Respiratory Meds

8/6/2019 Respiratory Meds

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Respiratory Medications



Bronchodilators A. Description

1. Symphathomimetic bronchodilators dilate theairways of the respiratory tree, making air exchange and respiration easier for the client,and relax the smooth muscle of the bronchi.

2. Xanthine bronchodilators stimulate the centralnervous system and respiration, dilate coronaryand pulmonary vessels, cause diuresis, andrelax smooth muscle

3. Used to treat allergic rhinitis and sinusitis, acutebronchospasm, acute and chronic asthma,bronchitis, chronic obstructive pulmonarydisease, and emphysema



4. Contraindicated in individuals with hypersensitivity, peptic ulcer

disease, sever cardiac disease and cardiac dysrythmias,

hyperthyroidism, or uncontrolled seizure disorders

5. Used with caution in clients with hypertension, diabetes mellitus, or

narrow angle-glaucoma6. Theophylline increases the risk of digitalis toxicity and decreases the

effects of lithium and phenytoin (Dilantin)

7. If theophylline and a beta-adrenergic agonist are administered

together, cardiac dysrhythmias may result

8. Betta blockers, cimetidine (Tagamet), and erythromycin increase theeffects of theophylline

9. Barbiturate carbamazepine (Tegretol) decrease the effects of

theophylline



B. Side effects

1. Palpitations and tachycardia

2. Dysrhythmias

3. Restlessness, nervousness, tremors

4. Anorexia, nausea, and vomiting5. Headaches and dizziness

6. Hyperglycemia

7. Decreased clotting time

8. Mouth dryness and throat irritation with inhalers9. Tolerance and paradoxic bronchoconstriction

with inhalers



C. Implementation

1. Asses vital signs

2. Monitor for cardiac dysrhythmias

3. Asses for cough, wheezing, decreased breath sounds, andsputum production

4. Monitor for restlessness and confusion

5. Provide adequate hydration

6. Administer the medication at regular intervals around the clock tomaintain a sustained therapeutic level

7. Administer oral medications with or after meals to decreasegastrointestinal (GI) irritation

8. Instruct the client not to rush enteric-coated or sustained-releasetablets or capsules

9. Instruct the client to avoid caffeine products, such as coffee, tea,cola, and chocolate



10. Instruct the client in the side effects of bronchodilators

11. Instruct the client in how to monitor the pulse and to

report any abnormalities to the physician

12. Instruct the client in how to use an inhaler or nebulizer and how to monitor the amount of medication remaining

in an inhaler canister

13. Instruct the client to avoid over-the-counter medications

14. Instruct the client to stop smoking and provideinformation regarding support resources

15. Instruct the client with diabetes mellitus to monitor

blood glucose levels



16. Instruct the client with asthma to wear a Medic- Alertbracelet

17. Monitor for a therapeutic serum theophylline level of 10to 20 ug/mL

18. Note that toxicity is likely to occur when the serum levelis greater than 20 ug/mL

19. IV aminophylline or theophylline preparations should beadministered slowly and always via an infusion pump



Bronchodilators: Sympathomimetics

BET A-RECEPTOR AGONISTS

Albuterol (Proventil, Ventolin)

Bitolterol mesylate (Tornalate)

Ephedrine sulfate

Epinephrine (base) suspension (Sus-Phrine)

Epinephrine ( AsthamaHaler Mist)

Epinephrine bitartrate (Bronkaid Suspension Mist)

Epinephrine (racemic) (Vaponefrin)

Epinephrine hydrochloride ( Adrenalin Chloride)Ethylnorepinephrine (Bronkephrine)

Isoetharine hydrochloride (Bronkosol)

Isoetharine mesylate (Bronkometer)



Isoproterenol hydrochloride (Isuprel Glossets, Isuprel

Mistometer)

Isoproterenol sulfate (Medihaler-Iso)

Metaproterenol sulfate ( Alupent, Metaprel)Pirbuterol acetate (Maxair, Autoinhaler)

Salmeterol (Serevent)

Terbutaline sulfate (Brethine, Bricanyl, Brethaire)

ANTICHOLINERGIC

Ipratropium bromide ( Atrovent)





II. Glucocorticoids

(Corticosteroids)

