DRUGS IN RESPIRATORY SYSTEM

GROUP NAME

 Mucolytic agent

 Anti tuberculotic

 Non steroidal anti-inflamatory

 Anti asthmatics

 Corticosteroid

 Antibiotics

 Anti histamine

 Anti cholinergics
 GROUP 1– MUCOLYTIC AGENT
ACTION:

Mucolytics are drugs belonging to the class of mucoactive agents. They

exert their effect on the mucus layer lining the respiratory tract with the motive of
enhancing its clearance.
EXAMPLE:
1. Acetylcysteine
2. Bromhexine
3. Ambroxol
4. Carbocisteine

DRUG – ACETYLCYSTEINE

THERAPEUTIC ACTIONS:

Decrease viscosity of secretions by braking di sulphide links of

mucoproteins: serves as a substrate in place of gluthathione which is necessary to
inactivate toxic metabolites with acetaminophen over dose.

INDICATIONS:
1. Acute and chronic Broncho pulmonary disease.
2. Emphysema with bronchitis
3. Asthematic bronchitis
4. Tuberculosis
5. Pneumonia
6. Pulmonary complication of cystic fibrosis and in tracheostomy

CONTRA INDICATIONS:
Mucolytic use:
Hypersensitivity to a to acetylcysteine

Antidotal use:

No contra indication, use caution with erophageal varies, peptic ulcer.

AVAILABLE FORMS:

Solution – 10%, 2%, injection – 200mg

DOSAGES:

Mucolytic use:

Nebulization with face mask, mouth piece, tracheostomy.

1-10 ml of 20% solution (or) 2 -20ml of 100% solution q 2-6 hrs.

SIDE EFFECTS:

 GI - Nausea, stomatitis
 Hypersensitivity – Urticaris
 Respiratory – Asthma
 Other – Rhinorrhea

INTERVENTIONS:

 Dilute the 20% acetylcysteine solution with either normal saline (or) saline
water for in injection, 10% solution undiluted.

 Inform the Patient that nebulization may produce an initial disagreeable

odour, but the odour will soon disappear.

 Establish routine for pulmonary toilet have suction equipment on

standby.

TEACHING POINTS:

 You may experience these side effects increased productive cough, nausea,
GI upset.
 Report difficulty breathing or nausea.
 GROUP 2 – ANTITUBERCULOTIC:
ACTION:

Antituberculars art by inhibiting RNA or DNA, or interfering with lipid and

protein synthesis therapies decreasing tubercle bacilli replication.

EXAMPLES:

 Isoniazid
 Rifampin
 Pyrazinamide
 Ethambutol
DRUG – ISONIAZID

THERAPEUTIC ACTION:

Bacterial: Interferes with lipid and nucleic acid biosynthesis in actively growing
tubercle bacilli.

INDICATION:
 Tuberculosis, all forms in which organisms are susceptible.
 Tuberculars or who are considered to be high risk. (patient with HIV, IV
drug uses.)

CONTRA INDICATIONS:

 Hepatic injury
 Acute hepatic disease
 Renal dys function
 Lacatation
 Pregnancy

AVAILABLE FORMS:

Tablets – 100, 300, syrup – 50mg/5ml.

Injection – 100mg/ml.
DOSAGES:

Treatment of active: TB: 5mg/kg/day up to 300mg) single dose.

Prophylaxis for TB: 300 mg/day po in a single dose.

SIDE EFFECTS:

CNS: peripheral neuropathy, seizoures, toxic encephalopathy, optic neuritis.

GI: Nausea, vomiting, epigastric distress, bilirubinemia, bilirubinuria, hepatitis

HAEMATOLOGY: Thrombocytopenia, agranulocytosis

HYPERSENSITIVITY: fever, skin eruptions

LOCAL: Local irritation.

TEACHING POINTS:

 Take drug regularly

 Avoid missing does
 Do not drink alcohol
 Avoid food containing tyramine
 Report weakness, fatigue, loss of appetite, nausea, vomiting & numbness.
 GROUP 3 - NON - STEROIDAL ANTI- INFLAMMATORY
ACTION:

Nonsteroidal anti inflammatories decrease prostaglandin synthesis by

inhibiting an enzyme needed for bio sysnthesis.
EXAMPLE :

 Aspirin
 Naproxen
 Celecoxib
 Ibuprofen
DRUG – IBUPROFEN

ACTION:

May inhibit prostaglandin syntesis, to produce anti inflammatory, analgesic

and antipyretic effects.

AVAILABLE FORMS:

 Capsules : 200mg
 Injection: 8 ml single dose vials.
 Oral drops: 40ml
 Tablet: 100mg, 200mg, 300mg, 400mg, 600mg, 800mg.

