ALLERGY AND RESPIRATORY SYSTEM DRUG THERAPY UNIT 2 pt.1

STRUCTURES OF THE RESPIRATORY SYSTEM

• Nostrils (nares)

• Nasal cavity; sinuses

• Mouth

• Pharynx

• Larynx

• Trachea

• Lungs

• Bronchi (R & L)

• Bronchioles

• Alveoli

FUNCTIONS OF THE RESPIRATORY SYSTEM

• Gas exchange

  • O2 in, CO2 out

• Smooth muscle in respiratory passages

• Sympathetic stimulation

  • beta-2 receptors

  • bronchodilation

• Parasympathetic stimulation

  • muscarinic receptors

  • bronchoconstriction

System	Receptor	What Happens to Smooth Muscle?	Airway Effect
Sympathetic (Fight or Flight)	Beta-2	Relaxes	Bronchodilation (OPEN)
Parasympathetic (Rest and Digest)	Muscarinic	Contracts	Bronchoconstriction (NARROW)

FUNCTIONS OF THE RESPIRATORY SYSTEM

Sympathetic vs Parasympathetic

Sympathetic (β2)

😨 Running from danger

⬇

β₂ stimulated

⬇

Smooth muscle relaxes

⬇

🫁 Airway OPENS

⬇

More O₂ gets in

---

Parasympathetic (Muscarinic)

😌 Relaxing

⬇

Muscarinic stimulated

⬇

Smooth muscle contractions

⬇

🫁 NARROWS Airway

⬇

Less airflow needed

Exam Cheat Sheet

🫁 Gas exchange = O₂ in, CO₂ out

⚡ Sympathetic → Beta-2 → Bronchodilation → Airways OPEN

🌿 Parasympathetic → Muscarinic → Bronchoconstriction → Airways NARROW

One-Line Memory Trick

"Beta-2 Breathing Opens Airways, Muscarinic Makes Airways Smaller."

Super Simple COPD Cheat Sheet

• COPD: Chronic Obstructive Pulmonary Disease

Chronic Bronchitis

Problem: Too much mucus

Cause: Smoking, pollutants

Symptoms:

• Productive cough

• Difficulty breathing

• Frequent infections

• increased respiratory infections

Memory: 🟢 "Mucus Problem"

---

Emphysema

Problem: Destroyed alveoli

Cause: Smoking

Symptoms:

• Shortness of breath

• Activity intolerance

Memory: 💥 "Air Sac Problem"

Chronic Bronchitis = Mucus blocks airways

Emphysema = Alveoli destroyed, air trapped

COPD = Hard to get air in and out of the lungs 😮‍💨🫁

COPD (Chronic Obstructive Pulmonary Disease) What is COPD?

COPD is a long-term lung disease that makes it hard to breathe.

Think of COPD as having two major problems :

1. Chronic Bronchitis = Airways are clogged with mucus

2. Emphysema = Air sacs are damaged

Both problems make it difficult for oxygen to get into the body and carbon dioxide to get out.

1. Chronic Bronchitis What's Happening?

The breathing tubes (bronchi) become:

🔥 Inflamed (swollen)

🟢 Full of thick mucus

🚫 Partially blocked

Because of this, air has trouble moving through the lungs.

2. Emphysema What's Happening?

The alveoli (tiny air sacs) are damaged and destroyed.

Normal Alveoli

🫧 Small stretchy air sacs

They:

• Fill with oxygen

• Release carbon dioxide

• COPD: Chronic Obstructive Pulmonary Disease

Treatment

1. Bronchodilators What do they do?

They relax airway smooth muscle.

⬇

Airways open wider

⬇

More air can move in and out

Remember

Bronchodilator = Dilates (opens) bronchi

2. Steroids What do they do?

They decrease inflammation (swelling).

