Podcast
Questions and Answers
A client with persistent asthma is unresponsive to both beta agonists and inhaled corticosteroids. Which medication class might be considered for long-term management?
A client with persistent asthma is unresponsive to both beta agonists and inhaled corticosteroids. Which medication class might be considered for long-term management?
- Antihistamines
- Antitussives
- Expectorants
- Xanthine Derivatives (correct)
In a client experiencing acute bronchoconstriction, which class of respiratory medications would provide the most immediate relief?
In a client experiencing acute bronchoconstriction, which class of respiratory medications would provide the most immediate relief?
- Inhaled Corticosteroids
- Long-acting Beta-2 Agonists
- Leukotriene Receptor Antagonists
- Short-acting Beta-2 Agonists (correct)
A client with a history of severe hypertension is prescribed a decongestant. Which of the following medications would be most concerning?
A client with a history of severe hypertension is prescribed a decongestant. Which of the following medications would be most concerning?
- Pseudoephedrine (correct)
- Cetirizine
- Dextromethorphan
- Guaifenesin
A client is prescribed both a short-acting beta-2 agonist and an inhaled corticosteroid. What teaching point is most important?
A client is prescribed both a short-acting beta-2 agonist and an inhaled corticosteroid. What teaching point is most important?
The nurse is providing discharge instructions to a client receiving an antihistamine medication. Which of the following instructions is most important to include?
The nurse is providing discharge instructions to a client receiving an antihistamine medication. Which of the following instructions is most important to include?
You're educating a client on taking guaifenesin. Which statement indicates they understand its purpose?
You're educating a client on taking guaifenesin. Which statement indicates they understand its purpose?
A client with asthma is prescribed montelukast. Which statement best describes the action?
A client with asthma is prescribed montelukast. Which statement best describes the action?
A client is started on the anticholinergic drug tiotropium. What should you emphasize about potential adverse effects?
A client is started on the anticholinergic drug tiotropium. What should you emphasize about potential adverse effects?
The nurse must administer diphenhydramine intravenously. Why is it critical to watch the client's respiratory rate when using it intravenously?
The nurse must administer diphenhydramine intravenously. Why is it critical to watch the client's respiratory rate when using it intravenously?
A client with a known allergy to diphenhydramine requires an antihistamine. Which of the following medications would be the safest choice?
A client with a known allergy to diphenhydramine requires an antihistamine. Which of the following medications would be the safest choice?
A 68-year-old client is prescribed diphenhydramine for allergy symptoms. Considering the client's age, what potential side effect should the nurse prioritize when providing education?
A 68-year-old client is prescribed diphenhydramine for allergy symptoms. Considering the client's age, what potential side effect should the nurse prioritize when providing education?
The nurse is instructing a client on the administration of fluticasone via an aerosol oral inhaler. Which instruction should the nurse emphasize to minimize the risk of oral candidiasis?
The nurse is instructing a client on the administration of fluticasone via an aerosol oral inhaler. Which instruction should the nurse emphasize to minimize the risk of oral candidiasis?
A client is prescribed long-term theophylline for persistent asthma. What client teaching information takes priority?
A client is prescribed long-term theophylline for persistent asthma. What client teaching information takes priority?
What medication should the practical nurse question for a client with hypersensitivity, glaucoma, enlarged prostate, hypertension, a urinary tract blockage, tachycardia, and heart failure?
What medication should the practical nurse question for a client with hypersensitivity, glaucoma, enlarged prostate, hypertension, a urinary tract blockage, tachycardia, and heart failure?
What medications are OK to give to preschool-aged children for asthma attacks as needed, with chronic asthma?
What medications are OK to give to preschool-aged children for asthma attacks as needed, with chronic asthma?
A client on antitussives with codeine should be educated to avoid?
A client on antitussives with codeine should be educated to avoid?
For adults who are 12 years and older based on research standards what is generally effective?
For adults who are 12 years and older based on research standards what is generally effective?
A client with the following should assess if taking any other OTC or medications that can interfere with dosing?
