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Respiratory sysytem


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Respiratory sysytem

  2. 2. Antiasthmatic are the drugs or medicines that treat or prevent asthma attacks.
  3. 3. 1. Bronchodilators: 2. Anticholinergic. 3. Mast cell stabilizers 4. Corticosteroids. 5. Anti-histamines. A A B C M
  4. 4.  Define as is a medication that relaxes and opens the airways, or bronchi, in the lungs.  Mechanism of action: They causes widening of the airway by relaxing bronchial smooth muscles by stimulate beta receptors
  5. 5. S. No. Drugs Doses 1 Salbutamol 2-4 mg orally 2 Terbutaline 5mg orally. 3 Formoterol 80 mcg B.D. orally 4 Albuterol 200-400 mcg inhaled every 6 hrly.
  6. 6.  Indications/uses • Relieving the distress of asthma. • Bronchospasm or broncho- constriction. Contraindication: • Patient with uncontrolled arrythmias. • Prolonged use of albuterol may cause hypokalemia Adverse effect: • Nervousness, Anxiety,Tremor, Headache, Palpitations, Tachycardia &Arrhythmias  Drug interaction: • (beta) blocker antagonize effects of adrenergic agonists. • Prolonged use of theophylline cause additive effects.
  7. 7. Nursing Responsibilities • Nurse should monitor the patient’s blood pressure, pulse, respiratory rate, and breathing sounds. • Teach the patients that how to use inhalers. • Instruct the patient to avoid respiratory irritants, such as smoke, dust, and strong smell.
  8. 8. •Mechanism of action: These drugs are weak CNS stimulants that are powerful smooth muscle relaxants thus they relax the smooth muscle of bronchi. They also havediuretic effect.
  9. 9. S. No. Drugs Doses 1 Theophylline 200-400 mg TDS orally. 2 Etiophylline 250 mg TDS IV/IM 3 Aminophylline 250-500mg TDS IV slow.
  10. 10. • To treat and prevent bronchospasm. • To treat asthma, bronchitis, emphysema Contraindications/ Precautions • Hypersensitivity to any xanthine. • Infection or irritation of rectum or lower portion. • Give cautiously in neonates, in elderly patients, heart disorders hepatic disorders. • Drug Interaction: • (beta) Blocker may antagonize the effects ofmethylxanthines. • Erythromycin may increase the half life of methylxanthines, and increasing the risk of methylxanthines toxicity. • Rifampicin, phenobarbital phenytoin, cigarette smoking and charcoal – broiled food may shorten the half- life of drugs and reducing their effectiveness. • Diarrhea. • Respiratory arrest. • Irritability. • Insomnia. • Vomiting. • Peptic ulcer. • Epigastric pain. • Tachycardia.
  11. 11. Nursing Responsibilities • Nurse should assess for signs and symptoms of toxicity. • Nurse also should know that therapeutic sr. level of theophylline ranges from 10 to 20 mcg/ml. • Advise patients to decrease consumption of xanthine – containing food and beverages. • Todetect toxicity, nurse should monitor sr drugs levels.
  12. 12. Mast cell Stabilizers – Introduction •Mast cell stabilizers works to prevent allergy cells called mast cell from breaking open and releasing chemicals that help to cause inflammation. •They are not effective once the allergic reaction has occurred and mediators are released from mast cells. So they are useless during asthmatic attack. •They are used in the prophylaxis of asthma.
  13. 13. • They inhibit mast cell activity, thus prevent the release of allergic mediators like histamine, serotonin, prostaglandins, cytokines. • These chemical are essential for an inflammation and allergic reactions • They block mast cell degranulation, stabilizing the cell and thereby preventing the release of histamine and related mediators..
  14. 14. S. No. Drug Doses 1 Cromolyn sodium 20mg 4times a day (Nebulization solution) 2 Sodium cromoglicate 20mg 6hrly 3 Ketotifen 1-2mg OD or BD
  15. 15. Indication / uses • Prevent asthma symptoms from occurring or prophylaxis to asthmatic attack. • Todecrease inflammation or bronchospasm. • Todecrease allergic reactions. • Rhinitis/conjunctivitis. Contraindications/ precautions • Hypersensitivity. • Precautiously with renal dysfunction, hepatic dysfunction. • Lactation, Cardiac arrhythmias •Adverse effect • Throat irritations, Nasal irritations, Wt. Gain, Headache, Drowsiness, Dry mouth, Dizziness
  16. 16. • Nurse should monitor drugs adverse reactions. • Instruct patients that this drug is not effective in an acute attack. • Nurse should instruct the patient how to use metered – dose inhaler or nebulizer. • If more than one inhalation is ordered, advise patient to wait 1-2 minutes before taking second puff. • If the parents is also receiving an inhaled bronchodilator, advise the patient to use bronchodilators first to open the airways and then wait approximately 5min before using cromolyn sodium to maximize its effectiveness.
