DRUGS AFFECTING THE

RESPIRATORY SYSTEM
OVERVIEW OF THE RESPIRATORY
SYSTEM
RT – 2 major parts – upper respiratory
tract which consist of the
[Link] [Link] cavity, pharynx and
larynx.
 LOWER RESPIRATORY TRACT
Consist of
1. Trachea 2. bronchi 3. bronchioles 4.
alveoli [Link] capillary membrane.
Air enters through the URT & travels to the
LRT, where gas exchange occur.
Lungs are divided into lobes. The
respiratory system acts to exchange gases
(oxygen and carbon dioxide)between the
blood & the air and regulates blood pH.
INSPIRATION – when you take a deep breath
diaphragm drops down at the same time, intercostal
muscles

› Contract, raising the ribs, increasing the

size of the chest and creating a negative
pressure. The negative pressure causes
air to rush into the lungs through
respiratory passages.
› EXPIRATION –breathing out. muscles
relax ,pressure increases in the chest and
air is passively forced out of the lungs.
 KEY TERMS
Ventilation – movement of air from the
atmosphere through the upper and
lower airways of the alveoli.
A phase in which oxygen passes
through the airways.
With every inspiration, air is moved
into the lungs and with every expiration
air is transported out of the lungs.
PERFUSION – involves blood flow at the
Alveolar-capillary bed.
For gas exchange to occur, perfusion
of each alveolus must be matched by
adequate ventilation.
Diffusion- movement of molecules
from higher to lower concentration,
takes place when oxygen passes into
the capillary bed.
UPPER RESPIRATORY TRACT CONDITIONS
[Link] COLD – number of viruses
cause common cold. Viruses invade the
tissues of the URT, initiating the release
of histamine and prostaglandin &
causing inflammatory response.
As a result mucous membrane becomes
engorged with blood, tissues swell and
an increase production of mucus.
These effects the person to complain of
›Sinus pain, nasal congestion, runny
nose, sneezing, watery eyes, scratchy
throat, and headache.
›Swelling can block the outlet of the
eustachian tube, which drains the
inner ear & equalizes pressure across
the tympanic membrane.
If it becomes blocked, feelings of ear
stuffiness & pain can occur and individual
› May likely to develop an ear infection
(otitis media).
› 2. Seasonal Rhinitis – condition occurs
when the upper airways respond to a
specific antigen (pollen, dust, mold)with
a vigorous inflammatory response.
Resulting again in nasal congestion,
sneezing, stuffiness and watery eyes.
[Link]– occurs when epithelial cells
› Lining of the sinus cavities becomes
inflamed. Swelling often causes severe
pain due to pressure against the bone,
which cannot stretch, leading to
blockage of the sinus passage.
› If left untreated, microorganisms can
travel up the sinus passages and into
the brain tissue.
4. Pharyngitis & Laryngitis – infections are frequently caused by common bacteria
and viruses. Commonly seen in influenza and produces uncomfortable respiratory
symptoms or other inflammations along with fever, muscle aches, pains and
malaise.
UPPER RESPIRATORY TRACT CONDITIONS
PNEUMONIA – inflammation of the
lungs caused either by bacteria or viral
invasion of the tissue by aspiration of
foreign substances into the lower
respiratory tract.
Respiratory membrane is affected,
resulting in decreased gas exchange.
Clients complain of difficulty in breathing
Fatigue, fever, noisy breath sounds
and poor oxygenation.
2. Asthma – characterized by
reversible bronchospasm,
inflammation and hyperactive airways.
Hyperactivity is triggered by allergens
or non allergic inhaled irritants or by
factors such as exercise and emotions.
The trigger causes an immediate release
of histamine which results in
Bronchospasm in about 10 minutes.
The later response (3-5 hours) is
cytokine-mediated inflammation
(process where specific signaling
molecules called cytokines play a
crucial role in triggering inflammatory
responses within the body).
 Excessive cytokine production can lead
to harmful inflammation or tissue
› damage., mucus production and edema
contributing to obstruction.
[Link] – occurs when bacteria, virus or
foreign materials infect the inner layer of the
bronchi.
