Bronchodilators Drug Study

In Partial Fulfillment
Of The Requirements for the Subject
Pharmacology
AY 2020 – 2021
Submitted by:
Vincent M. Material
BSN 2
Submitted to:
Ms. Maria Teresa Ira Bandelaria, MAN, RN, MHoA
NCM 107 Clinical Instructor
November 30, 2020
DRUG STUDY
Lipa City Colleges
College of Nursing

Bronchodilators are a type of medication that make breathing
easier by relaxing the muscles in the lungs and widening the
airways (bronchi). They're often used to treat long-term
conditions where the airways may become narrow and inflamed,
such as: asthma, a common lung condition caused by
inflammation of the airways.

DRUG DATA MECHANISM OF
ACTION
INDICATIONS CONTRAINDICATIONS ADVERSE
REACTIONS
DOSAGE NURSING ACTIONS &
CONSIDERATIONS
Generic
Name:
albuterol
(salbutamol)
Brand Name:
Proventil
CLASSIFICA-
TION:
Pharmacologic
class:
Sympathomimet
ic (beta2-
adrenergic
agonist)
Therapeutic
class:
Bronchodilator,
antiasthmatic
Pregnancy risk
Relaxes smooth
muscles by
stimulating
beta2-
receptors,
thereby causing
bronchodilation
and vasodilation
➣To prevent and
relieve
bronchospasm
in patients with
reversible
obstructive
airway disease
➣To prevent
exercise-induced
bronchospasm
● Hypersensitivity to
drug
Use cautiously in:
● cardiac disease,
hypertension,
diabetes mellitus,
glaucoma, seizure
disorder,
hyperthyroidism,
exercise-induced
bronchospasm,
prostatic hypertrophy
● elderly patients
● pregnant or
breastfeeding
patients
● children.
• CNS: dizziness,
excitement,
headache,
hyperactivity,
insomnia
• CV:
hypertension,
palpitations,
tachycardia,
chest pain
• EENT:
conjunctivitis,
dry and irritated
throat,
pharyngitis
• GI: nausea,
vomiting,
anorexia,
heartburn,
GI distress, dry
mouth
• Metabolic:
hypokalemia
• Musculoskelet
al: muscle
cramps
• Respiratory:
cough, dyspnea,
Availability
Aerosol: 90
mcg/actuation,
108 mcg/inhalation
Oral solution: 2 mg/5 ml
Solution for inhalation:
0.083% (3 ml), 0.5% (0.5
and 20 ml), 0.63 mg/3
ml, 1.25 mg/3 ml
Syrup: 2 mg/5 ml
Tablets: 2 mg, 4 mg
Tablets (extended-
release): 4 mg, 8 mg
Dosages
➣To prevent and relieve
bronchospasm in patients
with reversible obstructive
airway disease
Adults and children
ages 12 and older:
Tablets—2 to 4 mg P.O.
three or four times daily,
not to exceed 32 mg
daily.
Extended-release tablets—
4 to 8 mg P.O. q 12
hours, not to exceed 32
Patient monitoring
✓ Stay alert for
hypersensitivity
reactions and
paradoxical
bronchospasm. Stop
drug immediately if
these occur.
● Monitor serum
electrolyte
levels.
Patient teaching
● Tell patient to swallow
extended release tablets
whole and not to mix
them with food.
● Follow manufacturer’s
directions supplied with
inhalation drugs.
✓ Teach patient signs
and symptoms of
hypersensitivity reaction
and paradoxical
bronchospasm. Tell him
to stop taking drug
immediately and
contact prescriber if

category C wheezing,
paradoxical
bronchospasm
• Skin: pallor,
urticaria, rash,
angioedema,
flushing,
sweating
• Other: tooth
discoloration,
increased
appetite,
hypersensitivit
y reaction
mg daily in divided doses.
Syrup—2 to 4 mg (1 to 2
tsp or 5 to 10 ml) three or
four times daily, not to
exceed 8 mg q.i.d.
Aerosol—one to two
inhalations q 4 to 6 hours
to relieve bronchospasm;
two inhalations q.i.d. to
prevent bronchospasm.
Solution for inhalation—2.5
mg three to four times
daily by nebulization,
delivered over 5 to
15 minutes.
Children ages 6 to 12:
Tablets—2 mg P.O. three
or four times daily;
maximum daily dosage is
24 mg, given in divided
doses.
Extended-release tablets—
4 mg q 12 hours;
maximum daily dosage is
24 mg/kg given in divided
doses. Syrup—2 mg (1 tsp
or 5 ml) three or four
times daily, not to exceed
24 mg.
Adults and children age
4 and older
(with ProAir HFA): Two
inhalations q 4 to 6 hours
to treat acute
these occur.
✓ Instruct patient to
notify prescriber
immediately if
prescribed dosage fails
to provide usual relief,
because this may
indicate seriously
worsening asthma.
● Advise patient to limit
intake of caffeine-
containing foods and
beverages and to avoid
herbs unless prescriber
approves.
● Caution patient to
avoid driving and other
hazardous activities
until he knows how drug
affects concentration
and alertness.
● Advise patient to
establish effective
bedtime routine and to
take drug well before
bedtime to minimize
insomnia.
● As appropriate, review
all other significant
and life-threatening
adverse reactions and
interactions, especially
those related to the
drugs, foods, and herbs

bronchospasm
Children ages 2 to 12
weighing more
than 15 kg (33 lb):
Solution for inhalation—2.5
mg three to four
times/day by nebulization
Syrup—Initially, 0.1 mg/kg
P.O. t.i.d., not to exceed
2 mg (1 tsp t.i.d.
Maximum dosage is
4 mg (2 tsp) t.i.d.
➣To prevent exercise-
induced bronchospasm
Adults and children
older than age 4
(older than age 12 with
Proventil):
Two inhalations 15
minutes before exercise
Adults and children age
4 and older
(with ProAir HFA): Two
inhalations q 15 to 30
minutes before exercise
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
salmeterol
xinafoate
Brand Name:
Serevent Diskus
CLASSIFICA-
TION:
Pharmacologic
class: Beta2-
adrenergic
receptor agonist
(long-acting)
Therapeutic
class:
Bronchodilator
Pregnancy risk
category C
Stimulates
intracellular
adenylate
cyclase, an
enzyme that
catalyzes
conversion
of adenosine
triphosphate to
cyclic-3’, 5’-
adenosine
monophosphate
(cAMP).
Increased cAMP
levels relax
bronchial
smooth muscle
and inhibit
release of
mediators of
immediate
hypersensitivity
(especially from
mast cells).
➣Maintenance
treatment of
asthma;
prevention of
bronchospasm in
patients with
reversible
obstructive
airway disease;
maintenance
treatment of
bronchospasm
in patients with
chronic
obstructive
pulmonary
disease (COPD)
➣Prevention of
exercise-induced
bronchospasm
drug or its
components
● Acute asthma
attack
Use cautiously in:
● cardiovascular
disease, diabetes
mellitus,
hyperthyroidism
● concurrent use of
MAO inhibitors or
tricyclic
antidepressants
(extreme caution
required)
● pregnant or
breastfeeding
patients
● children younger
than age 4.
• CNS: headache,
nervousness,
dizziness,
tremor
• CV: palpitations,
hypertension,
tachycardia,
arrhythmias
• GI: nausea,
diarrhea,
abdominal pain
• Metabolic:
hyperglycemia,
hypokalemia
• Musculoskelet
al: muscle
cramps and
soreness
• Respiratory:
paradoxical
bronchospasm
• Skin: urticaria,
angioedema,
rash
• Other:
hypersensitivity
reaction
Availability
Powder for inhalation
using Diskus delivery
system: 50
mcg/blister (60
blisters)
Dosages
➣Maintenance
treatment of asthma;
prevention of
bronchospasm in
patients with
reversible obstructive
airway disease;
maintenance
treatment of
bronchospasm
in patients with
chronic obstructive
pulmonary disease
(COPD)
Adults and children
older than age 4:
50 mcg (one
inhalation) b.i.d.
approximately
12 hours apart
Patient monitoring
● Assess pulmonary status
and vital signs.
✓ Stay alert for signs and
symptoms of hypersensitivity
reaction, particularly rash,
urticaria, angioedema, and
paradoxical bronchospasm.
Patient teaching
● Remind patient that drug
isn’t a rescue bronchodilator
and won’t give immediate
relief in emergency.
● Teach patient proper
technique for using inhaler
or Diskus. Instruct him not
to exhale into device or use
a spacer with Diskus.
● Advise patient to keep
Diskus dry. Tell him not to
rinse, wash, or take it apart.
● Instruct patient to take
regular doses 12 hours
apart. Tell him to take doses
for exercise-induced
bronchospasm 30 to 60
minutes before exercising.

