FINALS

• Respiratory system


  Includes air passages, pulmonary vessels, the lungs, and breathing muscles, aids the body in the exchange of gases between the air and blood, and between the blood and the body's billions of cells
• Functions of the respiratory system

  • Inhalation and Exhalation
  • Exchange of gas between the lungs and the bloodstream
  • Exchange of gas between bloodstream and body tissues
  • Air vibration in the vocal cords create sounds
  • Olfaction
• Respiratory drugs


  • Antihistamine
  • Decongestants
  • Antitussive
  • Expectorants
  • Bronchodilators
• Antihistamines


  Block histamine effects that occur in an immediate (type I) hypersensitivity reaction, commonly called an allergic reaction
• Classes of antihistamines


  • Ethanolamines
  • Alkylamines
  • Phenothiazines
  • Piperidines
• Conditions treated by antihistamines

  • Allergic rhinitis
  • Vasomotor rhinitis
  • Allergic conjunctivitis
  • Urticaria
  • Angioedema
• Antihistamines


  • H1-receptor antagonists are absorbed well after oral or parenteral administration
  • Antihistamines are distributed widely throughout the body and central nervous system (CNS) except for Loratadine
  • Antihistamines are metabolized by liver enzymes and excreted in urine, with small amounts secreted in breast milk
• Pharmacodynamics of antihistamines


  • Block the action of histamine on small blood vessels
  • Decrease arteriole dilation and tissue engorgement
  • Reduce leakage of plasma proteins and fluids out of the capillaries
  • Inhibit most smooth muscle responses to histamine
  • Relieve symptoms by acting on the terminal nerve endings in the skin
  • Suppress adrenal medulla stimulation, autonomic ganglia stimulation, and exocrine gland secretion
• Epinephrine with antihistamines


  Reverse vasopressor effects producing vasodilation
• Aminoglycosides with antihistamines


  Mask toxic signs and symptoms of ototoxicity
• Tranquilizers and Alcohol with antihistamines


  Increases sedative and respiratory depressant effects
• Macrolide Antibiotics when taken with Loratadine


  May cause serious cardiac effects
• Adverse effects of antihistamines

  • Dizziness
  • Fatigue
  • Disturbed Coordination
  • Muscle Weakness
• Nursing responsibilities for antihistamines

  • Monitor the patient for adverse reactions and drug interactions
  • Monitor blood counts during long-term therapy; watch for signs of blood dyscrasia
  • Take the drug with meals or snacks to prevent GI upset
  • Avoid caffeine, nicotine, and alcohol
  • Use warm water rinses, artificial saliva, ice chips, or sugarless gum or candy to relieve dry mouth
  • Avoid hazardous activities such as driving until the full CNS effects of the drug are known
  • Stop taking antihistamines 4 days before diagnostic skin tests to preserve the accuracy of test results
  • Avoid using other products containing diphenhydramine (including over-the-counter and topical forms) while breast-feeding because of the risk of adverse reactions
• Decongestants


  Used to relieve the symptoms of swollen nasal membranes resulting from allergic rhinitis, vasomotor rhinitis, acute coryza, sinusitis, or common cold
• Types of decongestants


  • Systemic decongestants (Sympathomimetic drugs)
  • Topical decongestants (Vasoconstrictors)
• Systemic decongestants


  • Stimulate the sympathetic nervous system to reduce swelling of the respiratory tract's vascular network
• Topical decongestants


  • When applied directly to swollen mucous membranes of the nose, they provide immediate relief from nasal congestion
• Pharmacodynamics of systemic decongestants

  Cause vasoconstriction by directly stimulating alpha adrenergic receptors in the blood vessels of the body
• Sympathomimetic drugs like epinephrine with decongestants

  Increased CNS Stimulation
• MAO Inhibitors with decongestants

  May cause hypertensive crisis
• Adverse effects of decongestants

  • Nervousness
  • Restlessness and insomnia
  • Nausea
  • Palpitations and tachycardia
  • Difficulty urinating
  • Elevated blood pressure
• Nursing responsibilities for decongestants

  • Encourage the patient to perform deep-breathing exercises
  • Advise the patient not to take other medications, OTC products, or herbal remedies until talking with the prescriber or a pharmacist
  • Don't crush or break extended-release forms of the drug
  • Give the last dose at least 2 hours before bedtime to minimize insomnia
• Antitussives


  Suppress or inhibit coughing
• Major antitussives


  • Benzonatate
  • Codeine
  • Dextromethorphan hydrobromide
  • Hydrocodone bitartrate
• Benzonatate


  Relieves cough caused by pneumonia, bronchitis, the common cold, and chronic pulmonary diseases such as emphysema, can also be used during bronchial diagnostic tests
• Dextromethorphan


  The most widely used cough suppressant, not associated with sedation, respiratory depression, or addiction at usual dosages
• MAOIs with antitussives


  May cause excitation, an extremely elevated temperature, hypertension or hypotension, and coma
• Adverse effects of antitussives

  • Dizziness
  • Sedation
  • Headache
  • Nasal congestion
  • Burning in the eyes
  • GI upset or nausea
  • Constipation
  • Skin rash, eruptions, or itching
  • Chills
  • Chest numbness
• Nursing responsibilities for antitussives

  • Report ineffectiveness of the drug to the prescriber
  • Encourage the patient to perform deep-breathing exercises
  • Advise the patient not to take other medications, OTC products, or herbal remedies
  • Tell the patient taking an opioid antitussive to avoid driving and drinking alcohol
  • Monitor the patient's hydration level if adverse GI reactions occur
• Expectorants


  Increase bronchial secretions, which, in turn, thin mucus so that it's cleared more easily out of airways
• Guaifenesin


  The most commonly used expectorant, helps make mucus easier to cough up and is used for the relief of symptoms caused by productive coughs
• Pharmacodynamics of guaifenesin


  • Reduces the thickness, adhesiveness, and surface tension of mucus, making it easier to clear it from the airways
  • Provides a soothing effect on mucous membranes of the respiratory tract
• Adverse effects of expectorants

  • Vomiting (if taken in large doses)
  • Diarrhea
  • Drowsiness
  • Nausea
  • Abdominal pain
  • Headache
  • Hives or skin rash
• Nursing responsibilities for expectorants

  • Assess the patient's sputum production before and after giving the drug
  • Be aware that the drug may interfere with laboratory tests for 5-hydroxyindoleacetic acid and vanillylmandelic acid
  • Encourage the patient to perform deep-breathing exercises
  • Advise the patient not to take other medications, OTC products, or herbal remedies
• Other respiratory drugs


  • Beta2 Adrenergic Agonists
  • Bronchodilator (Ipatropium)
  • Corticosteroids
  • Mast Cell Stabilizers
  • Methylxantines
• Beta2 adrenergic agonists


  Used for the treatment of symptoms associated with asthma and chronic obstructive pulmonary disease (COPD)
• Types of beta2 adrenergic agonists

  • Short-acting (albuterol, levalbuterol, terbutaline)
  • Long-acting (albuterol, formoterol, salmeterol, Arformoterol, Olodaterol)
• Short-acting inhaled beta2 adrenergic agonists

  The drugs of choice for fast relief of symptoms in asthmatic patients
• Long-acting beta2 adrenergic agonists

  Used with anti-inflammatory agents, specifically inhaled corticosteroids, to help control asthma