Respiratory

• Beta2 Adrenergic Agonist


  • Albuterol
  • Salmeterol
• Short-acting (rescue inhaler)


  • Taken PRN to relieve asthma attack
  • 2-4 puff every 20 min for 3 rounds
• Long-acting (maintenance)

  • Not taken PRN
  • For patients who experience frequent attacks
• Expected Side Effects of Albuterol

  • Tachycardia, palpitation
  • Tremors
  • Toss & turning at night, Insomnia & difficulty sleeping
• Anticholinergic Bronchodilation

  • "-tropium"
  • Drugs: Tiotropium & Ipratropium
  • "Dry you out!" longer acting
• Ipratropium

  • No swallowing capsules
  • SLUDGE -> anticholinergic effects
  • Dry you out
• Ipratropium Patient Teaching

  • Use gum/candy for dry mouth
  • Drink fluids
• Methylxanthines & "-phylline"

  Almost like giving caffeine that makes your heart race & can become toxic
• Ipratropium 3 T's

  • Toxic over 20 mcg/mL
  • Tonic clonic seizures
  • Tachycardia, dysrhythmias
• Glucocorticoids ("-Sone")

  • Reduce the production and block the release of inflammatory responses
  • Reduce swelling
• Glucocorticoids

  • Slow onset
  • Increase sugar (normal SE)
  • Cause sores in mouth, immune system affected
• Glucocorticoid Administration

  1. Inhaler -> clean daily

  2. PO, IV, Nebulizer
• Leukotriene Antagonists ("-Lukast")

  Anti-inflammatory drug, help decrease bronchoconstriction, airway inflammation, mucous production, and edema in the airways
• Montelukast 3 L's

  • Like likes to sing (airway open)
  • Long term management
  • Long onset (1-2 weeks for therapeutic range)
• Montelukast Side Effects

  • Hepatic elevated liver enzyme
  • Black box warning: Neuropsychiatric, depression & suicidal thinking/behavior
• Mucolytics

  Liquefies and losses thick mucus secretions
• Mucolytics Administration

  1. Admin by nebulizer 5 minutes after a bronchodilator

  2. Should not be mixed w/ other drugs
• Nasal Decongestants Side Effects

  • CNS: Nervousness, restless
  • Rebound nasal congestions (3x)
• Nasal Decongestants

  Only use as directed, typically for no more than 3 consecutive days. Prolonged use can lead to tolerance and rebound congestion.
• Antihistamines Uses

  • Mild allergy
  • Allergic rhinitis
  • Common cold, sneezing, coughing
  • Urticaria
  • Motion sickness
  • Sleep aid
  • Adjunct in severe allergic reactions
  • Anaphylaxis
• Antihistamines First Generation

  • Anticholinergic effects
  • More drowsiness effects
• Antihistamines Second Generation

  • Less anticholinergic symptoms
  • Less sedative & drowsiness effects
• Antihistamines Second Generation

  • Loratadine (Claritin)
• Antitussives

  Suppress the cough reflex
• Antitussive Types

  • Opioid: codeine, hydrocodone, etc (severe coughing)
  • Non-opioid: guaifenesin (mild coughing)
  • Combination products: guaifenesin and codeine, guaifenesin and dextromethorphan (severe to mild coughing)
• Antitussives

  Act on the cough center
• Antitussives not used on children, because parents overdosed
• Expectorants

  Loosen bronchial secretions by reducing surface tension of secretions, making patient cough secretions out
• Expectorants

  • Guaifenesin (Mucinex)