Drugs affecting the

RESPIRATORY SYSTEM

Presented by:

Joyce Acena
The upper respiratory tract (URT)
The lower respiratory tract (URT)
 Upper respiratory tract infections
(URTI)
1. Common colds
2. Seasonal rhinitis
3. Sinusitis
4. Pharyngitis
5. Laryngitis
 Lower respiratory tract infections
(LRTI)
1. Pneumonia
2. Bronchitis
3. Bronchiectasis
4. Atelectasis
5. Obstructive pulmonary disease
 Asthma
 COPD
 Cystic fibrosis
 Respiratory distress syndrome
 Drugs for URT
1. Antibiotics for infections
2. Antitussives
3. Decongestants
4. Antihistamines
5. Expectorant
6. Mucolytics
 Drugs acting on the UPPER respiratory tract
Drug Drug Drug Action Contraindication Side effects/ Adverse effects
Classificat Examples
ion

Antitussiv Dextrome- • acts directly on • post-operative patients • dryness of the mucous

es thorphan the medullary • asthma, emphysema membrane
Codeine cough center of • Caution: allergy, history • increase viscosity of
Hydrocodone the brain to of addiction, patients who respiratory secretions
Benzonatate depress the needs to be alert • drowsiness, sedation,
cough reflex because drug can cause nausea, constipation, dry
sedation mouth, GI upset,
headache, feelings of
congestion, dizziness
Deconge Topical/ • cause local • topical agents are • rebound congestion,
stants Nasal: vasoconstrictio contraindicated to mucosal dryness,
Phenylephrin n which patients with lesions in headache, anxiety,
e decreases the the mucous membrane restlessness, tremors,
Ephedrine blood flow to • topical and oral agents hypertension,
the irritated and are both arrhythmias, sweating
Oral: dilated contraindicated to and pallor.
Pseudo- capillaries of patients with glaucoma,
ephedrine the mucous hypertension, diabetes,
membranes thyroid disease,
lining the nasal coronary disease and
passages and prostate problems
sinus cavities.
 Interventions in administering
NASAL DECONGESTANTS
1. Teach proper administration to ensure therapeutic
effect

2. Clear nasal passages before administering the drug

3. Tilt the head back when applying drops or spray for a

few seconds and after administration to ensure
contact with the affected nasal mucosa and prevent
the drug from reaching the throat which may lead to
more systemic effects.
 Interventions in administering
NASAL DECONGESTANTS
4. Do not use for more than 5 days to facilitate
detection of underlying medical conditions that
may require other treatment.
5. Caution not to combine with other drugs
without doctor’s prescription to avoid over
dosage due to similar ingredients as the
decongestants which may be contained in
other drugs
6. Safety measures in case of dizziness
7. Provide comfort measures such as increased
fluid intake, smoke-free environments, etc.
 Nursing considerations in giving NASAL DECONGESTANTS (URTI)
ex. Phenylephrine, Ephedrine
Assessment Diagnosis Intervention Evaluation

1. Check for any 1. Acute 1. Teach proper administration to ensure 1. Monitor

of the pain r/t therapeutic effect patient’s
mentioned GI, CNS 2. Clear nasal passages before administering response
contraindicatio or local the drug to drug
ns. effects of 3. Tilt the head back when applying drops or 2. Monitor
2. Baseline vital drugs spray for a few seconds and after for
signs 2. Disturbe administration to ensure contact with the adverse
3. Skin color, d affected nasal mucosa and prevent the drug effects
orientation, sensory from reaching the throat which may lead to 3. Evaluate
reflexes, perceptio more systemic effects. effects of
adventitious n r/t CNS 4. Do not use for more than 5 days to facilitate teaching
breath sounds, effects detection of underlying medical conditions plan
4. Bladder 3. Deficient that may require other treatment. 4. Monitor
percussion knowled 5. Caution not to combine with other drugs effectiven
5. Nasal mucous ge without doctor’s prescription to avoid over ess of
membrane regardin dosage due to similar ingredients as the comfort
evaluation g drug decongestants which may be contained in measures
therapy other drugs
6. Safety measures in case of dizziness
7. Provide comfort measures such as
increased fluid intake, smoke-free
environments, etc.
 Drugs acting on the UPPER respiratory tract
Drug Drug Examples Drug Action Contraindication Side effects/ Adverse
Classification effects

Antihistamines Chlorphenamine • Blocks the effects of • pregnancy, • drowsiness,

Diphenhydramine histamine at the lactation, sedation,
Loratadine receptor site renal and liver anticholinergic
Meclizine • Decrease allergic disease, effects
Promethazine response history of
Cetirizine • Has anti-cholinergic arrhythmias
Brompheniramine effect