➣Prevention of
exercise-induced
bronchospasm
Adults and children
older than age 4:
50 mcg (one
inhalation) 30 to 60
minutes Before
exercise. Withhold
additional doses for
at least 12 hours.
● Advise patient to take drug
exactly as prescribed and not
to exceed one inhalation
twice daily.
● Tell patient to consult
prescriber if he needs more
inhalations than usual.
● Caution patient not to stop
taking drug without
consulting prescriber.
● As appropriate, review all
other significant and life-
threatening adverse
reactions and interactions,
especially those related to
the drugs, tests, foods,
and herbs mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
tiotropium
Brand Name:
Spiriva
HandiHaler
CLASSIFICA-
TION:
Pharmacologic
class:
Antimuscarinic,
anticholinergic
Therapeutic
class:
Bronchodilator
Pregnancy risk
category C
Inhibits smooth-
muscle
muscarinic
M3-receptors,
leading to
bronchodilation
➣Long-term,
once-daily
maintenance
treatment of
bronchospasm
associated with
chronic
obstructive
pulmonary
disease
atropine or its
derivatives (including
ipratropium) or
drug components
Use cautiously in:
● angle-closure
glaucoma, prostatic
hyperplasia, bladder
neck obstruction,
moderate to severe
renal impairment,
severe
hypersensitivity to
milk proteins
other anticholinergics
● pregnant or
breastfeeding
patients
● children (safety
and efficacy not
established).
• CNS:
depression,
paresthesia
• CV: angina,
increased heart
rate
• EENT: eye pain
or discomfort,
blurred vision,
visual halos,
cataract, colored
images in
association with
red eyes (with
inadvertent eye
exposure),
epistaxis,
rhinitis,
sinusitis,
laryngitis,
pharyngitis,
dysphonia
• GI: vomiting,
constipation,
dyspepsia,
abdominal pain,
gastroesophage
al reflux,
Availability
Capsules for
inhalation: 18 mcg
Dosages
➣Long-term, once-
daily maintenance
treatment of
bronchospasm
associated with
chronic obstructive
pulmonary disease
Adults: Contents of
one capsule
inhaled orally once
daily using supplied
HandiHaler
Patient monitoring
✓ Closely monitor patient for
allergic reaction and
paradoxical bronchospasm; if
these occur, discontinue drug
and consider alternative
therapy.
● Closely monitor patients
with moderate to severe renal
impairment.
Patient teaching
● Give patient information
portion of package insert on
HandiHaler use.
● Inform patient that drug is
once daily maintenance
medicine that opens narrowed
airways and helps keep them
open for 24 hours. Stress that
it’s not for immediate (rescue)
relief of breathing problems.
● Tell patient that capsules are
intended for oral inhalation
only and should be used only
with HandiHaler device.
Emphasize that HandiHaler
must not be used to take any

stomatitis, dry
mouth
• GU: urinary
tract infection,
urinary
retention,
urinary difficulty
• Musculoskelet
al: myalgia,
skeletal pain,
arthritis, leg
pain
• Respiratory:
upper
respiratory tract
infection,
coughing,
paradoxical
bronchospasm
• Skin: rash
• Other:
nonspecific
chest pain,
edema,
infection,
candidiasis,
flulike
symptoms,
herpes zoster,
hypersensitivit
y reaction
(including
angioedema)
other drug.
✓ Caution patient not to let
powder get into eyes.
● Teach patient to take
prescribed dose in these
steps: Immediately before
use, open one sealed blister
foil and HandiHaler device,
insert capsule, press
HandiHaler button once to
pierce capsule, and exhale
completely before placing
mouthpiece into mouth with
head upright. Then breathe in
slowly and deeply at a rate
fast enough to hear capsule
vibrate, until lungs are full.
Holding breath as long as
comfortable, take HandiHaler
device out of mouth. Then
place device back in mouth
and inhale again to get full
dose.
● Tell patient not to exhale
into HandiHaler mouthpiece at
any time.
● Caution patient not to
swallow capsules.
● Tell patient not to store
capsules in HandiHaler device.
● Instruct patient to clean
device as shown in patient
information sheet.
● Instruct patient to discard

any capsules inadvertently
exposed to air while preparing
dose.
✓ Tell patient to contact
prescriber immediately if eye
pain or discomfort, blurred
vision, visual halos, or colored
images occur.
immediately stop drug and
report signs and symptoms of
hypersensitivity reaction
(including itching, rash,
swelling of the lips, tongue, or
throat) or difficulty breathing.
✓Tell patient to immediately
report signs and symptoms of
prostatic hyperplasia or
bladder-neck obstruction
(such as difficulty passing
urine or painful urination).
threatening adverse reactions
and interactions, especially
those related to the tests
mentioned above.

Corticosteroids (cortisone-like medicines) are used to provide
relief for inflamed areas of the body. They lessen swelling,
redness, itching, and allergic reactions. They are often used as
part of the treatment for a number of different diseases, such as
severe allergies or skin problems, asthma, or arthritis.

ACTION
INDICATIONS CONTRAINDICATIONS ADVERSE REACTIONS DOSAGE NURSING ACTIONS &
CONSIDERATIONS
Generic
Name:
Prednisone
Brand Name:
Winpred
CLASSIFICA-
TION:
Pharmacologic
class:
Corticosteroid
(intermediate
acting)
Therapeutic
class: Anti-
inflammatory,
immunosuppres
sant
Pregnancy risk
Decreases
inflammation by
reversing
increased cell
capillary
permeability
and inhibiting
migration of
polymorpho-
nuclear
leukocytes.
Suppresses
immune system
by reducing
lymphatic
activity.
➣Severe
inflammation;
immunosuppressi
on
➣Acute
exacerbation of
multiple sclerosis
➣Adjunctive
therapy for
Pneumocystis
jiroveci
pneumonia in
AIDS patients
drug, other
corticosteroids,
alcohol, bisulfite, or
tartrazine
(with some products)
● Systemic fungal
infections
● Live-virus vaccines
(with
immunosuppressant
doses)
● Active untreated
infections (except
in selected
meningitis patients)
Use cautiously in:
● diabetes mellitus,
glaucoma, renal or
hepatic disease,
hypothyroidism,
cirrhosis,
diverticulitis,
nonspecific ulcerative
colitis, recent
intestinal
anastomoses,
• CNS: headache,
nervousness,
depression, euphoria,
personality changes,
psychosis, vertigo,
paresthesia, insomnia,
restless-ness,
seizures, meningitis,
increased
intracranial pressure
• CV: hypotension,
hypertension,
vasculitis,
heart failure,
thrombophlebitis,
thromboembolism,
fat embolism,
arrhythmias, shock
• EENT: posterior
subcapsular cataracts
(especially in children),
glaucoma, nasal
irritation and
congestion, rebound
congestion, sneezing,
epistaxis,
nasopharyngeal and
oropharyngeal
Availability
Oral solution: 5
mg/ml, 5 mg/5
ml
Syrup: 5 mg/5
ml
Tablets: 1 mg,
2.5 mg, 5 mg,
10 mg,
20 mg, 50 mg
Dosages
➣Severe
inflammation;
immunosuppres
sion
Adults: Dosage
individualized
based on
diagnosis,
severity of
condition, and
response. Usual
dosage is 5 to
60 mg
P.O. daily as a
single dose or in
divided doses.
Patient monitoring
● Monitor weight, blood
pressure, and electrolyte
levels.
● Watch for cushingoid
effects (moon face, central
obesity, buffalo hump,
hair thinning, high blood
pressure, frequent
infections).
✓ Check for signs and
symptoms of depression
and psychosis.
● Assess blood glucose
level carefully in diabetic
patient.
● Monitor patient for signs
and symptoms of infection,
which drug may mask or
exacerbate.
✓ Assess for early
indications of adrenal
insufficiency (fatigue,
weakness, joint pain, fever,
appetite loss,
shortness of breath,
dizziness, syncope).
● Monitor musculoskeletal

category C inflammatory bowel
disease,
thromboembolic
disorders, seizures,
myasthenia gravis,
heart failure,
hypertension,
osteoporosis,
hypothyroidism,
ocular herpes
simplex,
immunosuppression,
emotional instability
● pregnant or
breastfeeding
patients
● children under age
6.
fungal infections,
perforated nasal
septum, anosmia,
dysphonia,hoarseness,
throat irritation (all
with longterm use)
• GI: nausea, vomiting,
abdominal distention,
rectal bleeding,
esophageal
candidiasis, dry mouth,
esophageal ulcer,
pancreatitis, peptic
ulcer
• GU: amenorrhea,
irregular menses
• Hematologic: purpura
• Metabolic: sodium
and fluid retention,
hypokalemia,
hypocalcemia,
hyperglycemia,
decreased
carbohydrate
tolerance, diabetes
mellitus, growth
retardation (in
children), cushingoid
effects (with long-term
use),
hypothalamicpituitar
y-adrenal
suppression (with
systemic use longer
➣Acute
exacerbation of
multiple
sclerosis
Adults: 200 mg
P.O. daily for 1
week, then 80
mg every other
day for 1 month
➣Adjunctive
therapy for
Pneumocystis
jiroveci
pneumonia in
AIDS patients
Adults: 40 mg
P.O. b.i.d. for 5
days,
then 40 mg
once daily for 5
days, then
20 mg once
daily for 11 days
status for joint, tendon,
and muscle pain.
Patient teaching
● Tell patient to take with
food or milk to reduce GI
upset.
✓ Teach patient to
recognize and immediately
report signs and symptoms
of early adrenal
insufficiency and
cushingoid effects.
✓Inform patient that drug
increases his risk of
infection. Instruct him to
contact prescriber at first
sign of infection.
✓ Caution patient not to
stop drug suddenly. Advise
him to discuss any changes
in therapy with prescriber.
✓ Tell patient to
immediately report
bleeding or joint,muscle,
tendon, or abdominal pain.
✓ Advise patient or
significant other to
immediately report
depression or psychosis.
take herbs or over-the-
counter drugs during
therapy.

than 5 days), adrenal
suppression (with
high-dose, longterm
use)
• Musculoskeletal:
muscle weakness or
atrophy,myalgia,myop
athy, osteoporosis,
aseptic joint necrosis,
spontaneous fractures
(with long-term use),
osteonecrosis, tendon
rupture
• Respiratory: cough,
wheezing,
bronchospasm
• Skin: rash, pruritus,
contact dermatitis,
acne, striae, poor
wound healing,
hirsutism, thin fragile
skin, petechiae,
bruising, subcutaneous
fat atrophy, urticaria,
angioedema
• Other: bad taste,
increased or
decreased appetite,
weight gain (with
long-term use), facial
edema, aggravation
or masking of
infections, hyper-
sensitivity reaction
● Instruct patient to avoid
vaccinations during
therapy. Tell him that
others in household
shouldn’t receive oral polio
vaccine because they could
pass poliovirus to him.
● Tell patient he may need
higher dosage during
periods of stress.
Encourage him to wear or
carry medical identification
stating this.
threatening adverse
the drugs, tests, herbs,
and behaviors mentioned
above.