  17. 17. •These drugs have anti- inflammatory as well as anti- allergic actions thus they are effective in bronchial asthma.
  18. 18. •They prevent the release of or counteract the bronchial mediators (Kinins, serotonin, Histamine) that cause tissue inflammation responsible for edema and airway narrowing.
  19. 19. S. No Drugs Doses 1 Prednisolone 5-60mg per day in divided dose. 2 Beclomethasone Dipropionate 100μgm (microgram) 6hrly by aerosol inhalation. 3 Budesonide 400 μgm (microgram) daily in divided dose. 4 Fluticasone 100-250μgm (microgram) BID by aerosol 5 Betamethasone Valerate 200μgm (microgram) 6hrly by aerosol.
  20. 20. Indication/uses •Chronic bronchitis. •Allergic Rhinitis. •Respiratory inflammatory disorders. •Bronchial asthma. •Prophylaxis in exercise induced asthma. •Allergic reaction.
  21. 21. Contraindications/precautions •Acute bronchospasm. •Use cautiously in patients who are immunosuppressed and in those taking prednisone or other corticosteroids. •Use very cautiously in patients with viral respiratory infections.
  22. 22. Adverse effects •Hoarseness. •Candida infections. •Oropharyngeal irritation. •Bronchospasm after inhalation of dry powder.
  23. 23. • Nurse should instruct the patient to rinse his mouth, after using inhaled steroids. • Nurse should teach the patient to:  Use bronchodilators several minutes before glucocorticoid inhaler. Rinse mouth after using inhaled steroids. Use and care for inhaler properly.
  24. 24. •Antihistamines are the drugs used in the treatment od allergic disorders and some other conditions.
  25. 25. •These drugs block the effect of histamine and its receptors. They also provide some sort of sedation. There are four types of antihistamines drugs. 1. Highly sedatives. 2. Moderate sedatives. 3. Mild sedatives. 4. Non sedatives.
  26. 26. S. No Drugs Doses Highly Sedative 1 Diphenhydramin e 25-50mg 2 Promethazine 25-50mg 3 Hydroxyzine 25-50mg Moderate Sedatives 4 Medizine 25-50mg 5 Buclizine 25-50mg 6 Phenivamine 25-50mg 7 Cyproheptadine 4mg
  27. 27. S. No. Drugs Doses Mild Sedatives 8 Chlorpheniramine 2-4mg 9 Cyclizine 50mg 10 Triprolidine 2.5-5mg Non Sedatives 11 Astemizole 10mg 12 Cetrizine 10mg 13 Lovatadine 10mg 14 Fexofenadine 120-180mg
  28. 28. •Allergic reactions (Hay fever, Vasomotor rhinitis urticaria, asthma,Anaphylaxis). •Because of their anticholinergic actions they are used as antiemetics and useful in motion sickness. •As hypnotics, Mild sedative/anxiolytics. •Parkinsonism.
  29. 29. •Hypersensitivity. •Lactation. •Hypokalemia. •Neonate. •Coma. •Special precautions in acute asthma and pregnancy, elderly, epilepsy.
  30. 30. Due to anticholinergic effect • Drowsiness in common. • Dryness of mouth. • Blurring of vision. • Urinary retention. • Constipation. • Delirium. • Convulsions. • Severe toxicity may causes death to cardiac and respiratory failure.
  31. 31. Nursing Responsibilities •Antihistamines are best given in the evening since all antihistamines cause drowsiness. •Advise to patient not to drive vehicle or do not operate machinery. •Advise to patient to avoid sedative such as alcohol or sedative hypnotics.
  32. 32. • These drugs reduced the viscosity of sputum that leads to easily expel the sputum.
  33. 33. S No. Drugs Doses 1 Acetylcysteine 2.5 ml of 10-20% solution given by inhalation or nebulization 2 Bromhexine 8-16 mg TDS.
  34. 34. • Totreat abnormal viscid, or thick and hard mucus. • As an antidote for acetaminophen overdose (acetylcysteine). Hypersensitivity to these drugs. Cautiously in elderly, pregnant or breastfeeding mothers • Stomatitis. • Drowsiness. • Bronchospasm. • Nausea/vomiting. • Severe rhinorrhea • Activated charcoal decreases acetylcysteine effectiveness. • Incompatible with chlortetracycline, erythromycin, amphotericin B, Hydrogen peroxide Contraindications /precautions Adverse effect Indication/Use Drug Interaction
  35. 35. •To assess the airway and maintain it patent. •Provide suction if needed. •Assess the pattern breath sounds, cough, and bronchial secretions. •Advise patient to maintain a fluid intake of 2- 3litres/day. •Warn the patient about the rotten egg smell of acetylcysteine.
