1. Drugs Acting on URT
Drugs for COPD
1

2. 1. Antitussives
2. Decongestants
1. Topical Nasal Decongestants
2. Oral Decongestants
3. Topical Nasal Steroid Decongestants
3. Antihistamines/H1 Receptor Agonist
1. Expectorants
2. Mucolytics
2

3. 1. ANTITUSSIVES
 Benzonatate
 Codeine
 Dextromethorphan hydrobromide (Balminil)
3

4. 1. ANTITUSSIVES
ACTION:
 Suppress the cough reflex by acting on the medulla’s
cough center
 Anesthetize cough receptors of vagal afferent
fibers throughout the bronchi, alveoli and pleura
(Benzonatate)
4

5. 1. ANTITUSSIVES
INDICATION:
 Tx of NONPRODUCTIVE cough
 Common colds
 Sinusitis
 Pharyngitis
 Pneumonia
5

6. 1. ANTITUSSIVES
CONTRAINDICATIONS:
 + hypersensitivity
 Pregnancy and lactation
 CNS depression
CAUTION:
 Asthma and emphysema –secretion can accumulate as a
result of cough suppression
 Hx of narcotic addiction = makes sedation and drowsiness
6

7. 1. ANTITUSSIVES
ADVERSE EFFECTS:
 Dryness on mucus membranes
 Increase viscosity of secretion
 CNS effects: drowsiness, sedation and HA
 GI: constipation, GI upset, nasal congestion
7

8. 1. ANTITUSSIVES
NURSING CONSIDERATIONS:
1. Maintain airway patency and suction secretions if necessary
2. Assess breath sounds and determine characteristics of cough
(productive/ nonproductive; viscosity of secretions)
3. Encourage to maintain fluid intake of 2-3 L a day
4. Advise to report to physician id cough persist for > 1wk or if
chest pain occurs.
8

9. 2. DECONGESTANTS
 Ephedrine sulfate (Ephedrine)
 Oxymetazoline hydrochloride
 phenylephrine
9

10. 2. DECONGESTANTS
 Adrenergic drugs
 produce LOCAL VASOCONSTRICTION decreasing
blood flow to the irritated capillaries of the mucus
membrane lining the nasal passages and sinus cavities
10

11. 2. DECONGESTANTS
TOPICAL NASAL DECONGESTANTS
ACTION:
 Imitate the effects of SNS
 Cause VASOCONSTRICTION
 Results to decreased nasal membrane inflammation
INDICATIONS:
 Relief from nasal congestion (common cold, sinusitis, allergic
rhinitis)
 Dilation of nares for dx procedure
 Relief from pain and congestion in otitis media
11

12. 2. DECONGESTANTS
TOPICAL NASAL DECONGESTANTS
CAUTION
 Mucous membrane lesions-lead to systemic
absorption
 Glaucoma, HPN, DM, thyroid dse, coronary dse and
prostate problems = may exacerbate by
decongestants
12

13. 2. DECONGESTANTS
TOPICAL NASAL DECONGESTANTS
ADVERSE EFFECTS:
 Local reaction = stinging & burning
 Rebound congestion:
 Nasal Congestion- when decongestants are used more than 3-
5 days
 Increased pulse, blood pressure and urinary retention
13

14. 2. DECONGESTANTS
TOPICAL NASAL DECONGESTANTS
NURSING CONSIDERATION:
1. Assess for presence of glaucoma, HPN, coronary dse and
prostate problems
 Can exacerbate the condition
2. Assess skin
color, temp, orientation, reflexes, respirations, breath
sounds and bladder
 To determine sympathomimetic effects of the drug
14

15. 2. DECONGESTANTS
TOPICAL NASAL DECONGESTANTS
NURSING CONSIDERATION:
3. Teach about proper administration to ensure
therapeutic effect
3. Instruct clear nasal passages
4. Keep head tilted backward when applying drops/spray
5. Maintain position for few seconds after drug administration
15

16. 2. DECONGESTANTS
ORAL DECONGESTANTS
ACTION:
 Stimulate alpha-adrenergic receptors in nasal mucous membrane
 Resulting to decrease membrane size, drainage of sinuses and
improvement of air flow
INDICATION:
 Relief from pain and congestion with otitis media
 Tx of nasal congestion related to common colds, sinusitis and
allergic rhinits
16