� A. Act as antiinflammatory agents and

reduce edema of the airways

� B. Refer to Chapter 52 for information on

glucocorticoids



Glucocorticoids

(Corticosteroids)� Beclomethasone dipropionate (Vanceril,

Beclovent)

� Triamcinolone ( Azmacort)� Fluticasone (Flonase, Flovent)

� Flunisolide ( AeroBid)



III. Inhaled Nonsteroidal Antiallergy

Agents

A. Description

1. Antiasthmatic, antiallergic, and mast cell

stabilizers that inhabit mast cell release

after exposure to antigens2. Used for the treatment of allergic rhinitis,

bronchial asthma, and exercised-induced

bronchospasm3. Contraindicated in clients with known

hypersensitivity



B. Side Effects

1. Cough or bronchospasm following

inhalation

2.Nasal sting or sneezing followinginhalayion

3. Unpleasant taste in the mouth



C. Implementation

1. Monitor vital signs

2. Monitor respirations and assess lung soundsfor rhonchi, wheezing, and rales

3.

Instruct the client to drink a few sips of water before and after inhalation to prevent coughand unpleasant taste in the mouth

4. Administer oral capsules (cromolyn sodium) atleast 30 minutes before meals

5. Instruct the client not to discontinue themedication abruptly because a reboundasthmatic attack can occur



Inhaled Nonsteroidal Antiallergy

Agents

M AST-CELL ST ABILIZERS

� Cromolyn sodium (Intal)

� Nedocromil (Tilade)



IV. Leukotriene Modifiers A. Description

1. Used in the prophylaxis and treatment of chronicbronchial asthma

2. Not used for acute asthma episodes

3. Inhibit bronchoconstriciton caused by specific antigens

4. Reduce airway edema and smooth muscle constriction

5. Contraindicated with hypersensitivity and in breast-feeding mothers

6. Used with caution in clients with impaired hepatic

function7. Coadministration of inhaled glucocorticoids increases

the risk of upper respiratory infection



B. Side Effects

1. Headache

2. Nausea and Vomting

3. Dyspepsia4. Diarrhea

5. Generalized pain, myalgia

6. Fever 7. Dizziness



C. Implementation


2. Assess lung sounds for rhonchi, wheezing,and rales

3. A

ssess liver function laboratory values4. Monitor for cyanosis

5. Instruct the client to take medication 1 hour before or 2 hours after meals

6. Instruct the client to increase fluid intake

7. Instruct the client not to discontinue medicationand to take as prescribed even duringsymptomfree periods



Leukotriene Modifiers

� Montelukast (Singulair)

� Zafirlukast ( Accolate)

� Zileuton (Zyflo)



V. Antihistamines

A. Description1. Called histamine antagonists or H1 blockers; these medications

compete with histamine for receptor sites, thus preventing ahistamine response

2. When the H1 receptor is stimulated, the extravascular smoothmuscles, including those lining the nasal cavity, are constricted

3. Decrease nasopharyngeal secretions by blocking the H1 receptor and decrease nasal itching that causes sneezing

4. Used for the common cold, rhinitis, nausea, and vomiting, motionsickness, urticaria, and as a sleep aid

5. Can cause central nervous system (CNS) depression if taken withalcohol, narcotics, hypnotics, or barbiturates

6. Used with caution in clients with chronic obstructive pulmonarydisease (COPD) because of the drying effects

7. Diphenhydramine (Benadryl) has an anticholinergic effect andshould be avoided in clients with narrow-angle glaucoma



B. Side Effects

1. Drowsiness and fatigue

2. Dizziness

3. Urinary retention

4. Blurred vision

5. Wheezing

6. Constipation

7. Dry mouth

8. GI Irritation

9. Hypotension

10. Hearing disturbances

11. Photosensitivity12. Nervousness and irritability

13. Confusion

14. Nightmares



C. Implementation


2. Monitor for signs of urinary dysfunction

3. Administer with food or milk

4. Avoid subcutaneous (SC) injection and administer

intramuscular (IM) injection in a large muscle if the IMroute is prescribed

5. Instruct the client to avoid hazardous activities,alcohol, and other CNS depressants

6. Instruct the client taking medication for motion

sickness to take the medication 30 minutes before theevent, and then before meals, and at bedtime duringthe event

7. Instruct the client to suck on hard candy or ice chipsfor dry mouth



Antihistamines

� Astemizole (Hismanal)