ACTION
CONSIDERATIONS
Generic
Name:
triamcinolone
acetonide
Brand Name:
Kenalog
CLASSIFICA-
TION:
Pharmacologic
class: Synthetic
corticosteroid
Therapeutic
class: Anti-
inflammatory
(steroidal)
Pregnancy risk
category C
Unknown.
Thought to
decrease
inflammation
mainly by
inhibiting
activities of
mast cells,
macrophages,
and other
mediators of
allergic
reactions.
Also suppresses
immune system
by depressing
lymphatic
activity.
➣Severe
inflammation;
immunosuppressi
on
➣Acute
exacerbation of
multiple sclerosis
➣Adjunctive
therapy for
Pneumocystis
jiroveci
pneumonia in
AIDS patients
drug, other
corticosteroids,
alcohol, bisulfite, or
tartrazine
(with some products)
● Systemic fungal
infections
● Live-virus vaccines
(with
immunosuppressant
doses)
● Active untreated
infections (except
in selected
meningitis patients)
Use cautiously in:
glaucoma, renal or
hepatic disease,
hypothyroidism,
cirrhosis,
diverticulitis,
colitis, recent
intestinal
anastomoses,
inflammatory bowel
• CNS: headache,
nervousness,
depression, euphoria,
personality changes,
psychosis, vertigo,
paresthesia, insomnia,
restless-ness,
seizures, meningitis,
increased
intracranial pressure
hypertension,
vasculitis,
heart failure,
thrombophlebitis,
thromboembolism,
fat embolism,
arrhythmias, shock
• EENT: posterior
subcapsular cataracts
(especially in children),
glaucoma, nasal
irritation and
congestion, rebound
congestion, sneezing,
epistaxis,
nasopharyngeal and
oropharyngeal
fungal infections,
Availability
Cream: 0.025%,
0.1%, 0.5%
Injectable
suspension: 10
mg/ml,
40 mg/ml
Lotion: 0.025%,
0.1%
Ointment:
0.025%, 0.1%,
0.5%
Suspension: 55
mcg/metered
spray
Dosages
➣Severe
inflammation;
immunosuppres
sion
Adults: Dosage
individualized
based on
diagnosis,
severity of
condition, and
response. Usual
dosage is 5 to
Patient monitoring
● Monitor weight, blood
pressure, and electrolyte
levels.
● Watch for cushingoid
effects (moon face, central
obesity, buffalo hump,
hair thinning, high blood
pressure, frequent
infections).
✓ Check for signs and
symptoms of depression
and psychosis.
● Assess blood glucose
level carefully in diabetic
patient.
● Monitor patient for signs
and symptoms of infection,
which drug may mask or
exacerbate.
✓ Assess for early
indications of adrenal
insufficiency (fatigue,
weakness, joint pain, fever,
appetite loss,
shortness of breath,
dizziness, syncope).
● Monitor musculoskeletal
status for joint, tendon,

disease,
thromboembolic
myasthenia gravis,
heart failure,
hypertension,
osteoporosis,
hypothyroidism,
ocular herpes
simplex,
immunosuppression,
emotional instability
● pregnant or
breastfeeding
patients
● children under age
6.
perforated nasal
septum, anosmia,
dysphonia,hoarseness,
throat irritation (all
with longterm use)
rectal bleeding,
esophageal
esophageal ulcer,
pancreatitis, peptic
ulcer
• GU: amenorrhea,
irregular menses
• Hematologic: purpura
• Metabolic: sodium
and fluid retention,
hypokalemia,
hypocalcemia,
hyperglycemia,
decreased
carbohydrate
tolerance, diabetes
mellitus, growth
retardation (in
children), cushingoid
effects (with long-term
use),
hypothalamicpituitar
y-adrenal
suppression (with
systemic use longer
than 5 days), adrenal
60 mg
P.O. daily as a
single dose or in
divided doses.
➣Acute
exacerbation of
multiple
sclerosis
Adults: 200 mg
P.O. daily for 1
week, then 80
mg every other
day for 1 month
➣Adjunctive
therapy for
Pneumocystis
jiroveci
pneumonia in
AIDS patients
Adults: 40 mg
P.O. b.i.d. for 5
days,
then 40 mg
once daily for 5
days, then
20 mg once
daily for 11 days
and muscle pain.
Patient teaching
● Tell patient to take with
food or milk to reduce GI
upset.
✓ Teach patient to
recognize and immediately
report signs and symptoms
of early adrenal
insufficiency and
cushingoid effects.
✓Inform patient that drug
increases his risk of
infection. Instruct him to
contact prescriber at first
sign of infection.
stop drug suddenly. Advise
him to discuss any changes
in therapy with prescriber.
✓ Tell patient to
immediately report
bleeding or joint,muscle,
tendon, or abdominal pain.
✓ Advise patient or
significant other to
immediately report
depression or psychosis.
take herbs or over-the-
counter drugs during
therapy.
● Instruct patient to avoid

suppression (with
high-dose, longterm
use)
muscle weakness or
atrophy,myalgia,myop
athy, osteoporosis,
aseptic joint necrosis,
spontaneous fractures
(with long-term use),
rupture
wheezing,
bronchospasm
• Skin: rash, pruritus,
contact dermatitis,
acne, striae, poor
wound healing,
hirsutism, thin fragile
skin, petechiae,
bruising, subcutaneous
fat atrophy, urticaria,
angioedema
• Other: bad taste,
increased or
decreased appetite,
weight gain (with
long-term use), facial
edema, aggravation
or masking of
infections, hyper-
sensitivity reaction
vaccinations during
therapy. Tell him that
others in household
shouldn’t receive oral polio
vaccine because they could
pass poliovirus to him.
● Tell patient he may need
higher dosage during
periods of stress.
Encourage him to wear or
carry medical identification
stating this.
threatening adverse
the drugs, tests, herbs,
and behaviors mentioned
above.

ACTION
CONSIDERATIONS
Generic
Name:
triamcinolone
acetonide
Brand Name:
Kenalog
CLASSIFICA-
TION:
Pharmacologic
class: Synthetic
corticosteroid
Therapeutic
class: Anti-
inflammatory
(steroidal)
Pregnancy risk
category C
Unknown.
Thought to
decrease
inflammation
mainly by
inhibiting
activities of
mast cells,
macrophages,
and other
mediators of
allergic
reactions.
Also suppresses
immune system
by depressing
lymphatic
activity.
➣Allergic rhinitis
➣Severe
inflammation;
immune-
suppression
➣Corticosteroid-
responsive
dermatoses
drug, tartrazine,
chlorofluorocarbon
propellants, alcohol,
propylene glycol, or
polyethylene glycol
● Systemic fungal
infections (parenteral
use)
● Idiopathic
thrombocytopenic
purpura (I.M. use)
● Administration of
live-virus vaccines
(with immune
suppressant doses of
triamcinolone)
Use cautiously in:
● active untreated
infection, systemic
infection,
immunosuppression,
hypertension,
osteoporosis,
diabetes mellitus,
glaucoma, renal
disease,
hypothyroidism,
• CNS: headache,
vertigo, paresthesia,
syncope, personality
changes,
pseudotumor
cerebri, seizures
• CV: hypertension,
thrombophlebitis,
arrhythmias,
thromboembolism,
heart failure
• EENT: cataract,
glaucoma, increased
intraocular pressure,
exophthalmos, otitis,
nasal or sinus
congestion, rhinitis,
epistaxis, sneezing,
dry mucous
membranes,
pharyngitis, throat
discomfort
dyspepsia, abdominal
distention or pain,
peptic ulcer, ulcerative
esophagitis, oral
pancreatitis
Availability
Cream: 0.025%,
0.1%, 0.5%
Injectable
suspension: 10
mg/ml,
40 mg/ml
Lotion: 0.025%,
0.1%
Ointment: 0.025%,
0.1%, 0.5%
Suspension: 55
mcg/metered spray
Dosages
➣Allergic rhinitis
Adults and children
older than age 12:
220 mcg (two sprays
of acetonide
suspension) in each
nostril daily. When
maximum benefit has
been achieved and
symptoms have been
controlled, reduce
dosage to 110
mcg/day (one spray
in each nostril daily).
Patient monitoring
● Monitor respiratory
status. Watch for
worsening signs and
symptoms.
● With long-term use,
assess for adverse
endocrine and
musculoskeletal
reactions.
● Monitor carefully for
signs and symptoms
of infection, which
drug may mask.
Patient teaching
● Teach patient
correct use of drug.
Make sure he has
received
manufacturer’s patient
information sheet.
● Inform patient that
drug can affect many
body systems. Urge
him to report serious
adverse effects
promptly.
● Tell parents drug

cirrhosis,
diverticulitis,
colitis, recent
intestinal
anastomoses,
thromboembolic
myasthenia
gravis, heart failure,
ocular herpes
simplex, emotional
instability
● pregnant or
breastfeeding
patients
than age 2 (safety
not established).
• GU: cystitis, urinary
tract infection,
glycosuria, menstrual
irregularities, vaginal
candidiasis
• Metabolic: fluid
retention,
hypernatremia,
hypokalemia,
hyperglycemia,
hypocalcemia,
decreased growth (in
children),
carbohydrate
intolerance,
exacerbation of latent
diabetes mellitus,
cushingoid appearance
(moon face, buffalo
hump), hypokalemic
alkalosis, acute
adrenal insufficiency
(with abrupt
withdrawal or acute
stress in long-term
use)
muscle weakness;
steroid myopathy; loss
of muscle mass;
myalgia; bursitis;
tenosynovitis;
osteoporosis;
fractures; aseptic
Children ages 6 to
12: Initially, 110
mcg (two sprays of
acetonide
suspension) as one
spray in each nostril
once daily. Use 220
mcg (two sprays in
each nostril) daily in
children not
responding
adequately to 110
mcg daily.
Children ages 2 to
5: Recommended
and maximum
dosage is 110 mcg as
one spray in each
nostril once daily.
➣Severe
inflammation;
immunosuppression
Adults and children
older than age 12:
60 mg (acetonide)
I.M. at 6-week
intervals. For
intralesional or
sublesional use, 1 mg
at each injection site,
repeated one or
more times weekly;
for intra-articular,
may make child more
vulnerable to
childhood infections,
such as chicken pox
and measles.
● As appropriate,
review all other
significant and life-
threatening adverse
reactions and
drugs and tests
mentioned above.

