RESPIRATORY

DRUGS
By: Keverne Jhay P. Colas
 CONTENTS
1. ANTIHISTAMINES
2. ANTITUSSIVES
3. BRONCHODILATORS
4. DECONGESTANTS
5. EXPECTORANTS
6. MUCOLYTICS
ANTIHISTAMINES
 Histamine antagonists are drugs
typically used in allergic reactions
MOA:
 inhibitthe action of histamine by
blocking it from attaching to histamine
receptors;
 or it may inhibit the enzymatic activity
of histidine decarboxylase, catalyzing
the transformation of histidine into
histamine (atypical antihistaminics).
INDICATIONS

1. Prevention and treatment

of symptoms of allergic
disorders that is either
seasonal or acute.
2. Parkinson’s disease
3. Motion sickness
4. Used as hypnotics in the
elderly (sedating
TYPES OF ANTIHISTAMINES
A. FIRST GENERATION:
(SEDATING)
 Oldest H1-antihistamine drugs and
are relatively inexpensive and
widely available.
 They are effective in the relief of
allergic symptoms.
 They treat runny nose, cough and
clogged sinuses associated with
allergies.

TYPES OF ANTIHISTAMINES
1. Alkylamines- among the most
potent antihistamines.
Minimal sedation, moderate
anticholinergic effect, and no
anitiemetic effects.
Paradoxical excitation may
also occur.
Examples: Brompheniramine,
Chlorpheniramine,
Dexchlorpheniramine.
TYPES OF ANTIHISTAMINES
2. Ethanolamine derivatives- Moderate
to high sedative, anticholinergic,
and antiemetic effect. Low incidence
of GI side effects.
Examples: Clemastine,
Diphenhydramine.
3. Phenothiazines- high antihistaminic,
sedative and anticholinergic effects;
very high antiemetic effect.
Example: Promethazine
TYPES OF ANTIHISTAMINES
4. Piperidines- moderate
antihistaminic and
anticholinergic effect; low to
moderate sedation, no
antiemetic effects.
Examples:
Azatadine
Cyprohepatidine
Phenindamine.
TYPES OF ANTIHISTAMINES
A. FIRST GENERATION: (SEDATING)
1. Chlorophenamine maleate (Antamin,
Cohistan)
2. Cyproheptadine hydrochloride
3. Diphenhydramine hydrochloride
(Benadryl)
4. Hydroxyzine hydrochloride
5. Hydroxizine pamoate
6. Meclizine hydrochloride (Antivert)
7. Promethazine hydrochloride
(Phenergan)
TYPES OF ANTIHISTAMINES
B. SECOND GENERATION:
(NON- SEDATING)
 Newer drugs that are much more
selective for peripheral H1 receptors
in preference to the central nervous
system histamine receptors.
 Reduces the occurrence of adverse
drug reactions, such as sedation.
TYPES OF ANTIHISTAMINES
B. SECOND GENERATION:
(NON- SEDATING)
1. Cetirizine hydrochloride
2. Desloratidine (AERIUS)
3. Fexofenadine hydrochloride
4. Loratidine (CLARITIN,
CLARICORT)
ANTIHISTAMINES
SIDE EFFECTS
1. CNS: Sedation ranging from
mild drowsiness to deep sleep.
2. Prolonged use may result in
local irritation and allergic
contact dermatitis.
NURSING MANAGEMENT
1. Document VS, I&O, CV status,
lung sound/status and
characteristics of secretion.
2. Take before or at the onset of
symptoms; cannot reverse
reactions but may prevent
them. Oral products may cause
gastric irritation; administer
with meals, milk, or snack.
NURSING MANAGEMENT
3. Do not drive or operate equipment
until drug effects of drowsiness
wears off. Sedative effects may
disappear after several days or
may not occur at all.
4. Report sore throat, fever,
unexpected bruising, bleeding or
petechiae; may cause blood
dyscrasia.
NURSING MANAGEMENT
5. May cause sensitivity to sun
or ultraviolet light; avoid long
exposure, use sunscreen,
sunglasses, and protective
clothing when exposed.
6. Severe CNS depression is a
symptom of overdose. Report
dizziness or weakness; avoid
other CNS depressants.
NURSING MANAGEMENT
7. Reduce symptoms of dry mouth by
frequent rinsing, good oral
hygiene, and sugarless gum or
candies.
8. Ensure adequate hydration. If
bronchial secretions are thick,
increase fluid to decrease secretion
viscosity; avoid milk temporarily.
Of problems with urination, void
prior to taking the drug.
 ANTITUSSIVES
 Any substance administered to
suppress a cough.
MOA:
 Suppress the cough reflex in the
medulla.
 Inhibiting cough receptors in the
throat, trachea, or lungs.
INDICATIONS:
 Inhibit frequency of dry, non
productive cough.
ANTITUSSIVES

