RESPIRATORY

PHARMACOLOGY
CHRISTIAN BENEDICT, MPhil, RN
Beta2 adrenergic agonists
• SELECT PROTOTYPE MEDICATION: Albuterol
• OTHER MEDICATIONS
• Formoterol
• Levalbuterol
• Salmeterol
• Terbutaline

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Beta2 adrenergic agonists
• PURPOSE
• EXPECTED PHARMACOLOGICAL ACTION
• Beta2 adrenergic agonists act by selectively activating the
beta2 receptors in the bronchial smooth muscle, resulting
• in bronchodilation. As a result of this:
• Bronchospasm is relieved. Histamine release is inhibited.
• Ciliary motility is increased.
• THERAPEUTIC USES

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Beta2 adrenergic agonists
• Albuterol, levalbuterol
• ROUTE
• Inhaled, short-acting
• Oral, long-acting (albuterol)
• THERAPEUTIC USES
• Inhaled, short-acting prevention of asthma episode
(exercise-induced)
• Inhaled, short-acting treatment for bronchospasm and
asthma
• Oral, long-acting, long-term control of asthma
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Beta2 adrenergic agonists
• COMPLICATIONS
• Tachycardia, angina
• Oral agents can cause tachycardia and angina due to activation
of alpha1 receptors in the heart.
• NURSING ACTIONS: Dosage might need to be reduced.
• CLIENT EDUCATION
• Observe for chest, jaw, or arm pain or palpitations, and notify
the provider if they occur.
• Check pulse and report an increase of greater than 20 to 30/min.
• Avoid caffeine.

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Beta2 adrenergic agonists
• Tremors
• Caused by activation of beta2 receptors in skeletal muscle
• NURSING ACTIONS
• Tremors usually resolve with continued medication use.
• Dosage might need to be reduced.

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Beta2 adrenergic agonists
• Formoterol, salmeterol
• ROUTE: Inhaled, long-acting
• THERAPEUTIC USES: Long-term control of asthma
• Terbutaline
• ROUTE: Oral, long-acting
• THERAPEUTIC USES: Long-term control of asthma

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Beta2 adrenergic agonists
• Precautions
• Contraindicated in clients who have tachydysrhythmia.
• Use cautiously in clients who have diabetes mellitus,
hyperthyroidism, heart disease, hypertension, and angina.

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Glucocorticoids
• SELECT PROTOTYPE MEDICATIONS
• Inhalation: beclomethasone
• Oral: prednisone

OTHER MEDICATIONS
• Inhalation: Budesonide, Budesonide and formoterol

• Oral: prednisolone
• IV Hydrocortisone, Methylprednisolone

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Glucocorticoids
• PURPOSE
• EXPECTED PHARMACOLOGICAL ACTION
• Prevent inflammation, suppress airway mucus
production, and promote responsiveness of beta2
receptors in the bronchial tree
• Reduction in airway mucosa edema
• The use of glucocorticoids does not provide immediate
effects, but rather promotes decreased frequency and
severity of exacerbations and acute attacks.

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Glucocorticoids
• THERAPEUTIC USES
• Short-term IV agents are used for status asthmaticus.
• Inhaled agents are used for long-term prophylaxis of asthma.
• Short-term oral therapy is used to treat manifestations
following an acute asthma episode.
• Long-term oral therapy is used to treat chronic, severe
asthma.
• Promote lung maturity and decrease respiratory distress in
fetuses at risk for preterm birth.

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Inhaled anticholinergics
• SELECT PROTOTYPE MEDICATION: Ipratropium
• OTHER MEDICATIONS: Tiotropium

PURPOSE
• EXPECTED PHARMACOLOGICAL ACTION: Block muscarinic
receptors of the bronchi, resulting in bronchodilation

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Inhaled anticholinergics
THERAPEUTIC USES
• Relieve bronchospasm associated with COPD, Allergen-
induced and exercise-induced bronchospasm
• Ipratropium is FDA approved only for bronchospasm
associated with COPD, though is often used off-label for
asthma and is part of the evidence-based guidelines for
asthma management

ROUTE OF ADMINISTRATION: Inhalation

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Inhaled anticholinergics
COMPLICATIONS
• Local anticholinergic effects
• Dry mouth, hoarseness
• CLIENT EDUCATION: Sip fluids and suck on sugar-free hard
candies to control dry mouth.
CONTRAINDICATIONS/PRECAUTIONS
• Contraindicated in clients who have an allergy to peanuts
because the medication preparations can contain soy lecithin.
• Use cautiously in clients who have narrow-angle glaucoma and
benign prostatic hyperplasia (due to anticholinergic effects).
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Inhaled anticholinergics
NURSING ADMINISTRATION
• Usual adult dosage is 2 puffs. Instruct clients to wait the
length of time directed between puffs.

CLIENT EDUCATION
• Rinse the mouth after inhalation to decrease unpleasant taste.
• If two inhaled medications are prescribed, wait at least 5 min
between medications.
• Do not swallow tiotropium capsules. An inhalation device is
used for administration of the capsule.

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Inhaled anticholinergics
NURSING EVALUATION OF MEDICATION EFFECTIVENESS
• Depending on therapeutic intent, effectiveness is
evidenced by the following.
• Control of bronchospasm in clients who have COPD
• Prevention of allergen-induced and exercise-induced
bronchospasm

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Methylxanthines
• SELECT PROTOTYPE MEDICATION: Theophylline
• PURPOSE
• EXPECTED PHARMACOLOGICAL ACTION
• Relaxation of bronchial smooth muscle, resulting in
bronchodilation Once the first-line medication for asthma, now
used infrequently because newer medications are safer and more
effective

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Methylxanthines
THERAPEUTIC USES:
• Oral theophylline is used for long-term control of chronic
asthma or COPD.