A client with the following should assess if taking any other OTC or medications that can interfere with dosing?
Second-generation antihistamines are indicated in what?
Second-generation antihistamines are indicated in what?
Clients on antihistamines should be taught to avoid what?
Clients on antihistamines should be taught to avoid what?
A client taking pseudoephedrine reports feeling nervous and has an elevated heart rate. Which client teaching is warranted given these adverse effects?
A client taking pseudoephedrine reports feeling nervous and has an elevated heart rate. Which client teaching is warranted given these adverse effects?
First-generation antihistamines are contraindicated in what?
First-generation antihistamines are contraindicated in what?
Expectorants decrease the viscosity of fluid by what?
Expectorants decrease the viscosity of fluid by what?
Oral prednisone is used in respiratory conditions to control what?
Oral prednisone is used in respiratory conditions to control what?
Theophylline relaxes bronchial smooth muscle by what?
Theophylline relaxes bronchial smooth muscle by what?
Atelectasis is mostly caused by?
Atelectasis is mostly caused by?
You are providing discharge instructions to a client admitted to the hospital due to pneumonia, the client is being discharged on a beta-agonist, what statement should you include in your teaching?
You are providing discharge instructions to a client admitted to the hospital due to pneumonia, the client is being discharged on a beta-agonist, what statement should you include in your teaching?
A client with asthma has the following medication list, which prescription should the nurse question?
A client with asthma has the following medication list, which prescription should the nurse question?
A respiratory medication is ordered to be given via nebulizer. What special consideration applies?
A respiratory medication is ordered to be given via nebulizer. What special consideration applies?
A client being discharged on an inhaler states they have difficulty coordinating pressing the inhaler and breathing in. What is the best response?
A client being discharged on an inhaler states they have difficulty coordinating pressing the inhaler and breathing in. What is the best response?
A client is prescribed short-acting albuterol. What statement by the nurse should be included?
A client is prescribed short-acting albuterol. What statement by the nurse should be included?
A client is ordered to take a beta-agonist, what statement best describes the mechanism of this drug?
A client is ordered to take a beta-agonist, what statement best describes the mechanism of this drug?
The order is to administer Ipratropium, explain this medication's action.
The order is to administer Ipratropium, explain this medication's action.
A client has a respiratory condition where secretions are thick. What is the expected outcome for guaifenesin?
A client has a respiratory condition where secretions are thick. What is the expected outcome for guaifenesin?
What is the contraindication for use with severe hypertension, coronary artery disease, narrow-angle glaucoma, and some antidepressant use?
What is the contraindication for use with severe hypertension, coronary artery disease, narrow-angle glaucoma, and some antidepressant use?
What is the expected outcome when using anti-histamines?
What is the expected outcome when using anti-histamines?
Fluticasone is an inhaled steroid with what expected outcome?
Fluticasone is an inhaled steroid with what expected outcome?
A client taking theophylline reports persistent nausea and tremors. What is the most accurate interpretation of these findings?
A client taking theophylline reports persistent nausea and tremors. What is the most accurate interpretation of these findings?
A client with a history of asthma and allergic rhinitis is prescribed both montelukast and loratadine. What is the rationale for prescribing both medications?
A client with a history of asthma and allergic rhinitis is prescribed both montelukast and loratadine. What is the rationale for prescribing both medications?
A client with COPD is prescribed tiotropium via a dry powder inhaler. What indicates the client needs further teaching?
A client with COPD is prescribed tiotropium via a dry powder inhaler. What indicates the client needs further teaching?
A client with asthma is prescribed a fluticasone inhaler. What statement demonstrates the client understands the primary purpose of this medication?
A client with asthma is prescribed a fluticasone inhaler. What statement demonstrates the client understands the primary purpose of this medication?
A client is prescribed guaifenesin for a persistent cough. What indicates the medication is exerting its therapeutic effect?
A client is prescribed guaifenesin for a persistent cough. What indicates the medication is exerting its therapeutic effect?
A client with a history of allergic rhinitis is considering using pseudoephedrine for nasal congestion. What pre-existing condition would be of greatest concern?