necrosis; with intra-
articular injection—
rupture, post-injection
flare
wheezing, chest
congestion
• Skin: delayed wound
healing; thin and
fragile skin; petechiae;
bruising; with
topical use—local
eruptions, pruritus,
hypopigmentation or
hyperpigmentation,
scarring, stinging, skin
maceration,
secondary infection,
cutaneous
or subcutaneous
atrophy, diaphoresis,
facial erythema
• Other: toothache,
weight gain, fever,
pain, voice alteration,
hypersensitivity
reaction
intrasynovial, or
softtissue injection,
2.5 to 40 mg,
repeated when
symptoms recur. Or
0.5 mg/square inch
of affected skin
(hexacetonide)
by intralesional or
sublesional injection
or 2 to 20 mg by
intraarticular
injection; may repeat
at 3- to 4-week
intervals.
Children ages 6 to
12: 0.03 to 0.2
mg/kg or 1 to 6.25
mg/m2 I.M. at
intervals of 1 to 7
days
➣Corticosteroid-
responsive
dermatoses
Adults and children
older than age 12:
Apply cream,
ointment, or lotion
sparingly to affected
area two to four
times daily.

ACTION
CONSIDERATIONS
Generic
Name:
dexamethasone
Brand Name:
Dexasone
CLASSIFICA-
TION:
Pharmacologic
class:
Glucocorticoid
Therapeutic
class: Anti-
inflammatory
Pregnancy risk
category C
Unclear.
Reduces
inflammation
by suppressing
polymorphonuc
lear leukocyte
migration,
reversing
increased
capillary
permeability,
and stabilizing
leukocyte
lysosomal
membranes.
Also
suppresses
immune
response (by
reducing
lymphatic
activity),
stimulates
bone marrow,
and promotes
protein, fat,
and
carbohydrate
➣Macular
edema
following
branch
retinal vein
occlusion or
central retinal
vein occlusion;
noninfectious
uveitis
affecting
posterior
segment of
eye
➣Allergic and
inflammatory
conditions
➣Cerebral
edema
➣Suppression
test for
Cushing’s
syndrome
drug, benzyl
alcohol, bisulfites,
EDTA, creatinine,
polysorbate 80, or
methylparaben
● Systemic fungal
infections
● Active or suspected
ocular or periocular
infections, advanced
glaucoma
(intravitreal implant)
Use cautiously in:
● renal insufficiency,
cirrhosis, diabetes
mellitus,
diverticulitis, GI
disease,
cardiovascular
disease, hypopro-
thrombinemia,
hypothyroidism,
myasthenia gravis,
glaucoma,
osteoporosis,
infections,
• CNS: headache,
malaise, vertigo,
psychiatric
disturbances,
increased
intracranial pressure,
seizures
thrombophlebitis,
myocardial rupture
after recent
myocardial
infarction,
thromboembolism
• EENT: cataracts;
elevated intraocular
pressure (IOP),
conjunctival
hemorrhage (with
intravitreal implant)
dry mouth, anorexia,
peptic ulcer, bowel
perforation,
pancreatitis,
ulcerative
esophagitis
Availability
Elixir: 0.5 mg/5 ml
Intravitreal implant:
0.7 mg
Oral solution: 0.5
mg/5 ml, 1 mg/ml
Solution for injection
(sodium phosphate):
4 mg/ml, 10 mg/ml,
20 mg/ml, 24 mg/ml
Tablets: 0.25 mg, 0.5
mg, 0.75 mg,
1 mg, 1.5 mg, 2 mg,
4 mg, 6 mg
Dosages
➣Macular edema
following branch
retinal vein occlusion
or central retinal
vein occlusion;
noninfectious uveitis
affecting posterior
segment of eye
Adults: 0.7 mg by
intravitreal implant
➣Allergic and
Patient monitoring
● Monitor blood glucose
level closely in diabetic
patients receiving drug
orally.
● Monitor hemoglobin
and potassium levels.
● Assess for occult
blood loss.
✓ In long-term therapy,
never discontinue drug
abruptly. Dosage must
be tapered gradually.
● Monitor patient for
increased IOP after
intravitreal injection.
Patient teaching
immediately report
sudden weight gain,
swelling of face or
limbs, excessive
nervousness or sleep
disturbances, excessive
body hair growth, vision
changes, difficulty
breathing, muscle

metabolism. underlying
immunosuppression,
psychotic tendencies
● pregnant or
breastfeeding
patients
● children
• Metabolic: decreased
carbohydrate tolerance,
hyperglycemia,
cushingoid appearance
(moon face, buffalo
hump), decreased
growth (in children),
latent diabetes mellitus,
sodium and fluid
retention, negative
nitrogen balance,
adrenal suppression,
hypokalemic
alkalosis
muscle wasting,
muscle pain,
osteoporosis, aseptic
joint necrosis, tendon
rupture, long bone
fractures
• Skin: diaphoresis,
angioedema, erythema,
rash, pruritus, urticaria,
contact dermatitis,
acne, decreased wound
healing, bruising, skin
fragility, petechiae
• Other: facial edema,
weight gain or loss,
increased susceptibility
to infection,
hypersensitivity
reactions
inflammatory
conditions
Adults: 0.75 to 9
mg/day
(dexamethasone)
P.O. as a single dose
or in divided doses; in
severe cases, much
higher dosages may
be needed. Dosage
requirements vary
and must be
individualized based
on disease and
patient response.
➣Cerebral edema
Adults: Initially, 10
mg (sodium
phosphate) I.V.,
followed by 4 mg I.M.
q 6 hours. Then
reduce dosage
gradually over 5 to 7
days.
➣Suppression test for
Cushing’s syndrome
Adults: 1 mg P.O. at
11 P.M. or 0.5 mg
P.O. q 6 hours for 48
hours (with urine
collection testing, as
ordered)
weakness, persistent
abdominal pain, or
change in stool color.
● Tell patient to take
oral drug with or after
meals.
report vision changes
and if eye becomes red,
sensitive to light, or
painful after intravitreal
implant, to promptly
report this to
ophthalmologist.
drug makes him more
susceptible to infection.
Advise him to avoid
crowds and exposure to
illness.
stop taking drug
abruptly.
all other significant and
life-threatening adverse
reactions and
drugs, tests, herbs, and
behaviors mentioned
above.

Antihistamines are medicines often used to relieve symptoms
of allergies, such as hay fever, hives, conjunctivitis and reactions
to insect bites or stings. They're also sometimes used to prevent
motion sickness and as a short-term treatment for insomnia.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
cetirizine
hydrochloride
Brand Name:
Zyrtec
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine1-
receptor
antagonist
(peripherally
selective)
Therapeutic
class: Allergy,
cold, and cough
agent;
Antagonizes
histamine’s
effects at
histamine1-
receptor sites,
preventing
allergic
response. Also
has mild
bronchodilatory
effects and
blocks
histamine-
induced
broncho–
constriction in
asthma.
➣Allergic
symptoms
caused by
histamine
release
drug or hydroxyzine
● Acute asthma
attacks
● Angle-closure
glaucoma
● Pyloroduodenal
obstruction
● Breastfeeding
Use cautiously in:
● renal impairment,
significant hepatic
dysfunction
● pregnant patients
than age 2 (safety
not established).
• CNS: dizziness,
drowsiness,
fatigue
edema
• EENT:
pharyngitis
• GI: nausea,
vomiting,
abdominal
distress,
dry mouth
• Musculoskelet
al: myalgia,
joint pain
• Respiratory:
bronchospasm
• Skin:
photosensitivity,
rash,
angioedema
• Other: fever
Availability
Syrup: 5 mg/5 ml
Tablets: 5 mg, 10 mg
Dosages
➣Allergic symptoms
caused by histamine
release
Adults and children
older than age 6:
5 to 10 mg P.O. daily
2.5 to 5 mg
P.O. daily
Dosage adjustment
● Renal impairment
● Hepatic impairment
Patient monitoring
● Monitor creatinine
levels in patients with
renal dysfunction.
● Assess hepatic
enzyme levels in
patients with hepatic
disease.
Patient teaching
with full glass of water.
drug may impair
alertness and that
alcohol may exaggerate
this effect.
and alertness.