INDICATION:

 RA, Osteoarthritis, arthritis.

 Mild to moderate pain fever

DOSSAGE:

 Adults: 300 to 800 mg

 Maximum daily dose is 3.2g.
  Adults: 200 to 400mg P.O for pain.
 I.V every 6hrs for fever 400mg

ADMINISTRATION:

P.O
 Give drug with milk or meals.
 Shake oral suspension and drops well before using.

I.V
 Dilute drug with NSS, 5% dextrose or Ringerlactated solution.
 Dilute solution are stable for 24hrs at room temperature.
 Correct dehydration before administration.

NURSING CONSIDERATION:
Assess:
 Renal, hepatic, blood studies: BUN, creatinine, Hgb, before treatment,
periodically thereafter.
 Autometric, opthalmic examination before, during and after treatment.
 For eye, ear problems; blurred vision, tinnitus, may indicate toxicity.

EVALUATE:

Therapeutic Response: decreased pain, stiffness in joints, decreased swelling

in joints: ability to move more easily.

TEACH PATIENT FAMILY:

 To report blurred vision, ringing, roaring in ears; may indicate toxicity.
 To avoid driving, other hazardous activities if dizziness, drowsiness occur,
especially geiratric patients.
 To report changes in urine pattern, increased weight, edema increased pain
in joints, fever, blood in urine: indicate nephrotoxicity.
 GROUP 4- ANTI ASTHMATIC
ACTION:

Can increase the rate of renal glomerular filteration, so it has certain diuretic
effect.
EXAMPLE:

 Ipratropium bromide
 Beta-2 agonists
 Salbutamol
 Salmeterol
 Formoterol

DRUG – IPRATROPIUM BROMIDE

ACTION:

Inhibits vagally medicated reflexes by antagonizing acetylcholine at

musacarinic receptors on bronchial smooth muscle.

AVAILABLE FORMS:

 Inhaler:17m(g)
 Nasal spray: (21 m(g), 42 m(g)
 Solution for inhalation: 500 m(g) vial).

INDICATION:

 Bronchospasm in chronic bronchitis and emphysema.

 Rhinorrhea caused by allergic and non allergic perennial rhinitis.
 Rhinorrhea caused by the common cold.
 Rhinorrhea caused by seasonal allergic Rhinitis
ADMINISTRATION:

 Inhalational: Shake canister before use, except for HFA aerosol.

 It more than inhalation is ordered, wait at least 2 minutes between
inhalations.

SIDE EFFECTS:

 CNS: Dizziness, pain, Headache.

 CV: Palpitations, chest pain, hyperstension
 ENT: Blurred vision, rhinitis, pharyngitis, sinustis, epitaxis.
 GI: Urinary tract infection
 Musculoskeletal: Back pain:
 Respiratory: Upper respiratory tract infection Bronchospasm, cough,
Bronchitis increased sputum, dyspnea.
 Skin: Rash
 Other: Fluclike symptoms.

GROUP 5-CORTICO STEROIDS

ACTION:
 Corticosteroids are divided into glucocorticoids and mineralcorticoid
glucocorticoids decrease inflammation by the suppression of migration of
polymorphonuclear leukocytes, fibroblasts, increased capillary permeability and
lusosomal stabilization. They also have varied metabolic effects and modify the
body’s immune responses to many stimuli. Mineralcorticoids act by increasing
resorption of sodium by increasing hydrogen and potassium excretion in the distal
tubule.

EXAMPLE:
 Prednisolone
 Betamethasone
 Dexamethasone
 Hydrocortisone
DRUG – BETAMETHASONE

ACTION:

Binds to intracellular corticosteroid receptors, thereby initiating many natural

complex reactions that are responsible for its anti inflammatory and
immunosuppressive effects.

INDICATION:

 Hypercalcemia associated with cancer.

 Short-term management of inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg,
pemphgus), status asthmaticus, and autoimmune disorders
 Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia
 Ulcerative colitis.
CONTRAINDICATIONS:

Contraindicated with infections, especially tuberculosis, fungal infections,

amoebiasis, vaccinia and vacicella, and antibiotic resistant infections,
lactation.

DOSAGE:

 Oral: Initial dosage, 0.6-7.2mg/dl

 IV: Initial dosage, up to 9mg/day
 IM: Initial dosage, 0.5-9mg/day

SIDE EFFECTS:
 CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis
 CV: Hypotension, shock, hypertension, thromboembolism, cardiac
arrhythmias
 Electrolyte imbalance: Na+ and fluid retension, hypokalemia,
hypocalcemia
 Endocrine: Amenorrhea, irregular menses, growth retardation, DM
 GI: Peptic or esophageal ulcer
 INTEG: Acne, atrophy, epidermal thinning.