  36. 36. •A Decongestant drugs used to relieve nasal congestion in upper respiratory tracts.
  37. 37. Mechanism of action •Decongestants are sympathomimetic drugs that act by stimulating the α (alpha) – adrenergic receptors. The decongestant effect due to vasoconstriction of the blood vessel in the nose sinuses etc. the vasoconstriction effect reduces swelling or inflammation and mucous formation in the nasal passage and make it easier to breath.
  38. 38. S. No. Drugs Doses 1 Oxymetazoline hydrochloride 0.05% solution or nasal spray. 2 Phenylephrine hydrochloride 10 mg 3 Pseudoephedrine hydrochloride 60 mg.
  39. 39. Indications /uses •For temporary relief of nasal congestion due to common cold. •Hay fever. •Sinusitis. •Upper respiratory tract allergens. •To promote nasal and sinus drainage.
  40. 40. •Hypersensitivity to these drugs. •MAO (Monoamine oxidase) inhibiters drugs therapy. •Use cautiously in older age patient they are more likely to experience adverse reaction. •Nasal contestant should not be used for more than three days, and oral decongestant should not used more than 7days because prolonged use will result in rebound congestion.
  41. 41. •Arrhythmias. •Tachycardia. •Insomnia. •Palpitation. •Hypertension. •Drowsiness. •Hypersensitivity reactions including rash, urticaria.
  42. 42. •If given with other sympathomimetic amines may increase central nervous system stimulation. •If given with MAO inhibiters may cause severe hypertension.
  43. 43. • Nurse should assess adverse effect of drugs. • Monitor pulse rate, BP, and ECG. • Advise patient not to share the container with other people and not allow the tip of the container to touch the nasal passage to avoid contamination.
  44. 44. Drugs for cough •The drug which used in cough are: 1.Antitussive. 2.Expectorants. 3.Bronchodilators.
  45. 45. Antitussives (Cough center suppressant) a)Opioids – Codeine, pholcodine. b)Non opioids – Noscapine, dextromethorphan. c)Antihistamine – Chlorpheniramine diphenhydramine.
  46. 46. a)Bronchial secretion enhances – sodium or potassium citrate, potassium iodide, ammonium chloride. b)Mucolytes – bromhexine ambroxol, acetylcysteine.
  47. 47. •They are used to suppress dry cough mostly because their aim to control rather than eliminate cough. These are also called cough center suppressants.
  48. 48. •These are the drugs that act in the CNS to increase threshold of cough center.
  49. 49. S. No Drugs Doses 1 Codeine (Opioids) 15-60mg up to every 4 hrs 2 Noscapine (Non opioids) PO 15-30 mg itramin maleate 3 Dextromethorphan (Non opioids) 10-30mg PO 4-8hrs max. 120/day 4 Chlorpheniramine (Antihistamine) 4 mg PO 4-6 hrly 5 Diphenhydramine (Antihistamine) 25 mg PO 4hrly not to exceed 150 mg / day.
  50. 50. Indications/uses •Dry & unproductive cough. •Allergic cough. •Spasmodic cough.
  51. 51. •Constipation. •Drowsiness. •Dryness of mouth. •Irritability. •Ataxia. •Respiratory depression in higher doses. •Addiction. •Vertigo. •Nausea, Headache.
  52. 52. Contraindication/precautions •Respiratory Depression. •Asthmatics. •Convulsion disorder. •Contraindicate while driving. •Obstructive airway disease.
  53. 53. •Assess the side effects or adverse reaction during the therapy. •Special precaution should be keep in mind before drug administration. •Advise to patient not to driving after taken opioids drugs such as codeine pholecodiene.
  54. 54. •These drugs help in removal of secretions of respiratory tract and mucolytic agents produce liquification of mucous making expectoration easier.
  55. 55. •They increase bronchial secretions or reduce its viscosity, sodium and potassium citrate increase bronchial secretion by salt action also these drugs stimulate gastric mucosa or directly acting on mucous membrane of lungs to increase the secretion of mucous.
  56. 56. Indications/uses •Chronic productive cough. •Thick mucous production. •Combinations with antitussives drugs for relieving cough.
  57. 57. Adverse effect •Allergic reactions / hypersensitivity. •Rhinorrhea. •Lacrimation. •Gastric irritation.
  58. 58. Contraindication/precautions •History of peptic ulceration. •Asthmatic patients. •Severe hepatic or renal function.
  59. 59. •They may increase the risk of bleeding when use with anticoagulants.
  60. 60. Nursing Responsibilities •Advise to take plenty of fluid during this therapy to easier removal of thick mucous. •Assess the adverse effects.