A client with a history of allergic rhinitis is considering using pseudoephedrine for nasal congestion. What pre-existing condition would be of greatest concern?
A client with asthma is prescribed albuterol via a metered-dose inhaler (MDI). What demonstrates proper inhaler technique?
A client with asthma is prescribed albuterol via a metered-dose inhaler (MDI). What demonstrates proper inhaler technique?
A client is prescribed both albuterol and ipratropium via nebulizer. What describes the rationale for combining these medications?
A client is prescribed both albuterol and ipratropium via nebulizer. What describes the rationale for combining these medications?
A client with a chronic, nonproductive cough is prescribed an antitussive. What information should the nurse prioritize when educating the client about this medication?
A client with a chronic, nonproductive cough is prescribed an antitussive. What information should the nurse prioritize when educating the client about this medication?
What is the most crucial assessment for a nurse to make when administering diphenhydramine intravenously?
What is the most crucial assessment for a nurse to make when administering diphenhydramine intravenously?
A client on long-term oral corticosteroids is being evaluated for inhaled fluticasone to manage their asthma. What represents the primary benefit?
A client on long-term oral corticosteroids is being evaluated for inhaled fluticasone to manage their asthma. What represents the primary benefit?
A nurse is educating a client on the use of a long-acting beta-2 agonist (LABA) inhaler. What statement by the client indicates a need for further teaching?
A nurse is educating a client on the use of a long-acting beta-2 agonist (LABA) inhaler. What statement by the client indicates a need for further teaching?
A client taking theophylline is advised to avoid certain foods and beverages. What dietary modification is most important for the nurse to discuss with the client?
A client taking theophylline is advised to avoid certain foods and beverages. What dietary modification is most important for the nurse to discuss with the client?
A nurse is caring for a client prescribed montelukast for exercise-induced bronchospasm. How should the nurse instruct the client to take this medication?
A nurse is caring for a client prescribed montelukast for exercise-induced bronchospasm. How should the nurse instruct the client to take this medication?
What adverse effect should the nurse prioritize when monitoring an elderly client receiving diphenhydramine for allergic rhinitis?
What adverse effect should the nurse prioritize when monitoring an elderly client receiving diphenhydramine for allergic rhinitis?
A child is prescribed diphenhydramine elixir for an allergic reaction. The order reads: '1.25 mg/kg every 6 hours as needed'. The child weighs 44 lbs. How many mg is this?
A child is prescribed diphenhydramine elixir for an allergic reaction. The order reads: '1.25 mg/kg every 6 hours as needed'. The child weighs 44 lbs. How many mg is this?
A nurse is instructing a client on using fluticasone via a dry powder inhaler. What step is most important?
A nurse is instructing a client on using fluticasone via a dry powder inhaler. What step is most important?
A client on antitussives with codeine should avoid what?
A client on antitussives with codeine should avoid what?
Second-generation antihistamines are frequently indicated for treatment of what condition?
Second-generation antihistamines are frequently indicated for treatment of what condition?
A client is prescribed pseudoephedrine for nasal congestion. What adverse effects should the nurse teach the client?
A client is prescribed pseudoephedrine for nasal congestion. What adverse effects should the nurse teach the client?
A client taking guaifenesin is instructed to avoid eating or drinking for 30 minutes after taking the medication. What is the rationale for this instruction?
A client taking guaifenesin is instructed to avoid eating or drinking for 30 minutes after taking the medication. What is the rationale for this instruction?
A client taking an antihistamine should be instructed to avoid what?
A client taking an antihistamine should be instructed to avoid what?
What is the mechanism of action for expectorants such as guaifenesin?
What is the mechanism of action for expectorants such as guaifenesin?
A client with a history of asthma and hypertension is prescribed a beta-agonist inhaler. What should the nurse be closely monitoring?
A client with a history of asthma and hypertension is prescribed a beta-agonist inhaler. What should the nurse be closely monitoring?
Theophylline relaxes bronchial smooth muscle through what mechanism?
