drugs affecting the respiratory system

1. DRUGS AFFECTING THE
RESPIRATORY SYSTEM
Group 4
JANINE ZALUN LANGUIDO
CARIL LAGGUI
CYRA MAE LABUGUEN
CLARISA GRANDE
EMERALD JADE GALAPON
JOANA GANGAN
LORIE FAITH GAMAYON
SHEEN FEI GAMIAO

2. The respiratory system is subject to many
disorders that interfere with respiration and
other lung functions, including;
Respiratory tract infection
Allergic disorders
Inflammatory disorders
Conditions that obstruct airflow (e.g.
asthma and chronic obstructive pulmonary
disease.

3. DRUGS AFFECTING THE RESPIRATORY SYSTEM
› Bronchodilators
 Xanthine derivatives
 Bata-agonists
› Anticholinergics
› Antileukotriene agents
› Mast cell stabilizers
› Corticosteroids
› Cromoglycates
› Leukotriene receptors antagonists
› Antihistamines
› Cough preparations
› Nasal decongestants

4. Bronchodilators: Xanthine Derivatives
› Xanthine derivatives are medications used to treat
bronchospasm caused by lung conditions such as asthma.
› Xanthine derivatives are a group of alkaloids that work as mild
stimulants and bronchodilators. Xanthine derivatives ease
symptoms of bronchospasm and make breathing easier by
relaxing the smooth muscles of the respiratory tract and
reducing the airway's hypersensitive response to stimuli.

5. Bronchodilators: Xanthine Derivatives
• Plant alkaloids:
caffeine,
theobromine, and
theophylline
•Only the
theophylline is
used as
bronchodilator
Examples:
Aminophylline
Dyphylline
Oxtriphylline
Aminophylline Dyphylline Oxtriphylline

6. Bronchodilators: Xanthine Derivatives
Therapeutic uses
› Dilation of airways in asthmas, chronic
bronchitis and emphysema
› Mild to moderate cases of asthma
› Adjunct agent in the management of COPD
› Adjunct therapy for the relief of pulmonary
edema and paroxysmal nocturnal edema in
left sided heart failure.

7. Bronchodilators: Xanthine Derivatives
Mechanism of Action
› Increase levels of energy-producing cAMP*
› This is done competitively inhibiting
phosphodiesterase
(PDE), the enzymes that breaks down cAMP
› Result: decreased cAMP levels, smooth muscle
relaxation, bronchodilation, and increased
airflow.
*cAMP= Cyclic Adenosine Monophosphate

8. Bronchodilators: Xanthine Derivatives
Drug Effects
› Cause bronchodilation by relaxing smooth muscles
of the airways
› Result: relief of bronchospasm and greater airflow
into out of the lungs
› Also causes central nervous system stimulation
› Also causes cardiovascular stimulation: increased
forced of contraction and increased HR, resulting in
increased cardiac output and increased blood flow to
the kidneys (diuretic effect)

9. Bronchodilators: Xanthine Derivatives
Side Effects
›Nausea, vomiting, anorexia
›Gastroesophageal reflux during sleep
›Sinus tachycardia, extrasystole,
palpitations, ventricular dysrhythmias
›Transient increased urination

10. Bronchodilators: Beta-Agonists
› Large group, sympathomimetics
› Used during acute phase of asthmatic
attacks
› Quickly reduce airway constriction and
restore normal airflow
› Stimulate beta2 adrenergic receptors
throughout the lungs

11. Bronchodilators: Beta-Agonists
Three Types
› Nonselective Adrenergics
- Stimulate alpha, beta (cardiac), and beta2 (respiratory)
receptors
Examples: epinephrine
› Nonselective beta-adrenergics
- Stimulate both beta1 and beta2 receptors
Example: isoproterenol (Isuprel)
› Selective beta2 drugs
- Stimulate only beta2 receptors
Example: albuterol

12. epinephrine isoproterenol (Isuprel)
albuterol

13. Bronchodilators: Beta-Agonists
Mechanism of Action
› Begins at the specific receptor stimulated
› Ends with the dilation of the airways
Activation of beta2 receptors activate cAMP,
which relaxes smooth muscles of the airway
and results in bronchial dilation and increased
airflow.