17. 2. DECONGESTANTS
ORAL DECONGESTANTS
CONTRAINDICATION:
 Glaucoma
 HPN
 DM
 Thyroid disease
 Coronary disease
 Prostate problems
17

18. 2. DECONGESTANTS
ORAL DECONGESTANTS
ADVERSE EFFECTS:
 Rebound congestion
 Anxiety
 Restlessness
 Tremors
 HPN
 Arrhythmias
 Sweating and pallor
18

19. 2. DECONGESTANTS
ORAL DECONGESTANTS
NURSING CONSIDERATIONS:
1. Assess for presence of disorders present in CI
2. Monitor PR, BP and cardiac response to detect adverse effects
3. Instruct that drug should not be used more than a week
4. Caution not to combine topical decongestants with other drugs
with the same components = lead to overdose
19

20. 2. DECONGESTANTS
TOPICAL STEROID NASAL DECONGESTANTS
ACTION:
 Exact mechanism of action is not known.
INDICATION:
 Tx of allergic rhinitis who do not respond to any other form of
decongestants
 Relief of inflammation following nasal polyp removal.
20

21. 2. DECONGESTANTS
TOPICAL STEROID NASAL DECONGESTANTS
PHARMACOKINETICS:
 Action is not immediate
 Require 1 week of admin to achieve therapeutic effect
CONTRAINDICATION:
 Acute infection
 Can cause Candida albican infection
 Should not be exposed to airborne infection: chickenpox and
measles
21

22. 2. DECONGESTANTS
TOPICAL STEROID NASAL DECONGESTANTS
ADVERSE EFFECT:
 Stinging and burning sensation
 Mucosal dryness
 HA
22

23. 2. DECONGESTANTS
TOPICAL STEROID NASAL DECONGESTANTS
NURSING CONSIDERATION:
1. Reinforce use of drug even if results are not seen immediately.
 Therapeutic effect can take up to 2-3 wks after use
2. Monitor for dev’t of infection.
3. Encourage to avoid areas where airborne infection may be
present.
4. Allow to clear nasal passages prior to drug administration.
23

24. 3. ANTIHISTAMINES / H1 RECEPTOR AGONISTS
ACTION:
 Compete with histamine for H1 receptor sites in the client’s
arterioles, capillaries and secretory glands in mucous membrane
 They do not inhibit histamine release
 Possess anticholinergic and antipruritic effect
24

25. 25

26. 3. ANTIHISTAMINES / H1 RECEPTOR AGONISTS
INDICATIONS:
 Systemic tx of allergic rhinitis and conjunctivitis
 Reduce rhinorrhea, lacrimation, nasal and conjunctival
pruritus and sneezing
26

27. 3. ANTIHISTAMINES / H1 RECEPTOR AGONISTS
CAUTIONS:
 Renal/hepatic impairment
 Hx of arrhythmias / prolong QT intervals
ADVERSE EFFECT:
 Sedation
 Anticholinergic effect
 Dry mouth, urinary retention, stuffy nose, blurred vision
27

28. 3. ANTIHISTAMINES / H1 RECEPTOR AGONISTS
NURSING CONSIDERATIONS:
1. Administer on an EMPTY STOMACH, 1 hr before or 2 hrs
after meal for best absorption
2. Administer with food if + GI upset
3. Monitor cough and viscosity of sputum; effects of drug can
impair expectoration of secretions
4. Encourage adeqaute fluid intake; 8-12 glasses/day
28

29. 3. ANTIHISTAMINES / H1 RECEPTOR AGONISTS
NURSING CONSIDERATIONS:
5. Instruct to eat ice chips/hard candy
 if mouth becomes dry
6. Caution from driving and ambulating without assistance = blurred
vision is 1 SE
7. Instruct to avoid alcohol intake while using the drug
 to prevent extreme sedation
8. Have client void before drug administration
 to prevent urinary retention
29

30. 3.1 EXPECTORANTS
ACTION:
 Decrease viscosity of secretion increasing the fluid
in the respiratory tract
 Reduce adhesiveness and surface tension of fluids to
allow easier movement of thin secretions.
30

