Respiratory Flashcards
Therapeutic Use
Beta2-Adrenergic Agonist - albuterol
Long-term management of asthma
Prevention of exercise-induced bronchospasm
Treatment of ongoing asthma exacerbations
Adverse Effects
Beta2-Adrenergic Agonist - albuterol
Chest pain, palpitations
Nervousness, restlessness, tremors
Medication Administration
Beta2-Adrenergic Agonist - albuterol
Follow manufacturer’s instructions for using delivery devices
Use short-acting preparations for acute exacerbations
Use long-acting preparations for long-term control
Inhale beta2-adrenergic agonists before inhaling glucocorticoids
Follow dosage limits and schedules
Watch for signs and triggers of impending exacerbations of asthma
Keep a log of the frequency and intensity of exacerbations
Notify the provider of changes in patterns of exacerbations
Therapeutic Use
Anticholinergics - ipratropium
Relief of bronchoconstriction in clients who have COPD
Decrease secretions in clients with COPD
Expected Pharmacological Action
Anticholinergics - ipratropium
Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchodilation
Adverse Effects
Anticholinergics - ipratropium
Dry mouth, irritation of pharynx
Increased intraocular pressure
Urinary retention
Medication Administration
Anticholinergics - ipratropium
Follow manufacturer’s instructions for using delivery devices
Follow the dosage limits and schedules
Allow the prescribed time between puffs
Delay use of other inhalants for 5 minutes
Do not use as an emergency rescue medication
Rinse the mouth after use to reduce unpleasant taste
Contraindications
Anticholinergics - ipratropium
Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide, history of sensitivity to soy or peanuts- avoid Combivent (ipratropium/albuterol combination) MDI form of drug
Adverse Effects
Methylxanthines - theophylline
Rare at therapeutic levels
When therapeutic levels are exceeded: restlessness, insomnia
Nausea, vomiting, diarrhea
Toxicity Symptoms
Methylxanthines - theophylline
Seizures, dysrhythmias
Client Education
Methylxanthines - theophylline
Reduce or eliminate caffeine intake
Have periodic laboratory testing of drug levels
Stop takin the drug and notify provider if experiencing seizure
Stop taking the drug and notify provider if experiencing dysrhythmias
Contraindications
Methylxanthines - theophylline
Clients with impaired metabolism Tobacco or marijuana use Caffeine Heart disease Liver dysfunction Acute pulmonary edema
Adverse Effects
Glucocorticoids - beclomethasone dipropionate
Inhaled: oral candidiasis
Oral: Suppression of adrenal function, bone demineralization, muscle wasting, hyperglycemia, peptic ulcer disease, infection, fluid and electrolyte imbalances
Nasal: dry mucous membranes, epistaxis, sore throat, headache
Client Education
Glucocorticoids - beclomethasone dipropionate
Rinse mouth or gargle water after use
Monitor for redness, sores, or white patches and report to provider if they occur. Treat candidiasis with nystatin oral suspension
Therapeutic Use
Mast Cell Stabilizers - cromolyn
Long-term treatment of allergy-related asthma
Prophylaxis for exercise-induced bronchospasm
Prophylaxis for seasonal allergy symptoms
Management of allergic rhinitis (intranassaly)
Medication Administration
Mast Cell Stabilizers - cromolyn
Use with a nebulizer or metered-dose inhaler
Expect several weeks of use for full effects to become apparent
Administer four times daily on a fixed schedule
Use the inhaler 15 minutes before exercising to prevent exercise-induced bronchospasms
Do not use to relieve an acute asthma exacerbation
Nursing Interventions
Mast Cell Stabilizers - cromolyn
Administer epinephrine and/or antihistamines to reverse anaphyaxis
Adverse Effects
Leukotriene Modifiers - Montelukast
Leukotriene modifiers zileuton and zafirlukast can cause liver damage. Does not occur with Montelukast
Neuropsychiatric effects such as suicidal ideations
Nursing Interventions
Leukotriene Modifiers - Montelukast
Monitor liver function with periodic testing
Observe for behavioral changes
Client Education
Leukotriene Modifiers - Montelukast
