This document discusses several types of drugs used to treat respiratory conditions. It includes sections on antiasthmatics like bronchodilators and corticosteroids; expectorants and mucolytics to loosen mucus; antitussives to suppress cough; antihistamines used for allergies; and decongestants to relieve nasal congestion. For each drug class, it provides examples of medications, their mechanisms of action, dosages, indications for use, contraindications, adverse effects, and nursing responsibilities.

2.  ANTIASTHMATICS
 MUCOLYTICS
 EXPECTORANT
 ANTITUSSIVES
 BROCHODILATORS
 BRONCHOCONTRICTORS
 ANTIHISTAMINES

3. Antiasthmatic are the drugs or medicines that treat or prevent asthma attacks.

4. 1. Bronchodilators:
2. Anticholinergic.
3. Mast cell stabilizers
4. Corticosteroids.
5. Anti-histamines.
A
A
B
C
M

5.  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

6. 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.

7.  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.

8. 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.

9. •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.

10. 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.

11. • 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.

12. 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.

14. 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.

15. • 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..

16. 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

17. 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

18. • 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.

19. •These drugs have anti-
inflammatory as well as anti-
allergic actions thus they are
effective in bronchial asthma.

20. •They prevent the release of or
counteract the bronchial mediators
(Kinins, serotonin, Histamine) that
cause tissue inflammation
responsible for edema and airway
narrowing.

21. 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.

22. Indication/uses
•Chronic bronchitis.
•Allergic Rhinitis.
•Respiratory inflammatory disorders.
•Bronchial asthma.
•Prophylaxis in exercise induced asthma.
•Allergic reaction.

23. 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.

24. Adverse effects
•Hoarseness.
•Candida infections.
•Oropharyngeal irritation.
•Bronchospasm after inhalation of
dry powder.

25. • 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.

26. •Antihistamines are the drugs
used in the treatment od
allergic disorders and some
other conditions.

27. •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.

28. 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

29. 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

30. •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.

31. •Hypersensitivity.
•Lactation.
•Hypokalemia.
•Neonate.
•Coma.
•Special precautions in acute asthma and pregnancy,
elderly, epilepsy.

32. 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.

33. 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.

34. • These drugs reduced the viscosity of sputum that leads to
easily expel the sputum.

35. S No. Drugs Doses
1 Acetylcysteine 2.5 ml of 10-20% solution given
by inhalation or nebulization
2 Bromhexine 8-16 mg TDS.

36. • 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

37. •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.

38. •A Decongestant drugs used
to relieve nasal congestion
in upper respiratory tracts.

39. 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.

40. S. No. Drugs Doses
1 Oxymetazoline
hydrochloride
0.05% solution or nasal spray.
2 Phenylephrine
hydrochloride
10 mg
3 Pseudoephedrine
hydrochloride
60 mg.

41. 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.

42. •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.

43. •Arrhythmias.
•Tachycardia.
•Insomnia.
•Palpitation.
•Hypertension.
•Drowsiness.
•Hypersensitivity reactions including rash, urticaria.

44. •If given with other
sympathomimetic amines may
increase central nervous system
stimulation.
•If given with MAO inhibiters may
cause severe hypertension.

45. • 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.

46. Drugs for cough
•The drug which used in cough are:
1.Antitussive.
2.Expectorants.
3.Bronchodilators.

47. Antitussives (Cough center suppressant)
a)Opioids – Codeine, pholcodine.
b)Non opioids – Noscapine,
dextromethorphan.
c)Antihistamine – Chlorpheniramine
diphenhydramine.

48. a)Bronchial secretion enhances – sodium
or potassium citrate, potassium iodide,
ammonium chloride.
b)Mucolytes – bromhexine ambroxol,
acetylcysteine.

49. •They are used to suppress dry cough
mostly because their aim to control
rather than eliminate cough. These
are also called cough center
suppressants.

50. •These are the drugs that act in
the CNS to increase threshold of
cough center.

51. 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.

52. Indications/uses
•Dry & unproductive cough.
•Allergic cough.
•Spasmodic cough.

53. •Constipation.
•Drowsiness.
•Dryness of mouth.
•Irritability.
•Ataxia.
•Respiratory depression in higher doses.
•Addiction.
•Vertigo.
•Nausea, Headache.

54. Contraindication/precautions
•Respiratory Depression.
•Asthmatics.
•Convulsion disorder.
•Contraindicate while driving.
•Obstructive airway disease.

55. •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.

56. •These drugs help in removal of
secretions of respiratory tract and
mucolytic agents produce liquification of
mucous making expectoration easier.

57. •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.

58. Indications/uses
•Chronic productive cough.
•Thick mucous production.
•Combinations with antitussives drugs for
relieving cough.

59. Adverse effect
•Allergic reactions / hypersensitivity.
•Rhinorrhea.
•Lacrimation.
•Gastric irritation.

60. Contraindication/precautions
•History of peptic ulceration.
•Asthmatic patients.
•Severe hepatic or renal function.

61. •They may increase the risk of bleeding
when use with anticoagulants.

62. Nursing Responsibilities
•Advise to take plenty of fluid during this
therapy to easier removal of thick
mucous.
•Assess the adverse effects.