Theophylline relaxes bronchial smooth muscle through what mechanism?
What condition is a contraindication (reason not to use) for use with decongestants like pseudoephedrine?
What condition is a contraindication (reason not to use) for use with decongestants like pseudoephedrine?
Which assessment finding would be of greatest concern in a client taking an anticholinergic medication?
Which assessment finding would be of greatest concern in a client taking an anticholinergic medication?
What is a critical step a client should take after using an inhaled corticosteroid such as fluticasone?
What is a critical step a client should take after using an inhaled corticosteroid such as fluticasone?
What should a nurse include in the discharge teaching for a patient being discharged with a beta-agonist?
What should a nurse include in the discharge teaching for a patient being discharged with a beta-agonist?
What scenario warrants the nurse questioning a prescription?
What scenario warrants the nurse questioning a prescription?
How should a respiratory medication that is ordered through a nebulizer be administered?
How should a respiratory medication that is ordered through a nebulizer be administered?
What intervention is best if a client has difficulty coordinating pressing the inhaler and breathing in?
What intervention is best if a client has difficulty coordinating pressing the inhaler and breathing in?
A client is ordered to take a beta-agonist, explain this medication's actions.
A client is ordered to take a beta-agonist, explain this medication's actions.
Adults (12 years and older) are generally advised to avoid which class of medications?
Adults (12 years and older) are generally advised to avoid which class of medications?
The client is prescribed diphenhydramine 50 mg PO now, and the available drug concentration is 12.5 mg/5 mL. How much should the nurse give?
The client is prescribed diphenhydramine 50 mg PO now, and the available drug concentration is 12.5 mg/5 mL. How much should the nurse give?
The client is prescribed Sunafed 60 mg Q6H and the available tablets are 30 mg per tablet. How many tablets should the nurse give?
The client is prescribed Sunafed 60 mg Q6H and the available tablets are 30 mg per tablet. How many tablets should the nurse give?
The client received 4 puffs of medication via Ventolin inhaler, each puff of Ventolin contains 0.1 mg of medication. How much medication did the client receive in total?
The client received 4 puffs of medication via Ventolin inhaler, each puff of Ventolin contains 0.1 mg of medication. How much medication did the client receive in total?
The client needs a total of 180 mcg, how many puffs of the inhaler are needed to reach the required dosage if the box states: 18 mcg/puff?
The client needs a total of 180 mcg, how many puffs of the inhaler are needed to reach the required dosage if the box states: 18 mcg/puff?
Order IV antihistamine medication in 50 mL NS in 15 min. What rate in mL/hr should the nurse regulate the IV at?
Order IV antihistamine medication in 50 mL NS in 15 min. What rate in mL/hr should the nurse regulate the IV at?
Order IV antihistamine medication in 50 mL NS in 15 min. The drop factor is 15 gtt/mL, at what flow rate in drops per minute should the nurse regulate the IV?
Order IV antihistamine medication in 50 mL NS in 15 min. The drop factor is 15 gtt/mL, at what flow rate in drops per minute should the nurse regulate the IV?
Flashcards
Conducting Zone
Conducting Zone
Organs/structures that facilitate air movement, warming, humidifying, and filtering without direct gas exchange.
Respiratory Zone
Respiratory Zone
Structures in the respiratory system directly involved in gas exchange with the blood.
Antihistamines
Antihistamines
Medications used to provide relief from allergy symptoms.
Decongestants
Decongestants
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Antitussives
Antitussives
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Expectorants
Expectorants
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Beta-2 Agonists
Beta-2 Agonists
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Anticholinergics
Anticholinergics
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Corticosteroids
Corticosteroids
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Leukotriene Receptor Antagonists
Leukotriene Receptor Antagonists
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Xanthine Derivatives
Xanthine Derivatives
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Antihistamine mechanism
Antihistamine mechanism
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Pseudoephedrine MOA
Pseudoephedrine MOA
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Antitussive use
Antitussive use
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Xanthine teaching
Xanthine teaching
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Study Notes
- Module #12 focuses on respiratory system medications and gas exchange.
