NCM 106
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MODULE NO: 2
MODULE TITLE: Drugs Acting on the Respiratory System
WRITER: MA. CRISTINA BENITO, RN
OPENING PRAYER
St. Thomas Aquinas: Prayer
before Study
Creator of all things,
true Source of light and wisdom,
lofty origin of all being,
graciously let a ray of Your brilliance
penetrate into the darkness of my
understanding
and take from me the double darkness
in which I have been born,
an obscurity of both sin and ignorance.
Give me a sharp sense of understanding,
a retentive memory,
and the ability to grasp things correctly and
fundamentally.
Grant me the talent of being exact in my
explanations,
and the ability to express myself with
thoroughness and charm.
Point out the beginning,
direct the progress,
and help in completion;
through Christ our Lord.
Amen.
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MODULE INTRODUCTION AND FOCUS QUESTIONS:
Respiratory disease is caused by airway obstruction and an example of these are patient
with COPD, lung infection like pneumonia and lung cancer. Different medications are given
to the patient depending on the severity and type of disease. Making sure that patients are
given the right medications, proper nursing care and continuous assessment of the nurse
ensures patients wellbeing.
As nursing students, will you be able to provide proper nursing intervention to patients with
respiratory problem ensuring their safety, comfort and holistic care?
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Online Class:
1. Enroll in the Google classroom.
2. Follow the instruction for each activity
uploaded in the Google Classroom.
3. Access the learning materials uploaded in the
Google classroom.
4. Submit the requirements posted in the Google
classroom.
Off-site:
1. Modules will be sent through courier for those
students without internet access.
2. Follow the instructions as provided in the
material.
3. Take note of the schedule and place of
Submission as provided.
Lesson Subtopics Learning Outcomes Estimated
Time
“ I SHOULD BE ABLE TO”...
2 Introduction to the Discuss the process involved in 30 min.
Respiratory System obstructive respiratory diseases,
correlating this to the signs and
symptoms of these diseases.
Drugs Acting on the Upper Use the nursing process to care for 1 hr.
Respiratory Tract patients who are receiving
pharmacotherapy for allergic rhinitis
and the common cold
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Drugs Acting on the Lower Describe the nurse’s role in the 1.5 hr.
Respiratory Tract pharmacologic treatment of lower
respiratory tract disorders.
To do well in this module, you need to REMEMBER and DO the following:
1. Open the indicated website. Explore.
2. Read and go through the module in your own time and pace.
3. Open the suggested references and video links. It will help you in understanding the whole
module.
4. Honestly answer the activities and the answers will be provided for you either online or at the
end of this module.
5. Go beyond the procedure given in the net. Explore more.
6. Before starting this module, it is best to start with a prayer to enlighten you and give you the
wisdom to understand the lesson.
Multiple Choice: Encircle the letter that best describes
your answer. Please answer all items. After taking this
exam, you will be able to check your answers. Take note of
the items that you were not able to correctly answer and
look for the right answer as you go through this module.
1. What are the precautionary measures that patients need to know when taking
Antitussive medications?
A. history of narcotic addiction
B. Any condition that might be exacerbated by sympathetic activity
C. Active infection
D. Avoid exposure to airborne infections
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2. Which of the following is an adverse reaction to topical nasal steroids?
A. Increased nasal drainage
B. Rebound effect
C. Suppression of healing
D. Local ulceration
3. What drug enhances the output of respiratory tract fluid by reducing the
adhesiveness and surface tension of the fluid, which facilitates the removal of viscous
mucus?
A. Guaifenesin
B. Flunisolide
C. Acetylcysteine
D. Dextromethorphan
4. What are the adverse effects of Theophylline?
A. Sympathomimetic stimulation
B. CNS stimulation
C. hyperthyroidism
D. tachycardia
5. Which of the following is a contraindication to using lung surfactants?
A. Prematurity
B. Older adult
C. No contraindications
D. COPD
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ACTIVITY 1: Anticipation Reaction Guide
Instruction: Respond to each statement twice. Once before the lesson and again after reading
the discussion of the lesson
❖ Write YES if you agree with the statement
❖ Write NO if you disagree with the statement
Response Statement Response
Before the After the
Lesson Lesson
YES 1. The common cold is a lower respiratory infection YES
caused by either a virus or bacteria.
YES 2. Cystic fibrosis is a hereditary disease that results in YES
an accumulation of thick mucus that obstructs the
airways and destroys lung tissue.
YES 3. Sinusitis is an infection of the sinuses that, if YES
untreated, can cause infection of the brain.
YES 4. Benzonatate (Tessalon) should not be used by YES
pregnant women because of the potential adverse
effects on the fetus.
NO 5. Pseudoephedrine (Sudafed, Decofed) is used to treat NO
patients with glaucoma because it decreases ocular
pressure.
