Respiratory Medications and Their Uses

Respiratory Medication Review

• Albuterol is used for bronchospasms related to asthma, exercise-induced asthma, and COPD
  • Side effects include palpitations, tachycardia, tremor, hypertension, throat irritation, dry mouth, and insomnia
• Ipratropium is used for bronchospasms in COPD, bronchitis, emphysema, and rhinorrhea (nasal spray)
  • Ipratropium is an anticholinergic
  • Side effects include tachycardia, constipation, and dry mouth
• Beclomethasone is used for persistent asthma and allergic rhinitis
  • Beclomethasone reduces swelling and irritation of airways
  • Side effects include candidiasis, hoarseness, taste alteration, upper respiratory tract infection, hyperglycemia, and growth delay
  • Patients should rinse mouth after use
• Cromolyn is used for asthma, mild to moderate resistant COPD, allergic rhinitis, and conjunctivitis
  • Cromolyn stabilizes mast cells and blocks histamine release
  • Side effects include bronchospasm, cough, and throat irritation
• Montelukast is used for persistent chronic asthma, COPD, and allergic rhinitis
  • Side effects include rhinitis, psychiatric events, and suicidal ideation
• Omalizumab is used for moderate to severe persistent asthma, nasal polyps, and chronic idiopathic urticaria
  • Omalizumab is a monoclonal antibody
  • Side effects include anaphylaxis and cardiovascular disease
• Theophylline is used for bronchodilation, asthma prophylaxis, status asthmaticus, and COPD
  • Adverse effects of elevated theophylline levels cause palpitations and restlessness

Cold Medications Summary

• Diphenhydramine is used for allergic reactions, insomnia, motion sickness, and pruritis
  • Side effects include paradoxical effects in children, drowsiness, and dry mouth
• Fexofenadine is used for allergic rhinitis, urticaria, and itchy eczema
  • Side effects include dyspepsia, dry mouth, and headache
• Fluticasone is used for allergic rhinitis, nasal polyps, and sinusitis
  • Side effects include epistaxis, nasal ulceration, irritated nasal mucosa, headache, and cough
• Pseudoephedrine is used for allergic rhinitis, sinus congestion, and obstructed Eustachian tubes
  • Side effects include rebound congestion, insomnia, restlessness, and anxiety
• Phenylephrine is used for nasal congestion, hemorrhoids (topical), and hypotension
  • Side effects include hypertension, reflex bradycardia, and excitability
• Codeine is used for chronic non-productive coughs
  • Side effects include respiratory depression, sedation, and dizziness
• Dextromethorphan is a cough suppressant that is more effective for chronic irritation
  • Side effects include sedation, dizziness, and CNS toxicity
• Guaifenesin is used for mucous secretion and chest congestion
  • Side effects include abdominal pain and dizziness
• Acetylcysteine is used for acetaminophen overdose, cystic fibrosis, and pre-contrast renal protection
  • Side effects include a rotten egg odor, nausea, and vomiting

Honey

• Honey is a natural cough suppressant
• Honey is more effective than many anti-cough medications in reducing cough
• Honey should not be given to children under 1 year of age

Glaucoma Treatment

• For closed-angle glaucoma, Timolol and Acetazolamide IV are used
• Mannitol is also used for closed-angle glaucoma
• For open-angle glaucoma, Timolol, brimonidine, and dorzolamide decrease aqueous humor production
• Latanoprost, bimatoprost, travoprost, and brimonidine increase aqueous humor outflow

Eye Drop Administration

• Wash hands before administration
• Verify the expiration date of the bottle
• Check the tip of the bottle for discoloration indicating contamination
• Place the lid on a clean tissue to prevent contamination
• Tilt the head back and look toward the ceiling or lie down
• Use the non-dominant hand to pull down the eyelid, creating a "pocket"
• Use the the dominant hand on the back of the non-dominant hand to stabilize the hand
• Make sure the dropper tip is aligned but not touching the eye or eyelashes
• Gently squeeze and apply the drop
• Close the eye without blinking frequently
• Gently push and hold the finger on the nasal side of the eye
• Properly replace the lid and store the bottle

Ear Infections

• Wash your hands
• Tilt your head so your ear is up
• Pull the auricle up and back
• Shake the ear drops and apply
• Pump tragus to push solution deeper into the ear
• Keep ear tilted for 2–3 minutes

Amoxicillin & Ciprofloxacin/Dexamethasone

• Amoxicillin (Antibiotic)
  • Mechanism: Bactericidal effect
  • Indication: Otitis media, assorted bacterial infections
  • Contraindication: Penicillin allergy, caution in cephalosporin allergy
  • Side Effects: Allergic reaction, GI upset, suprainfection
• Ciprofloxacin/Dexamethasone (Antibiotic)
  • Mechanism: Bactericidal effect, anti-inflammatory actions of dexamethasone which decreases pain, edema, erythema
  • Indication: Otitis externa
  • Side Effects: Dizziness, lightheadedness

Peptic Ulcer Disease (PUD) Treatment

• Proton pump inhibitors are used e.g. omeprazole
• Antibiotic #1 is used which is clarithromycin
• Antibiotic #2 is used which is amoxicillin or metronidazole

GERD and PUD Remedies

• Antacids: Alkaline compounds that neutralize stomach acid
  • Examples: Aluminum hydroxide, calcium carbonate, sodium bicarbonate, magnesium hydroxide
  • Adverse effects: Constipation (aluminum-based), diarrhea (magnesium-based)
• Acid Reducers: Reduce stomach acid production
  • H2 Histamine receptor blockers: Famotidine
  • Proton pump inhibitors: Omeprazole
  • Adverse effects: Vitamin B12 deficiency, malabsorption of iron/calcium, osteoporosis, and increased GI infection risk
• GI Protectants: Protect the stomach lining from damage
  • Sucralfate: Forms a gel-like substance to coat the stomach lining
  • Misoprostol: Enhances protective mucus secretion; inhibits gastric secretions
    • Indications: Prevention of gastric ulcers with long-term NSAID use, abortion (contraindicated in pregnancy), labor induction, and postpartum bleeding
• GI Stimulants: Increase the rate of food movement through the stomach
  • Metoclopramide: Has anti-dopamine effects; avoid in Parkinson's disease or extrapyramidal symptoms

Laxatives

• General rules include increased fluid and fiber intake, avoid if bowel obstruction present.
• Bulk-Forming (Psyllium)
  • Indigestible agents add increased bulk to the stool and promote fluid intake.
• Stimulant (Senna)
  • Increases intestinal peristaltic contractions; quickens onset for acute constipation but is not recommended for long-term use.
• Osmotic (Lactulose)
  • Draws water into the stool for easier passage.
    • Side effects include dehydration (increase fluid intake), hyperglycemia (caution in diabetics).

Laxative Types

• Psyllium: Stimulates peristaltic contractions in the intestine
• Senna: Draws water into the stool
• Lactulose: Adds bulk to stool

Antidiarrheal Agents

• Examples include diphenoxylate/atropine and loperamide
• Opioids such as loperamide and diphenoxylate, and anticholinergic drugs such as atropine slow down peristaltic contractions
• Indications: Diarrhea and ileostomy
• Do NOT use for diarrhea due to infection such as C. diff or salmonella
• Side effects include fatigue, dizziness and dependence

Inflammatory Bowel DIsease

• Sulfasalazine is used to treat inflammatory bowel disease
  • Avoid in patients with sulfa or aspirin allergies
  • Side include GI upset, photosensitivity, SJS rash, hepatotoxicity, and bone marrow suppression
• Probiotics are beneficial in inflammatory bowel disease because they
  • Restore normal flora
  • Effective for IBS and C. diff

Antiemetic Drugs

• Serotonin receptor antagonists like ondansetron
  • Useful for chemotherapy, radiation, or gastroenteritis
  • Can cause QT prolongation, avoid if there is a history of cardiac arrhythmias
• Anticholinergics like scopolamine
  • Used for motion sickness and to dry respiratory secretions
  • Anticholinergic adverse effects include dryness, urinary retention, constipation, and tachycardia, and sedation
• Substance P/Neurokinin antagonists like aprepitant
  • Used for chemotherapy or post-op
• Cannabinoids like dronabinol
  • Activates cannabinoid receptors
  • Used for chemotherapy-induced nausea/vomiting and to increase appetite
  • Side Include drowsiness, mood changes, orthostatic hypotension, depression, hallucinations, and dependence

Additional Antiemetic Drugs

• H1 Antihistamines like Dimenhydrinate
  • Used for motion sickness & vertigo
  • Can cause dryness, urinary retention, constipation & tachycardia (DUCT), sedation, and confusion
• Benzodiazepines like Lorazepam
  • Used for anxiety, sedation, insomnia, and alcohol withdrawal
  • Side effects include, sedation, addiction, dependence, falls, and respiratory depression
• Corticosteroids like Dexamethasone
  • Used for chemotherapy-induced N/V.
  • Side effects include hyperglycemia and immunosuppression

Pancrelipase

• Pancrelipase is a pancreatic digestive enzyme replacement
• Indications for usage includes pancreatic insufficiency and cystic fibrosis
• Do not administer in patients with pork allergies/objection

Weight Loss

• Only FDA approved for obese clients as an adjunct to diet and exercise
• Orlistat inhibits lipase enzymes, preventing the breakdown & absorption of fats
  • ADRs include steatorrhea which is oily stool, fecal urgency, and fat-soluble vitamin deficiency
• Phentermine is a CNS stimulant that decreases appetite & increase energy expenditure
  • ADRs include tachycardia, palpitations, HTN, and GI upset
  • Avoid in clients with cardiac disease, hyperthyroidism, or substance abuse
• Semaglutide also recently approved for weight loss, it was originally indicated for type 2 DM