Pharmacology Related to

Respiratory Care

by:
Heston M. Sial
UC-CON Faculty
 Overview of Respiratory Pharmacology
Introduction to Respiratory Pharmacology
Pharmacology plays a crucial role in treating various respiratory conditions by targeting
different aspects of respiratory physiology.
Medications Covered:

● Bronchodilators: Short-acting and Long-acting Beta Agonists

● Corticosteroids: Inhaled vs. Systemic
● Antibiotics: Used for bacterial pneumonia and tuberculosis
● Antitussives & Expectorants: Cough management
● Oxygen Therapy: Indications, benefits, and complications
Bronchodilators
Primary Function:

● Bronchodilators relieve bronchospasm, improving airflow by relaxing the smooth muscle

around the airways.

Indications:

● Used in asthma, COPD, bronchitis, and other obstructive lung diseases.

● May be used for both acute exacerbations and long-term management.
Short-acting Beta Agonists (SABA)
Example: Albuterol (Proventil, Ventolin)

Mechanism of Action:

● Binds to beta-2 adrenergic receptors in the lungs, causing smooth muscle relaxation.
● Acts quickly, within minutes.

Indication:

● Acute relief of bronchospasm (asthma attacks, exercise-induced bronchospasm).

Administration:

● Inhaler (MDI or DPI), nebulizer.

Common Side Effects:

● Tachycardia, jitteriness, tremors, palpitations, headache.

Nursing Interventions:

● Monitor vital signs: Heart rate and respiratory rate to assess for tachycardia or other
side effects.
● Educate patient on proper inhaler technique (e.g., shaking the inhaler before use,
inhaling slowly and deeply).
● Assess response to medication and need for additional doses.
● Instruct patient to carry a rescue inhaler at all times.
Long-acting Beta Agonists (LABA)
Example: Salmeterol (Serevent), Formoterol (Foradil)

Mechanism of Action:

● Similar to SABAs but with a prolonged effect (12+ hours).

● Provides sustained bronchodilation.

Indication:

● Chronic asthma and COPD management.

● Not for acute attacks (should not be used as monotherapy in asthma).
Administration:

● Inhalers, dry powder inhalers (DPI).

Common Side Effects:

● Tachycardia, muscle cramps, headache.

Nursing Interventions:

● Monitor for signs of overuse (e.g., frequent need for rescue inhaler).
● Instruct patient on not using LABAs as a rescue medication.
● Assess for side effects such as tachycardia and muscle cramps.
● Monitor lung function through spirometry or peak flow measurement.
Corticosteroids
Function of Corticosteroids:

● Reduce airway inflammation, decrease mucus production, and enhance responsiveness to

bronchodilators.
● Act at cellular level to decrease inflammation by inhibiting cytokine production and
immune cell activation.

Indications:

● Chronic asthma, COPD, acute exacerbations.

● Long-term control, not for immediate relief.
Inhaled Corticosteroids (ICS)
Example: Budesonide (Pulmicort), Fluticasone (Flovent)

Mechanism of Action:

● Decreases inflammation locally in the lungs.

● Reduces airway hyperresponsiveness and mucus production.

Indication:

● Long-term control of asthma and COPD.

Administration:

● Metered-dose inhalers (MDI), dry powder inhalers (DPI), nebulizers.

Common Side Effects:

● Oral thrush, hoarseness, dysphonia.

Nursing Interventions:

● Instruct patients to rinse mouth with water after each use to prevent oral candidiasis.
● Monitor for oral thrush and other signs of infection.
● Teach proper inhaler technique to ensure full delivery of medication.
● Assess lung function periodically to evaluate treatment efficacy.
● Monitor for signs of adrenal suppression with long-term use.
 Systemic Corticosteroids
Example: Prednisone, Methylprednisolone

Mechanism of Action:

● Suppresses immune system, reducing inflammation throughout the body.

Indications:
● Acute exacerbations of asthma or COPD, severe flare-ups.
● Short-term use to manage inflammation during acute attacks.

Administration:

● Oral (tablets), IV for severe cases.

Common Side Effects:

● Increased appetite, weight gain, fluid retention, mood swings.

● Long-term use: osteoporosis, hyperglycemia, adrenal suppression.