Expectorant Guiafenesin • enhances the output • children less • nausea, vomiting,

of respiratory tract than 12 years headache,
fluids by reducing the old dizziness and
adhesiveness and rashes
surface tension of
these fluids, allowing
easier movement of
the less viscous
secretions

Mucolytics Acetylcysteine • breaks down mucus • acute • nausea,

Dornase alta in order to aid the bronchospas stomatitis,
risk of coughing up m, peptic urticaria,
thick, tenacious ulcer, bronchospasm,
secretions esophageal rhinorrhea
varices
 Interventions in administering
ANTI-HISTAMINE
1. Administer drug on an empty stomach – 1 hour
or 2 hours after meals to increase the
absorption of the drug; Give with meals if
patient has GI problems.
2. Remind client that prescriber may need to try
several different agents because one may
have poor response to one agent but another
agent may be very effective.
3. Take sugarless candies or lozenges to prevent
dryness of the mouth which may also lead to
anorexia and nausea
 Interventions in administering
ANTI-HISTAMINE
4. Provide safety measures to prevent
injury due to CNS effects
5. Increase humidity and increase fluid
intake to decrease thickening of
secretions and dry nasal mucosa
6. Void before each dose to decrease
urinary retention if it is a problem
 Interventions in administering
ANTI-HISTAMINE
7. Provide skin care if skin dryness occurs
8. Caution the patient to avoid excessive
dosage especially when taking other
drugs in combination with antihistamine
9. Avoid alcohol intake to avoid serious
sedation
10. Patient teaching with regards to action,
contraindication, side and adverse
effects.
Nursing considerations in Giving ANTIHISTAMINES (URTI)
ex. Diphenhydramine, Chlorphenamine, Cetirizine, Loratidine, Meclizine,
Promethazine
Assessment Diagnosis Intervention Evaluation

1. Check for any 1. Acute pain 1. Administer drug on an empty stomach – 1 1. Monitor
of the r/t GI, CNS hour or 2 hours after meals to increase the patient’s
mentioned or local absorption of the drug; Give with meals if response
contraindicati effects of patient has GI problems. to drug
ons. drugs 2. Remind client that prescriber may need to try 2. Monitor
2. baseline vital 2. Disturbed several different agents because one may have for
signs sensory poor response to one agent but another agent adverse
3. Skin color, perception may be very effective. effects
texture and r/t CNS 3. Take sugarless candies or lozenges to prevent 3. Evaluate
lesions effects dryness of the mouth which may also lead to effects of
4. orientation, 3. Deficient anorexia and nausea teaching
affect, knowledge 4. Provide safety measures to prevent injury due plan
reflexes regarding to CNS effects 4. Monitor
5. Adventitious drug 5. Increase humidity and increase fluid intake to effectiven
breath therapy decrease thickening of secretions and dry ess of
sounds, nasal mucosa comfort
6. Serum liver 6. Void before each dose to decrease urinary measures
and renal retention if it is a problem
functions 7. Provide skin care if skin dryness occurs
7. Nasal 8. Caution the patient to avoid excessive dosage
mucous especially when taking other drugs in
membrane combination with antihistamine
evaluation 9. Avoid alcohol intake to avoid serious sedation
10. Patient teaching with regards to action,
contraindication, side and adverse effects.
 Interventions in administering
MUCOLYTIC
1. Avoid combining other drugs in the nebulizer
to avoid precipitate formation potential loss of
drug effectiveness.
2. Dilute with “sterile water for injection” to
prevent buildup of components which impedes
drug delivery
3. Wipe face after using a face mask to prevent
skin irritation. Also clean the face mask after
use to remove residue
4. Review the use of nebulizer to ensure proper
administration of drug
 Interventions in administering
MUCOLYTIC
5. Store the drug inside the refrigerator and
away from light.
6. Caution patient with cystic fibrosis that
mucolytic is only a palliate therapy and that
other therapies are still needed.
7. Provide thorough teaching.
Nursing considerations in giving MUCOLYTIC (URTI)
ex .Acetylsysteine, Dornase alta
Assessment Diagnosis Intervention Evaluation