antihistamine
Pregnancy risk
category B
drugs, tests, and
behaviors mentioned
above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
diphenhydramin
e hydrochloride
Brand Name:
Benadryl
CLASSIFICA-
TION:
Pharmacologic
class:
Ethanolamine
derivative,
nonselective
histamine1-
receptor
antagonist
Therapeutic
class:
Antihistamine,
antitussive,
Interferes with
histamine
effects at
histamine1-
receptor sites;
prevents but
doesn’t
reverse
histamine-
mediated
response. Also
possesses CNS
depressant
and
anticholinergic
properties.
➣Allergy
symptoms
caused by
histamine
release (including
anaphylaxis,
seasonal and
perennial allergic
rhinitis,
and allergic
dermatoses);
nausea; vertigo
➣Cough
➣Dyskinesia;
Parkinson’s
disease
➣Mild nighttime
sedation
drug
● Alcohol intolerance
● Acute asthma
attacks
● MAO inhibitor use
within past 14 days
● Breastfeeding
● Neonates,
premature infants
Use cautiously in:
● severe hepatic
disease, angle-
closure
glaucoma, seizure
disorders, prostatic
hypertrophy,
cardiovascular
disease,
hyperthyroidism
(safety not
established)
than age 2 (safety
not established).
• CNS:
drowsiness,
dizziness,
headache,
paradoxical
stimulation
(especially in
children)
• CV:
hypotension,
palpitations,
tachycardia
• EENT: blurred
vision, tinnitus
• GI: diarrhea,
constipation, dry
mouth
• GU: dysuria,
urinary
frequency or
retention
• Skin:
photosensitivity
• Other:
decreased
appetite, pain at
I.M. injection
site
Availability
Capsules: 25 mg, 50 mg
Elixir: 12.5 mg/5 ml
Injection: 10 mg/ml, 50
mg/ml
Strips (orally disintegrating):
12.5 mg,
25 mg
Syrup: 12.5 mg/5 ml
Tablets (chewable): 12.5 mg,
25 mg
Tablets (orally
disintegrating): 12.5 mg
Dosages
➣Allergy symptoms caused
by histamine release
(including anaphylaxis,
seasonal and perennial
allergic rhinitis, and allergic
dermatoses); nausea; vertigo
Adults and children over
age 12: 25 to 50 mg P.O. q
4 to 6 hours, or 10 to 50 mg
I.V. or I.M. q 2 to 3 hours
p.r.n. (Some patients may
need up to 100 mg.) Don’t
Patient monitoring
● Monitor
cardiovascular
status, especially in
patients with
cardiovascular
disease.
● Supervise patient
during ambulation.
Use side rails as
necessary.
Patient teaching
avoid alcohol and
other depressants
such as sedatives
while taking drug.
avoid driving and
other hazardous
activities until he
knows how drug
and alertness.
● As appropriate,
review all other
significant

antiemetic,
antivertigo
agent,
antidyskinetic
Pregnancy risk
category B
exceed 400 mg/day.
Children ages 6 to 12: 12.5
to 25 mg P.O. q 4 to 6 hours,
or 1.25 mg/kg (37.5 mg/m2)
I.M. or I.V. q.i.d. Don’t
exceed 150 mg/day.
mg P.O. q 4 to 6 hours.
Don’t exceed 37.5 mg/day.
➣Cough
Adults: 25 mg P.O. q 4
hours p.r.n. Don’t exceed
150 mg/day.
mg P.O. q 4 hours. Don’t
exceed 75mg/day.
mg P.O. q 4 hours. Don’t
exceed 37.5 mg/24 hours.
➣Dyskinesia; Parkinson’s
disease
Adults: Initially, 25 mg P.O.
t.i.d.; may be increased to a
maximum of 50 mg q.i.d.
➣Mild nighttime sedation
Adults: 50 mg P.O. 20 to 30
minutes before bedtime
Dosage adjustment
● Elderly patients
adverse reactions
and interactions,
especially those
related to the
drugs, tests, herbs,
and behaviors
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
loratadine
Brand Name:
Claritin
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine1-
receptor
antagonist
(second-
generation)
Therapeutic
class:
Antihistamine
(nonsedating)
Pregnancy risk
Selective
histamine1-
receptor
antagonist.
Blocks
peripheral
effects of
histamine
release during
allergic
reactions,
decreasing or
preventing
allergy
symptoms.
➣Seasonal
allergies; chronic
idiopathic
urticaria
drug
Use cautiously in:
● renal or hepatic
impairment
than age 2 (safety
not established).
• CNS: headache,
nervousness,
insomnia
• EENT:
conjunctivitis,
earache,
epistaxis,
pharyngitis
• GI: abdominal
pain; dry
mouth;
diarrhea,
stomatitis (in
children)
• Skin: rash,
photosensitivity,
angioedema
• Other: tooth
disorder (in
children),
fever, flulike
symptoms, viral
infections
Availability
Syrup: 1 mg/ml
Tablets: 10 mg
Tablets (rapidly
disintegrating): 10 mg
Dosages
➣Seasonal allergies;
chronic idiopathic
urticaria
Adults and children
ages 6 and older:
10 mg P.O. daily
Children ages 2 to 5: 5
mg P.O. daily
Dosage adjustment
● Renal or hepatic
impairment
Patient monitoring
● Watch for adverse
reactions, especially
in children.
● Assess patient’s
response to drug.
● Watch for new
symptoms or
exacerbation
of existing symptoms.
Patient teaching
● Advise patient to take
exactly as prescribed,
once a day on empty
stomach.
● Tell patient to report
persistent or worsening
symptoms.
● Instruct patient to
report adverse
reactions, such as
headache or
nervousness.
avoid driving and
other hazardous
activities until he knows
how drug affects

category B concentration and
alertness.
foods mentioned above.

Cough medicines aim either to suppress a dry cough, or to help
you to cough up the extra phlegm (mucus) of a chesty cough
when you have a URTI. There are 2 types of OTC cough
medicines: antitussives and expectorants. If you have a dry cough,
a preparation containing an antitussive is the most suitable to try.
If you have a chesty cough, a preparation containing an
expectorant is the most suitable to try

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
dextromethorph
an
hydrobromide
Brand Name:
Vicks 44 Cough
Relief
CLASSIFICA-
TION:
Pharmacologic
class:
Levorphanol
derivative
Therapeutic
class:
Antitussive
(nonnarcotic)
Pregnancy risk
Depresses
cough reflex
through direct
effect on cough
center in
medulla. Has no
expectorant
action and does
not inhibit
ciliary action.
Although
related
to opioids
structurally,
lacks analgesia
and addictive
properties.
➣Cough caused
by minor viral
upper respiratory
tract infections or
inhaled irritants
drug
● Chronic productive
cough
within past 14 days
Use cautiously in:
● tartrazine
sensitivity
● diabetes mellitus
(with
sucrosecontaining
drug products)
● pregnant or
breastfeeding
patients
than age 2 (safety
not established).
• CNS: dizziness
and sedation
• GI: nausea,
vomiting,
stomach pain
Availability
Gelcaps: 15 mg, 30 mg
Liquid: 3.5 mg/5 ml, 5
mg/5 ml,
7.5 mg/5 ml, 15 mg/5 ml
Lozenges: 5 mg, 7.5 mg
Oral suspension
(extended-release):
30 mg/5 ml
Syrup: 7.5 mg/5 ml, 10
mg/15 ml
Dosages
➣Cough caused by minor
viral upper respiratory
tract infections or
inhaled irritants
Adults and children
over age 12: 10 to
20 mg P.O. q 4 hours, or
30 mg P.O. q 6 to 8
hours, or 60 mg of
extendedrelease form
P.O. b.i.d. (not to exceed
120 mg/day)
to 10 mg P.O. q 4 hours,
or 15 mg P.O. q 6 to 8
Patient monitoring
● Monitor cough
frequency and type, and
assess sputum
characteristics.
● Assess hydration
status. Increase
patient’s fluid input to
help moisten secretions.
Patient teaching
avoid irritants, such as
smoking, dust, and
fumes. Suggest use of
humidifier to filter air
pollutants.
treatment aims to
decrease coughing
frequency and intensity
without completely
eliminating protective
cough reflex.
contact health care
provider if cough lasts
more than 7 days.

category C hours, or 30 mg of
extended-release form
P.O. q 12 hours (not to
exceed 60 mg/day)
2.5 to 7.5 mg (syrup)
P.O. q 4 to 8 hours or 15
mg (extended-release
form) P.O. b.i.d. Not to
exceed 30 mg/day.
Dosage adjustment
drugs and behaviors
mentioned above.