Nursing Interventions:

● Monitor vital signs for signs of fluid retention and changes in blood pressure.
● Assess blood glucose levels, especially in diabetic patients.
● Teach the patient to taper off the medication gradually (to avoid adrenal crisis).
● Educate on side effects such as increased appetite and mood swings.
● Monitor for signs of infection as corticosteroids suppress immune response.
● Recommend weight-bearing exercises to prevent bone loss with long-term use.
Antibiotics
Indications:

● Bacterial pneumonia, tuberculosis (TB), and other bacterial lung infections.

Mechanism of Action:

● Antibiotics target bacterial cell wall synthesis, protein synthesis, or DNA replication to
eliminate the infection.

Choosing the Right Antibiotic:

● Depends on the causative organism (e.g., Streptococcus pneumoniae for pneumonia,

Mycobacterium tuberculosis for TB).
Common Antibiotics for Pneumonia
Example: Amoxicillin, Azithromycin, Levofloxacin
Mechanism of Action:
● Amoxicillin: Inhibits bacterial cell wall synthesis.
● Azithromycin: Inhibits bacterial protein synthesis.
● Levofloxacin: Inhibits bacterial DNA gyrase.
Indication:
● Community-acquired pneumonia, hospital-acquired pneumonia.
Route:
● Oral or IV, depending on severity.
Common Side Effects:
● Nausea, diarrhea, rash, and allergic reactions.
Nursing Interventions:
● Ensure adherence to the full course of antibiotics to prevent resistance.
● Monitor for allergic reactions, especially after the first dose (e.g., rash, difficulty
breathing).
● Monitor renal and liver function for patients receiving antibiotics like levofloxacin.
● Educate patient about potential side effects like gastrointestinal upset.
● Assess sputum for changes in color or consistency, which can indicate effectiveness or
worsening infection.
Antitussives
Function:

● Suppress the cough reflex, useful in dry, non-productive coughs.

Example: Dextromethorphan, Codeine (in some cases)

Mechanism of Action:
● Acts on the cough center in the brain to reduce the urge to cough.

Indications:
● Dry cough from viral upper respiratory infections, postnasal drip.

Common Side Effects:

● Drowsiness, dizziness, GI upset.

Nursing Interventions:

● Monitor for sedation and avoid giving sedatives or alcohol with antitussives.
● Assess cough characteristics to ensure it is non-productive before recommending
antitussive use.
● Instruct patients to avoid driving or operating machinery if drowsiness occurs.
● Advise on hydration to help soothe irritated airways.
Oxygen Therapy
Indication:

● Hypoxemia (low oxygen levels), chronic respiratory diseases (COPD, pneumonia), and
acute respiratory failure.

Goals of Oxygen Therapy:

● Improve oxygen saturation (SpO2) levels to 90% or higher.

● Relieve symptoms of hypoxia (e.g., shortness of breath, confusion).

Administration Methods:

● Nasal cannula, face mask, non-rebreather mask, mechanical ventilation.

Complications of Hyperoxia
Definition:

● Oxygen toxicity or excessive oxygenation that may cause damage to tissues, especially
the lungs.

Risks:

● Oxygen toxicity (damage to alveoli), retinopathy of prematurity in neonates, CO2

retention in COPD patients.

Nursing Interventions:

● Monitor oxygen saturation (SpO2) frequently to avoid excessive oxygen levels.

● Titrate oxygen levels to maintain target SpO2 (typically 92-96% for most patients).
● Assess for signs of CO2 retention (e.g., confusion, lethargy) in COPD patients.
● Monitor for signs of oxygen toxicity in high-concentration settings (e.g., patients on
mechanical ventilation).
Summary & Conclusion
Key Points:

● Bronchodilators help relieve airway obstruction (SABAs for quick relief, LABAs for
long-term control).
● Corticosteroids reduce inflammation in the airways (inhaled for long-term control,
systemic for severe exacerbations).
● Antibiotics target bacterial infections (pneumonia, TB).
● Antitussives & expectorants help manage different types of cough.
● Oxygen therapy is essential in maintaining adequate oxygen levels, but requires careful
monitoring to avoid complications like hyperoxia.

Conclusion:

● Proper use and monitoring of respiratory medications are essential in managing chronic
and acute respiratory conditions to improve patient outcomes.