Report abdominal tenderness, nausea, or anorexia
Report behavioral changes such as agitation, insomnia, anxiety, or irritability
Therapeutic Use
First Generation Antihistamines - diphenhydramine
Management of: mild allergic reactions (seasonal allergic rhinitis, cough, urticaria, mild transfusion reaction), anaphylaxis (hypotension, acute laryngeal edema, bronchospasm), motion sickness, insomnia (short-term use, no longer than 2 consecutive weeks)
Expected Pharmacological Action
First Generation Antihistamines - diphenhydramine
Acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site
Decreases allergic response by blocking histamine
Adverse Effects
First Generation Antihistamines - diphenhydramine
Drowsiness, dizziness Anticholinergic effects (dry mouth, constipation)
Therapeutic Use
Second Generation Antihistamines - certirizine
Management of: allergic rhinitis, chronic idiopathic urticaria
Medication Administration
Second Generation Antihistamines - certirizine
May take with or without food
Do not take with other over-the-counter antihistamines
Expect dose to be lower in clients who have compromised renal or liver function
Client Education
Second Generation Antihistamines - certirizine
Take once-daily dose at time desired
Avoid driving and activities that require mental alertness until the drug’s effects are known
Take frequent sips of water
Suck on hard candy
Adverse Effects
Sympathomimetics - phenylephrine
CNS stimulation with oral agents (agitation, anxiety, insomnia)
Increased blood pressure
Tachycardia/palpitations
Overdose or systemic absorption: hypertension, tachycardia, and heart palpitations
Rebound congestion with prolonged use of topical agents
Client Education
Sympathomimetics - phenylephrine
Notify provider of excessive symptoms of CNS stimulation
Consult provider regarding alternative therapy or withdrawal of drug
Report prolonged tachycardia or heart palpitations
Have blood pressure checked while on medication if previously diagnosed with hypertension
Do not use for more than 3 to 5 days
Taper and discontinue the drug using one nostril at a time
Expected Pharmacological Action
Antitussives - codeine and dextromethorphan
Depress pain impulse transmission at the spinal cord level by interacting with opioid receptors
Decreases cough reflex, GI motility
Adverse Effects
Antitussives - codeine and dextromethorphan
CNS depression (drowsiness, sedation common with opioid antitussives; only occurs in non-opioid antitussives if you give large doses or other CNS depressant drugs concurrently)
Dizziness, lightheadedness (more common with opioid antitussives)
Gastrointestinal distress (nausea, vomiting)
Respiratory depression (opioids only)
Potential for abuse
Contraindications
Antitussives - codeine and dextromethorphan
Known sensitivity to the drug
MAO inhibitors or SSRIs
Prostatic hypertrophy
Reduce respiratory reserve (emphysema, chronic asthma)
History of substance abuse
Use cautiously in children and older adults
Expected Pharmacological Action
Expectorants - guaifenesin
The expected pharmacological action of expectorants is a reduction in the surface tension of secretions. This thins out thick mucous, making it easier to cough out of the lungs and drain out of the nose and sinuses
Client Education
Expectorants - guaifenesin
Do not take before driving or activities requiring mental alertness
Sit or lie down if feeling lightheaded
Change positions gradually
Take the drug with food and/or 8oz of water
Stop taking the drug and seek medical care if experiencing an allergic reaction
Evaluation of Medication Effectiveness
Expectorants - guaifenesin
Cough is more productive and mucous is easier to expectorate
Chest congestion is decreased
Therapeutic Use
Mucolytic - acetylcysteine
Decrease viscosity of mucous secretions
Reverse acetaminophen overdose
Client Education
Mucolytic - acetylcysteine
Report any difficulty breathing or worsening cough Expectorate secretions Take antiemetic as needed Proper use and cleaning of nebulizer Consume 2,000 to 3,000 mL of water daily
Contraindications
Mucolytic - acetylcysteine
Risk of actual gastric bleeding