� Azatadine maleate (Optimine)

� Azelastine hydrochloride ( Astelin)

� Brompheniramine maleate (Dimetane)� Cetirizine hydrochloride (Zyrtec)

� Chlorpheniramine maleate ( Aller-Chlor, Chlor-Trimeton)

�Clemastine fumarate (Tavist)

� Cyproheptadine hydrochloride (Periactin)

� Dexchlorpheniramine meleate (Polarmine)



� Diphenhydramine (Benadryl)

� Doxylamine succinate (Unisom)

� Fexofenadin ( Allegra)

�Loratadine (Claritin)

� Methdilazine hydrochloride (Tacaryl)

� Phenindamine tartrate (Nolahist)

� Pyrilamine maleate (Nisaval)

� Trimeprazine tartrate (Temaril)

� Tripelennamine citrate or hydrochloride (PBZ-SR)

� Triprolidine hydrochloride (Myidil)



VI. Nasal Decongestants A. Description

1. Stimulate the alpha-adrenergic receptors, thus producingvasoconstriction of the capillaries within the nasalmucosa

2. Shrink nasal mucosal membranes and reduce fluid

secretion3. Used for allergic rhinitis, hay fever, and acute coryza(profuse nasal discharge)

4. Contraindicated for used with extreme caution in clientswith hypertension, cardiac disease, hyperthyroidism, or diabetes mellitus

5. Nasal decongestants can cause tolerance and reboundnasal congestion (vasodilation), caused by irritation of the nasal mucosa, and should not be used for more than48 hours



Side Effects

1. Frequent use of decongestants,especially nasal sprays or drops, canresult in tolerance and rebound nasal

congestion (vasodilation), caused byirritation of the nasal mucosa

2. Nervousness

3.

Restlessness4. Hypertension

5. Hyperglycemia



C. Implementation

1. Assess the client for existing medical disorders

2. Monitor for cardiac dysrhythmias

3. Monitor blood glucose levels

4. Instruct the client to avoid caffeine in large

amounts because it can increase restlessness

and palpitations

5. Instruct the client in the importance of limitingthe use of nasal sprays and drops



Nasal Decongestants

� Oxymetazoline hydrochloride ( Afrin)

� Phenylephrine hydrochloride (Neo-

Synephrine)� Phenylpropanolaminen hydrochloride

(Dimetapp)

� Pseudoephedrine hydrochloride (Sudafed)

� Xylometazoline hydrochloride (Otrivin)





Side Effects

1. GI Irritation

2. Skin rash

3. Oropharyngeal irritation



Implementation

1. Instruct the client to take medication with a full glass of water loosen mucus

2. Instruct the client to maintain an adequate fluid intake

3. Encourage the client to cough and deep breathe

4. Acetylcysteine (Mucomyst), administered bynebulization, should not be mixed with another medication

5. If acetylcysteine (Mucomyst), is administered with abrochondilator, the brochondilator should be

administered 5 minutes before the acetylcysteine6. Monitor for side effects of acetylcysteine (Mucomyst),such as nausea and vomiting, stomatitis, and runnynose



Expectorants and Mucolytic Agents

EXPECTOR ANTS

Guaifenesin (glycerylguaiacolate) ( Anti-

Tuss, Glycotuss,H

umibid, Robitussin)

MUCOLYTIC

Acetylcysteine (Mucomyst)



VIII. Antitussives A. Description

1. Act on the cough control center

in medulla to suppress the

cough reflex2. Used for a cough that is

nonproductive and irritating



Side Effects

1. Dizziness, drowsiness, sedation

2. GI irritation, nausea

3. Dry mouth

4. Constipation

5. Respiratory depression



Implementation

1. Instruct the client that if the cough lasts longer than 1 week afever or rash occurs, the physician should be notified

2. Encourage the client to take adequate fluids with medication

3. Encourage the client to sleep with the head of the bed elevated

4. Instruct the client to avoid hazardous activities

5. Note that drug dependency can occur 6. Avoid administration to the client with a head injury or

postoperative cranial surgery

7. Avoid administration to the client using narcotics, sedative,hypnotics, barbiturates, or antidepressants, because CNSdepression can occur

8. Instruct the client to avoid the use of alcohol

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Respiratory Meds

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