Person with bronchitis may have narrowed
airway during the inflammation. Chronic
bronchitis is an inflammation of the bronchi
that does not clear.
4. COPD – a permanent, chronic
obstruction of airways, often related to
›Cigarette smoking .
›Results in airflow obstruction on
expiration as well as overinflation of
the lungs and poor gas exchange.
MNEMONICS – DRUG STUDY
C A I C A N
C- CLASSIFICATION
A-ADVERSE EFFECT
I-INDICATION
C- CONTRAINDICATION
A- ACTION
N- NURSING RESPONSIBILITIES
ANTIHISTAMINE – substances
Capable of reducing the physiologic
and pharmacologic effects of histamine.
Histamine is a chemical, the body
produces that causes the
 inflammatory response causing
 contraction of smooth muscle &
 dilation of capillaries.
When the body is injured , histamine is
released & causes the smooth
›muscle and vascular system to
increase blood flow by opening up the
capillaries.
›2 types of histamine receptors; H1 – is
stimulated-extravascular smooth
muscle are constricted.H2receptor an
increase in gastric secretions occurs.
 MECHANISM OF ACTION
During allergic reaction ,histamine and
other substances are released from
mast cells, basophils, and other cells in
response to antigens circulating in the
blood.
It can also prevent or alleviate itching.
 INDICATION
Indicated for management of nasal
allergies, seasonal or perennial
allergic rhinitis, urticaria & some
typical symptoms of common cold.
Useful in treatment of allergic
reactions, motion sickness.
Used as sleep aids.
 CONTRAINDICATIONS
1. Not to be used as the sole drug
therapy during acute asthmatic
attacks.(in this case
bronchodilator such as
albuterol, in extreme cases
epinephrine is urgently
needed.
2. Narrow angle glaucoma
[Link] disease
›4. Kidney disease
›[Link] [Link]
›6. Bronchial asthma
›7. COPD
›8. Peptic ulcer disease
›9. Seizure disorder
Loratadine is not recommended for
children younger than 2 years of age,
›Antihistamines should be used
with caution in clients with
impaired liver function or renal
insufficiency as well as lactating
mothers.
 ADVERSE EFFECTS
›[Link] [Link] mouth
[Link] in vision 4. constipation
›Cardiovascular – hypotension,
palpitation, syncope
›Gastrointestinal – nausea,
vomiting, diarrhea & constipation
Central nervous – dizziness, muscular
weakness, seizure, restlessness
›Some antihistamines are
prescription drugs, but most are
available over the counter.
›NON-SEDATING ANTIHISTAMINE
LIKE; Second generation
›1. Loratadine [Link]
[Link] 4. Fexofenadine
 These drugs were developed to
eliminate unwanted adverse effects
›mainly sedation.
›They work peripherally to block the
actions of histamine and
significantly fewer of CNS effects.
›Called peripherally acting
antihistamine – they do not readily
cross the blood-brain barrier.
LORATADINE (Claritin) – NSA –second
generation. used to relieve symptoms
› of seasonal allergic rhinitis.
›Contraindicated to drug allergy.
›Should not be given with potassium
chloride, ipratropium etc.
›Drug is available in oral form
[Link] as a 1mg/ml syrup.
DIPHENHYDRAMINE (Benadryl) –first
generation antihistamine
› traditional antihistamine that works
peripherally and centrally.
›It has anticholinergic and sedating
effects.
›Not advised in older adults because
of hangover effect. Increased
potential to falls.
if being misused excessive doses – can have serious
consequences including

› “DEATH”.
› It is to be used with caution in nursing
mothers.
› Diphenhydramine is also available in
cream, gel and spray.
› Available in combination with several other
drugs that are commonly given topically
like camphor, calamine and zinc oxide.
NURSING RESPONSIBILITY/CLIENT
›TEACHING
1. Take this drug only as prescribed.
Do not increase the dose if
symptoms are not relieved. Consult
your health care provider.
2. Do not drive or operate dangerous
machinery if drowsiness/dizziness
occurs.
3. Take the drug with food may limit
GI upset like nausea, vomiting, heartburn.
4. Frequent mouthcare & sucking
sugarless lozenges may help.
