Respiratory Drugs

SABA (Beta₂-Adrenergic Agonists)

albuterol

• rapid relief for acute asthma manifestations

• fast onset & short half-life

LABA (Beta₂-Adrenergic Agonists)

salmeterol, formoterol, terbutaline

• long term not a rescue medication

• maintenance therapy → decrease use of SABAs

  • used in combination with inhaled corticosteroids

MOA of Beta₂-Adrenergic Agonists

Bind to beta₂-adrenergic receptors in smooth muscles of airways → relaxation, improved airflow & decreased airway resistance

common adverse effects of albuterol

• tachycardia

• palpitations

• tremors

• nervousness

• headache

• possible hypokalemia.

CAUTION = existing heart conditions

findings that indicate albuterol is effective

• decreased wheezing/dyspnea

• improved oxygenation

• better air movement ( use spirometry)

Also monitor how often client uses metered does or dry powder inhaler

MOA of Anticholinergics

Bind to acetylcholine receptors → relaxing airway smooth muscles, decreasing mucus production allowing for bronchodilation and better airflow

short acting anticholinergic meds

ipratropium

• acute asthma exacerbations = individuals cant tolerate SABA

long acting anticholinergic meds

tiotropium bromide, umeclidium, aclidinium

• consistently open airways = improve manifestations over time

adverse effects of anticholinergics

• blurred vision

• dry mouth

• tachycardia

• constipation

• urinary retention

• dry skin

• reduced sweating

“anti-wet” = dry everything

contraindications for anticholinergics

• glaucoma

• bladder neck obstruction

• bladder outlet obstruction

• px w/ benign prostatic hyperplasia

• gi obstructive disorders

• severe cardiovascular disorders

Methyllxanthine medications

theophylline & caffieine

MOA of Methylxanthines

inhibits PDE4, increases cAMP → relaxation of smooth muscles around airways = bronchodilations

also increase alertness by stimulating CNS

Why must theophylline blood levels be monitored?

It has a narrow therapeutic range, so toxicity can develop when the level becomes too high

Where are Methylxanthines commonly used?

neonates

What are early manifestations of theophylline toxicity?

Nausea, vomiting, abdominal discomfort, headache, insomnia, irritability, dizziness, and tachycardia

What are severe manifestations of theophylline toxicity?

Life-threatening dysrhythmias, seizures, and cardiac arrest.

What should patients limit while taking theophylline?

Caffeine-containing foods and beverages because caffeine can increase CNS and cardiac stimulation

Corticosteroid Medications

prednisone & methylprednisolone

Budesonide and fluticasone (inhaled)

MOA of corticosteroids

They decrease airway inflammation, which decreases obstruction and slows disease progression

• acute exacerbations = oral corticosteroids

• long term management of COPd & asthma = inhaled corticosteroids (paired w/ LABA)

Adverse effects occur with inhaled corticosteroids

• Oral candidiasis

• hoarseness, cough

• throat irritation

• decreased bone mineral density (rare unless w/ 10-15 years of use)

• small potential decrease in growth velocity(children) = minimal impact

• rare suppressions in body’s natural stress horomones

contraindications of corticosteroids

known allergy or hypersensitivity to medication

• specific components like milk/formula in some dry powder inhalers

client education of corticosteroids

rinse mouth after each use

Why should long-term corticosteroids not be stopped suddenly?

Abrupt discontinuation can cause adrenal insufficiency because natural cortisol production may be suppressed.

Leukotriene modifiers meds

montelukast, zafirlukast

MOA of leukotriene modifers

suppress the effect leukotrienes = reduce inflammation, prevent tightening of airways, and decrease mucus production

Serious adverse effects are associated with montelukast

pharyngitis

cough

headache

elevated liver enzymes

neuropsychiatric effects:

• agitation

• depression

• hallucinations

• suicidal thoughts or behavior

drug-drug interactions of leukotrienes

• warfarin

• theophylline

• ASA

• phenytoin

What laboratory function may need monitoring with leukotriene modifiers?

Liver function, especially with zafirlukast or preexisting liver impairment.

