Respirotory Drugs PDF

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Respirotory Drugs...

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Drug Therapy for Non-Infectious Lower Respiratory Airflow Beta2-Adrenergic Agonists -erols Albuterol Formoterol Salmeterol MOA: Sympathetic stimulation causing bronchodilation Adverse: tachycardia, palpitations, tremors, Admin: oral or inhaled Precautions: Avoid caffeine, tricyclic antidepressants. MAOIs, hypoglycemic Anticholinergics -tropium Ipratropium Tiotropium MOA: Inhibits the vasoconstrictive mechanism of acetylcholine to cause vasodilation Adverse: dry mouth, intraocular pressure, headache, dizziness, epistaxis, bronchospasms, hypotension Admin: inhaler nebulizer, wait 5 min btw inhalers, Not rescue inhalers Precautions: glaucoma, prostatic hyperplasia, Beta2 Adrenergics enhance effects, can cause urinary retention Methylxanthines Theophylline Aminophylline MOA: relax smooth muscle of bronchi Adverse:few TOXICITY: restlessness & insomnia, nausea, diarrhea, seizure, dysrhythmia Admin: Orally, monitor blood for therapeutic levels based on age, weight. IV for ER slowly Precautions: Avoid caffeine, Smoking, Seizure disorder, TB, peptic ulcers, & bacterial infections have drug drug interactions. Cimetidine, Glucocorticoids Beclomethasone Prednisone Fluticasone MOA: suppress immune system & decrease inflammation. Prevents release of leukotrienes & prostaglandins which reduces edema Adverse: Oral candidiasis, suppress adrenals, muscle wasting& osteoporosis, hyperglycemia, dry mucus membranes, gastric bleeding Admin: inhaled, can use spacer, regular schedule, Oral avoid NSAIDs monitor adrenal function, take with food, smallest effective dose, hyperglycemic measures, monitor for infection, monitor electrolyte balance; Nasal, hard candy due to drying. Don’t give with K depleting diuretics, watch for black tarry stools, sore throat, muscle weakness, avoid anti-inflammatories Mast Cell Stabilizers

Cromolyn MOA: inhibit leukotrienes reduce inflammation Adverse: safest antiasthma drugs, cough bronchospasm Admin: 10-15 min prior to activity or prior to exposure, may take several weeks to be therapeutic Precautions: allergy Leukotriene Modifiers Montelukast Zileuton Zafirlukast MOA: suppress leukotrienes by preventing activation Adverse: liver damage, suicidal ideation Admin: mild analgesics, liver function tests, Oral QD PM, Precautions: note abdominal tenderness, neuropsychiatric changes, nausea or headaches Careful not to give with phytoene, rifampin, can increase theophylline, anticoagulants Upper Respiratory Disorders 1st Generation Antihistamines - sedating Diphenhydramine MOA: block release of histamine on H1 receptors, mild cholinergic blockers Adverse: drowsiness, dizziness, dry mouth Admin: oral advise against operating machinery, don’t take with CNS depressants take before bed, consume fluids, take with food Precautions: breast feeding & under age 2 shouldn’t use, glaucoma, acute asthma, can mix with alcohol to increase sedation 2nd Generation Antihistamines: Cetirizine Loratadine fexofenadine MOA: antagonize effects of histamine w/o binding Adverse: occasional sleepiness and dry mouth Admin: w/ or w/o food QD Precautions: don’t give to breast feeding or 6mo, allergy to hydroxyzine, those w/ impaired kidney or liver function Theophylline will inhibit clearance. Sedative, opioids or alcohol with potentiate CNS depression Sympathomimetics Phenylephrine Pseudoephedrine MOA: mimic sympathetic nervous system causing vasoconstriction Adverse: agitation, anxiety, insomnia, tachycardia, palpitations, abuse rebound, hypertension

Admin: don’t use topical more than 3-5 days, a sleep aid may be used, potential for abuse and rebound Precautions: Not for chronic rhinitis b/c contraindicated for long tem use, glaucoma, hypertension, disrhythmias. Don’t use with MAOIs. Beta2 Adrenergics will potentiate hypertensive effects. Antitussives Codine Dextromethorphan MOA: suppresses cough reflex in the brain Adverse: CNS depression, sedation/drowsiness, nausea, constipation, Admin: w/ food high fluids fiber, short-term basis, care of dizziness Precautions: MAOI and SSRI sensitivity, respiratory depression with use of depressants such as alcohol or opioids, St. John’s Wort may cause sedation Expectorants Guaifenesin MOA: thins mucus making it easier to cough out the lungs Adverse: dizziness, drowsiness, headache, GI distress, diarrhea, allergic rash Admin: Increase fluid intake to help liquefy secretions, avoid feats of mental alertness Precautions: Notify of fever indicative of pneumonia, contraindicated for those w/ sensitivity to phenylketonuria (asparatame), diabetes sugar contents, disulfiram alcohol content no signif drug drug interactions. Mucolytics Acetylcysteine MOA: breaks protein bonds to thin mucus Adverse: bronchospasm, GI distress and nausea Admin: rotten egg smell, inhalation through nebulizer, check ability to cough before, antiemetic if nauseated by smell, encourage expectoration of secretions to avoid GI distress, proper cleaning of nebulizer equipment no metal or rubber parts Precautions: asthmatics or those w/ hx of bronchospasm, activated charcoal may be less effective...