- It is part of the Practical Nursing Semester 2 program at Mohawk College.
Module Objectives
- Apply math principles to medication dosing and administration for oral, injection, inhaled, and intravenous routes.
- Review respiratory system physiology and gas exchange.
- Identify the actions of respiratory system drugs.
- Provide examples of when, how, and to whom respiratory system drugs can be administered.
- Recognize side effects and special considerations for respiratory drugs across the lifespan.
- Use evidence-based concepts in nursing, clinical reasoning, and decision-making regarding medications affecting the respiratory system.
IV Calculation Review
- A practice problem requires calculating the flow rate in drops per minute for an IV antihistamine medication:
- To administer IV antihistamine medication of 50 mL NS in 15 minutes with a drop factor of 15 gtt/mL, the IV should be regulated at a flow rate of 50 drops per minute.
- Another practice problem requires calculation of flow rate in mL/hr:
- To administer IV antihistamine medication of 50 mL NS in 15 minutes, the flow rate should be set to 200 mL/hr.
Oral Medication Math Review: Respiratory
- A practice problem involves calculating the correct volume of Diphenhydramine HCl to administer:
- If the order Diphenhydramine HCl 50 mg PO and the medication is available as Diphenhydramine HCl 12.5 mg/5 mL, administer 20 mL.
- A practice problem involves determining how many tablets to administer for a dose of Sunafed:
- For an order of Sunafed 60 mg Q6H and the available medication is Sunafed 30 mg per tablet, the patient should receive 2 tablets.
Inhalation Medication Math Review: Respiratory
- A practice problem involves calculating the total dose of medication received from a Ventolin inhaler:
- If each puff of Ventolin contains 0.1 mg of medication, and the client received 4 puffs, the total medication received is 0.4 mg.
- A practice problem involves calculating how many puffs of an inhaler are needed to reach the required dosage:
- A client needs 180 mcg of medication and the inhaler delivers 18 mcg/puff so 10 puffs are needed.
Brief Overview of the Respiratory System
- The Respiratory System Anatomy involves the:
- Lungs
- Intercostal Muscles
- Pleural Sac
- Visceral Pleura
- Pleural Cavity
- Diaphragm
- The Respiratory System include the following mechanisms:
- Respirations; Inhalation of Air
- Pulmonary Capillaries
- Gas Exchange; Expiration to Atmosphere
- Diffusion; Alveoli
- Delivery of oxygen and nutrients
- Hemoglobin carrying capacity; Cellular uptake of oxygen and nutrients
- Cells lining alveoli
- Perfusion
- Cellular metabolism and energy
- Waste products - carbon dioxide
- Capillaries carrying waste out of cell through perfusion
- Expiration
- The Conducting Zone involves:
- Organs and structures not directly involved in gas exchange
- A route for incoming and outgoing air, removing debris and pathogens, and warming/humidifying air
- Nasal cavity
- Nostril
- Oral cavity
- Larynx
- Pharynx
- Trachea
- Right main bronchus & Left main bronchus
- Right lung & Left lung
- Diaphragm
- The Respiratory Zone involves:
- Structures directly involved in gas exchange
- Terminal bronchiole
- Smooth muscle
- Deoxygenated blood from pulmonary artery
- Oxygenated blood to pulmonary vein
- Respiratory bronchiole
- Alveolus
- Capillaries
- Alveolar duct
- Alveolar sac
- Alveolar pores
- Respiratory Diseases include:
- Allergies & Anaphylaxis
- Asthma
- Bronchitis
- Common Cold
- Chronic Obstructive Pulmonary Disease (COPD)
- Pneumonia
Clinical Reasoning and the Nursing Process Related to Respiratory Medication Administration
- Assessment involves recognizing cues, such as the client's respiratory status and history of allergies or adverse drug responses.
- Interventions involve planning and taking action, considering various formulations of respiratory medications and anticipating expected outcomes and side effects.
- Evaluation involves assessing outcomes of action by comparing respiratory assessments before and after medication to determine if the patient's condition imroves.