31. 3.1 EXPECTORANTS
INDICATIONS:
 Cough associated with common cold
 Bronchial asthma
 Relief of dry and non-productive cough
 URTI
 Bronchitis
 Influenza
 Sinusitis
 Emphysema
31

32. 3.1 EXPECTORANTS
CONTRAINDICATION:
 + hypersensitivity to expectorants
CAUTION:
 Ineffective cough reflex
 Respiratory insufficiency
 Pregnant and breastfeeding
32

33. 3.1 EXPECTORANTS
ADVERSE EFFECTS:
 Vomiting (large dose)
 Diarrhea
 Nausea
 Drowsiness
 Abdominal pain
33

34. 3.1 EXPECTORANTS
NURSING CONSIDERATIONS:
1. Caution client not to take drug longer than a week and to
seek medical attention if cough persist
2. Assess breath sounds and evaluate characteristics and
frequency of cough
3. Instruct to maintain oral fluid intake of 2-3liters a day
to enhance effects of expectorants
34

35. 3.1 EXPECTORANTS
NURSING CONSIDERATIONS:
4. Instruct to check with physician before taking any
OTC/herbal preparation
5. Advise to avoid driving or engaging in dangerous
tasks if drowsiness and dizziness occurs to prevent
injury
35

36. 3.2 MUCOLYTICS
 Acetylcysteine (Mucomyst)
 Dornase alfa (Pulmozyme)
36

37. 3.2 MUCOLYTICS
ACTION:
 Decreased viscosity of mucus by breaking or altering the
chemical bonds of glycoprotein complexes in mucus
 Acetylcysteine protect liver cells from damage during
acetaminophen toxicity by normalizing hepatic glutathione level
and binding with acetaminophen’s hepatotoxic metabolite
 Dornase alfa breaks down mucus through separation of
extracellular DNA from protein
37

38. 3.2 MUCOLYTICS
INDICATIONS:
 Abnormal, thick and viscous mucus
 Antidote of acetaminophen overdose
CONTRAINDICATIONS:
 + allergy
CAUTION
 Acute bronchospasm, PUD & esophageal varices
38

39. 3.2 MUCOLYTICS
ADVERSE EFFECTS:
 Stomatitis
 N&V
 Drowsiness
 Rhinorrhea
 Bronchospasm
39

40. 3.2 MUCOLYTICS
NURSING CONSIDERATIONS:
1. Avoid combining with other drugs in nebulizer to prevent loss
of effectiveness
2. Client should wipe acetylcysteine residue from their face if
they are receiving the drug by face mask
3. Caution with cystic fibrosis who are taking dornase alfa to
continue with all therapies
 the drug serves as a palliative tx for respiratory symptoms associated
with the disorder.
40

41. 1. Bronchodilators/Xanthines
2. Sympathomimetic bronchodilators
3. Anticholinergic bronchodilators
4. Inhaled steroids
5. Leukotriene Receptor Antagonist
6. Lung Surfactant
7. Mast cell Stabilizers
41

42. 1. Bronchodilators/Xanthines
 Aminophylline (Truphylline)
 Caffeine
 Theophylline
 (*should not be taken with cimetidine and ciprofloxacin as
they cause toxicity)
42

43. 1. Bronchodilators/Xanthines
ACTION:
 Affects smooth muscles of respiratory tract by
releasing 2 prostaglandins, resulting in smooth muscle
relaxation
 Inhibit the release of slow-reacting substance of
anaphylaxis (SRSA) and histamine, results in
decreased swelling of the bronchi
43

44. 1. Bronchodilators/Xanthines
INDICATION:
 Acute bronchospasms
 Prevention and maintenance therapy for clients with
COPD and asthma
 Mgt of bronchospasm during anesthesia
44

45. 1. Bronchodilators/Xanthines
NURSING CONSIDERATIONS:
1. Administer with FOOD/MILK if gastric upset occurs
2. Assess if client is also taking beta-adrenergic blocker because
they can decrease bronchodilating effect
3. Assess if client smoke
 Nicotine increases metabolism of xanthenes= higher dosage may be
prescribed
4. Monitor HR and rhythm at regular intervals during the
duration of the therapy
45