⬇

Less airway swelling

⬇

Improved airflow

Remember

Steroids = Stop Swelling

• 1. chronic bronchitis: 

• 2. emphysema: 

Asthma vs COPD

Asthma	COPD
Reversible	Usually not fully reversible
Airways narrow suddenly	Long-term lung damage
Often triggered by allergens/exercise	Often caused by smoking
Bronchoconstriction is major problem	Mucus and alveolar damage are major problems

Super Simple Exam Cheat Sheet

 Asthma:

Asthma

🫁 Airways become inflamed

⬇

🤏 Bronchoconstriction (airway tightens)

⬇

🔥 Edema (swelling)

⬇

🟢 Increased mucus

⬇

😮‍💨 Difficulty breathing

Triggers

🌸 Allergens

🤧 URI (cold/flu)

🏃 Exercise

😨 Stress

❄ Cold air

🧹 Dust/fragrances/chemicals

💊 Certain drugs

One-Sentence Memory

Asthma = Tight muscles + swollen airways + extra mucus = narrowed airways and trouble breathing. 🫁😮‍💨

Asthma is …

… = "Tight, Swollen, and Sticky"

Tight
➡ Bronchoconstriction

Swollen
➡ Mucosal edema

Even less room for air.

Sticky
➡ Increased mucus

The airway becomes clogged.

Why Is Breathing Hard?

The airway becomes narrow because of:

✅ Tight muscles

✅ Swollen lining

✅ Extra mucus

All three reduce airflow.

• Inflammation of the bronchioles causing bronchoconstriction

• Mucosal edema, increased production of bronchial mucus
  

ASTHMA SYMPTOMS

• Wheezing

• Chest tightness

• Coughing

• Tachypnea- fast breathing

• Dyspnea

• Tachycardia= fast HB

• Respiratory Weakness (fatigue)/shortness of breath
  

• Treat with bronchodilator-widen the lungs, steroids-less swelling , and possibly allergy meds

Allergies (Super Easy Version)

Step 1: Allergen Enters the Body

An allergen is something that triggers an allergy.

Examples:

🌸 Pollen 🧹 Dust

Step 2: Immune System Thinks It's Dangerous

Your immune system mistakes the allergen for an enemy.

⬇

It starts an immune response

⬇

The body makes antibodies .

🛡 Antibodies = proteins that help fight things the body thinks are harmful

Step 3: Antigen-Antibody Reaction What's an Antigen?

An antigen is the substance that enters the body (the allergen).

Examples:

🌸 Pollen 🧹 Dust

When the allergen (antigen) meets the antibody:

⬇

Antigen + Antibody Reaction

⬇

The body thinks it must defend itself.

Step 4: Mast Cells Release Chemicals

Special cells called mast cells release chemicals.

The two important chemicals are: Histamine and Leukotrienes

Step 5: Allergy Symptoms Appear

The released histamine and leukotrienes cause symptoms.

Histamine Causes:

🤧 Sneezing👃 Runny nose

ALLERGIES 1

meaning

Allergy Process

🌸 Allergen enters

⬇

🛡 Antibodies react

⬇

💥 Mast cells release histamine & leukotrienes

⬇

🤧 Allergy symptoms

⬇

🫁 Bronchoconstriction can occur

---

Drugs

💊 Antihistamines → Block histamine

💊 Antiallergics → Prevent histamine/leukotriene release

💊 Steroids → Reduce inflammation

One-Line Memory

Allergen → Antibodies react → Mast cells release histamine & leukotrienes → Allergy symptoms and bronchoconstriction. 🤧🫁

Seasonal vs Perennial

ALLERGIES 2

Seasonal Allergic Rhinitis	Perennial Allergic Rhinitis
Happens during certain seasons	Happens all year
Spring, summer, early fall	Any time of year
Pollen, grasses, weeds, mold spores	Dust mites, pets, mold
Usually outdoor allergens	Usually indoor allergens

Allergic Rhinitis

Exam Cheat Sheet

= Immune system overreacts to allergens

⬇

Histamine released

⬇

🤧 Sneezing

👃 Runny nose

👃 Stuffy nose

👀 Itchy eyes

😴 Fatigue

• Seasonal allergic rhinitis

🌸 Spring/Summer/Fall

Caused by:

🌳 Trees

🌾 Grass

🌿 Weeds

🍄 Mold spores

• Perennial allergic rhinitis

📅 Year-round

Caused by:

🧹 Dust mites

🐱 Pet dander

🍄 Mold

….=Allergens trigger histamine release, causing a runny nose, sneezing, itchy eyes, and congestion. Seasonal happens during certain seasons; perennial happens all year. 🤧👃🌸📅

HISTAMINE RECEPTORS

Receptor	Main Location	Main Function
H1	Blood vessels, airways, intestines, CNS	Allergies
H2	Stomach, heart, uterus, blood vessels	Stomach acid secretion
H3	Brain neurons	Controls neurotransmitters
H4	White blood cells	Inflammation and immune response

H1 = Allergies

🤧 Sneezing

👃 Runny nose

👀 Itchy eye

🫁 Bronchoconstriction

---

H2 = Stomach

🍔 Stomach acid

🔥 Heartburn/ulcers if overstimulated

---

H3 = Brain

🧠 Controls neurotransmitter release

---

H4 = White Blood Cells

🦠 Immune response

🔥 Inflammation

😣 Pain

HISTAMINE RECEPTORS

notes

H-1 Receptors (associated with allergies)

Imagine pollen enters your body.

🌸 Pollen

⬇

💥 Histamine released

⬇

H1 Activated

🤧 Sneezing

👃 Runny nose

• Blood vessels

• Bronchial smooth muscles

• Intestinal smooth muscles

• CNS
  H-2 Receptors: (GI Issues)

• 🍔 Increased stomach acid

• Stomach

• Heart

• Uterine tissue

• Blood vessels

H-3/🧠 Helps regulate brain signaling

and

H-4 receptors (pain and inflammation)

🦠 Helps control inflammation and immune responses

• Neurons 

• Presynaptic areas of the brain

• H-4-WBCs

H1 = There is Fever (Allergies) 🤧 H2 = Heartburn (Stomach Acid) 🔥 H3 = Head (Brain) 🧠 H4 = Helpers of the Immune System 🦠🔥

ALLERGIC REACTION

what happens

Histamine Effect	What You See
Bronchoconstriction	😮‍💨 Trouble breathing
Increased mucus	👃 Runny nose, congestion
Vasodilation	⬇ Lower BP
Skin capillary dilation	🔴 Red skin (erythema)
Faster heartbeat	❤ Tachycardia
Capillary leakage	👃 Congestion, 🟠 hives
Brain vessel dilation	🤕 Headache (cephalgia)
Nerve irritation	😖 Itching
Increased peristalsis	💩 Diarrhea

ALLERGIC REACTION

steps

🌸 Allergen enters

⬇

💥 Mast cells release histamine

⬇

🫁 Airways tighten → Bronchoconstriction

👃 More mucus → Runny/stuffy nose

🔴 Skin redness → Erythema

💧 Leaky capillaries → Hives & congestion

❤ Fast heartbeat

🧠 Headache

😖 Itching

💩 Diarrhea

Histamine causes the body to become "red, runny, swollen, itchy, wheezy, and sometimes gives headaches and diarrhea." 🤧🔴😖🫁💩

Antiallergics (Mast Cell Stabilizers)

First, what are mast cells?

These drugs stabilize (calm down) mast cells .

Think:

🎈 Mast cell = balloon full of histamine

🔒 Mast cell stabilizer = puts a lock on the balloon

SW:

🌸 Allergen enters

⬇

🎈 Mast cell wants to release histamine

⬇

🔒 Drug prevents release

⬇

Less histamine released

⬇

Fewer allergy symptoms

"Stop Histamine Before It Starts"

Unlike antihistamines:

• Antihistamines block histamine AFTER it is released.

• Mast cell stabilizers stop histamine from being released in the first place.

ANTIALLERGICS (MAST CELL STABILIZERS)

what it does summary

Mast Cell Stabilizers MOA

🔒 Stabilize mast cells

⬇

Prevent histamine release

⬇

Decrease allergy symptoms

Uses

🤧 Prevent chronic allergic rhinitis

🫁 Prevent asthma attacks

Important

🛡 Prophylaxis = Prevention

❌ Not used to stop an asthma attack that's already happening

Side Effects

👃 Nasal itching/burning

👃 Nasal dryness

👀 Burning eyes

🤢 Nausea

😴 Drowsiness

🤕 Headache

👅 Bad taste

Mast cell stabilizers "lock up" mast cells so they can't release histamine, helping PREVENT allergies and asthma attacks before they start. 🔒🎈🤧🫁

  Mast Cell Stabilizers/Anti-allergics

DRUG

cromolyn sodium (Nasalcrom®)

Antihistamines

MOA

💊 Block histamine from H1 receptors

⬇

Prevent histamine from causing allergy symptoms

Uses

🤧 Allergies

👃 Runny nose

👀 Itchy eyes

🌸 Hay fever

A. Generation 1 Side Effects =Generation 1 is not a drug name . It is a group (class) of antihistamine drugs .

effects

😴 Sedation (sleepiness)

👅 Xerostomia (dry mouth)

H1 = Allergy Receptor Antihistamine = Blocks H1 Generation 1 = Makes You Sleepy

Think: "Generation 1 antihistamines block allergy symptoms, but they can make you sleepy and give you a dry mouth." 😴👅🤧

Antihistamines

DRUGS

a Generation I (sedating)

brompheniramine (Dimetapp®)

chlorpheniramine (Chlor-Trimeton®)

clemastine

diphenhydramine (Benadryl®)

hydroxyzine

promethazine (Phenergan®)

azelastine (Astepro®)

ANTIHISTAMINES

B. Generation II

✅ Generation … = Non-sedating (usually not sleepy)

✅ Blocks H1 receivers

⚠ Main side effect = Xerostomia (dry mouth)

Easy Memory

Generation 1 = Sleepy 😴

Generation 2 = Not Sleepy 🙂

Xerostomia = Dry Mouth 👅

b Generation II (non-sedating)

DRUG

loratadine (Claritin®)

fexofenadine (Allegra®)

cetirizine (Zyrtec®)

USES OF ANTIHISTAMINES

Condition	What It Means
Hay fever	Seasonal allergies
Insect bite	Itching, redness, swelling
Perennial allergic rhinitis	Year-round allergies
Seasonal allergic rhinitis	Seasonal allergies
Urticaria	Hives
Pruritus	Itching
Dermatitis	Skin inflammation/rash
Motion sickness	Feeling sick while traveling
Vertigo	Spinning sensation
Nausea/Vomiting	Upset stomach
Common cold	Helps runny nose/sneezing
Induce sleep	Helps make you sleepy

If histamine is causing the problem (itching, sneezing, runny nose, hives), antihistamines can help. Some older antihistamines are also used for sleep, motion sickness, and nausea because they affect the brain (CNS). 😊

USES OF ANTIHISTAMINES

Allergy Uses vs Non-Allergy Uses

Allergy Uses

🤧 Hay fever

🐱 Pet/dust allergies

🟠 Hives

😖 Itching

🔴 Dermatitis

---

Non-Allergy Uses

😴 Sleep

🚗 Motion sickness

🤮 Nausea/vomiting

🤧 Cold symptom relief

 BRONCHODILATORS

🫁 Asthma/COPD/ URI/ bronchitis

⬇

Airways narrow

⬇

💊 Beta-2 agonist given

⬇

Beta-2 receptors stimulated

⬇

🫁 Smooth muscle relaxes

⬇

🫁 Airways open

⬇

😮‍💨 Easier breathing

Beta-2 agonists stimulate Beta-2 receptors, relax airway muscles, open the airways (bronchodilation), and help patients breathe easier. 🫁😮‍💨✨

 BRONCHODILATORS

steps

MOA

💊 Stimulates Beta-2 receptors

⬇

🫁 Smooth muscle relaxes

⬇

🫁 Bronchodilation

⬇

😮‍💨 Easier breathing

Uses

🫁 Asthma

🫁 COPY

🤧 URI

🫁 Bronchitis

Side Effects

❤ Tachycardia

❤ Palpitations

✋ Tremors

😬 Nervousness

🤢 Nausea/Vomiting

🤕 Headache

• 1. Beta-2 adrenergic agonists (sympathomimetics) 

• DRUG

albuterol (Ventolin®)

formoterol                                                                

terbutaline                                                       

salmeterol (Serevent®)

• 2. Xanthine derivatives
  BRONCHODILATORS 3

💊 Xanthine derivative

⬇

⬆ cAMP

⬇

🫁 Airway muscles relax

⬇

🫁 Bronchodilation

⬇

😮‍💨 Easier breathing

Xanthine derivatives increase cAMP, which relaxes airway muscles, opens the airways, helps clear mucus, and can make patients feel jittery like they drink too much caffeine. ☕🫁😮‍💨

• 2. Xanthine derivatives

BRONCHODILATORS 3

how it works

MOA

💊 Increases cAMP

⬇

🫁 Bronchodilation

⬇

🧹 Improves mucus clearance

---

Uses

🫁 Asthma

🫁 COPD

---

Side Effects

🤢 Nausea/Vomiting

🚽 Increased urination

🤕 Headache

🔥 Flushing

⬇ Hypotension

😬 Restlessness

😳 Insomnia

✋ Tremors

☕ Jittery feeling

⚠ Seizures (toxicity

Important Nursing Point

🩸 Monitor blood levels

Because:

⚠ Narrow Therapeutic Index = easy to become toxic

• 2. Xanthine derivatives
  BRONCHODILATORS
  side by side

Term	Easy Meaning
Bronchodilation	Airways open
cAMP	Chemical that helps relax airways
Mucociliary clearance	Removes mucus from lungs
N/V	Nausea and vomiting
Vasodilation	Blood vessels widen
Hypotension	Low blood pressure
Restlessness	Can't relax
Insomnia	Can't sleep
Tremors	Shaky hands
Narrow TI	Small difference between safe and toxic dose

Xanthine Derivatives

These drugs help open the airways so you can breathe better.

Think:

🫁 Airway too narrow

⬇

💊 Xanthine drug

⬇

🫁 Airway opens

⬇

😮‍💨 Easier breathing

1. Xanthine Derivatives

2. DRUG

theophylline (Theo-Dur®)

aminophylline

MOA (How Anticholinergics Work)

Anticholinergic = Anti-ACH

Think:

🚫 ACH is blocked

⬇

🚫 Muscarinic receptors are blocked

⬇

ACH can't work

⬇

Airway muscles don't tighten

⬇

🫁 Airway muscles relax

⬇

🫁 Bronchodilation

⬇

😮‍💨 Easier breathing

ACH = Airways Close Anticholinergic = Stops ACH

⬇

🫁 Airways Open

Step-by-Step

BRONCHODILATORS 5

Normally:

ACH

⬇

Muscarinic receptor

⬇

🫁 Bronchoconstriction

With an Anticholinergic:

💊 Drug blocks muscarinic receptor

⬇

ACH can't attach

⬇

No bronchoconstriction

⬇

🫁 Bronchodilation

⬇

😮‍💨 Easier breathing

Uses

COPD

🫁 Opens airways

⬇

Improves breathing

Asthma

🫁 Helps prevent airway narrowing

URI (Upper Respiratory Infection)

🤧 Can help improve airflow when airways are irritated.

3.  Anticholinergics

• MOA:

• side effect

Dries Mucous Membranes What does this mean?

Anticholinergics reduce secretions.

⬇

Less mucus and saliva are made.

• blocks muscarinic receptors, blocks actions of ACH →  bronchodilation

---

Examples

👅 Dry mouth

👃 Dry nose

👁 Dry eyes

Easy Memory

Anticholinergics Dry Things Out

🏜👅 🏜👃 🏜👁

ACH Working	Anticholinergic Given
Airways tighten	Airways open
Bronchoconstriction	Bronchodilation
More secretions	Less secretions
More mucus	Drier mucus membranes

Exam Cheat Sheet

Anticholinergics

MOA

💊 Blocks muscarinic receptors

⬇

🚫 Blocks ACH

⬇

🫁 Bronchodilation/ widen

⬇

😮‍💨 Easier breathing

---

Uses

🫁 COPD

🫁 Asthma

🤧 URI

---

Side Effects

👅 Dry mouth

👃 Dry nose

👁 Dry eyes

🏜Dries mucous membranes

---

One-Line Memory

Anticholinergics block ACH at muscarinic receptors, preventing bronchoconstriction and causing bronchodilation, but they can dry out the mouth, nose, and eyes. 🫁✨🏜

Quick Memory Trick

"ACH Closes Airways — Anticholinergics Stop ACH and Open Airways." 🫁😮‍💨

Anticholinergics

DRUG

ipratropium bromide (Atrovent®)

Combination Bronchodilator (Easy Short Answer)

A combination bronchodilator contains 2 drugs in 1 inhaler :

💊 Anticholinergic + 💊 Beta-2 agonist

They work together to open the airways.

How?

🫁 Beta-2 agonist
→ Relaxes airway muscles
→ Opens airways

PLUS+

🫁 Anticholinergic
→ Blocks ACH (which normally narrows airways)
→ Opens airways

Result

✅ Better bronchodilation (airway opening)

✅ Easier breathing

Easy Memory

Two airway-opening drugs working together = stronger breathing relief. 🫁😮‍💨✨

1. Combination Bronchodilators

2. DRUG

ipratropium bromide + albuterol sulfate (Combivent®)

CYSTEINYL LEUKOTRIENE
RECEPTOR INHIBITOR

Leukotrienes causes

⬇

🫁 Bronchoconstriction

🟢 Mucus

🔥 Inflammation

⬇

😮‍💨 Breathing problems

With the Drug

💊

⬇

🚫 Blocks leukotrienes

⬇

🫁 Airways stay more open

🟢 Less mucus

🔥 Less inflammation

⬇

😮‍💨 Easier breathing

MOA -how it works

🚫 Blocks leukotrienes

⬇

🫁 Less bronchoconstriction

🟢 Less mucus

🔥 Less inflammation

CYSTEINYL LEUKOTRIENE
RECEPTOR INHIBITOR

easy memory

Uses

🫁 Asthma

🫁 COPD

🤧 URI

🫁 Bronchitis

---

Side Effects

🤕 Headache

🤢 Nausea

💩 Diarrhea

---

One-Line Memory

Leukotriene inhibitors block chemicals that cause airway tightening, mucus production, and inflammation, helping PREVENT asthma and breathing problems. 🫁✨🛡

Super Short Memory

Leukotrienes = Tight airways + mucus + inflammation.

Drug = Blocks all 3. 🚫🫁🟢🔥

Cysteinyl Leukotriene Receptor Antagonists/Inhibitors

DRUG

montelukast (Singulair®)

MOA = Mechanism of Action

INHALED/NASAL STEROIDS

💊 Steroid

⬇

🚫 Blocks inflammation

⬇

🔥 Less swelling

⬇

🟢 Less mucus

⬇

🫁 Airways stay more open

⬇

😮‍💨 Easier breathing

Steroids = Stop Swelling

🔥❌

INHALED/NASAL STEROIDS

what does steroids do? 2

What Happens Without Steroids?

🔥 Inflamed Airways

⬇

🟢 More mucus

⬇

🫁 Airways become narrow

⬇

😮‍💨 Trouble breathing

What Happens With Steroids?

💊 Steroid

⬇

🔥 Less inflammation

⬇

🟢 Less mucus

⬇

Airways more open

⬇

😮‍💨 Easier breathing

Side Effects of LONG-TERM Steroid Use

(Usually with prolonged use)

Blood Pressure Changes

🩸 BP may increase

---

Blood Sugar Changes

🍬 Blood glucose may increase

Important for diabetics.

---

Osteoporosis

🦴 Bones become weaker

⬇

Higher risk of fractures

Weight Gain

⚖ Gain weight more easily

---

Difficulty Sleeping

😳 Insomnia

Trouble falling asleep

Increased Risk of Infection

🦠 Steroids suppress the immune system

⬇

Higher chance of getting infections

Skin Breakdown

🩹 Skin becomes thinner and more fragile

INHALED/NASAL STEROIDS

Patient Teaching/ Side effects:

If Using an Inhaler Rinse Your Mouth After Every Use

💊 Inhaler used

⬇

🚰 Rinse mouth

⬇

Prevents thrush/ 🦠 Yeast infection in the mouth

Steroid Inhaler → Rinse Mouth

If Using a Nasal Spray Point Away From the Septum

The septum is the wall in the middle of your nose.👃

Why?

If the spray repeatedly hits the septum:

⬇

👃 Irritation

⬇

🩸 Nosebleeds

Spray toward the side of the nose, not the middle.

Steroids reduce inflammation and swelling, making breathing easier, but long-term use can cause high blood sugar, weak bones, weight gain, infection risk, and insomnia. 💊🔥❌🫁😮‍💨

Super Short Memory

Steroids = Stop Swelling.

Inhaler → Rinse Mouth 🚰

Nasal Spray → Aim Away From Septum 👃➡

INHALED/NASAL STEROIDS

easy summary

MOA

💊 Inhibits inflammatory response

⬇

🔥 Less inflammation

⬇

🫁 Easier breathing

Uses

🫁 Asthma

👃 Allergic rhinitis

🤧 URI, 🤒 Cold

🫁 Bronchitis

Long-Term Effects

🩸 BP changes

🍬 Increased blood sugar

🦴 Osteoporosis

⚖ Weight gain

😳 Insomnia

🦠 Increased infection risk

🩹 Skin breakdown

Patient Teaching

🚰 Rinse mouth after inhaler use → prevents thrush

👃 Point nasal spray away from septum → prevents nosebleeds

Corticosteroids (asthma or allergic rhinitis, inhaled or nasal steroids)

INHALED/NASAL STEROIDS 2

DRUG

budesonide (Rhinocort®, Pulmicort®)

mometasone (Nasonex®, Asmanex®)

fluticasone (Flonase®)

flunisolide

triamcinolone (Nasacort®)

EXPECTORANTS

An expectorant helps you cough mucus out of your lungs and airways.