ROUTE OF ADMINISTRATION:
• Oral or IV (emergency use only)

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Methylxanthines
COMPLICATIONS
• Mild toxicity reaction can include GI distress and restlessness.
• More severe reactions can occur with higher therapeutic levels and can
include dysrhythmias and seizures.
NURSING ACTIONS
• Monitor theophylline blood levels to keep within therapeutic range (5 to 15
mcg/mL).
• If adverse effects manifestations occur, stop the medication.
• Activated charcoal is used to decrease absorption, lidocaine is used to treat
dysrhythmias, and diazepam is used to control seizures.

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Methylxanthines
CLIENT EDUCATION:
• Periodic monitoring of blood levels is needed. Report nausea,
diarrhea, or restlessness, which are indicative of toxicity.

PRECAUTIONS
• Use cautiously in clients who have heart disease,
hypertension, liver and kidney dysfunction, and
diabetes mellitus.
• Use cautiously in children and older adults.

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Leukotriene modifiers
SELECT PROTOTYPE MEDICATION:
• Montelukast

OTHER MEDICATIONS
• Zileuton
• Zafirlukast

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Leukotriene modifiers
PURPOSE
EXPECTED PHARMACOLOGICAL ACTION:
• Leukotriene modifiers suppress the effects of
leukotrienes, thereby reducing inflammation,
bronchoconstriction, airway edema, and mucus
production.

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Leukotriene modifiers
THERAPEUTIC USES:
• Long-term therapy of asthma in adults and children, and
to prevent exercise-induced bronchospasm
• Montelukast is used in children as young as 12 months
of age.
• Zafirlukast is used in children age 5 years and up.
• Zileuton is used in adolescents and adults.

• ROUTE OF ADMINISTRATION: Oral

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Leukotriene modifiers
• COMPLICATIONS
Depression, suicidal ideation
• More common with montelukast
• NURSING ACTIONS: Monitor for behavior changes and report to
provider.
Liver injury with use of zileuton and zafirlukast
• NURSING ACTIONS: Obtain baseline liver function tests and
monitor periodically.
• CLIENT EDUCATION
• Monitor for indications of liver damage (nausea, anorexia,
abdominal pain).
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CONTRAINDICATIONS/PRECAUTIONS
• Use cautiously in clients who have liver dysfunction.

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Expectorants
• SELECT PROTOTYPE MEDICATION: Guaifenesin
• Guaifenesin is an expectorant and has mucolytic properties,
so clients should take this medication with a full glass of
water.

PURPOSE
• EXPECTED PHARMACOLOGICAL ACTION:
• Guaifenesin promotes increased cough production by
increasing and thinning mucous secretions.
• These actions allow clients to decrease chest congestion by
coughing out secretions. Pharmacology One
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Expectorants
• COMPLICATIONS
GI upset
• CLIENT EDUCATION: Take with food if GI upset occurs.
Drowsiness, dizziness
• CLIENT EDUCATION: Do not take prior to driving or activities
that require alertness, if these reactions occur.
Allergic reaction (rash)
• CLIENT EDUCATION: Stop taking guaifenesin and obtain
medical care if rash or other manifestations of allergy occur

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Mucolytics
• SELECT PROTOTYPE MEDICATION: Acetylcysteine
• OTHER MEDICATION: Hypertonic saline

• PURPOSE
• EXPECTED PHARMACOLOGICAL ACTION: Mucolytics thin and
enhance the flow of secretions in the respiratory passages.

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Mucolytics
• THERAPEUTIC USES
• Mucolytics are used in clients who have acute and
chronic pulmonary disorders exacerbated by large
amounts of secretions.
• Mucolytics are used in clients who have cystic fibrosis.
• Acetylcysteine is the antidote for acetaminophen
poisoning.

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Mucolytics
• COMPLICATIONS
Aspiration and bronchospasm when administered orally
• NURSING ACTIONS: Monitor clients for manifestations of
aspiration and bronchospasm. Stop medication immediately
and notify the provider.
Dizziness, drowsiness, hypotension, tachycardia
• NURSING ACTIONS: Monitor vital signs. Advise client to change
positions slowly and avoid activities that require alertness.
Hepatotoxicity
• NURSING ACTIONS: Monitor liver function tests.
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Decongestants
• SELECT PROTOTYPE MEDICATION: Phenylephrine
• OTHER MEDICATIONS
• Ephedrine
• Naphazoline
• Pseudoephedrine

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Decongesants
PURPOSE
EXPECTED PHARMACOLOGICAL ACTION:
• Sympathomimetic decongestants stimulate alpha1-
adrenergic receptors, causing reduction in the
inflammation of the nasal membranes.
THERAPEUTIC USES
• This medication can be used to treat allergic or
nonallergic rhinitis by relieving nasal stuffiness.
• Acts as a decongestant for clients who have sinusitis and
the common cold.
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Decongestants
• COMPLICATIONS
Rebound congestion
CNS stimulation: Agitation, nervousness, uneasiness
• NURSING ACTIONS
• CNS stimulation is rare with the use of topical agents.
• Stop medication if manifestations of CNS stimulation occur.
• CLIENT EDUCATION: Observe and report manifestations of CNS
stimulation.
Vasoconstriction

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