NO 6. Patient teaching for the use of a nasal decongestion NO
spray should include ensuring that the tip of the bottle
is placed into the nasal passage and slowly squeezed to
ensure that the medication reaches the sinuses.
NO 7. Women taking montelukast (Singulair) for asthma NO
may continue the medication during the preconception
period and pregnancy.
NO 8. Premature infants are at risk for alveoli collapse NO
because of an overproduction surfactant, which causes
the sacs to stick together.
YES 9. Beractant (Survanta) should be instilled directly into YES
the trachea and is indicated for rescue treatment of
infants who have developed respiratory distress
syndrome.
YES 10. The adverse effects of xanthines are directly related YES
to toxic concentrations of theophylline in the blood.
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At the end of this lesson go back to this ARG and
answer the third column. Compare your answer to
your previous answer
END OF STUDY:
Your grasp of the lesson will further be enhanced as you go through the
next phase. Try to incorporate everything that you’ve learned from
everyday experience especially as you start your clinical practice.
Activity 2: Enhance your knowledge
ONLINE: Download the PowerPoint presentation uploaded in google classroom.
OFFLINE: A copy of the Power Point presentation is enclosed at the end of this module.
Here are some questions to help you when going through your Learning Materials.
GUIDE QUESTIONS:
1. What are the major structures of the respiratory system, including the role of each
in respiration?
2. What are the underlying physiological events that can occur with upper respiratory
disorders?
3. What are the underlying pathophysiology involved in obstructive pulmonary
disease and how can you correlate this information with the presenting signs and
symptoms?
4. What are the therapeutic actions, indications, pharmacokinetics, contraindications,
most common adverse reactions, and important drug–drug interactions associated
with drugs acting on the upper and lower respiratory tract disorders?
5. What are the uses of drugs that act on the upper and lower respiratory tract
across the lifespan?
6. What are the nursing considerations, including important teaching points, for
patients receiving drugs acting on the upper and lower respiratory tract?
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1. The upper respiratory tract humidifies and cleans incoming air. The nasal mucosa is richly
supplied with vascular tissue and is the first line of immunologic defense.
2. Allergic rhinitis is a disorder characterized by sneezing, watery eyes, and nasal congestion.
Pharmacotherapy is targeted at preventing the disorder or relieving its symptoms.
3. Intranasal corticosteroids have become drugs of choice in treating allergic rhinitis due to their
high efficacy and wide margin of safety. For maximum effectiveness, they must be administered
2 to 3 weeks prior to allergen exposure.
4. Antitussives are effective at relieving cough caused by the common cold. Opioids are used for
severe cough. Nonopioids such as dextromethorphan are used for mild or moderate cough.
5. Expectorants promote mucus secretion, making it thinner and easier to remove by coughing.
Mucolytics directly break down mucus molecules.
6. Asthma is a chronic disease that has both inflammatory and bronchospasm components.
Drugs are used to prevent asthmatic attacks and to terminate an attack in progress.
7. Inhaled corticosteroids are often drugs of choice for the long-term prophylaxis of asthma.
Oral corticosteroids are used for the short-term therapy of severe, acute asthma.
8. Monoclonal antibodies offer a newer approach for the prevention of asthma symptoms.
These drugs are only used for persistent cases of the disease when other therapies have been
unsuccessful.
9. Chronic obstructive pulmonary disease (COPD) is a progressive disorder treated with multiple
pulmonary drugs. Bronchodilators, expectorants, mucolytics, antibiotics, and oxygen may offer
symptomatic relief.
10. The most commonly used decongestants are oral and intranasal sympathomimetics that
alleviate the nasal congestion associated with allergic rhinitis and the common cold. Intranasal
drugs are more efficacious but should be used for only 3 to 5 days due to rebound congestion.
Activity 3: Watch the video on Respiratory Drugs
Click the link:
https://youtu.be/SKGJsGOFBMI
https://youtu.be/k-EQb3OVhU4
https://youtu.be/_7tWc5s4z80
https://youtu.be/ls3zzWPFEPM 8
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PATHOPHYSIOLOGY OF ALLERGIC RHINITIS
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Changes in the bronchioles during an asthma attack:
END OF RESEARCH:
Information is power. Now it’s time for you to apply your understanding on
the topic.
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Instructions: Read and understand the situation provided below then answer correctly the
question.
Note: Answers that are just copied from the internet will not be given a score/point.
EXERCISE 1: CRITICAL THINKING
A 74-year-old male patient informs the nurse that he is taking diphendydramine (Benadryl) to
reduce seasonal allergy symptoms. This patient has a history of an enlarged prostate and mild
glaucoma (controlled by medication).
a. What is the nurse’s response?
ANSWER: The nurse needs to give his patient enlightenment and proper education about the
potential side effects of the anticholinergic effects as his medication, which gives potent
symptoms of as blurred vision, dry mouth, constipation, and urinary retention.