(mouthcare)
5. Use a humidifier, avoid smoke-
filled areas, drink plenty of fluids.
(thickening of mucus, difficulty
coughing. Tightening of the chest.
[Link] any of the following to your
›health care provider like difficulty of
breathing, rash ,hives, difficulty in
voiding, abdominal pain, visual
changes, disorientation or confusion.
7. Avoid the use of alcoholic
beverages while you are taking this
drug.
8. Avoid the use of OTC medication
›Without first checking with your
health care provider.
9. Inform your doctor, nurse involved
in your care that you are taking this
medicine.
10. Take this drug as prescribed. Keep
out of the reach of children.
11. Antihistamine should not be
given subcutaneously.
›12. IV injection should be done slowly
with the client lying down.
›13. Client should stop using
antihistamines for 48 hours before
having skin tests for allergies.
 GERIATRIC CONSIDERATIONS:
›1. When usual adult doses are given,
some elderly people may have sedation
or the opposite reaction like
hyperexcitability agitation, or
confusion.
›[Link] with memory has been
reported with continuous use of these
agents esp. with the elderly.
3. The elderly often have pronounced
anticholinergic side effects especially
›Constipation, dry mouth and urinary
retention especially in males.
›4. Anticholinergic dosing in the
elderly population should begin at
the lowest dose with gradual
increases until maximum
improvement is noted or intolerable
side effects.
5. “Go Slow and Stay Low” is the common
advice in giving medication to the elderly.
› PEDIATRIC CONSIDERATIONS:
›1. Closely watch pediatric clients with
spastic paralysis or brain damage
because they have increased reaction to
these agents requiring a dosage
reduction.
›2. Where hot weather prevails or
environmental temperatures are high
Children receiving these agents have an
increased risk of developing a rapid body
DECONGESTANTS-
› Nasal congestion(ping-ot) is due to
excessive nasal secretions and
inflamed and swollen nasal mucosa.
› Decreases the overproduction of
secretions by causing local
vasoconstriction of the URT.
› Leads to shrinking of swollen mucous
membranes & tends to open
Clogged nasal passages, providing relief from the discomfort of a blocked nose and

clogged nasal passages , providing relief

›From the discomfort of a blocked

nose and promoting drainage of
secretions and improved airflow.
›Decongestants – usually adrenergic
or sympathomimetics.
›Topical steroids are also used as
decongestants.
Topical Nasal Decongestants
includes Oxymetalozine (Afrin)
Phenylphrine (Coricidin)
These are OTC medications.
The choice of topical nasal
decongestant varies with the
individual.
 MECHANISM OF ACTIONS AND
INDICATIONS
› Topical decongestants-
sympathomimetics ,they may imitate the
effects of the sympathetic nervous system to
cause vasoconstriction leading to decreased
edema and inflammation of the nasal
membranes.
› Available in nasal sprays that are used to
relieve discomfort of nasal congestion that
accompanies common cold, sinusitis & allergic
rhinitis.
 Can be used when dilation of the nares
is desired to facilitate medical
Examination or to relieve pain and
congestion of otitis media. Opening of
the passage allows better drainage of
the eustachian tune, relieving pressure
in the middle ear.
PHARMACOKINETICS – onset of action
is immediate & less systemic effects.
 Metabolized in the liver and excreted in
the urine.
Contraindications and Cautions-
When there is any lesion or erosion in the
mucous membranes that could lead to
systemic absorption.
Caution should be used in clients with any
condition that might be exacerbated by
sympathetic activity such as glaucoma, HPN,
DM, Thyroid disease, coronary disease or
prostate problems. Has adrenergic properties.
 No studies regarding the effects of
these topical drugs in pregnancy or
›Lactation, caution is advised.
Drugs administered via ;
ORAL ROUTE – produce prolonged
decongestant effect.
Nasal products- produce a more
rapid effect. Can cause rebound
congestion. Occurs with repeated
use of inhaled decongestants applied
topically.
It has a rapid absorption of the drug
through mucous membranes followed by
›A more rapid decline in therapeutic
activity.(can lead to dependence
and overuse on the nasal spray).
