PHARMACOTHERAPY

OF THE
RESPIRATORY SYSTEM
The Laryngospasms - Breathe
CONCEPT: Oxygenation
CONCEPT: Oxygenation
Breath Sounds
CONCEPT:Oxygenation
GAS
EXCHANGE
Anxiety
Acid Base
Balance
Perfusion
Fatigue
Mobility
Nutrition
Interrelated Concepts
Altered Respiratory Function
Hypoxia what are the signs and
symptoms?
Assessment of Oxygenation Status
What does the nurse assess?
IN CLASS CASE STUDY ACTIVITY

Mr. Jimmy Bley


Marital
Status
Married to Cecelia for 60 years
Children/
Grand-
children
8 grown children and many grandchildren and great
grandchildren, all of whom live in the area
Religion Presbyterian
Hobbies
Building computers, playing computer games, surfing the
internet
Volunteer
Service
Donates the computers he makes to an organization that
sends them to Africa
Support
System
Very close to his wife, children, and grandchildren
Ethnicity Caucasian
Job Retired veteran, electronics technician
Salary
Veteran pension of $2230 per month. Social security of $1531
plus Cecelia's benefit of $765 per month.
Education High school graduate. Army training in electronics
Benefits Retired N/A
Health
Insurance
Medicare A and B
Housing Owns a 4 bedroom, 2-story house outside of town
Debt House is paid off. No debt. Lives frugally on monthly income
Jimmy has been experiencing increasing
shortness of breath over the past several
months with activities such as mowing the
lawn and household chores as well as walking
any distances
He has an Albuterol inhaler that expired 2
years ago but he refuses to refill it stating it is
a waste of money this one still works fine
He has come to see his MD for his 6 month
visit

After the visit Dr. Rowe adds Salmeterol 50
mcg/inhalation MDI one inhalation twice daily
to Jimmys medication regime
Jimmy's MD visit
Jimmy's Cigarette Log
Nicotine gum - no cigarettes
# of cigarettes in the jar: Mon 10, Tues 8,
Wed 7, Thurs 10, Fri 12, Sat 5, Sun 14
Jimmy's nighttime coughing fit
Two weeks PTA

Feels it is a bad cold
Cecilia puts a humidifier in the bedroom

One Week PTA

Productive cough
Increased fatigue
Decreased appetite
Decreased thirst

Night of Admission

Wakes up unable to take a breath
Hospital Admission
Group Activity
Look up Pain Medications and identify the following:
Pharmacokinetics


1. Any concerns related to absorption; distribution; metabolism; excretion?
2. Any contraindications?
3. How will the medication prescribed benefit the patient? (Mechanism of
Action and Indications) Is the prescribed dose appropriate? Any concerns
with the medication orders?
4. Side effects to be alert for?
5. Drug Interactions to be concerned about?
6. Food Interactions to be concerned about?
7. Nursing Implications:
8. Patient teaching: key points




Route(s) Onset of Action Peak Plasma
Concentration
Half Life Duration of
Action
Group In Class Assignment
1 2 3 4 5 6
Albuterol Salmeterol Atrovent
Pharmacokinetics
Questions 1, 2, 5
and 6
Questions
3, 4, 7 and 8
Pharmacokinetics
Questions 1, 2, 5 and
6
Questions
3, 4, 7 and
8
Pharmacokinetics
Questions 1, 2, 5
and 6
Questions
3, 4, 7 and
8
Pathophysiology of an Allergic Reaction
Describe the steps in an allergic reaction
Category: Anti-Inflammatory
Classification: Mast Cell Stabilizer
Prototypes:
cromolyn (Intal)
nedocromil (Tilade)

Drug Route Onset of
Action
Peak Plasma
Concentration
Half Life Duration
Intal Inhalation 2-4 weeks unknown unknown unknown
Indications: Mechanism of Action:
Chronic management of
asthma
Chronic management of
airway inflammation in
allergic asthma
Stabilizes mast cells ->
prevents histamine and
other inflammatory
mediators release (ie:
eosinophils, neutrophils,
macrophages)
Contraindications:
hypersensitivity
Pregnancy: Category B
Side Effects

RESP: Cough; Bronchospasm
Category: Anti inflammatory
Classification: Leukotriene Modifiers
AKA :Leukotriene Receptor Antagonists
Prototypes:
montelukast (Singulair)
zafirlukast (Accolate)
zileuton (Zyflo) (actually a
leukotriene synthesis inhibitor)


Route Onset of Action Peak Plasma
Concentration
Half Life Duration
PO 30 minutes 3-4 hours 2.7-5 hrs 24 hrs
Indications: Mechanism of Action:
Chronic asthma in adults
and children older than 12
years of age (except
montelukast)

prevent leukotrienes from
attaching to receptors on
cells in the lungs and in
circulation
Inflammation in the lungs is
blocked, and asthma
symptoms are relieved

Contraindications:
Hypersensitivity
Caution with pre-existing hepatic
impairment
Pregnancy: Category B
Zyflo CR: Category C
Side Effects:
CNS: headache, dizziness, insomnia
GI: nausea, vomiting, anorexia
Endo: liver dysfx