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Drugs that Affect the Respiratory System

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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  1. Drugs that Affect the Respiratory System P. Andrews Chemeketa Community College Paramedic Program Fall 07

  2. When do we consider respiratory medications? • Asthma • Decreases pulmonary function • May limit daily activity • Presents with • SOB • Wheezing • Coughing

  3. Or, perhaps…… • SOB, unknown etiology • Allergic reaction • Pneumonia • Congestive heart failure • Emphysema • Others…..?

  4. Asthma, cont. • Has numerous components! • Bronchoconstriction • Inflammation • Edema • Mucus hypersecretion • And others…. • Usually an allergic reaction

  5. Bronchodilators Beta2 specific agonists (short-acting) Beta2 specific agonists (long-acting) Methylxanthines Anticholinergics Glucocorticoids Leukotriene antagonists Mast-cell membrane stabilizer Categories of respiratory meds

  6. Advantages of Nebulized Meds. • Smaller doses • Onset Rapid • Targeted delivery • Less side effects

  7. Disadvantages of Inhaled Meds • Variables in delivery • Usage variables • User • Caregiver • Requires delivery to lungs • Not always adequate depth of respiration

  8. Remember This? • Absorption • Distribution • Metabolism • Elimination

  9. 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

  10. Quick Review of Receptors • Sympathetic • Adrenergic • Epinephrine or Nor-epinephrine • Primary neurotransmitters • Parasympathetic • Cholinergic • Acetylcholine • Primary neurotransmitter

  11. Muscarinic • A drug that stimulates Acetylcholine at Parasympathetic nerve endings. • When drugs refer to muscarinic or antimuscarinic action, • It ONLY acts on Parasympathetic sites!

  12. Adrenergic Stimulation • Alpha 1 • Vasoconstriction • Increase Blood Pressure • Beta 1 • Increase Heart Rate • Increase Force of Heartbeat • Beta 2 • Bronchial Smooth Muscle Dilation

  13. 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!)

  14. Adrenergic Bronchodilators • Adverse Effects • Dizziness, • Nausea, • Tolerance, • Hypokalemia, • Tremors • H/A

  15. 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)

  16. Bronchodilators, cont. • Inhaled Beta2 selective (long-acting) • Salmeterol (Serevent)

  17. Anticholinergic Bronchodilators • Indication • Bronchoconstriction • Mainly in COPD • Mode of Action • Competes at Muscarinic receptors • Blocks Acetylcholine at smooth muscle • Reduces Mucus Production

  18. 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

  19. Mucus Controlling Agents • Indication • Excessive , thick secretions • As in COPD and TB • Action • Lower viscosity of mucus

  20. Mucus Controlling Agents • Side effects • Irritation of Airway • Bronchospasm • Pharyngitis, voice change, laryngitis • Chest pain • Rash • Considerations • Have suction ready • Anticipate cough

  21. Mucus Controlling Agents • Examples • Mucomyst (Acetylcysteine) • COPD, TB • Acetaminophen OD • Pulmozyme • Cystic Fibrosis • Nebulized Saline • Simple yet effective!

  22. Inhaled Corticosteroids • Indications • Asthma • Anti-Inflammatory MAINTENANCE • Require Hours to Act! Preventative drug • Mode of Action • Modifies RNA/DNA action in Cells • Complicated Stuff

  23. 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

  24. Corticosteroids • Examples • Beclovent, Vanceril • Azmacort • Aerobid • Flovent • Pulmicort • Advair® • fluticasone (steroid) and salmeterol(bronchodialator)

  25. Glucocorticoids • Indications • Prophylactic treatment of Asthma • Hayfever

  26. 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

  27. Glucocorticoids (cont) • Adverse Effects • Include • H/A • Nausea • Diarrhea

  28. Cromolyn sodium • Similar to glucocorticoids • Adverse Effects • Only coughing or wheezing

  29. 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)

  30. Nasal Decongestants • Alpha1 agonist • Phenylephrine • Pseudoephedrine • Phenylpropanolamine • Administered as mist or drops • Side Effects – rebound congestion (use greater than 7 days)

  31. 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!

  32. Cough Suppressants • Antitussive meds – suppress cough stimulus in CNS • Codeine, hydrocodone

  33. A couple of ‘odd’ ones

  34. 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

  35. Epinephrine • Indications • Croup, Epiglottitise • Bronchospasm • Absorption • Absorption occurs following inhalation • Half-life • Unknown

  36. Epinephrine • Contraindications • Hypersensitivity • Precautions • Watch for Rebound Worsening • Watch ECG for changes • Increases Myocardial O2 demand • Side effects • Nervousness, restlessness, tremor, arrhythmias, hypertension, tachycardia

  37. 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

  38. 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

  39. 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.

  40. Status Asthmaticus

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