14. Bronchodilators: Beta-Agonists
Therapeutic uses
› Relief of bronchospasm, bronchial asthma, bronchitis,
and other pulmonary disease.
› Useful in treatment of acute attacks as well as
prevention.
› Used in hypotension and shock.
› Used to produce uterine relaxation to prevent
premature labor.
› Hyperkalemia- stimulates potassium to shift into the
cell.

15. Device used in Asthma Therapy
› Metered dose Inhaler (MDI)
- Contains medication and compressed air
- Delivers a specific amount of medication with each puff.
› Spacer
- Used with MDIs to help get medication into the lungs instead of
depositing on the back of the throat.
› Dry powder inhalers
– Starting to replace MDIs
– The patient turns the dial and a capsule full of powder is
punctured.
– The patient then inhales the powder.

16. Device used in Asthma Therapy
›Nebulizer
–Uses a stream of air that flows through
liquid medication to make a fine mist to
be inhaled.
–Very effective
–Must be cleaned and taken care of to
reduce risk of contamination

17. Respiratory Agent:
General Nursing Implications
› Encourage patients to take measures that promote a
generally good state of health in order to prevent, relieve,
or decrease symptoms of COPD.
– Avoid exposure to conditions that precipitate bronchospasm
(allergies, smoking, stress, air pollutants)
– Adequate fluid intake
– Compliance with medical treatment
– Avoid excessive fatigue, heat, extremes in temperature, caffeine.
› Encourage patients to get prompt treatment for flu or
other illnesses, and to get vaccinated against pneumonia
or flu.
› Encourage patients to always check with their physician
before taking any other medication, including OTC.

18. Respiratory Agent:
General Nursing Implications
› Perform a through assessment before
beginning therapy, including:
–Skin color
–Baseline vital signs
–Respirations (should be <12 or>24 breaths/min)
–Respiratory assessment, including PO2
–Sputum production
–Allergies
–History of respiratory problems
–Other medications

19. Respiratory Agent:
General Nursing Implications
› Teach patients to take bronchodilators exactly as prescribed.
› Ensure that patient know how to use inhalers, MDIs, and
have patients demonstrate use of devices.
› Monitor for side effects
› Monitor therapeutic effects
– Decreased dyspnea
– Decreased wheezing, restlessness and anxiety
– Improved respiratory patterns with return to normal rate and
quality.
– Improved activity tolerance
› Decreased symptoms and increased ease of breathing.

20. Bronchodilators: Nursing Implications
Xanthine Derivatives
› Contraindications: history of PUD or GI disorders
› Cautious use: cardiac disease
› Timed- release preparations should not be crushed or
chewed (causes gastric irritation)
› Report to physician: palpitations, nausea, vomiting,
weakness, dizziness, chest pain and convulsions.
› Be aware of drug interaction with: cimetidine, oral
contraceptives, allopurinol
› Large amount of caffeine can have deleterious effects

21. Bronchodilators: Nursing Implications
Beta-Agonist Derivatives
› Albuterol, if used too frequently, loses its beta2-specific
actions at larger doses.
› As a result, beta, receptors are stimulated, causing
nausea, increased anxiety, palpitations tremors and
increased heart rate.
› Patients should take medication exactly as prescribed,
with no omissions or double doses
› Patients should report insomnia, jitteriness,
restlessness, palpitations, chest pain or any change in
symptoms.

22. ( beta agonist derivatives) Albuterol

23. Anticholinergics:
Mechanism of Action
›Acetylcholine (Ach) causes bronchial
constriction and narrowing of the
airways.
›Anticholinergics bind to the ACh
receptors, preventing ACh from binding
›Result: bronchoconstriction is
prevented, airway dilate.