Think:

🟢 Thick mucus is stuck

⬇

💊 Expectorant makes mucus thinner

⬇

🤧 Easier to cough up

⬇

Airways become clearer

MOA = Mechanism of Action

💊 Expectorant

⬇

⬆ Increases respiratory secretions (more fluid)

⬇

🟢 Mucus becomes thinner

⬇

🟢 Mucus becomes less sticky

⬇

🤧 Easier to cough out

Expectorant = EXIT Mucus

EXPECTorant helps you EXPECTorate (cough out mucus).

🟢➡🤧➡🚪

EXPECTORANTS

easy summary

Uses

Colds -🤧 Helps loosen mucus

Bronchitis -🫁 Helps clear mucus from inflamed airways

URI (Upper Respiratory Infection) -🤧 Helps thin secretions

Chest Congestion -🟢 Breaks up thick mucus

⬇

Makes coughing more productive

Patient Teaching Drink Plenty of Water 💧

This is VERY important.

Why?

💧 Water helps thin mucus

⬇

💊 Expectorant works better

⬇

🤧 Easier to cough mucus out

Easy Memory Expectorant + Water = Works Better

💊 + 💧 = 🟢 Thin mucus

Expectorants add fluid to thick mucus, making it thinner and easier to cough out of the lungs. 🟢💧🤧🫁

Expectorant = Thin mucus so you can cough it out. 🟢➡🤧✨

Expectorants

DRUG

guaifenesin (Robitussin®, Mucinex®)

What's Happening?

MUCOLYTICS

Before Drug

🟢 Thick, sticky mucus

⬇

Blocks airways

⬇

It's hard to cough up

⬇

😮‍💨 Trouble breathing

After Drug

💊 Mucolytic

⬇

🟢 Mucus thins out

⬇

🤧 Easier to cough up

⬇

🫁 Airways clearer

⬇

😮‍💨 Easier breathing

Why Are They Often Given With a Bronchodilator?

MUCOLYTICS

Bronchodilator

💊 Open airways

⬇

🫁 Bronchodilation

⬇

😮‍💨 Easier breathing

Together

💊 Mucolytic → Breaks up mucus

PLUS

💊 Bronchodilator → Opens airways

⬇

🫁 Mucus comes out more easily

⬇

😮‍💨 Better breathing

• bronchospasm-usually combined with bronchodilator

Exam Cheat Sheet

MUCOLYTICS

MOA

💊 Liquefies (thins) bronchial secretions

⬇

🤧 Easier to remove mucus

---

Uses

🫁 Asthma

🫁 Bronchitis

🤧 Respiratory infections

Side Effects

⚠ Bronchospasm (airway tightening)

---

Patient Teaching

💧 Drink plenty of water/ water keeps mucus thin

💊Often used with a bronchodilator

Mucolytics break up and thin thick mucus so it can be coughed out more easily, but they can sometimes cause bronchospasm, so they are often given with a bronchodilator. 🟢💊🫁✨

Mucolytic = Breaks up thick mucus.

Bronchodilator = Opens airways.

Together = Easier breathing. 😮‍💨🫁

Expectorant vs Mucolytic

Expectorant	Mucolytic
Adds water to mucus	Breaks up thick mucus
Helps cough mucus out	Makes mucus thinner
Drink water	Drink water
Clears congestion	Clears congestion

MUCOLYTICS

• MOA:
  Liquefy bronchial secretions

• Uses: asthma, bronchitis, respiratory infections

• Patient teaching/Side effects: adequate hydration, can cause bronchospasm-usually combined with bronchodilator

• EXPECTORANTS

• MOA: increase respiratory secretions, lubricate and liquefy mucus

• Uses: colds, bronchitis, URI, chest congestion

• Patient teaching/Side effects: adequate water intake

Mucolytics

DRUG

acetylcysteine

Narcotic Antitussive vs Non-Narcotic Antitussive

ANTITUSSIVES

Narcotic Antitussive	Non-Narcotic Antitussive
Suppresses cough	Suppresses cough
May cause sedation	Usually less sedation
May slow breathing	Does not usually cause respiratory depression
Drink water	Drink water

2. Non-Narcotic Antitussives

These also reduce coughing.

