Drugs that affect the respiratory system
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Drugs that Affect the Respiratory System. P. Andrews Chemeketa Community College Paramedic Program Fall 07. When do we consider respiratory medications?. Asthma Decreases pulmonary function May limit daily activity Presents with SOB Wheezing Coughing. Or, perhaps…….

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Drugs that Affect the Respiratory System

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Drugs that Affect the Respiratory System

P. Andrews

Chemeketa Community College

Paramedic Program

Fall 07


When do we consider respiratory medications?

  • Asthma

    • Decreases pulmonary function

    • May limit daily activity

    • Presents with

      • SOB

      • Wheezing

      • Coughing


Or, perhaps……

  • SOB, unknown etiology

  • Allergic reaction

  • Pneumonia

  • Congestive heart failure

  • Emphysema

  • Others…..?


Asthma, cont.

  • Has numerous components!

    • Bronchoconstriction

    • Inflammation

    • Edema

    • Mucus hypersecretion

    • And others….

  • Usually an allergic reaction


Bronchodilators

Beta2 specific agonists (short-acting)

Beta2 specific agonists (long-acting)

Methylxanthines

Anticholinergics

Glucocorticoids

Leukotriene antagonists

Mast-cell membrane stabilizer

Categories of respiratory meds


Advantages of Nebulized Meds.

  • Smaller doses

  • Onset Rapid

  • Targeted delivery

  • Less side effects


Disadvantages of Inhaled Meds

  • Variables in delivery

  • Usage variables

    • User

    • Caregiver

  • Requires delivery to lungs

    • Not always adequate depth of respiration


Remember This?

  • Absorption

  • Distribution

  • Metabolism

  • Elimination


Absorption and Distribution

  • Absorption

    • Ionized drugs (Ipratropium)

      • Absorb poorly

      • Won’t distribute well to body

      • Mostly local effect

      • Used for AEROSOL

    • Non-Ionized drugs (Atropine)

      • Absorb well

      • Distribute well

      • Systemic Effect

      • Poor Aerosol Drug


Quick Review of Receptors

  • Sympathetic

    • Adrenergic

      • Epinephrine or Nor-epinephrine

        • Primary neurotransmitters

  • Parasympathetic

    • Cholinergic

      • Acetylcholine

        • Primary neurotransmitter


Muscarinic

  • A drug that stimulates Acetylcholine at Parasympathetic nerve endings.

  • When drugs refer to muscarinic or antimuscarinic action,

    • It ONLY acts on Parasympathetic sites!


Adrenergic Stimulation

  • Alpha 1

    • Vasoconstriction

    • Increase Blood Pressure

  • Beta 1

    • Increase Heart Rate

    • Increase Force of Heartbeat

  • Beta 2

    • Bronchial Smooth Muscle Dilation


Adrenergic Bronchodilators

  • Indication

    • Obstructive Airway Disease

      • Asthma, Bronchitis, Emphysema

  • Mode of Action

    • Adrenergic Receptors

      • Alpha 1…vasoconstriction

      • Beta 1…Increase HR

      • Beta 2…Bronchodilate (Yeah!)


Adrenergic Bronchodilators

  • Adverse Effects

    • Dizziness,

    • Nausea,

    • Tolerance,

    • Hypokalemia,

    • Tremors

    • H/A


Adrenergic Bronchodilators

  • Nonspecific agonists

    • Epinephrine (rarely used)

  • Beta2 Specific agonists – Short acting

    • Albuterol(Ventolin, Proventil)

      • 2.5 mg in 3 mL NS

    • Metaproterenol (Alupent)

    • Terbutaline (Brethine)


Bronchodilators, cont.

  • Inhaled Beta2 selective (long-acting)

    • Salmeterol (Serevent)


Anticholinergic Bronchodilators

  • Indication

    • Bronchoconstriction

    • Mainly in COPD

  • Mode of Action

    • Competes at Muscarinic receptors

    • Blocks Acetylcholine at smooth muscle

    • Reduces Mucus Production


Anticholinergic Bronchodilators

  • Adverse Effects

    • Watch for Cholinergic side effects

    • More with nebulized form than MDI

  • Examples

    • Atrovent (ipratropium)

      • 0.5 mg in 2.5 mL NS

    • Combivent (mixed w/ Albuterol)

      • 0.5 mg Atrovent & 2.5 mg Albuterol in 3 ml NS)

    • Atropine

      • 0.5 – 1 mg in 2 – 3 mL of NS

    • Robinul

  • Peak effects in 1 – 2 hrs


Mucus Controlling Agents

  • Indication

    • Excessive , thick secretions

    • As in COPD and TB

  • Action

    • Lower viscosity of mucus


Mucus Controlling Agents

  • Side effects

    • Irritation of Airway

    • Bronchospasm

    • Pharyngitis, voice change, laryngitis

    • Chest pain

    • Rash

  • Considerations

    • Have suction ready

    • Anticipate cough


Mucus Controlling Agents

  • Examples

    • Mucomyst (Acetylcysteine)

      • COPD, TB

      • Acetaminophen OD

    • Pulmozyme

      • Cystic Fibrosis

    • Nebulized Saline

      • Simple yet effective!