INDICATIONS:
 Should not be used with
productive cough.
CONTRAINDICATIONS/ CAUTIONS:
 Should be used with caution in
clients with addiction.
SIDE EFFECTS;
 Dizziness; Sedation
COMMON
ANTITUSSIVES
Narcotic antitussives
1. Codeine
2. Hydrocodone (HYCODAN)
Non-narcotic antitussives
3. Dextromethorphan
(ALLERIN, MYRACOF,
ROBITUSSIN, TUSERAN)
NURSING MANAGEMENT
1. Assess type and frequency of
cough present.
2. Assess if the cough is
interrupting rest and sleep.
3. Instruct the client to take the
medication only as prescribed
and not to increase the dose
without consulting the
physician.
NURSING MANAGEMENT
4. Teach the client that drowsiness
may occur, so driving or
performing any task that requires
full level of alertness should be
avoided.
5. Note that the medication may be
used in conjunction with a
vaporizer in the evening.
6. Instruct the client that if coughing
persists after 5 to 7 days to
return the physician.
BRONCHODILATORS

Bronchospasm
 An increase in the tone of
smooth muscle in the
bronchi resulting in a
narrowing of airway. May be
caused by allergy, emotional
factors, exercise or infection.
BRONCHODILATORS
BRONCHODILATORS
BRONCHODILATORS
  Action
 Bronchodilators produce the following effects:
 Cerebral Stimulation
 Skeletal Muscle Stimulation
 Bronchodilation with increase vital capacity
 Pulmonary Vasodilation
 Bronchial Smooth Muscle Relaxation
 Coronary Vasodilation
 Cardiac Stimulation
 Diuresis
Specific effects by major sub-groups

1. Anticholinergic agents
(ipratropium bromide) relieve
bronchospasm caused by
excessive parasympathetic
nervous system stimulation.
Specific effects by major sub-groups

2. Sympathomimetics (albuterol,
ephedrine, epinephrine,
isoetharine, isoproterenol,
metaproterenol, terbutaline)
3. Xanthines (aminophyline,
theophyline) are sometimes
called phosphodiesterase
inhibitors.
INDICATIONS
1. Symptomatic relief/prevention of
bronchial asthma and
bronchospasm associated with
chronic bronchitis and
emphysema.
2. Can also be used to treat
anaphylaxis and cardiac arrest
because they stimulate the heart
rate and the force of contraction.
INDICATIONS
3. Sometimes mixed with local
anesthetics to produce
vasoconstriction at the site of
injection. This reduces bleeding
at the site of injection and
prolongs the effect of the local
anesthetic.

4. Ephedrine is also a CNS stimulant

and may used to treat mental
INDICATIONS
5. Isoproterenol given
intravenously may be used to
treat ventricular arrhytmias due
to AV block.

6. Terbutaline may be used to stop

pre-term labor.
COMMON
BRONCHODILATORS
1. ALBUTEROL
2. EPHEDRINE
3. ISOPROTERENOL
4. METOPROTERENOL
5. TERBUTALINE
NURSING MANAGEMENT

1. Bronchodilators may aggravate

diabetes because they cause
hyperglycemia.

2. Patient with known hypertension

should be monitored closely when
given bronchodilators, because
these agents can sharply increase
blood pressure.
NURSING MANAGEMENT

3. Bronchodilators should be used

cautiously in patients with
hyperthyroidism and those receiving
cardiac glycosides because the
cardiac effects are additive.

4. Excessive use of bronchodilator

inhaler may cause tolerance and
paradoxic bronchospasm.
DECONGESTANTS
1. Decongestants may be purchased
OTC.
2. Decongestants are medicines
used to relieve nasal congestion
(stuffy nose)
 Actions:
 decongestants act through
sympathomimetic action,
usually by constricting
arterioles and reducing blood
DECONGESTANTS
Indications:
 Reduction of local blood
flow before nasal surgery.
 Reduction of rhinitis and
nasal congestion
associated with colds.
COMMON DECONGESTANTS
1. Pseudoephedrine (SUDAFED)
2. DECONSAL II (guaifenesin
600/pseudoephedrine 60)
3. ENTEX LA (guaifenesin
400/phenylpropanolamine 75)
4. ENTEX PSE, ZEPHREX OR
DURATUSS (guaifenesin
600/pseudoephedrine 120)
5. DURAVENT
(Guaifenesin600/Phenylpropanol
amine 600)
COMMON DECONGESTANTS
6. GUAIFED OR GUAIFED PD
(Guaifenesin/Pseudoephedr
ine)
7. TUSS-ORNADE
(Phenylpropanolamine/ETO
H)
COMMON DECONGESTANTS
Phenylpropanolamine
 It works by constricting (shrinking) blood vessels (veins
and arteries) in your body.
 Constriction of blood vessels in your sinuses, nose, and
chest allows drainage of those areas, which decreases
congestion.
 Used to treat nasal congestion associated with the
common cold, allergies, hay fever, or other respiratory
illnesses (e.g., rhinitis, sinusitis). It has also been used
as a nonprescription diet-aid for weight loss.
 COMMON DECONGESTANTS
Phenylpropanolamine
 SIDE EFFECTS
 Phenylpropanolamine stimulates a “fight or flight”
response. This means that the following effects may be
observed: rapid heart rate, elevation in blood pressure, and
restlessness. Appetite loss or reduction may be a problem.
Irritability and restlessness are documented side effects
that can occur in humans. 
COMMON DECONGESTANTS