›Commonly used intranasal steroids
include the following;
›1. Beclomethasone
dipropionate(Beconase)
2. Budesonide ( Rhinocort )
3. Triamcinolone (Nasacort)
› [Link] – Brompheniramine maleate
› MECHANISM OF ACTION
› Commonly used for their ability to
shrink engorged nasal mucous
membranes and relieve nasal stuffiness.
› Adrenergic drugs accomplish this by
constricting the small arterioles that
supply the structures of the URT.
Primarily the blood vessels surrounding
›The nasal sinuses.
›When blood vessels are stimulated
By alpha-adrenergic drugs they
constrict . Once it shrinks, the nasal
secretion in the swollen mucous
membranes are better able to drain.
INDICATIONS – reduce nasal congestion
›Associated with acute or chronic
rhinitis, common cold, sinusitis, fever
and other allergies.
›Used to reduce swelling of the nasal
passages and to facilitate
visualization of the nasal and
pharyngeal membranes before
surgery or diagnostic procedures.
CONTRAINDICATIONS –
›Known drug allergy
›Narrow-angle glaucoma
›Uncontrolled cardiovascular disease
›Hypertension
›Diabetes
›Hyperthyroidism
ADVERSE EFFECTS -
1. Nervousness
2. Insomnia
3. Palpitations
4. Tremor
5. Common adverse effect of intranasal
steroids –localized & include mucosal
irritation & dryness.
INTERACTIONS -
› Systemic sympathomimetic drugs and
sympathomimetic nasal decongestants
are likely to cause drug toxicity when
given together. Monoamine oxidase
inhibitors may result in addictive
pressor effects.(raising of bp)when
given with sympathomimetic nasal
decongestants.
Sympathomimetic effects like
›Increased pulse rate and blood
pressure, urinary retention, should
be monitored because systemic
absorption may occur.
ORAL DECONGESTANTS
› Taken orally to decrease nasal congestion
related to common colds, sinusitis and
allergic rhinitis.
› Tend to relieve pain and congestion of
otitis media.
› Opening of the nasal passage allows
better drainage of the eustachian tube
and relieving pressure in the middle ear.
 Shrinks the nasal mucous membranes
by stimulating the alpha-adrenergic
›Receptors in the nasal mucous
membranes.
›This shrinkage results in a decrease in
membrane size, promoting drainage of
the sinuses and improving airflow.
›Pharmacokinetics- generally well
absorbed & reaches peak level quickly in
20 to 45 minutes.
Widely distributed in the body,
›Metabolized in the liver and
primarily excreted in the urine.
›Contraindications –same with
topical
›Adverse Effects – anxiety, tremors,
restlessness, hypertension,
arrhythmias, sweating and pallor.
NURSING RESPONSIBILITY/
› CLIENT TEACHING –
› Monitor pulse rate, bp and cardiac response to
the drug ( to detect adverse effects early &
arrange to reduce dose or discontinue the
drug.
› Encourage the client not to use this drug
longer than 1 week, and to seek medical
evaluation if symptoms persist at that time.
› Need for periodic monitoring and evaluation
To enhance client knowledge about
›Drug therapy and to promote
compliance.
›Offer support and encouragement to
help the client cope with the disease
and the drug regimen.
ANTITUSSIVE-cough suppressant
Most of the time coughing is a beneficial
response, sometimes harmful(esp. after
surgical procedure like hernia repair).
.may enhance client’s comfort and
reduce respiratory distress.
.effective in suppressing cough reflex in
the brain or numbing cough receptors in
respiratory passages.
 MECHANISM OF ACTION
› The opioid antitussives, codeine and
hydrocodone, suppress the cough reflex
through direct action on the cough center
in the medulla.
› Opioid antitussives also provides analgesia
and have a drying effect on the mucosa of
the respiratory tract which increases the
viscosity of respiratory secretions.
.Helps to reduce symptoms such as runny
›Nose and postnasal drip.
›INDICATIONS: primarily used to stop
the cough reflex when the cough is
non productive and or harmful.
›CONTRAINDICATIONS – known drug
allergy.
Dextromethorphan- contraindication
›Hypothyroidism, advanced cardiac
and vessel disease, hypertension,
coma, and use of MAOIs within the
past 14 days.