46. 1. Bronchodilators/Xanthines
NURSING CONSIDERATION:
5. Instruct to maintain oral fluid intake of 2-3 L
 to make secretion less viscous
6. Advise to consult with physician before taking over-the-
counter medications
 to avoid possible AE
7. Instruct client to avoid respiratory irritants such as
smoke, dust and strong scents
46

47. 2. Sympathomimetic Bronchodilators
 Albuterol (Asmavent, Proventil, Ventolin)
 Bitolterol (Tornalate)
 Ephedrine
 Epinephrine (Adrenaline)
 Formoterol (Foradil)
 Isoetharine (Bronkometer)
 Isoproterenol (Isuprel)
 Levalbuterol (Xopenex)
 Terbutaline (Brethine, Bricanyl)
 Salmeterol (Serevent)
 Metaproterenol (Alupent, Orcipren)
 Pirbuterol (Maxair, Autohaler)
47

48. 2. Sympathomimetic Bronchodilators
ACTION:
 Stimulate beta receptors in the smooth muscle of
the tracheobronchial tree to open airway passages
INDICATION:
 Reversal of airway constriction in acute and chronic
bronchial asthma
48

49. 2. Sympathomimetic Bronchodilators
NURSING CONSIDERATIONS:
 Inform the client that the drug of choice may vary for each
individual
 Instruct to administer the minimal amount of the drug
necessary
 to produce therapeutic effect to avoid occurrence of adverse drug
reaction
 Client with exercise-induced asthma should take these drugs
30min to 1 hr before exercise
 Encourage small, frequent meal if GI upset occurs
49

50. 3. ANTICHOLINERGIC BRONCHODILATORS
 Ipratropium bromide (Atrovent)
 Tiotropium (Spiriva)
50

51. 3. ANTICHOLINERGIC BRONCHODILATORS
ACTION:
 Bronchodilation by inhibiting cholinergic receptors in bronchial smooth
muscle
INDICATION:
 Long-term tx of reversible bronchospasm associated with COPD
 Initial bronchodilation occurs within 1st few minutes after inhalation
 Max therapeutic effects 1-2hrs
51

52. 3. ANTICHOLINERGIC BRONCHODILATORS
NURSING CONSIDERATIONS:
 Provide small, frequent meals if GI upset occurs.
 Instruct not to excess 12 inhalations in 24h to prevent occurrence
of AE
 Instruct to avoid driving or operating dangerous machinery to
prevent injury
 Have client to void before each dose if urinary retention becomes a
problem.
52

53. 4. INHALED STEROIDS
 Beclomethasone (Beclodisk, Beclovent)
 Budesonide (Entocort)
 Flunisolide (Aerobid, Bronalide)
 Fluticasone (Flonasone)
53

54. 4. INHALED STEROIDS
ACTION:
 Decrease swelling by inhibiting the effectiveness of
anti-inflammatory cells
 Promote beta-adrenergic receptors activity
resulting to relaxation of smooth muscles and
bronchodilation
54

55. 4. INHALED STEROIDS
INDICATION:
 Chronic bronchitis
 Bronchial asthma in clients with steroid-dependent
asthma
 Tx of allergic rhinitis and prophylactic tx of
exercise-induced asthma
 Systemic adverse reactions are reduced , though
rapidly absorbed thru IV
55

56. 4. INHALED STEROIDS
CONTRAINDICATION:
 Acute asthma attack
CAUTION:
 TB , viral infection
 HPN, DM, PUD
ADVERSE EFFECTS:
 Mouth irritation
 Oral candidiasis
 URTI
56

57. 4. INHALED STEROIDS
NURSING CONSIDERATION:
 Instruct to pt who’s receiving a corticosteroid and bronchodilator to
administer the bronchodilator 1st before steroid
 to ensure penetration of steroids in airway
 Instruct to perform oral care after using inhaled steroids.
 Instruct on the proper use of inhaler
 Provide food with oral doses to minimize GI upset
 Inform that the drug must not be stopped abruptly, doses must be tapered
to avoid AE
57

58. 5. LEUKOTRIENE RECEPTOR ANTAGONISTS
 Montelukast (Singulair)
 Zafirlukast (Accolate)
 Zileuton (Zyflo)
58