DRUG DATA MECHANISM
OF ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
guaifenesin
(glyceryl
guaiacolate)
Brand Name:
Robitussin
CLASSIFICA-
TION:
Pharmacologic
class:
Propanediol
derivative
Therapeutic
class:
Expectorant
Pregnancy risk
category C
Exerts
vasoconstric-
tive action
that leads to
decreased
edema and
congestion.
Also increases
respiratory
secretions and
reduces
mucus
viscosity.
➣Cough due to
upper respiratory
tract infection
drug
(with some
products)
Use cautiously in:
cough lasting more
than 1 week or
accompanied by
fever, rash, or
headache
● patients receiving
disulfiram
concurrently
● pregnant patients.
• CNS:
headache,
dizziness
• GI: nausea,
vomiting,
diarrhea,
stomach pain
• Skin: rash,
urticaria
Availability
Capsules: 200 mg
Oral solution: 100 mg/5 ml,
200 mg/5 ml
Syrup: 100 mg/5 ml
Tablets: 100 mg, 200 mg, 400
mg
Tablets (extended-release):
600 mg
Dosages
➣Cough due to upper
respiratory tract infection
Adults: 200 to 400 mg P.O. q 4
hours (not to exceed 2,400
mg/day), or 600 to 1,200 mg
P.O. (extended-release tablets)
q 12 hours (not to exceed
2,400 mg/day)
Children ages 6 to 12: 100 to
200 mg P.O. q 4 hours (not to
exceed 1,200 mg/day), or 600
mg P.O.(extendedrelease)
q 12 hours (not to exceed
1,200 mg/day)
Children ages 2 to 6: 50 to
100 mg P.O. q 4 hours (not to
exceed 600 mg/day)
Patient monitoring
● Assess cough quality
and productivity.
Reevaluate treatment if
cough persists and is
accompanied by fever
or headache.
Patient teaching
with 8 oz of water and
to drink plenty of fluids.
cough lasts more than 1
week.
and alertness.
tests mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
codeine sulfate
Brand Name:
Codeine Sulfate
CLASSIFICA-
TION:
Pharmacologic
class: Opioid
agonist
Therapeutic
class: Opioid
analgesic,
antitussive
Controlled
substance
schedule II
Pregnancy risk
Binds to opioid
receptors in
CNS, altering
perception of
painful stimuli.
Causes
generalized CNS
depression,
decreases
cough reflex,
and reduces GI
motility.
➣Mild to
moderately
severe pain
drug, its
components, or other
opioids
● Respiratory
depression, severe
bronchial asthma,
hypercarbia
● Paralytic ileus or
suspected paralytic
ileus
Use cautiously in:
● severe renal,
hepatic, or
pulmonary disease
● adrenal
insufficiency,
circulatory shock,
hypotension,
pancreatic or biliary
tract disease,
urethral stricture,
seizures, head
trauma,
hypothyroidism,
increased intracranial
pressure, prostatic
hypertrophy,
• CNS: confusion,
sedation,
malaise,
agitation,
euphoria,
floating feeling,
headache,
hallucinations,
unusual dreams,
apathy, mood
changes
• CV:
hypotension,
bradycardia,
peripheral
vasodilation,
reduced
peripheral
resistance
• EENT: blurred
or double vision,
miosis,
reddened sclera
• GI: nausea,
vomiting,
constipation,
decreased
gastric motility
• GU: urinary
Availability
Tablets: 15 mg, 30 mg,
60 mg
Dosages
➣Mild to moderately
severe pain
Adults: 15 to 60 mg P.O.
q 4 hours as needed.
Doses above 60 mg may
fail to give commensurate
pain relief, and may be
associated with an
increased incidence of
undesirable adverse
effects.
Dosage adjustment
● Renal or hepatic
impairment
● Elderly or debilitated
patients
Patient monitoring
● Monitor vital signs and
CNS status.
● Assess pain level and
efficacy of pain relief.
● Evaluate patient for
adverse reactions.
✓ Stay alert for
overdose signs and
symptoms, such as CNS
and respiratory
depression, GI
cramping, and
constipation.
● Assess other drugs in
patient’s drug regimen
for those that could
cause additive or
adverse interactions.
● Monitor patient for
signs and symptoms of
drug dependence or
tolerance.
Patient teaching
● Teach patient to
minimize adverse GI
effects by taking doses
with food or milk.

category C undiagnosed
abdominal pain,
alcoholism
● concomitant use of
alcohol, other
opioids, illicit drugs
● elderly or
debilitated patients
● pregnant or
breastfeeding
patients
● labor and delivery
patients
than age 18 (safety
and efficacy not
established).
retention,
urinary tract
spasms, urinary
urgency
• Respiratory:
suppressed
cough reflex,
respiratory
depression
• Skin: flushing,
sweating
• Other: physical
or psychological
drug
dependence,
drug tolerance
✓ Tell patient to notify
prescriber promptly if
he experiences
shortness of breath or
difficulty breathing or if
nausea, vomiting, or
constipation become
pronounced.
affects concentration,
alertness, vision,
coordination, and
physical dexterity.
move slowly when
sitting up or standing,
to avoid dizziness or
light-headedness from
sudden blood pressure
decrease.
drugs, herbs, and
behaviors mentioned
above.

A decongestant, or nasal decongestant, is a type of
pharmaceutical drug that is used to relieve nasal congestion in
the upper respiratory tract.

DRUG DATA MECHANISM
OF ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
phenylephrine
hydrochloride
Brand Name:
Rhinall
CLASSIFICA-
TION:
Pharmacologic
class:
Sympathomimet
ic, alpha-
adrenergic
agonist
Therapeutic
class:
Vasopressor,
nasal
decongestant,
ophthalmic
Stimulates
alpha-
adrenergic
receptors,
increasing
blood pressure
and causing
pronounced
vasoconstricti
on in skin,
mucous
membranes,
and mucosa.
Produces
mydriasis by
contracting
papillary
dilator muscle.
➣Mild to
moderate
hypotension
➣Severe
hypotension
and shock
➣Hypotensive
emergency
during
spinal
anesthesia
➣To prolong
spinal
anesthesia
➣Vasoconstri
ctor for
regional
anesthesia
➣Paroxysmal
supraventricul
ar tachycardia
➣Nasal
congestion
➣Vasoconstri
ction and
pupil dilation
➣Uveitis
drug or its
components
● Severe
hypertension
● Ventricular
tachycardia
● Angle-closure
glaucoma
● Aneurysm (10%
ophthalmic solution)
● During intraocular
surgery when
corneal epithelial
barrier has been
disturbed
(ophthalmic solution)
with severe
arteriosclerotic
or cerebrovascular
disease
● Some low-birth-
weight infants
Use cautiously in:
● sulfite sensitivity
(some products)
• CNS:
headache,
weakness,
anxiety,
restlessness,
tremor, light-
headedness,
dizziness,
drowsiness,
insomnia,
hallucinations,
nervousness,
restlessness,
giddiness,
prolonged
psychosis,
orofacial
dystonia
• CV:
hypertension,
palpitations,
tachycardia,
bradycardia,
arrhythmias
• EENT: with
ophthalmic
solution—
transient
Availability
Injection: 10 mg/ml
Nasal solution: 0.125%, 0.25%,
0.5%, 1%
Ophthalmic solution: 0.12%, 2.5%,
10%
Tablets (chewable): 10 mg
Dosages
➣Mild to moderate hypotension
Adults: 1 to 10 mg subcutaneously
or I.M.; don’t exceed an initial
dosage of 5 mg.
➣Severe hypotension and shock
Adults: 0.1 to 0.18 mg/minute I.V.
infusion. For maintenance infusion,
40 to 60 mcg/minute.
➣To prevent hypotension during
spinal anesthesia
Adults: 2 to 3 mg subcutaneously
or I.M. 3 to 4 minutes before spinal
anesthetic is injected
➣Hypotensive emergency during
spinal anesthesia
Adults: 0.2 mg I.V., up to a
Patient monitoring
● Monitor ECG
continuously during
I.V. administration;
monitor blood
pressure every 5 to
15 minutes until it
stabilizes, then every
30 to 60 minutes.
● Monitor central
venous pressure and
fluid intake and
output. Keep in mind
that drug doesn’t
eliminate need for
fluid resuscitation.
● Assess CBC; watch
for evidence of blood
dyscrasias.
● Monitor I.V. site;
extravasation can
cause tissue
damage.
● Assess for
symptomatic
improvement in
patients using nasal
form.

vasoconstrictor
Pregnancy risk
category C
➣Open-angle
glaucoma
➣For wide
pupil dilation
before
intraocular
surgery
➣Refraction
➣Provocative
test for angle-
closure
glaucoma
➣Retinoscopy
(shadow test)
➣Blanching
test
➣Decongesta
nt to relieve
minor eye
irritation
● hyperthyroidism,
partial heart block,
bradycardia,
hypertension, cardiac
disease,
arteriosclerosis,
unstable vasomotor
syndrome
● type 1 (insulin-
dependent) diabetes
mellitus,
hypertension,
hyperthyroidism,
arteriosclerosis or
other cardiac
disease (10%
● within 21 days of
MAO inhibitors
(2.5% or 10%
● pregnant or
breastfeeding
patients.
pigment
floaters in
aqueous
humor;
rebound
miosis;
rebound
hyperemia
(with
prolonged
use); light
sensitivity;
photophobia;
blurred
vision;
allergic
conjunctivitis;
eye burning,
stinging, and
irritation;
transient
epithelial
keratitis;
decreased
IOP; with
nasal
solution—
rebound
congestion,
burning,
stinging,
sneezing,
dryness, local
irritation
maximum of 0.5 mg/dose
➣To prolong spinal anesthesia
Adults: 2 to 5 mg added to
anesthetic solution (prolongs spinal
block by up to 50%)
➣Vasoconstrictor for regional
anesthesia
Adults: 1 mg of phenylephrine
added to every 20 ml of local
anesthetic solution
➣Paroxysmal supraventricular
tachycardia
Adults: 0.5 mg by rapid I.V.
injection, not to exceed initial
dosage of 0.5 mg. Subsequent
dosages (determined by blood
pressure) shouldn’t exceed
preceding dosage by more than 0.1
to 0.2mg; maximum dosage is 1mg.
➣Nasal congestion
Adults: One or two sprays of 0.25%
or 0.5% nasal solution in each
nostril q 3 to 4 hours p.r.n.; severe
congestion may warrant 1%
solution. Or 10 to 20 mg P.O.
(chewable tablets) q 4 hours.
➣Vasoconstriction and pupil dilation
Adults: After topical anesthetic is
applied, instill one drop of 2.5%
✓ Monitor for
adverse reactions,
particularly life-
threatening
asthmatic episodes.
Patient teaching
exactly as directed
and not to exceed
recommended
dosage.
● Advise patient
using nasal solution
that dropper,
inhaler, or spray
dispenser shouldn’t
be used by more
than one person.
Teach proper
instillation
technique: instill
nasal solution into
dependent nostril
with head down and
in lateral position.
Stay in this position
for 5 minutes; then
instill solution in
other nostril in same
manner. Advise
patient to rinse
container tip with
hot water after each

