Respiratory Medications

Upper and Lower Respiratory Medications

Upper Respiratory Tract

nose, mouth, pharynx, larynx

Lower Respiratory Tract

trachea, bronchi, bronchioles, alveoli

Alveoli

site of gas exchange

gets filled w/mucus when sick

Pediatric Trachea

funnel shaped

increases risk of inflammation

less air way space

Adult trachea

trachea is cylinder shaped

Conducting Airways

Path: Nose → pharynx → larynx → trachea → bronchi

Filtered by cilia and mucus (“mucociliary escalator”)
Reflexes: cough & sneeze clear irritants

Respiratory Airways

Bronchioles end in alveolar sacs

Alveoli = functional unit

Surrounded by pulmonary capillaries

Gas Exchange

Occurs in alveoli

O₂ diffuses into capillaries

CO₂ diffuses into alveoli for exhalation

Requires surfactant to reduce surface tension (prevents them from collapsing); in NICU preemies, they put surfactant

Ventilation Control

controlled by medulla and pons

chemoreceptors respond to CO2 and pH

Sympathetic effects

bronchodilation

use more in meds

Parasympathetic effects

bronchoconstriction

Upper Resp Tract Infections

cold, rhinitis, sinusitis, laryngitis, bronchitis

Lower Resp Tract Infections

pneumonia (crackles in lungs), TB(wheezing in lungs)

Key Symptoms of Resp Tract Infections

congestion, cough, fever, dyspnea(abnormal breathing)

Atelectasis

alveolar collapse

looks white in x-ray

black color is normal

Asthma

reversible inflammation/bronchospasm

COPD

chronic obstruction (emphysema + bronchitis)

Cystic Fibrosis

thick secretions, recurrent infection

no cure; body creates mucus and clogs organs

life long genetic disease

chest physio therapy breaks mucus so it can be suctioned out

ARDS

severe inflammation, decreased lung compliance

occurs when pt is on vent for long time

Normal SpO2

95-100%

goal is equal or more than 92% in illness

ABGs

assess PaO2 and PaCO2 for ventilation/oxygenation

Early Hypoxia

restlessness, anxiety, tachycardia, pallor

due to lack of O2

Late Hypoxia

cyanosis, confusion, bradycardia, Respiratory distress

bradycardia occurs because body can’t compensate anymore

Hypoxia

low O2 in tissues

Hypoxemia

low O2 in arterial blood

Drugs Acting on teh Upper Resp Tract

antitussives, Decongestants, Antihistamines, Expectorants, Mucolytics

Antitussives

suppress cough reflex

cough center in medulla or anesthetize airway (numbs)

What are Antitussives used for?

dry, unproductive cough

Examples of Antitussives

Dextromethorphan, Codeine, Benzonatate

Implications for Antitussives

avoid when airway clearance needed

good for bedtime because it helps sleep better because cough gets worse at night due to flat laying

Decongestants

reduce nasal swelling

vasoconstrict nasal vessels —> decreases edema, increases drainage

congestion comes out

Topical Decongestants

Oxymetazoline (Afrin), phenylephrine

Oral Decongestants

Pseudoephedrine (Sudafed)

Risk of Decongestants

rebound congestion (with sprays)

mimics sympathetic system

Steroid Nasal Sprays

intranasal Corticosteroids

anti-inflammatory —> decreases swelling and congestion

Examples of Steroid Nasal Sprays

Fluticasone (Flonase), Budesonide, Triamcinolone

Indications for Steroid Nasal Sprays

allergic rhinitis- nose bleeds; can get if used long term

nasal polyps

Onset of Steroid Nasal Sprays

~1 week

takes 3-4 days to start working

use for couple of days

Antihistamines

block histamine (allergy relief)

decreases allergy symptoms, itching, watery eyes, sneezing

includes 1st and 2nd Gen

1st Gen Antihistamines

Diphenhydramine, Brompheniramine (sedating)

educate about drowsiness

dry mouth, urinary retention (SLUDGE) long term

2nd Gen Antihistamines

Loratadine, Cetirizine, Fexofenadine (non-sedating)

for those who need to stay awake in need

Expectorants

Thin & Loosen Mucus

Example: Guaifenesin (Mucinex)

Action: ↓ mucus thickness → easier cough

Teaching: ↑ fluid intake, avoid long-term use

Mucolytics

break down thick mucus

Route: inhalation (neubalizer)

What are Mucolytics used for?