Respiratory Medications and Special Considerations
- Administration Considerations: Medications can be administered through inhalation, oral, sublingual, injectable, and nebulized routes, each impacted by the client’s needs.
- Therapeutic Effect: The expected result of administering respiratory drugs is generally improved breathing.
- Adverse and Side Effects: Nurses need to understand the negative consequences of medications and try to prevent them.
- Client Teaching: Educating clients about their medications, how to take them, possible side effects, and therapeutic effects is essential.
- Examples of Respiratory Medications: Antihistamines, Decongestants, Antitussives, Expectorants, Beta-2 Agonists, Anticholinergics, Inhaled Corticosteroids, Leukotriene Receptor Antagonists, and Xanthine Derivatives.
Respiratory Medication Examples
- First-generation antihistamines: diphenhydramine
- Second-generation antihistamines: cetirizine (reactine), loratidine, blexten (bilastine)
- Routes of of administration: PO/IV/IM/Suppository
- Adult dosage: PO 25-50mg every 4-6 hours as needed, or IV/IM 10-50 mg
- Children (4+): 1.25mg per kg of body weight injected intramuscularly up to 4 times daily
Antihistamines
- Action: Histamine is blocked at H1 receptors.
- Inhibits smooth muscle constriction in blood vessels and the respiratory and GI tracts.
- Decreases capillary permeability, salivation, and tear formation.
- Used for: Relief of allergy or cold symptoms.
- Side effects: First-generation drugs may cause anticholinergic effects or CNS depression/stimulation and increase confusion in the elderly. Second-generation drugs may cause headache, nausea, vomiting, dysmenorrhea, and fatigue.
- Not safe for children under 2 years old without a doctor's order.
- Sedation must be considered, especially with IV administration of diphenhydramine, and respirations monitored.
- May cause drowsiness, and frequent oral hygiene may assist in alleviating discomfort.
Decongestants
- Available over-the-counter (OTC).
- Example: Pseudoephedrine.
- Action: Acts directly on adrenergic receptors and indirectly by releasing norepinephrine, producing vasoconstriction and shrinking nasal mucosa membranes.
- Indication: Relieves nasal obstruction due to inflammation.
- Not safe for children under 4 years of age.
- Drink 2-3 liters of water.
- Determine if the patient has heart disease, diabetes, or a thyroid disorder.
- Determine if the patient is taking any other OTC or medications that can interfere with dosing.
- Side Effects: Hypertension, dysrhythmia, dizziness, headache, insomnia, and restlessness.
- May experience blurred vision, tinnitus, chest tightness, a dry nose, and nasal congestion.
- Clients with severe hypertension, CAD, narrow-angle glaucoma, and those taking antidepressants are contraindicated.
- Use with caution with clients who have cardiac dysrhythmias, hyperthyroidism, DM, prostatic hypertrophy, and glaucoma.
- Follow dosing recommendations
- Surpassing dosing standards may cause cause Increased nervousness, Breathing difficulties, Heart rate changes and Hallucinations
Antitussives
- Prevents cold and flu symptoms.
- Examples: Dextromethorphan; Hycodan (Codeine/Morphine), which is a narcotic based cough syrup.
- A prescription is required for Hycodan use.
- Action: Suppresses cough by depressing the cough center in the medulla oblongata or cough receptors.
- Use: For dry, hacking, nonproductive coughs.
- PO by elixir (most often); Adults (12 years and over) based on research standards - generally no effective anti-tussives for children under 8.
- Side effects: Nausea and drowsiness.
- Some clients endure a rash or difficulty breathing, and high doses may cause hallucinations and disassociation.
- Avoid irritants and taking with CNS depressants or alcohol.
Expectorants - Guaifenesin
- Example: Guaifenesin (Mucinex).
- Action: Reduces viscosity of tenacious secretions by irritating gastric vagal receptors to stimulate fluid production, which increases volume but decreases viscosity.
- Use: For productive coughs and loosening mucus.