24. (anticholinergics) Ipratropium bromide

25. Anticholinergics
› Ipratropium bromide (Atrovent) is the only
anticholinergic used for respiratory disease.
› Slow and prolonged action
› Used to prevent bronchoconstriction
› NOT used for acute asthma exacerbations
Sides effects
› Dry mouth or throat, gastrointestinal distress,
headache, coughing, anxiety

26. (antileukotrienes) Montelukast

27. Antileukotrienes
› Also called leukotriene receptor antagonists
(LRTAs)
› New class of asthma medications
› Three subcategories of agents
› Currently available agents:
–Montelukast (Singulair)
–Zafirlukast (Accolate)
–Zileuton (Zyflo)

28. (antileukotrienes) Zileuton

29. Antileukotrienes:
Mechanism of Action
› Leukotrienes are substances released when a trigger, such
as cat hair or dust, starts a series of chemical reactions in
the body.
› Leukotrienes cause inflammation, bronchoconstriction,
and mucus production.
› Result: coughing, wheezing, shortness of breath
› Antileukotriene agents prevent leukotrienes from
attaching to receptors on cells in the lungs and circulation
› Inflammation in the lungs is blocked, and asthma
symptoms are relieved.

30. Antileukotrienes:
Drug Effects
› By blocking leukotrienes:
– Prevent smooth muscle contraction of the bronchial airways
– Decrease mucus secretion
– Prevent vascular permeability
– Decrease neutrophil and leukocyte infiltration to the lungs,
preventing inflammation.
Antileukotrienes: Therapeutic Uses
› Prophylaxis and chronic treatment of asthma in adults and
children over age of 12
› NOT meant for management of acute asthmatic attacks
› Montelukast is approved for use in children age 2 and older

31. Antileukotrienes: Side effects
Zileuton Zafirlukast
Headache
Dyspepsia
Nausea
Dizziness
Insomnia
Liver dysfunction
Headache
Nausea
Diarrhea
Liver dysfunction

32. Antileukotrienes: Nursing Implications
› Ensure that the drug is being used for chronic
management of asthma, not acute asthma
› Teach the patient the purpose of the therapy
› Improvement should be seen about 1 week
› Check with physician before taking any OTC or
prescribed medications- many drug interactions
› Asses liver function before beginning therapy
› Medications should be taken every night on a
continuous schedule, even if symptoms improve

33. Corticosteroids
› Anti-inflammatory
› Used for CHRONIC asthma
› Do not relieve symptoms of acute
asthmatic attacks
› Oral or inhaled forms
› Inhaled forms reduce systemic effects
› May take several weeks before full effects
are seen

34. Corticosteroids: Mechanism of action
› Stabilize membranes of cells that release harmful
broncho constricting substances
› These cells are leukocytes or white blood cells
› Also increase responsiveness of bronchial smooth
muscle to beta-adrenergic stimulation.
Inhaled Corticosteroids
› Beclomethasone dipropionate (Beclovent, Vanceril)
› Triamcinolone acetonide (Azmacort)
› Dexamethasone sodium phosphate (Decadron
phosphate Respihaler)
› Flunisolide (AeroBid)

35. Beclomethasone dipropionate
(Beclovent, Vanceril)
Triamcinolone acetonide (Azmacort)
Dexamethasone sodium phosphate (Decadron
phosphate Respihaler)
Flunisolide (AeroBid)

36. Inhaled Corticosteroids:
Therapeutic Uses
› Treatment of bronchospastic disorders that are not
controlled by conventional bronchodilators
› NOT considered first-line agents for management of
acute asthmatic attacks or status asthmaticus
Inhaled Corticosteroids: Side Effects
› Pharyngeal irritation
› Coughing
› Dry mouth
› Oral fungal infections
Systemic effects are rare because of the low doses used for
inhalation therapy

37. Inhaled Corticosteroids: Nursing Implications
› Contraindicated in patients with psychosis, fungal infections,
AIDS, TB
› Cautious use in patients with diabetes, glaucoma,
osteoporosis, PUD, renal disease, CHF, edema
› Teach patients to gargle and rinse the mouth with water
afterward to prevent the development or oral fungal
infections
› Abruptly discontinuing these medications can lead to serious
problems
› If discontinuing, should be weaned for a period of 1-2 weeks,
and only if recommended by physician
› REPORT any weight gain of more than 5 pounds a week or
the occurrence of chest pain.

38. Mast Cell Stabilizers
› Cromolyn (Nasalcrom, Intal)
› Nedocromil (Tilade)
› Indirect acting agents that prevent the release of
the various substances that cause bronchospasm
› Stabilize the cell membranes of inflammatory cells
(mast cells, monocytes, macrophages), thus
preventing release of harmful cellular contents
› No direct bronchodilator activity
› Used prophylactically

39. Cromolyn (Nasalcrom,
Intal)
Nedocromil (Tilade)

40. Mast Cell Stabilizers: Therapeutic Uses
› Adjuncts to the overall management of COPD
› Used solely for prophylaxis, NOT for acute asthma attacks
› Used to prevent exercise-induced bronchospasm
› Used to prevent bronchospasm associated with exposure
to known precipitating factors, such as cold, dry air or
allergies
Mast Cell Stabilizers: Side Effects
Coughing Taste changes
Sore throat Dizziness
Rhinitis Headache
Bronchospasm

41. Mast Cell Stabilizers: Nursing Implications
› For prophylactic use only
› Contraindicated for acute exacerbations
› Not recommend for children under age 5
› Therapeutic effect may not be seen for up
to 4 weeks
› Teach patients to gargle and rinse the
mouth with water afterwards to minimize
irritation to the throat and oral mucosa

42. CORTICOSTEROIDS
› Used for prophylaxis of chronic asthma
› Suppressing inflammation
Decrease synthesis and release of inflammatory
mediators
 decrease infiltration and activity of inflammatory cells
Decrease edema of the airway mucosa
› Decrease airway mucus production
› Increase the number of bronchial beta2 receptors
and their responsiveness to beta2 agonist.

43. CORTICOSTEROIDS (CONT’D)
DRUG: BECLOMETHASONE
FORMULATION DOSAGE
Inhaler 50 mcg/ dose (MDI) ADULT: 200 mcg twice daily/ 100
mcg three to four times daily
Up to 800 mcg daily
CHILD: 80-100 mcg two to four
times daily
Inhaler 250 mcg/ dose (MDI) ADULT: 500 mcg twice daily/ 250
mcg four times daily
CHILD: not recommended

44. INHALER BECLOMETHASONE (MDI)

45. CORTICOSTEROIDS (CONT’D)
DRUG (CONT’D): BUDESONIDE
FORMULATION DOSAGE
Inhaler 50 mcg/dose (MDI)
Inhaler 200 mcg/dose (MDI)
ADULT: 200 mcg twice daily
Up to 1.6 mg daily
CHILD: 50-400 mcg twice daily
Up to 800 mcg daily
Inhaler 100 mcg/ dose (Turbuhaler )
Inhaler 200 mcg/ dose (Turbuhaler )
Inhaler 400 mcg/ dose (Turbuhaler )
ADULT: 200-800 mcg once a daily in evening
Up to 1.6 mg daily in two divided doses
CHILD: 200-800 mcg daily in two divided doses/
200-400 mcg once daily in evening (<12 yrs)

46. INHALER BUDESONIDE
INHALER BUDESONIDE (TURBOHALER)

47. CORTICOSTEROIDS (CONT’D)
DRUG (CONT’D): FLUTICASONE
FORMULATION DOSAGE
Inhaler 25 mcg/ dose (MDI)
Inhaler 50 mcg/ dose (MDI)
Inhaler 125 mcg/ dose (MDI)
Inhaler 250 mcg/ dose (MDI)
Inhaler 250 mcg/ dose (Accuhaler)
Inhaler 100 mcg/ dose (Accuhaler)
Inhaler 250 mcg/ dose (Accuhaler)
ADULT: 100- 1000 mcg twice daily
CHILD: 50-100 mcg twice daily ( 4-16 yrs)

48. INHALER FLUTICASONE (MDI)
INHALER CROMOGLYCATE SODIUM

49. CORTICOSTEROIDS (CONT’D)
› Adverse effects
 Inhaled corticosteroids:
• Candidiasis of the mouth or throat
• Hoarseness
• Can slow growth in children
• Adrenal suppression may occur in long-term high dose
therapy
• Increase the risk of cataracts
 Nursing alerts
• Rinse mouth with water without swallowing after
administration to reduce the risk of candidiasis
• If taking bronchodilators by inhalation, use bronchodilators
several minutes before the corticosteroid to enhance
application of the corticosteroid in to the bronchial tract

50. CROMOGLYCATES
›Stabilize mast cells & prevent the release
of broncho constrictive & when
inflammatory substances when mast cells
are confronted with allergies & other
stimuli.
›Only for prophylaxis of acute asthma
attacks

51. CROMOGLYCATES: (CONT’D)
DRUG FORMULATION DOSAGE
CROMOGLYCATE Na Inhaler (1 mg & 5 mg
/dose)
ADULT: 10 mg four times
daily, may be increased to
six to eight times daily
CHILD: same as adult
Nebulizer solution
10mg/ ml 2 ml
ADULT: 20 mg four times
daily, may be increased six
times daily
CHILD: same as adult
NEDOCROMIL SODIUM Inhaler 2 mg/dose
(MDI)
ADULT: 4 mg two to four
times daily
CHILD: same as adult (>6
yrs)

52. INHALER CROMOGLYCATE SODIUM
(NEBULIZER SOLUTION)
INHALER NEDOCROMIL
SODIUM (MDI)
CROMOGLYCATE INHALER
NEDOCROMIL SODUIM (MDI)

53. CROMOGLYCATES: (CONT’D)
ADVERSE EFFECT NURSING ALERTS
Transient bronchospasm A selected B2 agonist such as salbutamol or
terbutaline may be inhaled a few minutes
beforehand.
Others: coughing and throat irritation
Nursing alerts ( cont’d)
 Cromoglycates are for long term prophylaxis, patient
should administer on a regular schedule and the full
therapeutic affects may take several weeks to develop
 They are contraindicated in patients who are
hypersensitive to the drug

54. LEUKOTRIENE RECEPTOR ANTAGONIST
› Act by suppressing the effects of
leukotrienes, compounds that promote
broncho constriction as well as eosinophil
infiltration, mucus productions and airway
edema.
› Help to prevent acute asthma attacks
induced by allergens and other stimuli
› Indicated for long treatment of asthma

55. LEUKOTRIENE RECEPTOR ANTAGONIST (cont’d)
› Dosage:
Montelukast (5 & 10 mg tablets)
 ADULT: 10 mg daily at bedtime
 CHILD: (2-5 yrs) mg daily at bedtime
(6-14 yrs) 5 mg daily at bedtime
Adverse effects:
 GI disturbances
 Hypersensitivity reactions
 Restlessness and headache
 Upper respiratory tract infection
 Manufacturer advises to avoid these drugs in pregnancy and
breast feeding unless essential.

56. ANTIHISTAMINES
›H1 receptor antagonist
Inhibit smooth muscle constriction in blood
vessels and respiratory and GI tracts
Decrease capillary permeability
 Decrease salivation and tear formation
›Use for variety of allergic disorders to
prevent or reverse target organ
inflammation

57. ANTIHISTAMINES (cont'd)
› All antihistamines are of potential value in the treatment of
nasal allergies, particularly seasonal allergies rhinitis (high
fever)
› Reduce rhinorrhea and sneezing but are usually less effective
for nasal congestion
› Are also used topically in the eye, in the nose and on the skin
› First-generation H, receptor antagonist
– Non-selective/sedating Bind to both central & peripheral H,
receptors
– Usually cause CNS depression ( drowsiness, sedation)but may cause
CNS stimulation (anxiety, agitation), especially in children
– Also have substantial anticholinergic effects.

58. ANTIHISTAMINES (cont'd)
Drug Dosage
Adult Child
Chorphenira
mine (4 mg
tablet,
2mg/ml Elixir
&
expectorant)
4 mg q4-6hr, max:
24 mg daily
1-2yrs: 1 mg twice daily
2-12yrs: 1- 2 mg q4-6h, Max:12 mg daily
Hydroxyzine
(25 mg tablet)
25 mg at night;
25mg three to four
times daily when
necessary
6 months-6yrs: 5-15 mg daily; 50 mg daily in divided dose
if needed
>6yrs: 15-25 mg daily; 50-100 mg daily in divided dose if
needed
Diphendrami
ne (10
mg/5ml Elixir)
25-50 mg q4-6h 6.25-25 mg q4-8 hr ( >1 yr)

59. ANTIHISTAMINES (cont'd)
Drug (Cont’d) Dosage
Adult Child
Promethazine
(10 & 25 mg
tablets,
5mg/5ml Elixir)
25 mg at night; 25 mg
twice daily if needed
2-10yrs: 5-25 mg daily in 1
to 2 divided dose
Azatadine (1
mg tablet)
1 mg twice daily 1-12 yrs: 0.25-1 mg twice
daily

