McKenna's Pharmacology for Nursing, 2e

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Drugs acting on the lower respiratory tract

Learning objectives Upon completion of this chapter, you should be able to: 1. Describe the underlying pathophysiology involved in obstructive pulmonary disease and correlate this information with the presenting signs and symptoms. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions and important drug–drug interactions associated with drugs used to treat lower respiratory tract disorders. 3. Discuss the use of drugs used to treat obstructive pulmonary disorders across the lifespan. 4. Compare and contrast the prototype drugs used to treat obstructive pulmonary disorders with other agents in their class and with other classes of drugs used to treat obstructive pulmonary disorders. 5. Outline the care considerations, including important teaching points, for people receiving drugs used to treat obstructive pulmonary disorders.

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Glossary of key terms bronchodilator: medication used to facilitate respirations by dilating the airways; helpful in symptomatic relief or prevention of bronchial asthma and bronchospasm associated with chronic obstructive pulmonary disease Cheyne–Stokes respiration: abnormal pattern of breathing characterised by apnoeic periods followed by periods of tachypnoea; may reflect delayed blood flow through the brain leukotriene receptor antagonists: drugs that selectively and competitively block or antagonise receptors for the production of leukotrienes D 4 and E 4 , components of slow-reacting substance of anaphylaxis (SRSA) mast cell stabiliser: drug that works at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inflammatory mediators sympathomimetics: drugs that mimic the effects of the sympathetic nervous system xanthines: naturally occurring substances, including caffeine and theophylline, that have a direct effect on the smooth muscle of the respiratory tract, both in the bronchi and in the blood vessels Simulation-based learning On completion of the chapter, consider the scenario of Jennifer Hoffman (Part 1) who arrives in the emergency room with respiratory distress. Continue to Part 2. Consider the medication management of Jennifer’s condition throughout her episode of care, as it relates to your learning in this chapter. Then, work through the scenarios of Vincent Brody (Parts 1 and 2) and consider how the concepts learnt in this chapter relating to airway medication management apply to his case. What learning can be applied?

BRONCHODILATORS/ ANTIASTHMATICS Xanthines aminophylline caffeine theophylline

DRUGS AFFECTING INFLAMMATION Inhaled steroids beclomethasone

Sympathomimetics adrenaline eformoterol

salmeterol terbutaline Anticholinergics ipratropium tiotropium

ephedrine indacaterol salbutamol

budesonide ciclesonide fluticasone