Monday, April 30, 2012

Respiratory Drugs


·         It suppresses the cough reflex by acting on medulla’s cough-control center.
·         Indications:
o    Nonproductive cough, cough that interferes with sleep or daily activities
·         Contraindications:   
o     Hypersensitivity, pregnancy, breastfeeding, used cautiously in patients with benign prostatic hyperplasia, debilitation, thoracotomy, laparotomy, or a history of drug or alcohol abuse

Narcotics ( Opioid)
Nonnarcotics( Nonopioid)
codeine phosphate, codeine sulfate (Codeine®)
benzonatate (Tessalon®)
hydrocodone (Hycodan®)
dextromethorpan (Robitussin DM®)

diphenhydramine (Benadryl®, Benylin®)

Side Effects:

·         Dizziness, drowsiness
·         GI irritation, nausea
·         Dry mouth
·         Constipation
·         Respiratory depression

Nursing Considerations:

ü  Assess breath sounds, cough characteristics, frequency and bronchial secretions.
ü  Maintain patent airway, suction if necessary.
ü  Maintain a fluid intake of 2-3 L a day for adults.
ü  Instruct patient if cough lasts longer than 1 week, and a fever or rash occurs, notify the physician.
ü  Place the patient with the head of the bed elevated.
ü  Stress the importance of smoking cessation, and maintain adequate environmental humidity.
ü  Avoid alcohol and other over-the-counter products.
ü  Avoid administration to the patient using narcotics, sedative hypnotics, barbiturates, or anti-depressants, due to CNS depression can occur.
ü  Advise the patient that possible dependency can occur if an opioid drug is used.
ü  Encourage compliance with the therapy, and take the drug as prescribed.
ü  Stress the need of follow up care and repeat laboratory test if necessary to monitor condition.

(bronchomucotropic agents)

·         Used to assist in the removal of secretions or exudates from the trachea, bronchi, or lungs.
·          It acts by liquefying viscid mucus or mucopurulent exudates
·         Indications:
o    Common cold, upper respiratory tract infections, minor bronchial irritations, bronchitis, influenza, sinusitis, emphysema, bronchial asthma, relieve dry hacking cough
·         Contraindications:   
o    Hypersensitivity, used cautiously with ineffective cough reflex or respiratory insufficiency, pregnancy, breastfeeding

guaifenesin (Humibid® L.A., Liquibid®,
Mucinex®, Robitussin®, Tussin®)

Side effects:

·         Drowsiness
·         GI irritations
·         Skin rash
·         Oropharyngeal irritation

Nursing Considerations:

ü  Take medication with a full glass of water to enhance effects of expectorants by making secretions less viscous.
ü  Inform health care provider before taking any over-the-counter or herbal medications.
ü  Instruct the patient not to take guaifenesin for a persistent cough associated with smoking, asthma, emphysema, or excessive secretions.


·         Reduce the viscosity of the bronchial secretions by liquefying and loosening thick mucous secretions by cleaving disulphide bonds cross-linking mucus glycoprotein molecules.
·          Indications:
o    Treat abnormal, viscid, or thick and hard mucus, antidote for acetaminophen overdose
·         Contraindications:   
o    Hypersensitivity; cautiously used in elderly, debilitated, pregnant, or breastfeeding, and patients with asthma

acetylcysteine (Mucomyst®)
dornase alfa (Pulmozyme®)

Side effects:

·         Nausea, vomiting
·         Drowsiness
·         Stomatitis
·         Rhinorhhea
·         Chest tightness

Nursing Considerations:

ü  Assess the respiratory status before and after each dose.
ü  Administer acetylcysteine (Mucomyst) by nebulizer because this drug reacts with iron, copper, and rubber; frequently monitor the patient’s nebulizer equipment for reactive effects.
ü  Avoid contamination of the solution and refrigerate an opened vial. Discard opened vials after 4 days.
ü  Provide chest physiotherapy, postural drainage and encourage coughing and deep breathing to facilitate removal of respiratory secretions.
ü  Instruct the patient to gargle after administration of the drug to relieve unpleasant odor and dryness.
ü  Keep suction equipment available for emergency use.
ü  Seek medical help if condition worsens.