NURSING RESPONSIBILITY:
Assess:
 Temperature: If fever develops, product should be discontinued
 For systemic absorption, increased temperature, inflammation, irritation.

ADMINISTER:
 Only to affected areas, do not get in eyes
 Leaving site uncovered or lightly covered, occlusive dressing is not
recommmended-systemic absorption may occur.
 Use only on dermatoses, do not use on weeping, denuded, or infected area.
 Cleansing before application of product
  Continuing treatment for a few days after area has cleared
 Store at room temperature.

EVALUATE

 Therapeutic response: absence of severe itching, patches on skin.

TEACH PATIENT FAMILY:

 To avoid sunlight on affected areas, burns may occur
 To limit treatment to 14 days.
 GROUP 6 - ANTIBIOTICS
ACTION:

Substances (eg. Penicilin), produced by certain bacteria and fungi, that

prevent the growth of, or destroy, other bacteria. A resistance the evolution and
survival, as a result of worldwide antibiotic misuse, of bacteria undergoing the
process of natural selection, despite the use of antibiotics to which they were once
sensitive.
ANTIBIOTICS

EXAMPLE:
 Clarithromycin
 Amoxicillin
 Doxycycline
 Cephalexin
 Ciprofloxacin
 Clindamycin
 Metronidazole
 Azithromycin
 Sulfamethaxazole

DRUG-CLARITHROMYCIN

TRADE NAME: Macrolicles

GRPOUP NAME: Antiinfective

ACTION: Binds to 50s ribasomal submits of susceptible bacteria and suppresses
protein synthesis.

INDICATIONS

 Treatment of respiratory tract infections including streptococcal pharyngitis,

sinusitis , bronchitis and pneumonia
  Treatment (with ethambutol) and prevention of disseminated
mycobacterium avium complex (NAC)
 Treatment of following pediatric infections:
 Otitis media
 Sinusitis
 Pharyngitis
 Skin/skin structure infections
 Part of a cambination regimen for ulcer disease due to Helicobacter
 Endocaoditis prophylaxis

CONTRAINDICATION:

 Hypersensitivity to clarithromycin, erythromycin, or othher macrolide anti-

infectives.
 Concurrent use of pimozide
 Pregnancy and lactation (avoid use during pregnancy unless no alternatives
are available)

SIDE EFFECT

CNS: headache

CV: ventricular arrhythmias

GI: Pseudomembranous colitis, abdominal pain/discomfort, abnormal taste,

diarrhoea, dyspepsia, nausea.

DOSAGE: 250mg

NURSING RESPONSIBILITY

ASSESS:
 For infection: wound characteristics, urine, stool, sputum, WBC,
temperature
  Cardiac function due to QT effects.

 For ulcers: abdominal pain, bleeding in stools, emesis

 Respiratory status: rate, charcter, wheezing, tightness, in chest,

discontinuous product

 Allergies before treatment, reaction of each meditation

Patient and family teaching:

 To take with full glass H2O, may give with foo to decrease GI symptoms.
 GROUP - 7 ANTIHISTAMINE

ACTION:

Antihistamines complete with histamines for H1 receptor sites. They

antagonize in varying degrees most of the pharmacologic effects of histamines.

ANTIHISTAMINE

EXAMPLE:

 Cetirizine
 Brompheniramine
 Chlorpheniramine
 Celemastine
 Diphenhydramine
 Fexofenadine
 Loratadine

DRUG-CETERIZINE

GROUP NAME: Antihistamine

TRADE NAME: Zyrtec

DOSAGE AND ROUTE: Adult and child greater than equal to 6 yr: Po5/10
mg/day

AVAILABLE FORMS: Tab 5,10mg 5Sryp 5 mg/5ml.

SIDE EFFECTS

CNS: Headache, stimulation, drowsiness, sedation, fatigue, confusion, blurred

vision, tinnitus, restlessness, tremors, paradoxical excitation in children or geriatric
patient.

UTI: Dry mouth, increase LFTS, constipation

INTEG: Rash, eczema, Photosensitivity, urticaria

RESP: Thickening of bronchial secretions dry nose, throat.

CONTRAINDICATIONS

Breast feeding newborn or premature infants, hypersensitivity to this product or

hydroxyzine severe hepatic disease.

NURSING CONSIDERATIONS:

ASSESS:
 Allergy symptoms: Pruritus, uriticaria, watering eyes, baseline and during
treatment.
 Respiratory status: rate, rhythm increase in bronchial secretions, wheezing
chest tightness.

EVALUATE

 Therapeutic response: Absent of running of congested nose or rashes.