• GI: nausea,
vomiting,
gastric
irritation,
anorexia
• GU: urinary
retention (in
males with
prostatitis)
• Hematologic
: leukopenia,
agranulocyt
osis,
thrombocyto
penia
• Musculoskel
etal: brow
ache (with
ophthalmic
solution)
• Respiratory:
asthmatic
episodes
• Skin:
sweating,
rash,
urticaria,
contact
dermatitis,
necrosis and
sloughing
(with
extravasation
at I.V. site)
ophthalmic solution into lacrimal
sac; repeat 1 hour later.
➣Uveitis
Adults: Instill one drop of 2.5% or
10% ophthalmic solution to upper
surface of cornea.May repeat up to
three times p.r.n.
➣Open-angle glaucoma
Adults: Instill one drop of 10%
ophthalmic solution to upper surface
of cornea as often as necessary.
➣For wide pupil dilation before
intraocular surgery
Adults: Instill 2.5% or 10%
ophthalmic solution, as prescribed,
into lacrimal sac 30 to 60 minutes
before surgery.
➣Refraction
Adults: Before procedure, instill one
drop of 2.5% ophthalmic solution
combined with a rapid-acting
cycloplegic into lacrimal sac, as
prescribed.
Children: Before procedure, instill
one drop of 2.5% ophthalmic
solution into lacrimal sac 5 minutes
after cycloplegic administration, as
prescribed.
➣Provocative test for angle-closure
use. Instruct him to
discontinue use and
symptoms don’t
improve after 3
days. Tell him not to
use for more than
3 days and to
symptoms persist.
● Teach proper
technique for
instilling eye drops.
Stress importance of
compressing lacrimal
sac after instilling, to
decrease systemic
drug absorption. Tell
patient that
ophthalmic solution
may cause light
sensitivity lasting
several hours.
Inform elderly
patient that he may
see transient floaters
40 to 45 minutes
after administration.
● As appropriate,
review all other
significant and life-
threatening adverse
reactions and
interactions,

glaucoma
Adults: 2.5% ophthalmic solution
applied to dilate pupil, with
intraocular pressure (IOP) measured
before application and after dilation.
IOP rise of 3 to 5 mm Hg suggests
angle block in patients with
glaucoma; however, negative
response doesn’t rule out glaucoma
from other causes.
➣Retinoscopy (shadow test)
Adults: 2.5% ophthalmic solution
➣Blanching test
Adults: Instill one to two drops of
2.5% ophthalmic solution into
affected eye.
➣Decongestant to relieve minor eye
irritation
Adults: Instill one or two drops of
0.12% ophthalmic solution into
eye(s) up to q.i.d. p.r.n.
Dosage adjustment
● Hyperthyroidism
● Cardiac disease
especially those
related to the drugs,
tests, and behaviors
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
pseudoephedrin
e hydrochloride
Brand Name:
Sudafed
CLASSIFICA-
TION:
Pharmacologic
class:
Sympathomimet
ic
Therapeutic
class:
Decongestant
(systemic)
Pregnancy risk
category C
Stimulates
alpha-
adrenergic
receptors,
causing
vasoconstriction
of respiratory
tract; relaxes
bronchial
smooth
muscle through
beta2-
adrenergic
stimulation
➣Cough caused
by minor viral
upper
respiratory tract
infections or
inhaled irritants
drug or other
sympathomimetics
(with some liquid
products)
● Hypertension
● Severe coronary
artery disease
within past 14 days
● Children younger
than age 12
(extended-release
forms)
Use cautiously in:
● hyperthyroidism,
diabetes mellitus,
prostatic hypertrophy,
ischemic heart
disease, glaucoma
(more sensitive to
drug’s CNS effects)
● pregnant or
breastfeeding
patients.
• CNS: anxiety,
nervousness,
dizziness,
drowsiness,
excitability, fear,
hallucinations,
headache,
insomnia,
restlessness,
asthenia,
seizures
hypertension,
tachycardia,
cardiovascular
collapse
• GI: anorexia,
dry mouth
• GU: dysuria
• Respiratory:
respiratory
difficulty
Availability
Capsules: 60 mg
Capsules (extended-
Capsules (soft gel): 30mg
Oral solution: 15 mg/5
ml, 30 mg/ 5 ml
Syrup: 30 mg/5 ml
Tablets (chewable): 15mg
Tablets (extended-
Dosages
➣Nasal, sinus, or
eustachian tube
congestion
Adults and children
ages 12 and older:
60 mg P.O. q 4 to 6 hours
p.r.n. (not to exceed 240
mg/day); or 120 mg
(extended-release) q 12
hours or 240 mg
(extended-release) q 24
hours
Patient monitoring
● Monitor vital signs.
● Assess neurologic and
cardiovascular status
regularly.
Patient teaching
at least 2 hours before
bedtime to reduce
insomnia.
● Tell patient not to
crush or break
extended-release
tablets or capsules.
discontinue use and
consult prescriber if he
experiences
nervousness, dizziness,
or insomnia.
● Tell patient to consult
prescriber before taking
other over-the-counter
products.
avoid driving and
other hazardous

activities until he knows
how drug affects
concentration and
alertness.
drugs and foods
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
oxymetazoline
hydrochloride
Brand Name:
Afrin
CLASSIFICA-
TION:
Pharmacologic
class:
sympathomimeti
c
Therapeutic
class:
decongestant,
vasoconstrictor
Pregnancy risk
category C
Oxymetazoline
is a direct acting
sympathomimeti
c amine, which
acts on alpha-
adrenergic
receptors in the
arterioles of the
conjunctiva and
nasal mucosa. It
produces
vasoconstriction
, resulting in
decreased
conjunctival
congestion in
ophthalmic. In
nasal it
produces
constriction,
resulting in
decreased blood
flow and
decreased nasal
congestion.
➣ Nasal
Congestion
➣ Relief of minor
eye redness
Contraindicated in:
patients
hypersensitive to
drug. Ophthalmic
form contraindicated
in patients with
angle-closure
glaucoma.
Use cautiously in:
patients with
hyperthyroidism,
cardiac disease, or
hypertension and in
those receiving MAO
inhibitors. Use nasal
solution cautiously in
patients with
diabetes mellitus.
Use ophthalmic form
cautiously in those
with eye disease,
infection, or injury.
• CNS: headache;
insomnia;
drowsiness,
dizziness, and
possible
sedation from
nasal form; light
headedness and
nervousness
from ophthalmic
form.
• CV: palpitations;
CVcollapse and
hypertension
with nasal form;
tachycardia, bra
dycardia, and
irregular
heartbeat with
ophthalmic
form.
• EENT: rebound
nasal congestion
or irritation with
excessive or
long-term use,
dryness of nose
and throat,
Availability
Nasal drops or
spray: 0.05%
Nasal solution: 0.025%
(drops) for children
Ophthalmic
solution: 0.025%
Dosages
Nasal
congestion. Adults and
children older than age
6: 2 to 3 drops or
sprays of 0.05% solution
in each nostril q 10 to
12 hours for no longer
than 3 to 5 days.
Dosage for younger
children hasn’t been
established.
Relief of minor eye
redness. Adults and
children older than age
6: 1 to 2 drops in the
conjunctival sac up to
q.i.d. (spaced at least 6
Special Considerations
• Excessive dosing may
irritate nasal mucosa and
cause rebound congestion
(nasal) or rebound
hyperemia (ophthalmic).
• Watch for adverse
reactions in patients with
CV disease, diabetes
mellitus, or prostatic
hypertrophy because
systemic absorption can
occur.
Pediatric patients
• Children may exhibit
increased adverse effects
from systemic
absorption; 0.05% nasal
solution is contraindicated
in children younger than
age 6; 0.025% nasal
solution should be used in
children younger than
age 2 only under medical
direction and supervision.
Geriatric patients
• Use drug cautiously in

increased nasal
discharge,
stinging,
sneezing (with
nasal
form); transient
stinging upon
instillation, blurr
ed vision,
reactive
hyperemia,
keratitis,
lacrimation,
increased
intraocular
pressure (with
ophthalmic
form).
• Other: systemic
effects in
children (with
excessive or
long-term use of
nasal form);
trembling (with
ophthalmic
form).
hours apart) elderly patients with
cardiac disease, poorly
controlled hypertension,
or diabetes mellitus.
Patient teaching
• Emphasize that only
one person should use
dropper bottle or nasal
spray.
• Advise patient not to
exceed recommended
dosage and to use drug
only when needed.
• Tell patient to stop drug
and report symptoms
that persist after 3 days
of self-medication.
• Tell patient that nasal
mucosa may sting, burn,
or become dry.
• Warn patient that
excessive use may cause
bradycardia, hypotension,
dizziness, and weakness.
• Show patient how to
apply drug. Have him
bend head forward and
sniff spray briskly or
apply light pressure on
lacrimal sac after
instillation of eyedrop.

