased capillary permeability

5. Antihistamines:Nursing Implications
 Instruct patients to report excessive
sedation, confusion, or hypotension
 Instruct patients to avoid driving or operating
heavy machinery; advise against consuming
alcohol or other CNS depressants
 Instruct patients not to take these
medications with other prescribed or over-
the-counter medications without checking
with prescriber

6. Antihistamines: Nursing Implications
 Best tolerated when taken with meals—
reduces GI upset
 If dry mouth occurs, teach patient to perform
frequent mouth care, chew gum, or suck on
hard candy (preferably sugarless) to ease
discomfort
 Monitor for intended therapeutic effects

7. Nasal Decongestants:
Mechanism of Action
Site of action: blood vessels surrounding
nasal sinuses
 Adrenergics
◦ Constrict small blood vessels that supply URI
structures
◦ As a result these tissues shrink, and nasal
secretions in the swollen mucous membranes
are better able to drain
◦ Nasal stuffiness is relieved

8. Nasal Decongestants:
Nursing Implications
 Decongestants may cause hypertension,
palpitations, and CNS stimulation—avoid in
patients with these conditions
 Patients on medication therapy for
hypertension should check with their
physician before taking over-the-counter
decongestants
 Assess for drug allergies

9. Two Basic Types of Cough
 Productive cough
◦ Congested, removes excessive secretions
 Nonproductive cough
◦ Dry cough

11. Antitussives
 Drugs used to stop or reduce coughing
 Opioid: codeine (Robitussin AC, Dimetane-DC)
 Nonopioid: dextromethorphan (Vicks Formula 44,
Robitussin-DM)
 Used only for nonproductive coughs!
 May be used in cases where coughing is
harmful

12. Antitussives: Nursing Implications
 Perform respiratory and cough assessment,
and assess for allergies
 Instruct patients to avoid driving or operating
heavy equipment because of possible
sedation, drowsiness, or dizziness
 Patients taking chewable tablets or lozenges
should not drink liquids for 30 to 35 minutes
afterward

13. Expectorants
 Drugs that aid in the expectoration
(removal) of mucus
 Reduce the viscosity of secretions
 Disintegrate and thin secretions

14. Expectorants:
Nursing Implications
 Expectorants should be used with
caution in the elderly or those with
asthma or respiratory insufficiency
 Patients taking expectorants should
receive more fluids, if permitted, to help
loosen and liquefy secretions
 Report a fever, cough, or other
symptoms lasting longer than a week
 Monitor for intended therapeutic effects

16. CHAPTER 37
Bronchodilators and Other
Respiratory Drugs

17. Diseases of the Lower Respiratory
Tract
 COPD
◦ Asthma
◦ Emphysema
◦ Chronic bronchitis

19. Asthma
 Status asthmaticus
◦ Prolonged asthma attack that does not
respond to typical drug therapy
◦ May last several minutes to hours
◦ Medical emergency

20. Bronchitis Emphysema

21. Drugs Used to Treat Asthma
 Quick relief
◦ Intravenous systemic corticosteroids
◦ Short-acting inhaled beta2-agonists
 Bronchodilators
◦ Beta-adrenergic agonists
 Xanthine derivatives
 Long-term control
◦ Leukotriene receptor antagonists
◦ Inhaled steroids
◦ Long-acting beta2-agonists

22. Nursing Implications
 Encourage patients to take measures that promote a
generally good state of health so as to prevent,
relieve, or decrease symptoms of COPD
◦ Avoid exposure to conditions that precipitate bronchospasm
(allergens, smoking, stress, air pollutants)
◦ Adequate fluid intake
◦ Compliance with medical treatment
◦ Avoid excessive fatigue, heat, extremes in temperature,
caffeine

23. Nursing Implications
 Beta-agonist derivatives
◦ Albuterol, if used too frequently, loses its
beta2-specific actions at larger doses
◦ As a result, beta1 receptors are stimulated,
causing nausea, increased anxiety, palpitations,
tremors, and increased heart rate
◦ Inform patients to report insomnia, jitteriness,
restlessness, palpitations, chest pain, or
any change in symptoms

24. Inhaler

25. Inhalers: Patient Education
 For any inhaler prescribed, ensure that the
patient is able to self-administer the
medication
◦ Provide demonstration and return
demonstration
◦ Ensure that the patient knows the correct time
intervals for inhalers
◦ Provide a spacer if the patient has difficulty
coordinating breathing with inhaler activation
◦ Ensure that the patient knows how to keep
track of the number of doses in the inhaler
device

26. Anticholinergics
 Ipratropium bromide (Atrovent) and
tiotropium (Spiriva)
 Slow and prolonged action
 Used to prevent bronchoconstriction
 NOT used for acute asthma
exacerbations!

27. Bronchodilators: Xanthine Derivatives
 Also cause cardiovascular stimulation:
increased force of contraction and increased
heart rate, resulting in increased cardiac
output and increased blood flow to the
kidneys (diuretic effect)
 Only theophylline is used as a bronchodilator
 Synthetic xanthines: aminophylline and
dyphilline

29. Leukotriene Receptor Antagonists
(LTRAs)
 Newer class of asthma medications
 Currently available drugs
◦ montelukast (Singulair)
◦ zafirlukast (Accolate)
◦ zileuton (Zyflo)

30. LRTAs: Indications
 Prophylaxis and chronic treatment of
asthma in adults and children older than
age 12
 NOT meant for management of acute
asthmatic attacks
 Montelukast is approved for use in
children ages 2 and older, and for
treatment of allergic rhinitis

31. LRTAs: Nursing Implications
 Ensure that the drug is being used for chronic
management of asthma, not acute asthma
 Assess liver function before beginning therapy
 Teach patient to take medications every night on a
continuous schedule, even if symptoms improve
 Improvement should be seen in about
one week
 Watch out for myalgia (adverse reaction)

32. Corticosteroids
 Antiinflammatory properties
 Used for chronic asthma
 Do not relieve symptoms of acute
asthmatic attacks
 Oral or inhaled forms
◦ Inhaled forms reduce systemic effects
 May take several weeks before full
effects are seen

33. Inhaled Corticosteroids
 beclomethasone dipropionate
(Beclovent, Vanceril)
 dexamethasone sodium phosphate
(Decadron Phosphate Respihaler)
 fluticasone (Flovent, Flonase)
 triamcinolone acetonide (Azmacort)

35. Inhaled Corticosteroids:
Nursing Implications
 Contraindicated in patients with psychosis,
fungal infections, AIDS, TB
 Teach patients to gargle and rinse the
mouth with lukewarm water afterward to
prevent the development of oral fungal
infections

36. Inhaled Corticosteroids:
Nursing Implications
 If a beta-agonist bronchodilator and
corticosteroid inhaler are both ordered, the
bronchodilator should be used several
minutes before the corticosteroid to
provide bronchodilation before
administration of the corticosteroid

37. Inhaled Corticosteroids:
Nursing Implications
 Teach patients to monitor disease with a
peak flow meter
 Encourage use of a spacer device to
ensure successful inhalations
 Teach patient how to keep inhalers and
nebulizer equipment clean after uses

38. Nursing Implications
 Monitor for therapeutic effects
◦ Decreased dyspnea
◦ Decreased wheezing, restlessness, and
anxiety
◦ Improved respiratory patterns with return to
normal rate and quality
◦ Improved activity tolerance
 Decreased symptoms and increased
ease of breathing

39. CHAPTER 41
Antitubercular Drugs

40. Chapter 41: Antitubercular
Drugs
 Tuberculosis (TB)
› Caused by Mycobacterium tuberculosis
 Antitubercular drugs treat all forms of
Mycobacterium
Common infection sites
 Lung (primary site)
 Brain
 Bone
 Liver
 Kidney

41. Antitubercular Drugs
First-line drugs
› isoniazid (INH)*
› rifapentine
› ethambutol
› rifabutin
› pyrazinamide (PZA)
› rifampin
› streptomycin
*Primary drug used

42. Antitubercular Drugs (cont’d)
 Second-line drugs
◦ capreomycin
◦ amikacin
◦ cycloserine
◦ levofloxacin
◦ ethionamide
◦ ofloxacin
◦ kanamycin
◦ para-aminosalicyclic acid (PAS)

43. Isoniazid (INH)
 Drug of choice for TB
 Resistant strains of Mycobacterium
emerging
 Metabolized in the liver through
acetylation—watch for “slow acetylators”
 Used alone or in combination with other
drugs
 Contraindicated with liver disease

44. Adverse Effects
 INH
◦ Peripheral neuropathy, hepatotoxicity
 ethambutol
◦ Retrobulbar neuritis, blindness
 rifampin
◦ Hepatitis; discoloration of urine, stools, and
other body fluids

47. Nursing Implications
 Perform liver function studies in patients
who are to receive isoniazid or rifampin
(especially in elderly patients or those who use
alcohol daily)
 Rifampin causes oral contraceptives to become
ineffective; another form of birth control will be
needed
 Patients should not consume alcohol while on
these medications or take other medications,
including over-the-counter medications,

48. Nursing Implications
Patient education is critical
 Therapy may last for up to 24 months
 Take medications exactly as ordered,
at the same time every day
 Emphasize the importance of strict adherence to
regimen for improvement of condition or cure
 Remind patients that they are contagious during the
initial period of their illness—instruct in proper
hygiene and prevention of the spread of infected
droplets

49. Nursing Implications
 Patients who are taking rifampin should be told that
their urine, stool, saliva, sputum, sweat, or tears
may become reddish orange; even contact lenses
may be stained
 Pyridoxine may be needed to combat neurologic
adverse effects associated with INH therapy
 Oral preparations may be given with meals to
reduce GI upset, even though recommendations are
to take them 1 hour before or 2 hours after meals

50. Nursing Implications
Monitor for therapeutic effects
 Decrease in symptoms of TB, such as cough
and fever
 Lab studies (culture and sensitivity tests)
and CXR should confirm clinical findings
 Watch for lack of clinical response to therapy,
indicating possible drug resistance