›Codeine and hydrocodone –
contraindicated with alcohol use.
ADVERSE EFFECTS
›Benzonatate – dizziness, headache,
nausea, constipation, pruritus and
nasal congestion.
›Codeine and hydrocodone – nausea,
vomiting, constipation,
lightheadedness.
›Dextromethorphan – dizziness,
drowsiness, nausea
Diphenhydramine – dry mouth
›INTERACTIONS – very few drug
interactions.
EXPECTORANT -
›Aid in the expectoration(coughing
up and spitting out)of excessive
mucus that has accumulated in the
respiratory tract.
›They work by breaking down and
thinning out of secretions.
MECHANISM OF ACTION
› Guaifenesin – act by increasing the hydration
of the rt and reduce viscosity of the mucus all
of which facilitates mucus removal.
› INDICATIONS -for relief of productive cough
and may also be used for the suppression of
cough caused by chronic paranasal sinusitis.
By loosening and thinning of sputum and
bronchial secretions. May diminish the
tendency to cough.
CONTRAINDICATIONS -
› Guaifenesin is contraindicated if drug
allergy is present & to be used with
caution in pregnancy & lacation bec. of
its effects on the fetus or baby.
› ADVERSE EFFECTS - nausea, vomiting &
gastric irritation.
› INTERACTIONS – No known significant
interactions involving guaifenesin.
Pharmacokinetic- rapidly absorbed
›With an onset of 30 minutes and a
duration of 4 to 6 hours .
›NURSING RESPONSIBILITY/CLIENT
TEACHING;
›Caution the client not to use these
drugs for longer than 1 week & to
seek medical attention.
 Advise the client to take small frequent meals to alleviate some of the

Advise the client to take small frequent meals to alleviate some of

› GI discomfort .
› Advise the client to avoid driving or
performing dangerous tasks if dizziness and
drowsiness occur to prevent client injury.
› Provide thorough client teaching including
drug name, dosage, measures to help avoid
adverse effects. To promote compliance.
ROBITUSSIN DM – contains 2 active
ingredients like;
› Dextromethorphan(antitussive) and
guaifenesin.
› Robitussin is an expectorant – helps to
loosen congestion of the chest and throat,
making easier to cough out through your
mouth.
› Guaifenesin- it works by thinning the mucus
in air passages to make it easier to cough out
 NURSING RESPONSIBILITIES
Clients taking Antihistamine;
1. Assess your clients for any
allergies.
2. If clients are driving – advice them
not to drive. Take the medication
before going to sleep(at bedtime).
Prevent from any accidents/fall.
3. if client is undergoing allergy testing,
these medications are discontinued for
4 days before the testing.
4. inform/made aware of the client
that antihistamine can dry up
secretions. If client cannot expectorate
the secretions, secretions becomes
viscous (thick) occludes airways & leads
to infections or occlusion of the
bronchioles.
5. In elderly – may lead to dizziness
Confusion , sedation and
hypotension. Best taken with meals.
Clients taking Decongestants;
1. Inform your client, taking
decongestant can increase blood
pressure and heart rate & other vital
parameters.
6. Encourage client who are experiencing
dry mouth to chew or suck on candy
(sugar-free)if needed or over the counter .
Cold lozenges or to chew gum.
Perform frequent mouth care to ease
dryness & discomfort.
Instruct client to increase fluid intake up to
3th ml/day unless contraindicated. Helps to
liquefy secretions. Assist in breaking up thick
secretions, and makes it easier to cough out.
2. Assess and document a description
Of cough, secretions and breath sounds.
Clients taking ANTITUSSIVE medications
1. In respiratory assessment -Include rate,
and depth, breath sounds & oxygen
saturation.
2. Include presence of cough and
description of cough and sputum.
[Link] clients against driving or
›Engaging in any other activities that
requires mental alertness.
Clients taking in Expectorant -
Generally tolerated well. The only
contraindication is drug allergy.
Clients must avoid taking alcohol &
products containing alcohol.
Medications are not to be used for
longer than 1 week.
Encourage fluid intake.