Phenylpropanolamine
 FDA has asked manufacturers of human PPA products to
voluntarily withdraw their products from the market due to
the rare but serious cerebral hemorrhage reaction seen
occasionally in humans suffering from high blood pressure.
COMMON DECONGESTANTS
Phenylpropanolamine
 Do not take phenylpropanolamine
for longer than 7 days if your
condition does not improve or if
your symptoms are accompanied
by a high fever.
COMBINATION OF
DECONGESTANTS-
ANTIHISTAMINES
 D and A Combination
 Antihistamine and decongestant
combinations are used to treat
the nasal congestion (stuffy
nose), sneezing, and runny nose
caused by colds and hay fever.
 D and A Combination
 ALLEGRA D
 Fruit juices and certain antacids can make it harder for
your body to absorb Allegra.
 Take the disintegrating tablet on an empty stomach, at
least 1 hour before or 2 hours after a meal.
 FDA PC-C
 CLARITIN-D
 Claritin-D contains a combination of loratadine and
pseudoephedrine
 FDA PC-B
DECONGESTANTS FOR
SINUSITIS
Oxymethazoline
Hydrochloride (Afrin)
Phenylephrine
Hydrochloride (Neo-
Synephrine, Sinex
Decongestant Nasal
Spray)
DECONGESTANTS FOR
SINUSITIS
Pseudoephedrine
Hydrochloride (SINE-OFF,
SUDAFED)
Combination of a pain reliever
and a decongestant.
It is used to treat symptoms of
the common cold and other
sinus congestion with pain or
NURSING MANAGEMENT

 Beaware that nasal sprays

often have rebound effect.
The client should
understand the serious
nature of rebound and know
not to use nasal
decongestants unless
absolutely necessary.
EXPECTORANTS

 Expectorants are used to facilitate

expectoration.
 Many preparations are OTC, so be
sure the client exercises caution
when self medicating.
 Expectorant- substances added to
cough mixtures to encourage the
secretion of mucus in the airways,
making it easier to cough up.
EXPECTORANTS
Action
 Expectorants facilitate the
secretion of fluid in the
respiratory tract, thus
liquefying secretions and
allowing for easier
expectoration during cough.
 These agents also decrease
the viscosity of mucus, making
removal easier.
EXPECTORANTS
Indications
 Relief
of dry, unproductive coughs
that accompanies respiratory
conditions such as colds, influenza,
bronchitis, asthma, and chronic
obstructive pulmonary disease.
 Facilitation
of secretion removal in
respiratory condition associated
with increased mucous production
such as bronchitis, asthma, and
chronic obstructive pulmonary
EXPECTORANTS
Common Expectorants
 Guaifenesin (Robitussin)

NURSING MANAGEMENT
1. Encourage the client to take
fluids liberally.
2. Instruct the client to avoid
smoking and being near
cigarette smoke.
EXPECTORANTS
NURSING MANAGEMENT
3. Have the client call the
physician if the cough
persists for 5 to 7 days after
treatment is initiated.
4. Instruct the client to use
other therapies such as
vaporizer, humidifier,
increased fluid intake, and
adequate nutrition.
MUCOLYTICS

 Used in the reduction of sputum

viscosity, and thus are given to
help expectoration in chronic
asthma and bronchitis.
 Usedto facilitate sputum
expectoration for disorders
characterized by thick resistant
secretions.
COMMON MUCOLYTICS
1. Acetylcysteine
(MUCOMYST, MUCOSIL-
10, MUCOSIL-20)
2. Carbocisteine
3. Methylcysteine
Hydrochloride
MUCOLYTICS
Nursing Management
 
 (Antidotal) – Dilute to minimize the
risk of vomiting
 Treat fluid and electrolyte
imbalance, Hypoglycemia.
 Do not administer Diuretics.
END