1. Check for any of 1. Acute pain 1. Avoid combining other drugs in the 1. Monitor
the mentioned r/t GI, CNS nebulizer to avoid precipitate formation patient’s
contraindication or local potential loss of drug effectiveness. response to
s. effects of 2. Dilute with “sterile water for injection” to drug
2. Baseline vital drugs prevent buildup of components which 2. Monitor for
signs 2. Disturbed impedes drug delivery adverse
3. Skin color and sensory 3. Wipe face after using a face mask to effects
lesions perception prevent skin irritation. Also clean the 3. Evaluate
4. Adventitious r/t CNS face mask after use to remove residue, effects of
breath sounds effects 4. Review the use of nebulizer to ensure teaching
3. Ineffective proper administration of drug plan
airway 5. Store the drug inside the refrigerator and 4. Monitor
clearance r/t away from light. effectivene
bronchospas 6. Caution patient with cystic fibrosis that ss of
m mucolytic is only a palliate therapy and comfort
4. Deficient that other therapies are still needed. measures
knowledge 7. Provide thorough teaching.
regarding
drug therapy
 Drugs for LRT
1. Antibiotics for 6. Inhaled steroids
infections 7. Leukotriene receptor
2. Bronchodilators antagonists
3. Anti-asthmatics 8. Lungs surfactants
4. Sympathomimetics 9. Mast cell stabilizers
5. Anticholinergics

 Word files\Pharma 18
Drugs affecting the
respiratory system.doc
 Drugs acting on the LOWER respiratory tract
Drug Classification/ Drug Drug Action Contraindication Side effects/
Indication Examples Adverse effects

Anti-asthmatics/ Theophylline • relaxes smooth • GI problems, coronary • Increased theophylline

Bronchodilators Aminophylline muscles disease, respiratory effects (Normal= 10-20
(Xantines) Dyphilline dysfunction, renal or mcg/ml)
Caffeine hepatic disease, • GI upset, nausea,
Indication: alcoholism, irritability, tachycardia,
Asthma hyperthyroidism seizures, brain damage
and even death.

Sympathomimetics Terbutaline • dilates bronchi • Caution in patients with • CNS stimulation, GI

Epinephrine • increased rate cardiac disease, vascular upset, cardiac
Indication: Ephedrine and depth of disease, arrhythmias, arrhythmias,
Acute asthma Albuterol respiration diabetes, hypertension,
attacks, chronic hyperthyroidism, bronchospasm,
bronchitis, reversible pregnancy, lactation. sweating, pallor and
obstructive flushing.
respiratory disease

Anti-cholinergics / Ipratropium • blocks the action • Allergy • dizziness, headache,

Bronchodilators Tilotropium of the • Caution: glaucoma, fatigue, nervousness,
neurotransmitter bladder neck obstruction, dry mouth, sore throat,
Indications: COPD, acetylcholine at prostatic hypertrophy, dry palpitations and urinary
bronchospasm and the vagus nerve mouth & throat retention
emphysema • Relaxes smooth
muscle in the
bronchi
• dilates bronchi
 Interventions in administering
ANTI-ASTHMA / XANTHINES
1. Administer oral drug with food or milk to relieve GI
irritation, if GI upset is a problem.
2. Monitor patient’s response to the drug to determine
the effectiveness of the drug dosage and adjust
dosage as needed.
3. Provide comfort measure including rest periods,
quiet environment, dietary control of caffeine and
headache therapy to cope with the effects of the
drug therapy.
4. Provide periodic follow-up, including blood tests to
monitor THEOPHYLLINE LEVEL.
 Interventions in administering
ANTI-ASTHMA / XANTHINES
5. Watch out for theophylline level toxicity:
 nausea, vomiting
 abdominal pain
 mild metabolic acidosis
 hypokalemia, hypophosphatemia,
hypomagnesemia, hypocalcemia/hypercalcemia
 hyperglycemia
 Chronic signs seizure, hypotension,
dysrrhythmia (for theophylline level more than 40
mcg/ml)
6. Provide thorough teaching.
Nursing considerations giving ANTI-ASTHMA/ /XANTINES (LRTI)
ex .Aminophylline, Theophylline, Dyphylline, Caffeine
Assessment Diagnosis Intervention Evaluation

