Respiratory medications

• Causes of narrowed airways are mucosal swelling, constriction of smooth muscle, mucosal swelling and constriction of smooth muscle and mucus plug
• Major drugs for COPD patients are anti-inflammatory drugs or bronchodilators
• Anti-inflammatory drugs can be inhaled or oral glucocorticoids. They prevent and reduce inflammation
• Bronchodilators can be Beta-2 agonists, they relax smooth muscle or anticholinergics, they prevent the binding of cholinergic substances that cause constriction and increase secretion
• When administering drugs by inhalation, drugs are delivered directly to their site of action. Systemic effects are minimized, relief of attacks is rapid and you avoid the first pass effect of the liver
• Types of inhalation devices are a metered dose inhaler, a dry powder inhaler, a soft mist inhaler and a nebulizer
• Having an inhaler with a spacer (chamber) will help more medication get into the lungs rather than the throat
• Bronchodilators (beta 2 agonists or anticholinergics) have the goal of dilating the constricted bronchi and bronchioles
• Beta 2 agonists can be long or short acting
• beta 1 receptors: increased contractility and heart rate

  beta 2 receptors: dilation
• Beta 2 agonists activate beta 2 receptors which will relax smooth muscles of the airway, resulting in bronchial dilation and airflow increase
• Beta 2 agonists will provide symptomatic relief (dyspnea) but will not alter the underlying disease process of inflammation
• Indications for beta 2 agonists

  • relief bronchospasm
  • used for treatment of acute bronchospasm or prevention of bronchospasm
• Contraindications of beta 2 agonists

  • known drug allergy
  • uncontrolled cardiac dysrhythmias (because of adverse effect of increased HR)
• Salbutamol (ventolin) is a short acting beta 2 agonist. It is taken PRN to abort an ongoing attack. For an exercice induced bronchospasm, it can be taken before exercise to prevent an attack
• Salmeterol (serevent) is a long acting beta 2 agonist. It is for long-term control in patients who experience frequent attack or can be effective in treating stable COPD. Dosing is on a fixed schedule, not PRN.
• Beta 2 agonists nursing implications

  • ensure patients know how to self-administer
  • educate on systemic effects of tachycardia, angina and tremors
• Beta 2 receptors are part of the sympathetic nervous system, which is part of the autonomic and peripheral nervous system
• Anticholinergics bind to the ACh receptors and prevent Ach from binding. ACh causes bronchial constriction and narrowing of the airways
• Anticholinergics result in prevention of bronchoconstriction, dilation of the airways and decreased bronchial secretions
• Anticholinergics indications:

  • relieve bronchospasm
  • used for long-term maintenance treatment
• Contraindications of anticholinergics are a known drug allergy
• Tiotropium (spiriva) and ipatropium (atrovent) are examples of anticholinergics
• Nursing implications of anticholinergics

  • ensure that patients know how to self-administer
  • educate on systemic effects of dry mouth, irritation of pharynx, constipation, urinary retention
• You should wait 1 minute between the administration of different inhaled medications
• Anti-inflammatory drugs (glucocorticoid) suppress inflammation. They can be taken inhaled, orally or by IV
• Indications for glucocorticoids

  • anti-inflammatory
  • used for long term control of airway inflammation or management of COPD oral exacerbations
• Contraindications of glucocorticoids

  • known drug allergy
  • sputum test positive for candida organisms
  • systemic fungal infections
• Examples of glucocorticoids

  • inhaled: fluticasone (flovent)
  • oral: prednisone
• Nursing implications of glucocorticoids:

  • ensure that patients know how to self administer
  • educate on adverse effects of inhaled glucocorticoids: thrush (fungal infection), dysphonia (hoarseness, difficulty speaking
  • educate on adverse effects of oral glucocorticoids: need the lowest dose possible, risk of hyperglycemia
• Nursing implications for resp meds:

  • teach patient purposes for various inhalers
  • ensure patient proper use and have them demonstrate the use of the devices
  • monitor for adverse effects
  • monitor for therapeutic effects
• Therapeutic effects of resp meds:

  • 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
• Using a spacer can minimize the effect of inhaled glucocorticoids since more medication goes to the lungs
• Antihistamines are drugs that block histamine, a molecule involved in allergic reactions. Symptoms of mild allergy are largely caused by histamine such as rhinitis, itching and localized edema
• Antihistamines are drugs that directly compete with histamine for specific receptors. The two histamine receptors are histamine 1 and 2.
• Antihistamine (H1 antagonists) indications:

  • relieve sneezing, rhinorrhea (runny nose) and nasal itching
  • used for mild to moderate allergic rhinitis
• Antihistamines (H1 antagonists) contraindications

  • known drug allergy
  • lower respiratory diseases like pneumonia
• There are 2 types of antihistamines: first and second generation. First generation are older, sedating drugs like Benadryl. Second generation are newer less sedating drugs like clairitin and reactine
• Nursing implications of antihistamines

  • most effect if taken prophylactically (prevention)
  • should be taken regularly throughout the allergy season even when symptoms are absent
  • there are more adverse effects with 1st generation
  • educate on adverse effects
• Adverse effects of antihistamines

  • drying of nasal secretions
  • dry mouth
  • urinating hesitancy
  • constipation
  • drowsiness