Bronchodilators
Lilley Pharmacology Text: Chapter 35
Original PPT modified by:
Professor of Nursing
Original by:
Review of Glossary Terms:
Lilley pg. 542
Alveoli:
Antigen:
Antibody:
Asthma
Attack:
Bronchial
Asthma:
Chronic
Bronchitis:
Emphysema:
ADDITIONAL TERMS
Acute:
Exacerbation:
Diseases commonly treated with Bronchodilators
Asthma
COPD
Chronic
Bronchitis
Emphysema
BRONCHODILATOR CLASSIFICATIONS
Bronchodilators:
ό Xanthines Derivatives
ό Beta-Agonists
Xanthine Derivatives
(Refer to Prototype List in syllabus, pg. 19)
Prototype
Drugs:
Aminophylline
How Do These Drugs Work?
Relieve
Bronchoconstriction
Cause
bronchodilatation
Mechanism of Action
Cause
bronchodilation by:
Increasing
the levels of the energy producing substance called cAMP
Inhibiting
PDE the enzyme that breaks down *cAMP
.
Subsequently,
this causes smooth muscle relaxation and broncchodilation; also inhibits
release of chemical mediators such as histamine, etc.
*
Mechanism of Action contd.
Slow
onset of action, so used more as preventative measure, however, also used as a continuous
IV infusion to treat reversible bronchospasm in COPD clients who have an
exacerbation of symptoms
Drug Effects
Relieve
bronchopasms by causing airways to dilate, thereby improving air passage into
and out of lungs
Stimulates CNS:
Increases
contractility of heart (+ inotropic)
Increases
heart rate (+chrontropic)
Increases
cardiac output, thereby causing a
.
Diuretic
effect
what would cause this???????
Therapeutic Uses
Dilate airways
in asthma, chronic bronchitis and emphysema
Adjunctive
agent for treatment of pulmonary edema and dyspnea in left-sided heart failure
by increasing cardiac output and increasing bloodflow to kidneys ΰdiuresis
Lab Diagnostics
Cavanaugh Text: pg. 215
Side and Adverse Effects
Nausea
Vomiting
Anorexia
Gastroesophageal
reflux
CARDIAC!!!!!!!! HIGH ALERT!!!!
Sinus
Tachycardia
Palpitations
Ventricular
Dysrhythmias
Hyperglycemia
(transient)
Increased
urinary output (transient)
Interactions
Allopurinol
Cimetidine
Erythromycin
Flu
Vaccine
Oral
Contraceptives
Need
blood levels monitored closely
Available Theophylline Preparations
Oral
Parenteral
(aminophylline infusion)
Rectal
Beta-Agonists or Sympathomimetic Bronchodilators
(Refer to Prototype List in syllabus,
pg. 19
Also listed
in Lilley, pg. 548)
Prototype
Drugs: (Brand name in parentheses)
- Albuterol (Proventil) Beta2 Selective
OTHERS:
-Ephedrine
-Epinephrine (Adrenalin, Primatene, Bronkaid)
-Terbutaline (Brethine)
When are Beta-Agonists used?
During acute
phase of asthmatic attack
To quickly
reduce airway constriction and cause bronchodilation
WHY ARE THEY CALLED AGONISTS????
AGONISTS or
stimulators of SNS receptors----->
SYMPATHOMIMETIC ACTION
WHAT IS THE PRIMARY MECHANISM OF ACTION??
Imitate the
effects of norepinephrine on receptors
Stimulate
beta2-adrenergic receptors in the lungs causing dilation within the airways of
the lungs (Example: Albuterol/Proventil)
Specific Receptors
Refer to Lilley text, pg. 547
Nonselective
adrenergic: stimulate the alpha,
beta1 (cardiac), and beta2-
(respiratory) receptors (Example:
epinephrine)
Nonselective
beta-adrenergic: stimulate both beta1 and beta2 receptors (Example:
Isuprel)
Selective
beta2: stimulate the beta2 receptors (Example: albuterol)
Drug Effects
**SELECTIVE BETA2
Beta2
stimulationΰ causes bronchodilation; also a decreased diastolic
B/P, decreased K+ level
Mechanism of Action
Begins
with specific receptors stimulated and ends with the dilation of airways
Smooth
muscles relax and airflow increased
Therapeutic Uses of
Beta-Agonists
Pulmonary
disorders for relief of bronchospasm
Nonselective:
Used for hypotension and shock treatment and to relieve nasal congestion and
stuffiness
Bronchodilators:
Beta-Agonists
Side Effects
Alpha-Beta Beta1
and Beta2 Beta2
(epinephrine) (isoproterenol) (albuterol)
Insomnia
cardiac stimulation
hypotension
restlessness tremor vascular headache
anorexia anginal pain
cardiac stimulation vascular
headache tremor
vascular headache
Interactions
Beta-agonist
with nonselective beta-adrenergic blocker (beta-blocker)ΰ
antagonizes the bronchodilation effect!!!
Avoid
Available Selected
Beta-Agonist Preparations
SC
Inhaler
Nebulizer
IM
Nursing Considerations for Bronchodilators
Does
the client have cardiac disease??
If
so, which type of bronchodilator should be the drug of choice??
Does
the client have diabetes??
If
the client is receiving a xanthine, what blood levels should be monitored???
A client is receiving IV aminophylline for a severe
exacerbation of COPD. Which of the following would you expect when evaluating
for a therapeutic response to the medication?
A. Drowsiness
B. Increased heart
rate
C. Dilatation
of bronchioles
D. Increased respiratory rate
Which of the following side effects is associated with
the use of xanthine derivatives?
A. Bradycardia
B. Palpitations
C. Increase in appetite
D. Constriction of bronchioles
Overview of Drugs Affecting
the Respiratory System
Bronchodilators
Xanthine
derivatives
Beta-agonists
Anticholinergics
Antileukotriene
agents
Corticosteroids
Mast
cell stabilizers
THE END