1. Check for any of 1. Acute 1. Administer oral drug with food or milk to 1. Monitor
the mentioned pain r/t GI relieve GI irritation, if GI upset is a problem. patient’s
contraindications. upset and 2. Monitor patient’s response to the drug to response
2. Baseline vital signs headache determine the effectiveness of the drug to drug
3. Cigarette use- will 2. Disturbed dosage and adjust dosage as needed. 2. Monitor
affect the sensory 3. Provide comfort measure including rest for
metabolism of the perceptio periods, quiet environment, dietary control adverse
drug n r/t CNS of caffeine and headache therapy to cope effects
4. Skin color and effects with the effects of the drug therapy. 3. Evaluate
lesions 3. Deficient 4. Provide periodic follow-up, including blood effects of
5. Peripheral knowledg tests to monitor THEOPHYLLINE LEVEL. teaching
perfusion e 5. Watch out for theophylline level toxicity: plan
6. Baseline ECG regarding a. nausea, vomiting 4. Monitor
7. Adventitious breath drug b. abdominal pain effectiven
sounds therapy c. mild metabolic acidosis ess of
8. Bowel sounds d. hypokalemia, hypophosphatemia, comfort
9. Liver evaluation hypomagnesemia, measures
and blood tests hypocalcemia/hypercalcemia
10. Serum e. hyperglycemia
Theophylline level f. Chronic signs seizure, hypotension,
as baseline dysrrhythmia (for theophylline level
reference Normal= more than 40 mcg/ml)
10-20 mcg/ml) 6. Provide thorough teaching.
 Interventions in administering
ANTI-CHOLINERGIC /
BRONCHODILATORS
1. Ensure adequate hydration and provide
environmental controls, such as the use of
humidifier, to make the patient more comfortable
2. Encourage the patient to void before each dose of
medication to prevent urinary retention r/t drug
effects
3. Provide safety measures if CNS effects occur to
prevent injury
4. Provide small, frequent meals and sugarless
lozenges to relieve dry mouth and GI upset.
 Interventions in administering
ANTI-CHOLINERGIC /
BRONCHODILATORS
5. Review use of the inhalator with the patient;
caution the patient not to exceed 12
inhalations in 24 hours to prevent serious
adverse effects
6. Advise patient not to drive or use hazardous
machinery if nervousness, dizziness and
drowsiness occur
7. Provide thorough teaching.
Nursing considerations in giving ANTICHOLINERGIC BRONCHODILATORS (LRTI)
ex . Ipratorium, Tiotropium
Assessment Diagnosis Intervention Evaluation

1. Check for any of 1. Acute pain 1. Ensure adequate hydration and provide 1. Monitor
the mentioned r/t CNS, GI environmental controls, such as the use patient’s
contraindication or of humidifier, to make the patient more response to
s. respiratory comfortable drug
2. Baseline vital effects of the 2. Encourage the patient to void before 2. Monitor for
signs drug each dose of medication to prevent adverse
3. Adventitious 2. Imbalanced urinary retention r/t drug effects effects
breath sounds nutrition: 3. Provide safety measures if CNS effects 3. Evaluate
4. Skin color less than occur to prevent injury effects of
lesions to body 4. Provide small, frequent meals and teaching
assess for requirement sugarless lozenges to relieve dry mouth plan
dryness or s, r/t dry and GI upset. 4. Monitor
allergic reaction mouth and 5. Review use of the inhalator with the effectivene
5. Orientation, GI effects patient; caution the patient not to exceed ss of
reflex, affect 3. Deficient 12 inhalations in 24 hours to prevent comfort
6. urinary output knowledge serious adverse effects measures
and prostate regarding 6. Advise patient not to drive or use
palpation to drug therapy hazardous machinery if nervousness,
assess for anti- dizziness and drowsiness occur
cholinergic 7. Provide thorough teaching.
effect
 Drugs acting on the LOWER respiratory tract
Drug Drug Drug Action Contraindication Side effects/
Classification/ Examples Adverse effects
Indication
• sore throat,
Inhaled steroids Budesonide • decrease inflammatory • pregnancy, hoarseness, dry
Beclometha response in the airway. lactation, mouth, coughing,
Indication: sone • inhibit bronchoconstriction acute pharyngeal and
Prevention & • promote smooth muscle asthma laryngeal fungal
treatment of dilation attacks, infection
asthma • increase airflow and facilitates emergency • lesions
respiration

Leukotriene Montelukast • blocks receptors for the • liver and • headache, dizziness,
receptor Zafirlukast production of leukotriene renal myalgia, nausea,
antagonists Zileuton components of slow reacting impairment, diarrhea, abdominal
substance of anaphylaxis pregnancy pain, elevated liver
Indication: (SRSA) & lactation enzymes
Prophylaxis and • blocks the increase in capillary concentration,
treatment of permeability vomiting, generalized
bronchial asthma pain, fever, myalgia.
 Interventions in administering
INHALED STEROIDS
1. Do not administer to treat acute asthma or status
asthmaticus. This drug is for prophylaxis and
treatment and not for emergency.
2. Taper systemic steroids carefully during the transfer
to inhaled steroids. Deaths have occurred due to
adrenal insufficiency with sudden withdrawal.
3. Have the patient use decongestant drops before
using the inhaled steroid to facilitate penetration of
the drug if nasal congestion is a problem.
 Interventions in administering
INHALED STEROIDS
4. Have the patient rinse the mouth after using
the inhaler because it will help to decrease
systemic absorption and decrease GI upset
and nausea.
5. Monitor patient for any signs of respiratory
infection to prevent serious complications r/t
depression of the inflammatory and immune
responses
6. Provide thorough teaching.
Nursing considerations in giving INHALED STEROIDS (LRTI)
ex .Budesonide, Beclomethasone
Assessment Diagnosis Intervention Evaluation

