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Chapter 7: Respiratory Drugs

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TERMS TO LEARN

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Antitussive Drug that relieves or prevents cough.
Antihistamine Drug that counteracts histamine; can be divided into two groups: those that block H1 histamine receptors and those that block H2 receptors.
Area Postrema A region of the brain located in the medulla at the base of the 4th ventricle; location of the chemoreceptive trigger zone where vomiting is triggered.
Churg-Strauss Syndrome Vasculitis of the small arteries and veins; characterized by extravascular necrotizing granulomas; typically seen in patients with asthma or an allergy history.
Decongestant Drug that reduces congestion or swelling.
Expectorant Drug that promotes ejection of mucus or exudate from respiratory tract.

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I. COLD MEDICATIONS

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CLASSIFICATION OF COLD MEDICATIONS

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COLD MEDICATIONS: DRUG FACTS

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Drug Class Pharmacokinetics Mechanism of Action Drawbacks/Side Effects
Systemic Decongestants
Pseudoephedrine (Sudafed as well as numerous other OTC preparations)

  • α adrenergic agonist

  • A: PO

  • E: Primarily excreted unchanged in urine

  • α adrenergic stimulation in respiratory mucosa leads to vasoconstriction in the nasal mucosa causing decreased nasal congestion

  • Hypertension

  • Palpitations

  • Restricted access secondary to use in the illicit manufacturing of amphetamines
Phenylephrine (Sudafed PE as well as numerous OTC preparations)

  • A: PO, topical, nasal

  • M: Intestinal wall and hepatic

  • E: Metabolites excreted in urine

  • Hypertension

  • Reflex bradycardia

  • Decreased cardiac output
Diphenhydramine (Benadryl as well as numerous OTC preparations)

  • Antihistamine

  • A: PO, IM, IV, topical

  • M: Hepatic (P450)

  • E: Parent drug and metabolites excreted in urine

  • Blockade of histamine action of H1 receptors prevents stimulation of the sneeze reflex receptors

  • Sedation

  • Urinary retention

  • Inhibits P450 enzymes
Chlorpheniramine (Chlor-Trimeton as well as numerous OTC preparations)

  • A: PO

  • M: Hepatic (P450)

  • E: Metabolites excreted in urine
Topical Decongestants
Oxymetazoline (Afrin as well as numerous other OTC preparations)

  • α adrenergic agonist

  • A: Nasal

  • E: Primarily excreted unchanged in urine

  • α adrenergic stimulation in respiratory mucosa leads to vasoconstriction in the nasal mucosa causing decreased nasal congestion

  • Use with caution in patients with cardiac disease, hyperthyroidism, glaucoma, and diabetes

  • Rebound nasal congestion following cessation of chronic use
Phenylephrine (Neo-Synephrine)

  • A: PO, topical, nasal

  • M: Intestinal wall and hepatic

  • E: Metabolites excreted in urine
Naphazoline (Privine)

  • A: Nasal

  • M: Unavailable

  • E: Unavailable
Expectorant
Guaifenesin (Mucinex, Robitussin)

  • Expectorant

  • A: PO

  • M: Hepatic

  • E: Parent drug and metabolites excreted in urine

  • Thought to act as GI irritant triggering increased respiratory secretions therefore creating thinner, more voluminous mucus

  • Drowsiness

  • Renal stone formation with consumption of large quantities
Antitussive
Codeine

  • Centrally acting antitussive

  • Opioid

  • A: PO

  • M: Hepatic (P450)

  • E: Primarily excreted as metabolites in urine

  • Suppression of cough by action of the μ receptors in the area postrema

  • Nausea/vomiting

  • Constipation

  • Respiratory depression and death in pediatric patients in the setting of T&A

  • Histamine ...

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