Immune Modulators - monoclonal antibody-injectables

duplixent (duplilumab) = eosinophillic or oral corticosteroid dependent asthma

xolair( omalizumab) = used to moderate severe allergy or severe allergic asthma

Subq - slowly

caution for immune modulators

dont use for acute asthma attacks

adverse effect of immune modulators

• URI

• fever

• myalgia

• increased risk of herpes

• pulmonary or cardiac complications

• neuropathy

How do decongestants relieve nasal congestion?

They cause local vasoconstriction, shrinking swollen nasal mucous membranes

decongestants (meds)

phenylephrine - topical nasal decongestant

phenylephrine & pseudoephedrine - oral decongestants

fluticasone - steroid nasal decongestant

treatment for steroid nasal decongestants

• allergic rhinitis

• remove inflammation

onset may take a week

contraindications of steroid nasal decongestants

• acute infections

• avoid exposure of airborne infections

adverse of effects of steroid nasal decongestants

• dryness of mucous membranes

• headache

• burning

• irritation

• stinging

MOA of decongestants

they cause local vasoconstriction, shrinking swollen nasal mucous membranes.

MOA of decongestants(topical)

vasoconstriction decreases edema & inflammations

MOA of decongestants(oral)

decrease nasal congestion, shrink nasal mucous membranes

Adverse effect of decongestants(oral)

• rebound congestion

• anxiety

• tremors

• HTN

• overdose

contraindications of decongestants(oral)

• HTN

• glaucoma

• diabetes

• thyroid disease ( hyperthyroidism)

• prostate issues

• coronary disease

What is rebound congestion?

Worsening nasal congestion caused by overusing a topical nasal decongestant

Antitussives (meds)

Banzonatate, codeine, dextromethrophan

purpose of an antitussive

suppress the cough reflex

adverse effects of antitussives

• respiratory depression

• drowsiness

• sedation

• risk of addiction

• GI upset

contraindication of antitussives

• px who need to cough

• asthmatics

• emphysema

• driving/operating machinery

Expectorants (meds)

guaifenesin (mucinex)

MOA of Expectorants

It thins secretions and makes coughing more productive.

Adverse effects of Expectorants

• GI prolonged use of OTC → masking of important symptoms

What teaching is most important with guaifenesin?

Drink plenty of fluids unless fluids are restricted.

Mucolytics (meds)

acetylcysteine

What is acetylcysteine used for in respiratory care?

It breaks down thick mucus in conditions such as COPD, cystic fibrosis, pneumonia, and tuberculosis.

contraindications of mucolytics

caution w/ asthmatics

adverse effects of mucolytics

• GI

• stomatitis

• bronchospasm

MOA of antihistamines

they block histamine at H₁ receptors.

first-generation antihistamine

Diphenhydramine (benadryl)

What is the main difference between first- and second-generation antihistamines?

First-generation medications cause more sedation and anticholinergic effects. Second-generation medications are usually less sedating

second-generation antihistamines?

• loratadine (claritin)

• cetirizine (zyrtec)

• levocetirizine (xyzal)

• fexofenadine (allegra)

• astepro (azeastine nasal spray)

contraindications of antihistamines

pregnancy

px who have arrhythmias or prolong QT intevals

What safety teaching is important for diphenhydramine?

Avoid alcohol, driving, and other CNS depressants until its effects are known.

A patient experiencing acute wheezing and shortness of breath has several prescribed inhalers. Which medication should the nurse administer first?

albuterol

Which assessment finding after albuterol requires further evaluation?

heart rate increasing from 76 to 124 beats/min

Which statement by a patient prescribed salmeterol requires correction?

“I will use this when I suddenly cannot breathe.”

Which patient should use an inhaled anticholinergic cautiously?

a patient with urinary retention

Which finding is most concerning in a patient receiving theophylline?

New seizure activity

What is the priority after administering omalizumab?

Monitor for anaphylaxis

Which assessment is the priority before administering codeine for cough?

Respiratory rate

Which instruction is most important for a patient taking guaifenesin?

Increase fluid intake if permitted

A patient develops wheezing during an acetylcysteine nebulizer treatment. Which complication should the nurse suspect?

Bronchospasm

The nurse should question an oral pseudoephedrine prescription for which patient?

patient with uncontrolled hypertension