TEACH PATIENT AND FAMILY:

 All aspects of product use: notify prescriber if confusion, sedation,
hypotension occurs.
 To avoid driving, other hazardous activity if drowsiness occurs.
 To avoid alcohol, other CNS depressants,OTC antihistamines.
 To avoid exposure to sunlight, burns may occur.
 To use sugarless gum, candy, frequent sips of water to minimize dry
mouth. Not to breast feed.
 GROUP- 8 ANTICHOLINERGIC

ACTION:

Anticholinergics inhibit the muscarinic actions of acetylcholine at receptor sites in

the autonomic nervous system. Anticholinergics are also known as antimuscarinic
products.
DRUG-ANTICHOLINERGIC

EXAMPLE:
 Propantheline
 Atropine
 Belladonna alkaloids
 Benztropinemesylate
 Clidinium
 Cyclopentolate
 Darifenacin
 Dicyclomine
 Fesoterodine
DRUG-PROPANTHELINE

GROUP NAME: Anticholinergic

TRADE NAME: Propanthel

DOSAGE AND ROUTE: Adult: Po 15mg tid before meats, 30mg at bedtime.

AVAILABLE FORMS: Tab 7.5, 15mg.

ACTION:
 Inhibits action of acetylcholine at postganglionic parasympathetic
neuro effector sites.
SIDE EFFECTS

CNS: Confusion stimulation in geriatric patients, headache, insomnia dizziness,

drowsiness, anxiety, weakness, hallucinations.
CV: Palpitations, tachycardia, orthostatic hypotension.

EENT: Blurred vision, photophobia mydriasis, cycloplegia, increased ocular

tension.

GI: Dry mouth, constipation, paralytic ileus, heart burn, nausea, vomiting,
dysphagia, absence of taste.

GU: Urinary hesitancy, retension impotence.

INTEG: Uriticaria, rash, pruritus, anhidrosis, fever, allergic reactions.

CONTRAINDICATIONS:

 Hypersensitivity to anti cholinergics, angle-closure glaucoma, GI

obstruction, myasthenis, gravis, paralytic ileus, GI at any, toxic
megacolon, urinary tract obstruction.

NURSING CONSIDARATION:

ASSESS:
 VS, cardiac status: checking for dysrhythmias, increased rate
palpitations.
 I&O ratio, check for urinary retention or hesitancy.
 GI complaints: pain,

ADMINISTER

 ½ - 1hr, before meals for better absorption if taking with an antacid

give 1hr before, or after the antacid.
 Decrease dose to geriatric patient’s metabolism may be slowed.
 Gum, hard candy, frequent rinsing for dry mouth.
 Avoid use with other CNS depressants.
PERFORM PROVIDE

 Storage in tight container protected from light.

 Increased fluids, bulk, exercise to decrease constipation.

EVALUATE:
 Therapeutic response: absence of epigastric pain, bleeding, nausea,
vomiting.

TEACH PATIENT /FAMILY:

 To avoid driving, other hazardous activity until stabilized on

medication: may cause blurred vision: to use caution when standing
due to orthostatic hypotension.
 To avoid alcohol: will enhance sedating properties of this product.
 To drink plenty of fluid
 To report dysphagia.
 GROUP 9 ANTI- TUSSIVE

ACTION:
These are the drugs that act in the CNS to increase threshold of cough center.
DRUG EXAMPLE:
 Codeine
 Noscopine
 Dextromethorphan
 Chlorpheniramine
 Diphenhydramine

DRUG CODEINE
ACTION:

Depress pain impulse transmission at the spinal cord level by interacting

with opioid receptors; decreases cough reflex, GI motility.

INDICATION:

Mild to moderate pain

CONTRAINDICATION:

 Breast feeding
 Hypersensitivity
 Respiratory depression
 Increased intracranial pressure
 Seizure disorders

DOSAGE AND FREQUENCY:

ADULT: 15-60 mg, for IM/IV

CHILD: 3mg/kg/day.
AVAILABLR FORMS:

 Tab 15,30 mg,inj 15,30,60 mg/ml

 Syrup 5mg/ml

SIDE EFFECTS:

CNS:Drowsiness,Sedation,Dizziness,Agitation,Lethergy,Restlessness,Seizures

GI:Nausea,Vomiting,Anorexia,Constipation,Dry mouth.

GU:Urinary retention

RESP: Respiratory dipretion, respiratory paralysis, dyspnea

NURSING CONSIDERATIONS

ASSESS:

 Allergic reaction: rash

 CNS Changes, dizziness, Drowsiness, hallucinations pupil reaction.
 Respiratory dysfunction: Respiratory Depression, Character, Rate, Rhythm

TEACH PATIENT/FAMILY:

 To report any symptoms of CNS changes, allergic reaction

 To change position slowly; orthostatic hypotension may occur
 To avoid alcohol
 To avoid hazardous activities if drowsiness or dizziness occur.