The drugs, cromolyn sodium (or cromolyn) and nedocromil, are
commonly grouped together as chromones (also called
cromoglycates). The chromones are listed as alternate initial
controller therapies for mild asthma in national and international
guidelines, although inhaled glucocorticoids (also known as
inhaled corticosteroids) are the preferred agents

DRUG DATA MECHANISM
OF ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
cromolyn
sodium
Brand Name:
Gastrocrom
CLASSIFICA-
TION:
Pharmacologic
class:
Chromone
derivative
Therapeutic
class: Mast cell
stabilizer,
antiasthmatic,
ophthalmic
decongestant
Pregnancy risk
Inhibits
release of
histamine and
reacting
substances of
anaphylaxis
from
mast cells,
stabilizing the
cell
membrane
and reducing
the
allergic
response and
inflammatory
reaction
➣Mastocytosis
➣Vernal
keratoconjunct
ivitis, vernal
conjunctivitis,
and vernal
keratitis
➣To prevent
and relieve
nasal
symptoms of
hay fever and
other nasal
allergies
➣Prevention of
acute
bronchospasm
➣Management
of bronchial
asthma
drug
● Status asthmaticus
Use cautiously in:
● renal or hepatic
impairment, acute
bronchospasm
attacks
● pregnant or
breastfeeding
patients
than age 5.
• CNS:
headache,
drowsiness,
dizziness
• EENT: nasal
irritation,
sneezing,
epistaxis,
postnasal drip
(with nasal
solution);
stinging of
eyes,
lacrimation
(with
ophthalmic
solution)
• GI: nausea,
diarrhea,
stomachache,
swollen parotid
glands
• GU: difficult or
painful
urination,
urinary
frequency
• Musculoskelet
Availability
Nasal solution: 40 mg/ml
(5.2 mg/ spray) in 13-ml
container (100 sprays) or
26-ml container (200
sprays)
Ophthalmic solution: 4%
Oral solution: 100 mg/5ml
Solution for nebulization: 10
mg/ml
Dosages
➣Mastocytosis
Adults and children ages
13 and older: 200 mg P.O.
q.i.d.
mg P.O. q.i.d.
➣Vernal
keratoconjunctivitis,
vernal conjunctivitis, and
vernal keratitis
4 and older:
One to two drops of
ophthalmic solution in each
eye four to six times daily at
Patient monitoring
● Monitor pulmonary
function periodically.
● Evaluate patient for
signs and symptoms
of overdose, including
bronchospasm and difficult
or painful urination.
Patient teaching
With nasal form—
● Teach patient how to
instill nasal spray as
directed.
● Tell patient that drug
may cause unpleasant
taste, but that rinsing
mouth and performing
frequent oral care may
help. Also inform him that
drug may cause headache.
● Advise patient to report
increased
sneezing; nasal burning,
stinging, or
irritation; sore throat;
hoarseness; or nosebleed.
With oral form—

category B al: myopathy
• Respiratory:
wheezing,
cough,
bronchospas
m
• Skin:
erythema, rash,
urticaria,
angioedema
• Other: altered
taste,
substernal
burning,
allergic
reactions
including
anaphylaxis,
serum
sickness
regular intervals
➣To prevent and relieve
nasal symptoms of hay fever
and other nasal allergies
2 and older:
Spray once into each nostril.
To prevent nasal allergy
symptoms, use up to 1 week
before contact with cause of
allergy. To relieve nasal
symptoms, repeat three to
four times daily q 4 to 6
hours. If needed, may use
up to six times per day. Use
every day while in contact
with allergen.
➣Prevention of acute
bronchospasm
2 and older: 20 mg q.i.d.
via nebulization at regular
intervals or no more than 1
hour before exposure to
triggering event
➣Management of bronchial
asthma
2 and older:
20 mg via nebulization q.i.d.
at regular intervals
● Tell patient to take oral
form 30 minutes before
meals.
With ophthalmic form—
● Instruct patient to wash
hands before using.
● Teach patient how to
instill drops: Instruct him
to tilt his head back and
look up, place drops inside
lower eyelid, close his eye,
and roll eyeball in all
directions. Tell him not to
blink for
about 30 seconds, and
then to apply gentle
pressure to inner corner of
eye for 30 seconds.
let applicator tip touch eye
or any other surface.
● Tell patient drug may
cause temporary stinging
of eye or blurred vision.
● Advise patient not to
wear contact lenses during
therapy.
With all forms—
adverse reactions.

Leukotriene receptor antagonists (LTRA) are a new class of
drugs for asthma treatment, available in tablet form. Their unique
mechanism of action results in a combination of both
bronchodilator and anti-inflammatory effects.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
montelukast
sodium
Brand Name:
Singulair
CLASSIFICA-
TION:
Pharmacologic
class:
Leukotriene
receptor
antagonist
Therapeutic
class:
Antiasthmatic
Pregnancy risk
category B
Blocks action of
leukotrienes,
decreasing
smooth muscle
contractions
and edema in
bronchial
airways and
preventing
inflammation
and
bronchospasm
➣Long-term
asthma
management
➣Prevention of
exercise-induced
bronchoconstricti
on (EIB)
➣Seasonal
allergic rhinitis
➣Perennial
allergic rhinitis
drug or its
components
Use cautiously in:
● acute asthma
attack, hepatic
impairment,
phenylketonuria
● pregnant or
breastfeeding
patients
than age 6 when
used for EIB
prevention (safety
not established)
than age 2 when
used for seasonal
allergy (safety not
established)
than age 1 when
used for asthma
(safety not
established)
• CNS: fatigue,
headache,
dizziness,
asthenia,
agitation,
aggressive
behavior
or hostility,
anxiousness,
depression,
disorientation,
dream
abnormalities,
hallucinations,
insomnia,
irritability,
restlessness,
somnambulism,
tremor, suicidal
thinking and
behavior
(including
suicide)
• EENT: nasal
congestion,
otitis and
sinusitis (in
children)
Availability
Oral granules: 4-mg
base/packet
Tablets: 10 mg
Tablets (chewable): 4 mg,
5 mg
Dosages
➣Long-term asthma
management
Adults and children
ages 15 and older:
10-mg tablet P.O. daily in
evening
5-mg chewable tablet P.O.
daily in evening
Children ages 2 to 5: 4-
mg chewable tablet or one
4-mg packet oral granules
P.O. daily in evening
months: 4-mg packet
oral granules P.O. daily in
evening
➣Prevention of exercise-
induced
Patient monitoring
● Assess eosinophil
count.
● Monitor temperature.
Watch for fever and
other signs and
symptoms of infection.
✓ Monitor patient for
change in mood or
behavior, including
suicidal ideation.
Patient teaching
● Advise patient (or
caregiver) who has
asthma or asthma and
rhinitis to take drug in
evening.
● Instruct patient (or
caregiver) who has EIB
not to take another
dose within 24 hours of
previous dose.
● Inform patient (or
caregiver) that he may
sprinkle granules onto
soft foods (applesauce,
carrots, rice, or ice

than age 6 months
when used for
perennial allergy
(safety not
established).
• GI: abdominal
pain; nausea
and diarrhea
(in children);
dyspepsia;
infectious
gastroenteritis
• Respiratory:
cough
• Skin: rash
• Other: dental
pain, influenza,
fever
bronchoconstriction (EIB)
Adults and children
ages 15 and older:
Single-dose, 10-mg tablet
P.O. at least 2 hours
before exercise; additional
dose shouldn’t be taken
within 24 hours. Patients
already taking 1 tablet
daily for another
indication shouldn’t take
an additional dose.
5-mg chewable tablet P.O.
at least 2 hours before
exercise; additional dose
shouldn’t be taken
within 24 hours. Patients
already taking 1 tablet
daily for another
indication shouldn’t take
an additional dose.
➣Seasonal allergic rhinitis
Adults: 10 mg P.O. daily
mg P.O. daily either as
either chewable tablet or
packet of oral granules
➣Perennial allergic rhinitis
Adults and children
ages 15 and older: 10
mg tablet P. O. daily
cream only) and take
immediately. Drug isn’t
intended to be dissolved
in any liquid other than
breast milk or baby
formula. Don’t store
drug that has been
mixed with food or
liquids for future use.
● Instruct patient or
caregiver that after
opening packet of oral
granules, dose must be
taken within 15
minutes.
✓ Tell patient or
caregiver that drug
is for preventive use
only, not for treatment
of acute asthma attacks
and that appropriate
rescue medication
should be available.
✓ Instruct patient or
caregiver to notify
prescriber if mood or
behavior changes.
hazardous activities,
because drug causes
dizziness.

mg P.O. daily as chewable
tablet
mg P.O. daily as either
chewable tablet or one 4-
mg packet of oral
granules
months: 1 packet (4 mg)
oral granules P.O. daily
drugs and tests
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
zafirlukast
Brand Name:
Accolate
CLASSIFICA-
TION:
Pharmacologic
class:
Leukotriene
receptor
antagonist
Therapeutic
class:
Antiasthmatic,
bronchodilator
Pregnancy risk
category B
Antagonizes
activity of three
leukotrienes
at specific
receptor sites in
airway smooth
muscle,
inhibiting
inflammation
➣Prophylaxis
and long-term
treatment of
asthma
drug or its
components
● Hepatic
impairment,
including hepatic
cirrhosis
Use cautiously in:
● acute asthma
attacks
warfarin
● patients older than
age 55
● breastfeeding
patients (use not
recommended)
than age 5 (safety
not established).
• CNS: headache,
dizziness,
asthenia,
insomnia,
depression
(especially in
children and
adolescents)
• GI: nausea,
vomiting,
diarrhea,
abdominal pain,
dyspepsia
• Hepatic:
hepatic
dysfunction
including
liver failure
and death
(rare)
• Musculoskelet
al: joint or back
pain, myalgia
• Other: fever,
infection, pain
Availability
Tablets (coated): 10
mg, 20 mg
Dosages
➣Prophylaxis and
long-term treatment
of asthma
Adults and children
ages 12 and older:
20 mg P.O. b.i.d.
Children ages 5 to
11: 10 mg P.O. b.i.d.
Patient monitoring
● Assess patient’s
respiratory status to help
evaluate drug efficacy.
✓ Monitor liver function
tests closely; watch for
signs and symptoms of liver
dysfunction.
Patient teaching
● Tell patient to take at
least 1 hour before or 2
hours after a meal.
exactly as prescribed, even
if he is symptom-free.
✓ Tell patient to
immediately report asthma
attack. Advise him not to
use drug for rapid relief of
bronchospasm.
continue taking other
asthma drugs unless
prescriber directs otherwise.
immediately report signs
and symptoms of liver

dysfunction (nausea,
anorexia, fatigue, lethargy,
pruritus, jaundice, flulike
symptoms, or right upper
quadrant abdominal pain).
● Instruct patient or
caregiver to report insomnia
or depression.
● Instruct female patient to
consult prescriber if she
plans to breastfeed.
other significant adverse
the drugs and foods
mentioned above.

Bronchodilators Drug Study

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