- May be administered as liquid syrup or elixir, PO pill form - 12 hr effect (1 tablet is 600 mg) Max dose is 1200 mg in 24hrs
- No eating or drinking for 30 minutes after syrup
- Stay hydrated (2-3 liters/day)
- For adults 12 years and older
- Adverse - Side Effects: Skin rash, headache, nausea, and vomiting
- Recommended for use during pregnancy and breastfeeding when the benefit outweighs risk.
- Avoid irritants, can cause drowsiness, and should not be taken with other CNS depressants or alcohol.
Beta-2 Agonist
- Short Acting
- Albuterol (Ventolin)
- Prevent or treat asthma attack
- Long Acting
- Salmeterol
- prevent bronchospasm
- Stimulates Beta 2-adrenergic receptors in the smooth muscle of bronchi and bronchioles to produce bronchodilation (tachycardia may occur if beta-1 receptors are also stimulated)
- Take as directed for proper dosing
- Onset: Short acting: 1-5 mins with duration of action 4-6hrs; Long acting: 30-45 mins and duration of action greater than 12hrs
- Oral inhalation: Can be given IV and PO and Wait at least 2 minutes between inhalations
- Nursing Considerations: Monitor respiratory rate, oxygen saturation, and lung sounds; safe for pediatric and older adult populations; use a spacer for preschool aged children (best route is a pressurized metered dose inhaler with a spacer)
- Side effects: Muscle tremor, Excessive cardiacstimulation and CNS stimulation
- Client Health Teaching: Take medication as directed reporting any sustained or worsening symptoms to their healthcare provider; teach the patient how to use an inhaler and prime unit prior to use; rinse mouth with water before and after use and teach onset of medication use
Anticholinergics – Inhaler based
- Short-acting anticholinergic: Ipratropium
- Long-acting anticholinergic: Tiotropium
- Action: Block the action of acetylcholine in bronchial smooth muscle = reduces Broncho-constrictive substance release
- Use: Maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema
- Administration: Inhaler use should be done with proper technique to get appropriate dosages and can also be administered via a nebulizer
- Side effects: Can cause cough, drying of the nasal mucosa, nervousness, nausea, Gl upset, headaches, and dizziness and should be used with caution with the elderly
- Other considerations:
- Watch for swelling in face and notify health care provider if this occurs
- Do not exceed dose recommendations
- Do not use anticholinergics with Myasthenia gravis, hyperthyroidism, glaucoma, enlarged prostate, hypertension, urinary tract blockage, tachycardia and heart failure
Corticosteroids
- Examples:
- Fluticasone (flovent) - inhaled corticosteroid
- Prednisone - oral corticosteroid
- Methylprednisolone - IV corticosteroid
- Action: Fluticasone is a locally-acting anti-inflammatory and immune modifier, used in nasal spray for allergies and oral inhaler for long-term asthma control (often with salmeterol). This combination has many benefits including decreased frequency and severity of asthma attacks, as well as improving overall asthma symptoms (Advair 250/50) if fluticasone is used in conjugation with salmeterol.
- Use: Fluticasone prevents asthma attacks, while oral prednisone treats severe allergic conditions/respiratory conditions
- Fluticasone aerosol or powder oral inhalers are inhaled once twice and once a day respectively; Use at the same time each day and follow directions exactly to get proper dose. Finally, rinse mouth before and after usage to prevent infection in oral cavity, also called thrush
Leukotriene Receptor Antagonists
- Example: Montelukast (Singulair)
- Action: Blocks leukotriene receptors and decreases inflammation
- Use: Long-term control of asthma and reducing asthma attacks, as well as exercise-induced bronchospasm and allergic rhinitis
- Administration: Granule packs 4 mg, chewable tablets 4 and 5 mg, and regular tablets 10mg
- Side Effects: Headache, cough, nasal congestion, nausea, and hepatotoxicity
Leukotriene Receptor Antagonists
- Nursing Considerations Across the Lifespan
- Safe for children 12 months and older
- It is available in granule packets, chewable tablets, and regular tablets
- Not a rescue drug-long-term medication
Client Health Teaching
- