focus on pharmacology essentials for health professionals

Copyright ©2008 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

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Focus on Pharmacology, First EditionBy Jahangir Moini

Focus on PharmacologyEssentials for Health

Professionals

Chapter 25Effects of Drugs on Respiratory Disorders

Jahangir Moini, MD, MPH




Asthma

• Chronic disease caused by increased reactivity of the tracheobronchial tree to various stimuli

• Affects about 16 million Americans

• Classified according to cause: allergy, exercise-induced, or infections of respiratory tract




Isoproterenol

• Isoproterenol (Isuprel) is often used to treat asthma in children

• However, this use is not a labeled indication for the drug

• Advise parents and children that saliva and sputum may appear pink after inhalation—this is normal




Bronchodilators

• Agents that widen the diameter of bronchial tubes:




Corticosteroids: Uses

• Mechanism of action believed to be diminished activation of inflammatory cells and increased production of anti-inflammatory mediators, which reduces production of mucus and decreases edema

• Used to treat respiratory conditions such as nasal congestion and allergic conditions such as rhinitis and asthma




Corticosteroids: Adverse Effects

• Irritation of mucous membranes

• Headache

• Pharyngitis

• Epistaxis

• Nausea and vomiting

• Coughing




Corticosteroids: Contraindications

• Contraindicated in children younger than 4 years

• Cautious use in pregnancy and lactation, and in those with immune system infections, tuberculosis, herpes simplex, ulcers, and nasal surgery or trauma




Mast Cell Stabilizers: Uses

• Inhibit release of bronchoconstrictors such as histamine from pulmonary mast cells (cells in connective tissue)

• Used for prophylaxis of mild to moderate seasonal bronchial asthma and allergic rhinitis; prevention of exercise-related bronchospasm; prevention of acute bronchospasm




Mast Cell Stabilizers: Adverse Effects

• Nausea and vomiting• Dry mouth• Throat irritation• Cough• Hoarseness• Headache• Dizziness• Rash




Mast Cell Stabilizers: Contraindications

• Contraindicated in patients with coronary artery disease or history of arrhythmias, acute asthma, during pregnancy; or in children younger than 6 years




Advise patients to gargle with water or to suck on lozenges after each treatment to reduce throat irritation, cough, and hoarseness.

Mast Cell Stabilizers: Patient Information




Antitussives: Uses

• Opioids work by causing respiratory depression; nonopioids reduce activity of peripheral cough receptors and appear to increase threshold of central cough centerl.

• Opioids are used to suppress nonproductive cough; nonopioids offer temporary relief of cough spasms.




Antitussives: Adverse Effects

• Difficulty breathing

• Drowsiness

• Rash

• Itching

• Dizziness

• Nausea

• Nervousness and restlessness




Antitussives: Contraindications

• Contraindicated in asthma, emphysema, diabetes, heart disease, seizures, thyroid conditions, chronic bronchitis, and liver disease.

• Cautious use in pregnancy and lactation




Antitussives: Patient Information

Advise patients to call physician if coughing continues longer than 1 week or mucus is yellow.




Natural Expectorant

• Wild cherry bark acts as an expectorant and a mild sedative. It is available in syrup or tincture forms.

• It should not be used during pregnancy.




Opioids for Cough

Opioid analgesics are among most effective drugs used as cough suppressants: 15-mg doses are often sufficient.




Expectorants and Mucolytics: Uses

• Work by lowering viscosity and facilitating removal of mucous secretions or enhancing reflex outflow of respiratory tract fluids by irritating gastric mucosa (guaifenesin)

• Used to treat bronchopulmonary disease and cystic fibrosis




Expectorants and Mucolytics: Adverse Effects and Contraindications

• Common adverse effects: very few

• Contraindicated in pregnancy and lactation.

• Guaifenesin may interact with heparin.




Expectorants and Mucolytics: Patient Information

• Instruct patients to increase fluid intake.

• Tell patients to report a persistent cough beyond 1 week.




Decongestants: Uses

• Vasoconstricting agents that shrink swollen mucous membranes of nasal airway passage

• Used for relief of nasal congestion due to common cold, upper respiratory allergies, and sinusitis.




Decongestants: Adverse Effects

• Nervousness and restlessness

• Insomnia

• Dizziness

• Headache

• Irritability




Decongestants: Contraindications

• Diabetes

• Heart disease

• Uncontrolled hypertension

• Hyperthyroidism




Decongestants: Patient Information

• Instruct patients to avoid taking oral decongestants with 2 hours of bedtime because they may act as stimulants.

• Advise patients to discontinue and immediately report extreme restlessness or signs of sensitivity.

• Women should not breast feed.

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