 MUCOLYTIC – liquefy respiratory
secretions to aid the clearing of the
›Airways in high-risk respiratory clients
who are coughing up thick, tenacious
secretions. Clients may be suffering
from conditions such as COPD, cystic
fibrosis, pneumonia or tuberculosis.
›Mucolytics include
ACETYLCYSTEINE(generic) Fluimucil
Fluimucil 600mg – dissolve in half a glass
of water. Can be taken with or
Without meals. To be taken in the
morning and evening.
Can be taken before of after meals.
Acetylcysteine granules (1/2 glass
of water)and Acetylcysteine
effervescent tablet (1/2 glass of
water).
 Dornase alfa (Pulmozyme)
ACTIONS & INDICATIONS –
Acetylcysteine used orally to protect
liver cells from being damaged during
episodes of acetaminophen toxicity
because it normalizes hepatic
glutathione levels and binds with a
reactive hepatotoxic metabolite of
acetaminophen.
 Result is a decrease in the tenacity
and viscosity of the secretions.
›Pharmacokinetics – medication may
be administered by nebulization or by
direct instillation into the trachea via
endotracheal tube or tracheostomy.
›It is metabolized in the liver &
excreted in the urine.
Contraindications and Cautions
›Caution should be used in cases of
acute bronchospasm, peptic ulcer and
esophageal varices because of
increased secretions could aggravate
the problem.
›ADVERSE EFFECTS –GI upset,
stomatitis, rhinorrhea, rashes &
bronchospasm.
Nursing Responsibilities/ Client teaching
› If for nebulization, avoid combining with
other drugs . Formation of precipitates
and potential less effectiveness of the
drug.
› The client having acetylcysteine by face
mask should have the residue wiped off
the face mask and off their face with
plain water to prevent skin breakdown.
 Clients be cautioned to store the
›Drug in the refrigerator, from
protection from light.
›Provide thorough client teaching
regarding the drug regimen.
›Offer support and encouragement
to help the client cope with the
disease and the drug regimen.
 DRUGS AFFECTING THE LOWER
RESPIRATORY TRACT.
› Bronchodilator/Anti-asthmatic - used to
facilitate respiration by dilating the
airways.
› Symptomatic relief or prevention of
bronchial asthma and for bronchospasm
associated with COPD.
› Given orally, other medications
administered directly into the airway by
Bronchodilators include;
› Xanthine – sympathomimetics and
anticholinergics
› Xanthine including caffeine and
theophylline were once the main treatment
choices of asthma and bronchospasm, but
because it interacts with many other drugs,
they are not anymore considered as the
first choice bronchodilators.
Therapeutic Actions and Indications
› Direct effect on the smooth muscles of the
respiratory tract both in the bronchi and in the
blood vessels.
› Exact mechanism of action is not known but
one theory suggest that Xanthine work directly
affecting the mobilization of calcium within the
cell.
› They do these by stimulating 2 prostaglandins
resulting in smooth muscle relaxation which
›That has been impaired by
bronchospasm pr air trapping.
›It also inhibit the release of slow –
›reacting substance of anaphylaxis &
histamine , decreasing the bronchial
swelling & narrowing that occurs of
these 2 chemicals.
›Unlabeled uses includes stimulation in
Cheyne-stokes respiration, an abnormal
pattern of breathing characterized by
› Apneic episodes followed by periods of
tachypnea that may reflect delayed blood
flow through the brain and treatment of
apnea and bradycardia of premature infants.
› But because xanthine is associated with
many adverse effects & management can be
difficult, they are not the drug of choice
when starting treating the client with COPD.
 Still used in ICU when acute asthma
›Attacks have progressed to a critical
situation.
›PHARMACOKINETICS
›Rapidly absorbed from git when given
orally reaching peak levels of 2 hours.
›If IV, reaching peak effects within
minutes.
 Widely distributed and metabolized in
the liver & excreted in the urine.
›Crosses the placenta & enters the
breast milk.
›CONTRAINDICATIONS:
›Cautioned be taken with client’s having
GI problems, coronary disease,
respiratory dysfunction, renal or
hepatic disease, alcoholism or
 Xanthine are available for oral and
parenteral, the parenteral drug should
› be switched to the oral form as soon as
possible because systemic effects of the
oral form are less acute and more
manageable.