60. Chorpheniramine
Hydroxyzine

61. Diphendramine
Promethazine
Azatadine

62. ANTIHISTAMINES (cont'd)
Adverse effects
 Sedation
 Dry mouth
 Blurred vision
 Gl disturbances
 Headache
 Urinary retention
 Hydroxyzine is not recommended for pregnancy & breast –feeding
Second -generation H, reception antagonist
 Selective/non-sedating
 Cause less CNS depression because they are selective for peripheral H,
receptors & do not cross blood -brain barrier
 Longer-acting compared to first-generation antihistamines

63. ANTIHISTAMINES (cont’d)
Drug Dosage
Adult Child
Acrivastine
(Semprex)
8 mg three times daily Not recommended
Cetirizine
(Zyrtec)
10 mg daily 5 mg daily / 2.5 mg twice daily (2-6
yrs)
Desloratadi
ne (Aerius)
5 mg daily 1.25 mg daily (2-5 yrs)
2.5 mg daily (6-11yrs)
Fexofenadi
ne (Telfast)
120-180 mg daily Not recommended
Loratadine
(Clarityne)
10 mg daily` 5 mg daily (2-5 yrs)

64. Acrivastine (Semprex)
Cetirizine (Zyrtec)
Desloratadine (Aerius)

65. Fexofenadine (Telfast)
Loratadine (Clarityne)

66. ANTIHISTAMINES (cont'd)
 Adverse Effects
•May cause slight sedation
some antihistamines may interact with
antifungal, e.g. ketoconazole; antibiotics,
e.g. erythromycin Prokinetic drug tiapride
or grapefruit juice, leading to potentially
serious ECG changes e.g. terfenadine

67. Cough preparations
 There are three classes of cough
preparations:
•Antitussives
•Expectorants
•Mucolytics

68. Cough preparations (Cont’d)
›Antitussives
–Drugs that suppress cough
–Some act within the CNS, some act
peripherally
–Indicated in dry, hacking,
nonproductive cough that interfere
with rest & sleep

69. Cough preparations (Cont’d)
Drug Dosage
Codeine phosphate 25mg/5ml
syrup
15-30 mg three to four times daily
Pholcodine 5mg/5ml Elixir 5-10 mg three to four times daily
Dextromethorphan 10mg/5ml in
Promethazine Compound Linctus
10-30 mg q4-8h
Diphenhydramine 10 mg/ 5ml 25 mg q4h, Max:150 mg daily

70. Codeine phosphate
25mg/5ml syrup
Pholcodine
5mg/5ml Elixir

71. Dextromethorphan
10mg/5ml in Promethazine
Compound Linctus
Diphenhydramine
10 mg/ 5ml

72. Cough preparations (Cont’d)
› Adverse effects:
–Drowsiness
–Respiratory depression (for opioid antitussives)
–Constipation (for opioid antitussives)
–Preparations containing codeine or similar
analgesics are not generally recommended in
children & should be avoided altogether in
those under 1 year of age

73. Cough preparations (Cont’d)
›Nursing Alerts:
–Observe for excessive suppression of the
cough reflex (inability to cough effectively
when secretions are present). This is a
potentially serious adverse effect because
retained secretions may lead to lungs
collapse, pneumonia, hypoxia,
hypercarbia, and respiratory failure

74. Cough preparations (Cont’d)
›Expectorants
–Render the cough more productive by
stimulating the flow of respiratory tract
secretions
–Guaifenesin is most commonly used
–Available alone & as an ingredient in
many combination cough & cold remedies

75. Cough preparations (Cont’d)
›Dosage
–Guaifenesin
›100-400 mg q4h po
–Ammonia & Ipecacuaha Mixture
›10-20 ml three to four times daily
po

76. Guaifenesin Ammonia & Ipecacuaha
Mixture

77. Cough preparations (Cont’d)
›Mucolytics
–Reacts directly with mucus to
make it more watery. This
should help make the cough
more productive

78. Cough preparations (Cont’d)
› Dosage
–Acetylcysteine
› 100 mg two to four times daily
› 200 mg two to three times daily
› 600 mg once daily
–Bromhexine
› 8-16 mg three times daily po
–Carbocisteine
› 750 mg three times daily, then 1.5 g daily in divided
doses