EXERCISE 2: CRITICAL THINKING
A 7-year-old boy with a history of asthma goes to the health room at his elementary school and
states that he has increased shortness of breath and chest tightness. On assessment, the
school nurse notes scattered expiratory wheezes throughout his upper and middle lung fields
and a decreased peak meter flow. The current therapeutic regimen for this child includes
salmeterol (Serevent) two puffs every 12 h, montelukast (Singulair) 5 mg/day PO in the
evening, triamcinolone (Azmacort) two puffs tid, and albuterol (Proventil) two puffs every 4 h
prn. After observing the child’s technique in using the metered-dose inhaler (MDI), the school
nurse wishes to reinforce the child’s education as it relates to the administration technique of
his inhalants.
a. What areas should be emphasized?
ANSWER:
1. Remove protective cap from the end of the mouthpiece
2. Prime the inhaler by shaking it well then press down on the canister to release the sprays
into the air, away from your face.
3. Shake the inhaler well
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4. Exhale as completely as possible through your mouth followed by normal breath.
5. Hold the canister with the mouthpiece on the bottom, facing you and the canister pointing
upward. Place the open end of the mouthpiece into your mouth and close your lips tightly
around the mouthpiece.
6. Breathe in slowly and deeply for about 10 seconds through the mouthpiece. At the same
time, press down once on the container to spray the medication into your mouth.
7. Wait approximately for 2 minutes before taking the second dose
8. Replace the protective cap on the inhaler
9. Rinse mouth with water after each use, especially after steroids.
Output of this activity can be submitted in the following portals:
1. Google classroom
2. Messenger
3. Email: macristina.benito@ust-legazpi.edu.ph
END OF ANALYSIS:
Now is the time to assess yourself whether you need additional time to
study and go through the module again or you can now go to the next
phase
Multiple Choice: Encircle the letter that best describes
your answer. Please answer all items. After taking this
exam, you will be able to check your answers. Take note
that this is already an evaluation of your learning. If you
score below the expected level, its best to go through the
module again.
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PHARMACOLOGY
1. What are the adverse effects of Theophylline?
A. Sympathomimetic stimulation
B. CNS stimulation
C. hyperthyroidism
D. tachycardia
2. What are the precautionary measures that patients need to know when
taking Antitussive medications?
A. History of narcotic addiction
B. Any condition that might be exacerbated by sympathetic activity
C. Active infection
D. Avoid exposure to airborne infections
3. What drug enhances the output of respiratory tract fluid by reducing the
adhesiveness and surface tension of the fluid, which facilitates the removal
of viscous mucus?
A. Guaifenesin
B. Flunisolide
C. Acetylcysteine
D. Dextromethorphan
4. Which of the following is an adverse reaction to topical nasal steroids?
A. Increased nasal drainage
B. Rebound effect
C. Suppression of healing
D. Local ulceration
5. A client has a prescription for fluticasone (Flonase). Place the instructions that
follow in the order in which the nurse will instruct the client to use the drug.
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3. A. Instill one spray directed high into the nasal cavity.
2. B. Clear the nose by blowing.
1. C. Prime the inhaler prior to first use.
4. D. Spit out any excess liquid that drains into the mouth.
END OF ACTION
You are almost done with Lesson 2 of your module, go back to the last
column of your ARG and answer the questions again. This time compare
your previous answers to your latest answers. Was there any
improvement?
Learning Skills
I’m an Expert I still need to Oh no, I need help
Practice
1. I Can Discuss the ✓
process involved in
obstructive respiratory
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diseases, correlating this to
the signs and symptoms of
these diseases.
2. I Can Use the nursing ✓
process to care for patients
who are receiving
pharmacotherapy for allergic
rhinitis and the common cold
3. I Can Describe the ✓
nurse’s role in the
pharmacologic treatment of
lower
respiratory tract disorders.
Textbook:
1. Smith, B.T., Pacitti, D., 2020. Pharmacology for Nurses, 2nd Edition. Jones &Barlett Learning,
LLC, Burlington, Massachusette.
2. Karch, Amy M., 2017, Focus on Nursing Pharmacology, , 7th edition. Wolters Kluwer Health
3. Adams, M., Holland, N., Urban, C., 2020. Pharmacology for Nurses: A Pathophysiologic
Approach, 6th Edition. Pearson
4. Lippincott William & Wilkins, 2015. Pharmacology A 2-in-1 Reference for Nurses, Lippincott
William & Wilkins
Links:
https://youtu.be/SKGJsGOFBMI
https://youtu.be/k-EQb3OVhU4
https://youtu.be/_7tWc5s4z80
https://youtu.be/ls3zzWPFEPM
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CLOSING PRAYER
May God the Father bless us.
May God the son Heal us.
May God the Holy Spirit enlighten us, and give us eyes to
see with, ears to hear with, hands to do the work of God
with, feet to walk with, a mouth to preach the word of
salvation with and the angel of peace to watch over us
and lead us at last, by our Lord’s gift to the kingdom,
AMEN.
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