Respiratory Medications

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Respiratory Medications

• Theresa Till Ed.D, RN,CCRN

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Pathophysiology of Asthma

• HYPERRESPONSIVENESS OF AIRWAYS that results in
• Usually, reversible constriction of bronchial
  smooth muscle (bronchoconstriction).
• Hypersecretion of mucus
• Mucosal inflammation and edema (Considered more a
  disease of inflammation than obstruction
  obstruction occurs secondarily)

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Triggers to Asthma
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Asthma(narrowed airways)
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Asthma
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Chronic Bronchitis

• Usually caused by smoking or inhaled irritants.
• Mega mucous
• Airway inflammation
• Irreversible

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EmphysemaAlveolar Destruction
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Emphysema

• IRREVERSIBLE destruction of alveolar walls which
  decreases surface area for gas exchange.
• Loss of lung elasticity springs that hold open
  alveolar walls are sprung and collapse.
• Air becomes trapped and distal airways
  hyperinflate and rupture.

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Quit smoking

• Major cause of COPD.

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Nicotine Patch
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Medications that Treat Respiratory Disease

• Steroids
• REDUCE INFLAMMATION.
• CONSIDERED A DRUG OF PREVENTION
• Not used acutely
• Best to use spacer (aerochamber) to decrease
  systemic effects.
• Rinse spit after use.
• Commonly ends in sone, olone

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Bronchodilators

• Fast acting USED ACUTELY.
• Open airways. Most bronchodilators are given via
  nebulizer, MDI or DPI.
• Beta adrenergic agonists (erol, enol) Common side
  effects are palpitations , tachycardia. Note If
  patients are using more than one canister a month
  (200puffs), their disease is in poor control.
  Dont use as fire extinguisher. Ask why is
  fire breaking out?

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Bronchodilators

• Bronchodilators (fast or slow acting) work by
  relaxing muscle walls and thereby making the air
  passage larger.

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Bronchodilators

• Methylxanthines theophylline Aminophylline
  second line drug given when extra treatment is
  needed. Given IV or PO. Most common side effects
  of aminophylline are tachycardia, shakiness, and
  palpitations.
• Anticholinergics relax bronchial smooth muscle
  but less effective than beta agonists.
• http//www.use-inhalers.com/

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Respiratory PreventativesMast Cell Stabilizers

• Not used acutely. Used to prevent an exacerbation
  of asthma.
• Examples of mast cell stabilizers
• Cromolyn (Intal)
• Nedocromil (Tilade)
• Inhibit histamine release from mast cells thus
  decreasing immune response.

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Respiratory PreventativesLeukotriene Modifiers

• Not used acutely. Used to prevent an exacerbation
  of asthma
• Leukotriene Modifiers interfere with synthesis
  or block the action of leukotrienes which cause
  inflammation. Examples are
• lukast
• Montelukast (Singulair)

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Valuable Miscellaneous Interventions
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Respiratory and Physical Therapy

• Encourage to attend pulmonary rehabilitation
  classes (exercise supervised by professionals)
• Breathing retraining (handout)
• Purse-lip
• Diaphragmatic (abdominal breathing)
• Increase exercise tolerance
• Effective coughing
• Flutter mucus clearance device
• Acapella- hand-held device that loosens
  secretions via vibrations positive pressure
• Teach patients to assess sputum
• Avoid conversation with exercise

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Metered Dose Inhalers

• Common treatment.
• Note location of MDI when a spacer or aerochamber
  is not used.

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Peak Flow Meters
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Flutter Mucus Device
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COPD

• Abdominal Breathing

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Pursed Lip Breathing

• http//www.bing.com/videos/search?qteachingpurse
  dlipbreathinganimationqsnformQBVRpqteachi
  ngpursedlipbreathinganimationsc0-30sp-1sk
  viewdetailmid76EC2961EE65A64565A976EC2961EE65
  A64565A9

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Nutritional Therapy

• Weight loss and malnutrition are common
• Pressure on diaphragm from a full stomach causes
  dyspnea
• Difficulty breathing while eating leads to
  inadequate consumption
• Drink fluids in between meals
• Rest at least 30 minutes prior to eating
• Frequent small meals (high calorie and protein)
• Prepare foods in advance

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Respiratory Therapy

• Aerosol nebulization therapy
• Deliver suspension of fine particles of liquid
  (medication) in a gas
• Easy to use
• Must be kept clean at home to prevent bacterial
  growth

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Managing Oxygen Liter Flow

• Outdated information Never exceed 2 liters of
  oxygen per nasal cannula for patients with
  chronic lung disease because can knock out drive
  to breath. This can occur but is rare.
• New standard is to use oxygen saturation level
  as guide to how much oxygen to deliver. Increase
  oxygen level to maintain therapeutic oximetry. If
  Sp02? with ? O2, stop.