Cystic Fibrosis, atelectasis from mucus plugs

Precaution for Mucolytics

may trigger bronchospasm

Nursing Considerations for Upper Resp Tract Meds

Assess infection before suppressing cough

Monitor BP & HR (decongestants)

Avoid multiple combo OTC drugs

Encourage fluids for mucus clearance

Teach proper spray & inhaler technique

Safety: Avoid driving with sedating antihistamines

Lower Resp Tract Drug Classes

bronchodilators, anti-inflammatories, biologics, others

Bronchodilators

Xanthines, Beta₂-agonists, Anticholinergics

Anti-inflammatories

Inhaled steroids, Leukotriene antagonists

Biologics

Immune modulators

Other Lower resp Tract Drug Classes

Mast cell stabilizers, Lung surfactants

Xanthines

Bronchodilator

relax smooth muscle —> bronchodilation

What are Xanthines used for?

asthma, COPD

*rarely 1st line for COPD

Examples of Xanthines

Theophylline, Aminophylline

usually end w/-lline

Nursing consideration Xanthines

narrow range 10-20 mcg/mL

monitor lvls to make sure its within range

can cause arrhythmias 

Sympathomimetics (Beta₂-Agonists)

Bronchodilator

stimulates B2 receptors which relaxes bronchioles

Short Acting (SABA) and Long acting (LABA)

Examples of Sympathomimetics

Albuterol, Salmeterol, Epinephrine

mostly end in -rol

Short Acting (SABA)

rescue inhaler

Long acting (LABA)

maintenance therapy

Nursing Considerations for Sympathomimetics

only take when needed

have a high risk of they take it 2x a day for weeks

Anticholinergics

Bronchodilator

blocks acetylcholine which prevents bronchoconstriction

Uses for Anticholinergics

maintenance for COPD

adjunct for asthma

Examples of Anticholinergics

Ipratropium (Atrovent), Tiotropium (Spiriva)

usually end w/-pium

Side Effects of Anticholinergics

dry mouth, throat irritation

make sure they rinse their mouth

Inhaled Corticosteroids

anti-inflammatory, inhaled steroids

lowers inflammation and mucus, increases B-receptor sensitivity

Uses of Inhaled Corticosteroids

long term asthma control

daily management

Examples of Inhaled Corticosteroids

Budesonide, Fluticasone, Beclomethasone

Teachings for Inhaled Corticosteroids

rinse mouth after use due to oral thrush

Leukotriene Receptor Antagonists

anti-inflammatory

capsule form

once a day at bed time, not 1st drug of choice

blocks leukotrienes —> decreases inflammation and bronchoconstriction (prevents mucus)

Uses of Leukotriene Receptor Antagonists

maintenance for chronic asthma, allergy prevention

Examples of Leukotriene Receptor Antagonists

Montelukast (Singulair), Zafirlukast (Accolate)

usually end w/-kast

Side Effects of Leukotriene Receptor Antagonists

headache, ↑ liver enzymes (liver toxicity), mood changes

Immune Modulators

biologics

rarely used

monoclonal antibodies block IgE or cytokines

Uses of Immune Modulators

severe persistent asthma not controlled by inhalers

Examples of Immune Modulators

Omalizumab (Xolair), Dupilumab (Dupixent)

usually ends w/-mab

Route of Immune Modulators

subcutaneous injection

2-4 wks in clinical setting that depends on severity 

mast cell Stabilizer and Surfactants

cromolyn, lung surfactants

replace surfactant to keep alveoli open

Cromolyn

prevents histamine release

rarely used

Lung Surfactants

Beractant, Calfactant (for neonatal RDS)

Stepwise Asthma Management 

Step 1: SABA PRN

Step 2: + Inhaled corticosteroid

Step 3: + LABA or leukotriene modifier

Step 4: + Oral steroid or biologic

Inhaler Technique

Use bronchodilator first → wait 5 mins → steroid inhaler next

Rinse mouth after steroid

Use spacer if needed

Asthma Action Plan

plan to control asthma

green, yellow, red zone

Green Zone

symptoms controlled, PEF greater than or equal to 80% —> continue controller meds

Yellow Zone

cough/wheeze, PEF 50-79% —> use rescue inhaler, monitor response

Red Zone

severe SOB, PEF <50% —> use rescue inhaler, seek emergency care

Nurse’s Role 

teach inhaler use and step wise plan

assess triggers and adherence

reinforce peak flow monitoring

evaluate response to therapy 

Nursing Considerations for Lower resp Tract Drug Classes

Monitor breathing, lung sounds, O₂ sat

Educate Rescue vs maintenance meds

Rinse mouth after steroids

Check HR/tremors with beta-agonists (w/continuous albuterol in hospital, HR can be 140 (normal))

Watch theophylline levels

Encourage adherence to daily regime

A newborn has difficulty breathing and is diagnosed with respiratory distress syndrome. What physiological factor contributes?
A. Excess surfactant
B. Lack of surfactant
C. Bronchospasm
D. Fluid overload

B. Lack of surfactant

A patient with hypertension is prescribed pseudoephedrine (Sudafed).

Which nursing action is most appropriate?
A. Encourage salt intake
B. Monitor blood pressure
C. Advise lying flat
D. Discontinue fluids

B. Monitor blood pressure

A patient is prescribed theophylline for COPD. Which finding requires immediate nursing intervention?
A. Heart rate 102 bpm
B. Nausea and restlessness
C. Mild tremor after inhaler use
D. Dry mouth and hoarseness

B. Nausea and restlessness

early signs of toxicity