59. 5. LEUKOTRIENE RECEPTOR ANTAGONISTS
 Compete with receptor sites, thus inhibiting inflammatory
reaction associated with asthma and blocking its s/sx
INDICATION:
 Prophylactic and long-term tx of bronchial asthma
 Montelukast = for children <1.2mos
59

60. 5. LEUKOTRIENE RECEPTOR ANTAGONISTS
NURSING CONSIDERATION:
 Administer on an empty stomach to facilitate absorption
 Inform that the drug should be taken continuously according to
prescribed regimen
 Instruct to avoid OTC containing aspirin while taking leukotriene
receptor antagonist
 Aspirin may cause decrease effectiveness of drug
 Use in caution in administering these drugs if client is taking
propanolol, theophylline and warfarin
 Lead to toxicity
60

61. 6. LUNG SURFACTANTS
 Beractant (Survanta)
 Calfactant (Infasurf)
 Colfosceril (Exosurf Neonata)
 Poractant (Curosurf)
61

62. 6. LUNG SURFACTANTS
 Naturally occurring lipid compounds that reduce
alveoli surface tension
 Expanding the alveoli to allow gas exchange
INDICATION:
 Replacement of surfactant in neonates with RDS
62

63. 6. LUNG SURFACTANTS
 Onset of action begins immediately after instillation
into the neonate’s trachea
ADVERSE EFFECTS:
 PDA, hypotension, IVH, pneumothorax,
hyperbilirubinemia, sepsis
63

64. 6. LUNG SURFACTANTS
NURSING CONSIDERATION:
 Monitor neonate continuously during administration and
prepare life support measures
 Ensure proper placement of the endotracheal tube to
provide adequate delivery of the drug
 Suction the infant before administering the drug.
64

65. 7. MAST STABILIZERS
ACTION:
 Cromolyn
 inhibit histamine release to prevent allergic response when
respiratory tract is exposed to potential allergens
 Neodocromil
 Inhibits mediators of inflammatory cells such as
eosinophil, neutrophils, macrophage and mast cells thereby
blocking the overall inflammatory response
65

66. 7. MAST STABILIZERS
 Cromolyn
 Active in lungs, most of the inhaled dose is excreted during
exhalation
 Neodocromil
 Excreted unchanged in urine
66

67. 7. MAST STABILIZERS
NURSING CONSIDERATION:
 Caution against discontinuing the drug abruptly
 May cause rebound adverse effects
 Administer oral drugs 30 minutes before meals and at
bedtime
 to promote relief from symptoms of asthma
 Advise not to wear soft contact lenses if cromolyn eye
drops are used
 Cause stain
67

68. 68

69.  Instruct to blow nose gently
 Have client lie down with head tilted back ward over the edge
of the bed.
 Young children and infants, hold the head over the edge of the bed or
pillow; “football” hold to immobilize the infant
 Draw medication from dropper and hold dropper above the
nostril to instill the medication
 Have the client turn to the other side and repeat the process
on the other nostril
 Instruct to remain in that position for 2-3min, to allow the
drops to reach the nasal mucosa.
69

70.  Instruct to blow nose gently
 Have client sit upright
 Block the client’s right/left nostril
 Hold spray bottle and shake. Immediately after
shaking, insert tip of the bottle into the open nostril
 Ask the client to inhale through the open nostril as you
squeeze a puff of spray at the same time
70

71.  If the medication is a suspension, shake the canister
to disperse and mix the active bronchodilator with
the propellant
 Open client’s mouth and place the canister outlet 2-
4 inches in front of the mouth. This space will allow
the propellant to evaporate and will prevent large
particles from settling in the mouth
 Activate the metered dose inhaler and instruct the
client to inhale deeply for 10 seconds to open the
airways and disperse the drug
71

72.  Instruct to hold breath, and exhale slowly so that the
drug will reach the p.tissue
 If prescribed, repeat the procedure after 2-3min. The
use of small dose with 2-3 inhalations enhances deposition
of the drug in the smaller airways.
 Rinse mouth taking inhalers
 Cleanse the apparatus according to manufacturer’s
instructions.
72