1. Check for any of 1. Acute pain 1. Do not administer to treat acute asthma 1. Monitor
the mentioned r/t local or status asthmaticus. This drug is for patient’s
contraindication effects of the prophylaxis and treatment and not for response to
s. drug emergency. drug
2. Baseline vital 2. Risk for 2. Taper systemic steroids carefully during 2. Monitor for
signs injury r/t the transfer to inhaled steroids. Deaths adverse
3. Adventitious immuno- have occurred due to adrenal effects
breath sounds supression insufficiency with sudden withdrawal. 3. Evaluate
4. Assess the 3. Deficient 3. have the patient use decongestant drops effects of
nares to knowledge before using the inhaled steroid to teaching
evaluate any regarding facilitate penetration of the drug if nasal plan
lesions which drug therapy congestion is a problem. 4. Monitor
may lead to 4. Have the patient rinse the mouth after effectivene
systemic using the inhaler because it will help to ss of
absorption of decrease systemic absorption and comfort
the drug decrease GI upset and nausea. measures
5. Monitor patient for any signs of
respiratory infection to prevent serious
complications r/t depression of the
inflammatory and immune responses
6. Provide thorough teaching.
 Interventions in administering
LEUKOTRIENES RECEPTOR
ANTAGONISTS
1. Administer drug on an empty stomach – 1
hour or 2 hours after meals to increase the
absorption of the drug; Give with meals if
patient has GI problems.
2. Do not administer to treat acute asthma,
status asthmaticus or bronchospasm
3. Do not stop the medication during symptom-
free periods to ensure therapeutic levels are
maintained.
 Interventions in administering
LEUKOTRIENES RECEPTOR
ANTAGONISTS
4. Provide appropriate safety measures.

5. Avoid OTC drugs containing ASPIRIN which

may interfere with the drug effectiveness.

6. Provide thorough teaching.

Nursing considerationsin giving LEUKOTRIENE RECEPTOR ANTAGONISTS (LRTI)
ex . Montelukast, Zafirlukast, Zileuton
Assessment Diagnosis Intervention Evaluation

1. Check for any of 1. Acute pain 1. Administer drug on an empty stomach – 1. Monitor
the mentioned r/t headache, 1 hour or 2 hours after meals to increase patient’s
contraindication GI upset or the absorption of the drug; Give with response to
s. myalgia meals if patient has GI problems. drug
2. Baseline vital 2. Risk for 2. Do not administer to treat acute asthma, 2. Monitor for
signs injury r/t status asthmaticus or bronchospasm adverse
3. Adventitious CNS effects 3. Do not stop the medication during effects
breath sounds 3. Deficient symptom-free periods to ensure 3. Evaluate
4. Liver and renal knowledge therapeutic levels are maintained. effects of
functions regarding 4. Provide appropriate safety measures. teaching
drug therapy 5. Avoid OTC drugs containing ASPIRIN plan
which may interfere with the drug 4. Monitor
effectiveness. effectivene
6. Provide thorough teaching. ss of
comfort
measures
 Drugs acting on the LOWER respiratory tract
Drug Drug Drug Action Contraindication Side effects/
Classification/ Examples Adverse effects
Indication
• None • Patent ductus
Lungs surfactants Proctant • replaces surfactant arteriosus,
Beractant that is missing in hypotension,
Indication: Calfactant neonates with intraventricular
Respiratory respiratory distress hemorrhage,
distress syndrome syndrome pneumothorax,
(RDS) pulmonary air leak,
hyperbilirubemia
and sepsis
• allergy, acute attack, • swollen eyes,
Mast cell Nedocromil • inhibits the release pregnancy and headache, dry
stabilizers Cromolyn of histamine from lactation, children mucosa, nausea
mast cell. under 2 years of age • fatigue, tearing GI
• prevents allergic (cromolyn) / less upset, cough
asthmatic response than12 years old for
nedocromil.