·         Used to reduce the swelling of the nasal passages by stimulating the alpha-adrenergic receptors, thus producing vasoconstriction of the capillaries within the nasal mucosa.
·         Indications:
o    Common cold, hay fever, sinusitis, allergic rhinitis, cough, congestion associated with rhinitis
·         Contraindications:   
o    Hypersensitivity, used cautiously patients with hypertension, cardiac disease, hyperthyroidism, or diabetes mellitus

oxymetazoline hydrochloride ( Afrin®)
phenylephrine hydrochloride (Neo-Synephrine®)
phenylproponalamine hydrochloride (Dimetapp®)
pseudoephedrine hydrochloride (Sudafed®)
xylometazoline hydrochloride (Otrivin®)

Side effects:

·         Nervousness
·         Nausea, vomiting
·         Restlessness
·         Hypertension
·         Tachycardia
·         Hyperglycemia
·         Blurred vision

Nursing Considerations:

ü  Monitor for cardiac dysrhythmias, and blood glucose levels.
ü  Avoid over-the-counter products, and herbal remedies.
ü  Inform the patient that the drug may interfere with sleep, therefore take the drug a few hours before bedtime.
ü  Do not break, cut, crush, or chew the capsule or tablet; take the drug in its complete form.
ü  Teach the patient how to administer topical decongestant properly in the lateral head-low position for drops; in the upright position for sprays.
ü  Instruct patient the importance of limiting the use of nasal sprays or drops, and not to exceed the recommended amount, frequency, duration of topical decongestants.
ü  Topical administration may cause rebound congestion if used for more than 5 days in a row.
ü  Encourage use of humidifier if nasal dryness occurs.


·         Act as anti-inflammatory agents which inhibit the production of cytokines, leukotrines, and prostaglandins, the recruitment of eosinophils, and the release of other inflammatory mediators.
·         It works by decreasing the number and activity of inflammatory cells in the respiratory tract while inhibiting bronchoconstriction.
·         Indications:
o    Chronic asthma, chronic bronchitis, allergic rhinitis, and prophylactic treatment for exercise-induced asthma
·         Contraindications:   
o    Hypersensitivity, acute bronchospasm, status asthmaticus, acute episodes of asthma; cautiously used in patients with compromised immune systems, glaucoma, kidney disease, liver disease, convulsive disorders, and diabetes.

Example: (Inhaled corticosteroids)
beclomethasone dipropionate (Vabceril®, Beclovent®)
triamcinolone (Azmacort®)
(Oral corticosteroids)
fluticasone (Flonase®, Flovent®)
flunisolide ( AeroBid®)
                  ( I.V. corticosteroids)

methylprednisolone sodium
hydrocortisone sodium succinate
(Cortef® ,Hydrocortone®)
(See also Endocrine System Drugs)

Adverse Reactions:

·         Throat irritation
·         Hoarseness
·         Cough
·         Fungal infection of the mouth and throat
·         Vertigo
·         Headache
·         Hyperglycemia

Oral/ IV
·         Immunosuppression

Nursing Considerations:

ü  Assess the respiratory condition regularly and assess peak flow readings before starting treatment
ü  Monitor the patient on signs & symptoms of oropharyngeal fungal infection.
ü  Instruct patient to rinse mouth with water after dose.
ü  Monitor the growth especially in children receiving systemic agents or higher doses of inhaled agents. Use the lowest effective dose to reduce the risk of adverse reactions.
ü  For elderly patients, suggest ways to prevent osteoporosis such as increased calcium intake and weight-bearing exercise.
ü  Instruct the patient to follow the prescribed administration and dosage of the drug.
ü  Give oral doses with food to prevent GI irritation.
ü  Teach the patient on how to administer the inhaled form properly via inhalation with the use of a spacer.
ü  Recognize early signs & symptoms of adrenal insufficiency such as fatigue, muscle weakness, fever, anorexia, dyspnea, and fainting; if these occur notify the physician.
ü  Do not stop the drug abruptly.

General Instructions for Metered-Dose Inhalers:

o    Shake the inhaler well, with the canister in place, for 5 to 10 seconds immediately after use.
o    Remove the cap and hold the inhaler system upright.
o    Tilt your head back slight and breathe out to the end of a normal breath.
o    Hold the inhaler on preferred method use:  holding the lips around the mouthpiece, holding the inhaler away from the mouth, and use spacer or extender (Spacers are useful for all patients, especially young children and older adults).
o    Position the mouthpiece 2 to 3 finger-widths from open mouth or use spacer.
o    Activate the inhaler, press down the inhaler to release the medicine, while taking a slow, deep breath for 3 to 5 seconds.
o    Hold the breath for about 10 seconds to allow the medicine goes deeply into the lungs and exhale slowly.
o    If more than one inhalation is required, wait about 1 minute between inhalations. Two minutes are allowed between inhalations for metaproterenol (see manufacturer’s directions for specific times).
o    Rinse or gargle the mouth after each dose to relieve dry mouth and throat irritation and prevent fungal infection.
o    If applicable, rinse the extender and mouthpiece daily in warm water and store them away from heat.
o    To monitor the amount of drug remaining in the canister, test the canister by placing it in a container of water (i.e. a full canister sinks; an empty canister floats).
o    Remember if two different inhaled medications are prescribed, and one of the medications contains glucocorticoids (corticosteroid), administer the bronchodilator first and the corticosteroids second, wait 5 minutes following the bronchodilator before inhaling the corticosteroids.

1 comment:

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