💊

⬇

🧠 Reduce stimulation of the cough center

⬇

🤧 Less coughing

Side Effects/Teaching

💧 Drink plenty of water

1. Narcotic (Opioid) Antitussives

Side Effect: Respiratory Depression-➡ Breathing becomes slower

Why is this important?

Too much opioid can slow breathing too much.

⚠ Breathing monitor.

Side Effect: Drowsiness/Sedation Sedation

😴 Sleepy 😴 Drowsy 😴 Less alert

Water Intake

💧 Drink plenty of water

ANTITUSSIVES

short easy memory

💊 Stop coughing

MOA

🧠 Suppress cough center

⬇

🤧 Less coughing

Use

🤧 Cough suppression

Narcotic (Opioid)

⚠ Respiratory depression

😴 Drowsiness

💧 Drink water

Non-Narcotic

💧 Drink water

Antitussives work by calming the cough center in the brain, reducing coughing. Narcotic antitussives may cause drowsiness and slow breathing, while non-narcotic antitussives mainly require adequate hydration. 🤧❌🧠💊

Antitussive = Stops cough.

Narcotic = Watch for slow breathing and sleepiness.

Non-Narcotic = Drink water. 💧🤧❌

Antitussives

Narcotic

DRUG

hydrocodone

codeine/guaifenesin

 

Antitussives

Non-narcotic

DRUG

dextromethorphan/guaifenesin (Robitussin DM®)

benzonatate 

What are decongestants?

Decongestants help un-stuff your nose. 👃

Think:

👃 Stuffy nose

⬇

💊 Decongestant

⬇

👃 Nose opens up

⬇

😮 Easier to breathe

Alpha-1 Receptors

Decongestants stimulate Alpha-1 receptors .

⬇

🩸 Blood vessels in the nose get smaller

⬇

Vasoconstriction

(Vaso = blood vessel, constriction = squeeze)

⬇

Less swelling in the nose

⬇

Less congestion

⬇

Secretions can drain

Alpha-1 = Squeeze Blood Vessels 🩸🤏

Decongestant = Decreases Congestion 👃❌

DECONGESTANTS 

What's Happening?

Before Drug

👃 Swollen nasal tissues

⬇

👃 Stuffy nose

⬇

Mucus trapped

⬇

Hard to breathe

After Drug

💊 Decongestant

⬇

🩸 Blood vessels constrict

⬇

👃 Swelling decreases

⬇

🟢 Mucus drains

⬇

😮 Easier breathing

Uses Colds

🤧 Helps stuffy nose

Sinus Infections

😖 Helps sinus drainage

URI (Upper Respiratory Infection)

🤧 Reduces nasal congestion

DECONGESTANTS 

easy short summary

💊 Decongestant

⬇

Alpha-1 receptors stimulated

⬇

🩸 Vasoconstriction

⬇

👃 Less swelling

⬇

🟢 Secretions drain

⬇

😮 Easier breathing

MOA

💊 Stimulates Alpha-1 receptors

⬇

🩸 Vasoconstriction

⬇

👃 Decreased nasal swelling

⬇

😮 Easier breathing

Uses

🤧 Colds, 😖 Sinus infections, 🤧 URI

Contraindication

⚠ HTN (High Blood Pressure)

Side Effects

⬆ BP, ❤ Increased HR, 😬 Nervousness, ☕ Wired feeling

Decongestants stimulate Alpha-1 receptors, causing vasoconstriction in the nose, which decreases swelling and congestion but can increase blood pressure and heart rate. 👃🩸🤏

Decongestant = Unstuffs the nose.

Alpha-1 = Squeeze blood vessels.

Watch for ↑ BP and ↑ HR. 👃✨❤🩸

Decongestants

DRUG

oxymetazoline (Afrin®, Dristan®)

phenylephrine (Neo-Synephrine®)

pseudoephedrine (Sudafed®)