79. Acetylcysteine
Bromhexine
Carbocisteine

80. Nasal Decongestants
›Sympathomimetics are used to
reduce nasal congestion
›Stimulate alpha1-adrenergic
receptors on nasal blood vessels,
which causes vasoconstriction &
hence shrinkage of swollen
membranes

81. Nasal Decongestants (Cont’d)
›Topical administration:
–Response is rapid & intense
›Oral administration:
–Response are delayed, moderate &
prolonged

82. Nasal Decongestants (Cont’d)
Drug Formulation Dosage
Adult Child
Oxymetazoline Nasal Drops 0.025%
20 ml
- 2-3 drops q12h (2-5
yrs)
Nasal Spray 0.05%
15 ml
2-3 sprays q12h Same as adults for
children >6 yrs
Phenylephrine Nasal Drops 0.5% 10
ml
Several drops q2-
4h
-
Xylometazoline Nasal Drops 0.05% /
0.1%
2-3 drops q8-10h
(0.1%)
2-3 drops q8-10h
(2-12 yrs) (0.05%)

83. Oxymetazoline
Phenylephrine
Xylometazoline

84. Nasal Decongestants (Cont’d)
›Adverse effects:
–Rebound congestion develops with
topical agents when used for more than a
few days
–CNS stimulation (such as restlessness,
irritability, anxiety and insomnia) occurs
with oral sympathomimetics

85. Nasal Decongestants (Cont’d)
›Nursing alerts:
–Overuse of topical nasal decongestants
can cause rebound congestion, meaning
that the congestion can be worse with the
use of drug. To minimise this, drug
therapy should be discontinued gradually.
–The use of topical agents is limited to no
more than 3 to 5 days

86. Nasal Decongestants (Cont’d)
›Nursing alerts (Cont’d):
–The patient’s blood pressure and pulse
should be assessed before a decongestant
is administered
–Inform the patient that nasal burning and
stinging may occur with topical
decongestants

87. QUIZ
1. Anticholinergics have which of the following respiratory effects
A. Prevent bronchodilation B. Decreased respiratory secretion
C. Increase bronchoconstriction D. All of the above E. None of the above
Answer: B
2. Which of the following is an expected result of inhaled corticosteroids
A. Reduced bronchial reactivity B. Decreased airway caliber
C. Direct relaxation of bronchial smooth muscle D. All of the above
Answer: A
3. Which of the following is not a type of bronchodilator?
A. Beta- adrenergic- agonist B. Anticholinergic C. Antihistamine
Answer: C
4. Which of the following drugs block Acetylcholine in order to prevent bronchoconstriction?
A. Aminopentamide B. Theobromine C. Naloxone D. Phenylephrine
Answer: A
5. Which of the following drugs stimulates Beta-2 receptors, causing bronchodilation?
A. Acetylcysteine B. Yohimbine C. Chlorpheniramine D. Albuterol
B. Answer: D

88. 6. Which of the following is an Antihistamine?
A. Chlorpheniramine B. Pseudoephedrine C. Glycopyrrolate D. Epinephrine
Answer: A
7. How would the circulatory and respiratory systems be affected by asthma?
A. The respiratory would be over delivering oxygen to the lungs because the person would be breathing too rapidly.
B. The respiratory system would have difficulty delivering enough oxygen to the lungs because the airways are not wide
enough.
C. The circulatory system would have a significantly reduced supply of carbon dioxide in the blood, causing oxygen delivery
to cells to be reduced.
D. The circulatory system would have a significantly reduced supply of oxygen in the blood, causing oxygen delivery to
cells to increase.
Answer: A
8. What causes bronchial constriction and narrowing of the airways?
a. Leukotriene b. Acetylcholine c. Ipratropium Bromide
Answer: B
9. Which of the following drugs is an antileukotrienes?
a.) Montelukast b.) Ipratropium Bromide c.) theophylline
Answer: A
10. Enumerate the three types of Bronchodilators Beta Agonist?
-Nonselective Adrenergics
-Nonselective beta-adrenergics
-Selective beta2 drugs

89. THANK YOU
FOR LISTENING