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RESPIRATORY
MEDICATIONS
Medical Surgical Nursing
Bronchodilators

• Sympathomimetic dilate the airways of the respiratory tree & relax smooth muscle
• Methylxanthinie stimulate the CNS and respiration, dilate coronary and pulmonary
    vessels causes diuresis & relax smooth muscle
•   Bronchodilators treat allergic rhinitis, sinusitis, acute bronchospasm, acute &
    chronic asthma, COPD, emphysema
•   Contraindicated w/hypersensitivity, peptic ulcer, severe cardiac disease &
    dysrhythmias, hyperthyroidism, uncontrolled seizures
•   ***Use caution in hypertension, diabetes mellitus or narrow angle glaucoma
•   ***Theophylline increase risk of digoxin toxicity & decrease the effects of lithium and
    phenytoin (Dilantin)
•   Theophylline and a B2-adrenergic agonist together may result in cardiac
    dysrhythmias
•   B-blockers, cimetidine (Tagamet), & erythromycin increase effects of Theophylline
•   Barbiturates and carbamazepine (Tegretol) decrease the effects of Theophylline
Bronchodilators Side Effects
• Palpitations
• Tachycardia
• Dysrhythmias
• Restlessness – may mean hypoxia
• Nervousness & tremors
• Anorexia, nausea & vomiting
• Headaches & dizziness
• Hyperglycemia
• Decreased clotting time
• Mouth dryness
• Tolerance & paradoxical bronchoconstriction w/inhalers
Bronchodilators Interventions
• Assess vital signs
• Monitor for cardiac dysrhythmias
• Assess for cough, wheezing, decreased breath sounds & sputum production
• Monitor for restlessness and confusion
• Provide adequate hydration
• Give meds at regular interval around the clock
• Give oral meds with or after meals to decrease GI irritation
• Instruct client not to crush enteric-coated or sustained release tab or capsules
• Instruct on side effects
• Instruct how to monitor pulse and report abnormalities
• Instruct how to use inhaler or nebulizer & how to monitor amounts of med remaining in inhaler
• Instruct how to use spacer
• Instruct to avoid over the counter meds, to stop smoking
• Instruct client w/diabetes to monitor blood glucose levels
• Instruct client w/asthma to wear a Medic-Alert bracelet
• ***Monitor serum theophylline of 10-20 mcg/mL >20 toxicity
• IV aminophylline or theophylline should be administered slowly and Always via an infusion pump
Glucocorticoids
• Beclomethasone dipropionate (Qvar)
• Budesonide (Pulmicort Turbohaler, Pulmicort Respules)
• Flunisolide (AeroBid)
• Fluticasone propionate (Flovent HFA, Flovent
    Rotadisk, Flovent Diskus)
•   Mometasone furoate (Asmanex Twisthaler)
•   Triamcinolone (Azmacort)
•   Prednisone
•   Prednisolone
Inhaled Non-steroidal Anti-allergy agents
• Mast Cell Stabilizers, antiasthmatic, antiallergic inhibit mast
    cell release after exposure to antigens
•   Used to treat allergic rhinitis, bronchial asthma, exercise-
    induced bronchospasm
•   Contraindicated in known hypersensitivity
•   Orally administered Cromolyn sodium (Intal)
•   Nedocromil (Tilade)
•   Side Effects
    • Cough
    • Bronchospasm
    • Nasal sting
    • Sneezing
    • Unpleasant taste
Leukotriene modifiers
• Receptor Antagonists
   • Montelukast (Singulair)
   • Zafirlukast (Accolate)
• Inhibitor
   • Zileuton (Zyflo)
• Side Effects
   • Headache
   • Nausea & vomiting
   • Dyspepsia
   • Diarrhea
   • Generalized pain
   • Fever dizziness
• Interventions
   • Monitor vital signs, lung sounds for rhonchi & wheezing
   • Assess liver function, cyanosis
   • Instruct to take meds 1 hour before or 2 hours after meals, increase fluid intake
   • Instruct not to discontinue med take as prescribed, even during symptoms free
     periods