› No studies are available of xanthine
effects on human pregnancy, they have
been associated with fetal abnormalities
and breathing difficulties at birth.
 In animal studies, the usage should be
limited to situations in which the
›Benefit outweighs the potential risk to
the fetus. Bec. Xanthine enters the
breast milk & affects the baby.
›Another method of feeding should be
selected if these drugs are needed
during lactation.
ADVERSE EFFECTS :
›GI upset
›Nausea . death
›Irritability
›Tachycardia
›Seizure
›Brain damage
NURSING CONSIDERATIONS/CLIENT
TEACHING:
1. Assess for possible contraindications
or cautions. Any known allergies to
prevent hypersensitivity reactions.
Cigarette use which affects metabolism
of the drug , peptic ulcer, gastritis,
renal or hepatic dysfunction& coronary
disease, all of which could be
exacerbated & requires caution.
2. Perform a physical examination to
establish baseline data for assessing
› effectiveness of the drug and the
occurrence of the adverse effects
› 3. Perform skin examination including color
and the presence of skin lesions to provide
a baseline as a reference for drug
effectiveness.
› 4. Monitor bp,pr, cardiac auscultation &
baseline ecg to provide a baseline for
5. Assess bowel sounds , do a liver
evaluation and monitor liver & renal
› Function tests to provide a baseline renal and
liver function test.
› 6. Administer oral drug with food or milk to
relieve gi irritation.
› 7. Monitor clients responses to the drug.
› [Link] comfort measures including rest
periods, quiet envt., dietary control of caffeine
& headache therapy as needed, to help client
cope with the effects of drug therapy.
9. Provide periodic-follow up including
blood test to monitor serum theophylline
›Levels.
›10. Provide thorough client teaching
about the drug therapy.
 SYMPATHOMIMETICS
› Dilation of the bronchi with increased rate
and depth of respiration.
› Drugs like; Albuterol, Epinephrine,
Indacaterol, Isoproterenol, Salmeterol and
Terbutaline.
› Therapeutic actions & Indications-
› Increased bp, increased hr,
vasoconstriction & decreased renal and gi
Epinephrine – drug of choice in adults and
children for treatment of acute
› bronchospasm & anaphylaxis.
› PHARMACOKINETIC- Sympathomimetics
available only as an inhalant. Like indacaterol,
formoterol, levalbuterol, formoterol and
salmeterol.
› Transformed in the liver to metabolites that
are excreted in the urine. Known to cross the
placenta & to enter the breastmilk. Inhaled
drugs are absorbed into the lung tissue.
Contraindications & Cautions
›Should be used with caution
depending on the severity of the
condition like cardiac disease, vascular
disease, dm, hyperthyroidism and
arrhythmias.
›These drugs should be used during
pregnancy and lactation only.
Adverse Effects -
›CNS stimulation
›GI upset
›Cardiac arrythmias
›HPN
›Bronchospasm
›Sweating, pallor and flushing
Nursing Considerations for Clients
Receiving Sympathomimetics
›Assess for possible contraindications
or cautions. Cigarette use which
affects the metabolism of the drug,
pregnancy or lactation which requires
cautious use of the drug.
›Perform physical examination to
establish baseline data for assessing
effectiveness of the drug.
 Assess reflexes and orientation to
evaluate CNS effects of the drug.
Monitor respirations and adventitious
sounds to establish a baseline for drug
effectiveness and possible adverse effects.
Evaluate pulse, bp, and in certain cases a
baseline ECG to monitor CV effects of
sympathetic stimulation.
Evaluate liver function test to assess for
changes that could interfere with metabolism
of the drug and require dose adjustment.
 Provide safety measures as needed if
CNS effects becomes a problem to
Prevent client injury.
Provide small, frequent meals and
nutritional consultation if GI effects
interfere with eating to ensure proper
nutrition.
Provide thorough client teaching
including the drug regimen.
 ANTICHOLINERGIC
Clients who cannot tolerate the
sympathetic effects of the
sympathomimetics might respond
to the anticholinergic drugs
ipratropium (Atrovent), Tiotropium,
Aclidinium.