Inhaled Corticosteroids

  • Indications

    • Asthma

    • Anti-Inflammatory MAINTENANCE

    • Require Hours to Act! Preventative drug

  • Mode of Action

    • Modifies RNA/DNA action in Cells

    • Complicated Stuff


Inhaled Corticosteroids

  • Adverse Effect

    • Small incidence with nebulized

      • Oral doses have high incidence

  • Considerations

    • Not valuable in Acute Care

    • Watch for these in Pt Drug Lists


Corticosteroids

  • Examples

    • Beclovent, Vanceril

    • Azmacort

    • Aerobid

    • Flovent

    • Pulmicort

    • Advair®

      • fluticasone (steroid) and salmeterol(bronchodialator)


Glucocorticoids

  • Indications

    • Prophylactic treatment of Asthma

    • Hayfever


Glucocorticoids (cont)

  • Mode of Action

    • Lowers release of Histamine in Mast Cells

    • Lowers release of Inflammatory Response

      • Prevents Bronchospasm, airway inflammation

    • Acts in allergic and non-allergic asthma

    • Not a bronchodilator!

      • Not for use in acute setting

      • Controllers, not relievers


Glucocorticoids (cont)

  • Adverse Effects

    • Include

      • H/A

      • Nausea

      • Diarrhea


Cromolyn sodium

  • Similar to glucocorticoids

  • Adverse Effects

    • Only coughing or wheezing


Anti-inflammatory Agents, cont.

  • Corticosteroids - Injected

    • Methylprednisolone (Solu-Medrol)

      • Children; 0.25 mg/kg (max dose 125 mg IVP)

      • Adults; 125 mg IVP

    • Dexamethasone (Decadron)


Nasal Decongestants

  • Alpha1 agonist

    • Phenylephrine

    • Pseudoephedrine

    • Phenylpropanolamine

  • Administered as mist or drops

  • Side Effects – rebound congestion (use greater than 7 days)


Antihistamines

  • Blocks histamine receptors

  • Common 1st generation – cause sedation

    • Chlor-Trimeton

    • Benadryl

    • Phenergan

  • Common 2nd generation – does not cause sedation

    • Seldane

    • Claritin

    • Allegra

  • Caution: thickens bronchial secretions – do not use in Asthma!


Cough Suppressants

  • Antitussive meds – suppress cough stimulus in CNS

    • Codeine, hydrocodone


A couple of ‘odd’ ones


Epinephrine Racemic Epinephrine(microNEFRIN)

  • Class

    • Bronchodilator (adrenergic agonist)

  • Action

    • Affects both beta1 and beta2 receptors sites. Bronchodilation, reduces subglottic edema

    • Also increases pulse rate and strength

    • Also Alpha effects, vasoconstriction, Increased BP


Epinephrine

  • Indications

    • Croup, Epiglottitise

      • Bronchospasm

  • Absorption

    • Absorption occurs following inhalation

  • Half-life

    • Unknown


Epinephrine

  • Contraindications

    • Hypersensitivity

  • Precautions

    • Watch for Rebound Worsening

    • Watch ECG for changes

    • Increases Myocardial O2 demand

  • Side effects

    • Nervousness, restlessness, tremor, arrhythmias, hypertension, tachycardia


Epinephrine

  • Interactions

    • Beta blockers may negate effects

  • Route and dosage

    • Inhalation

      • One time Only

      • 1 mg Epinephrine, 1:1000 in 3 mL NS

  • Considerations

    • Give ENROUTE

    • ONLY if patient in Extreme Distress


Epi, cont.

  • May also consider Epi SQ

    • Patients who can’t cope with aerosol admin.

    • 0.3 – 0.5 mg SQ, then Neb treatment once patient can move air

  • Or Infusion;

    • 1 mg Epinephrine 1:1000 in 250 mL NS (concentration 4 mcg/mL) infuse at 1 mcg/min, titrating to effect


Magnesium Sulfate

  • Not usually admin. in pre-hospital setting

  • Can be used to treat moderate to severe asthma in patients who respond poorly to beta-agonists

  • Don’t use in patients with heart blocks, myocardial damage, or hypertension

  • 2 gm in 100 mL NS, given over 2 – 5 min.


Status Asthmaticus


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