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Respiratory medications

  • 2. Bronchodilators • Sympathomimetic dilate the airways of the respiratory tree & relax smooth muscle • Methylxanthinie stimulate the CNS and respiration, dilate coronary and pulmonary vessels causes diuresis & relax smooth muscle • Bronchodilators treat allergic rhinitis, sinusitis, acute bronchospasm, acute & chronic asthma, COPD, emphysema • Contraindicated w/hypersensitivity, peptic ulcer, severe cardiac disease & dysrhythmias, hyperthyroidism, uncontrolled seizures • ***Use caution in hypertension, diabetes mellitus or narrow angle glaucoma • ***Theophylline increase risk of digoxin toxicity & decrease the effects of lithium and phenytoin (Dilantin) • Theophylline and a B2-adrenergic agonist together may result in cardiac dysrhythmias • B-blockers, cimetidine (Tagamet), & erythromycin increase effects of Theophylline • Barbiturates and carbamazepine (Tegretol) decrease the effects of Theophylline
  • 3. Bronchodilators Side Effects • Palpitations • Tachycardia • Dysrhythmias • Restlessness – may mean hypoxia • Nervousness & tremors • Anorexia, nausea & vomiting • Headaches & dizziness • Hyperglycemia • Decreased clotting time • Mouth dryness • Tolerance & paradoxical bronchoconstriction w/inhalers
  • 4. Bronchodilators Interventions • Assess vital signs • Monitor for cardiac dysrhythmias • Assess for cough, wheezing, decreased breath sounds & sputum production • Monitor for restlessness and confusion • Provide adequate hydration • Give meds at regular interval around the clock • Give oral meds with or after meals to decrease GI irritation • Instruct client not to crush enteric-coated or sustained release tab or capsules • Instruct on side effects • Instruct how to monitor pulse and report abnormalities • Instruct how to use inhaler or nebulizer & how to monitor amounts of med remaining in inhaler • Instruct how to use spacer • Instruct to avoid over the counter meds, to stop smoking • Instruct client w/diabetes to monitor blood glucose levels • Instruct client w/asthma to wear a Medic-Alert bracelet • ***Monitor serum theophylline of 10-20 mcg/mL >20 toxicity • IV aminophylline or theophylline should be administered slowly and Always via an infusion pump
  • 5. Glucocorticoids • Beclomethasone dipropionate (Qvar) • Budesonide (Pulmicort Turbohaler, Pulmicort Respules) • Flunisolide (AeroBid) • Fluticasone propionate (Flovent HFA, Flovent Rotadisk, Flovent Diskus) • Mometasone furoate (Asmanex Twisthaler) • Triamcinolone (Azmacort) • Prednisone • Prednisolone
  • 6. Inhaled Non-steroidal Anti-allergy agents • Mast Cell Stabilizers, antiasthmatic, antiallergic inhibit mast cell release after exposure to antigens • Used to treat allergic rhinitis, bronchial asthma, exercise- induced bronchospasm • Contraindicated in known hypersensitivity • Orally administered Cromolyn sodium (Intal) • Nedocromil (Tilade) • Side Effects • Cough • Bronchospasm • Nasal sting • Sneezing • Unpleasant taste
  • 7. Leukotriene modifiers • Receptor Antagonists • Montelukast (Singulair) • Zafirlukast (Accolate) • Inhibitor • Zileuton (Zyflo) • Side Effects • Headache • Nausea & vomiting • Dyspepsia • Diarrhea • Generalized pain • Fever dizziness • Interventions • Monitor vital signs, lung sounds for rhonchi & wheezing • Assess liver function, cyanosis • Instruct to take meds 1 hour before or 2 hours after meals, increase fluid intake • Instruct not to discontinue med take as prescribed, even during symptoms free periods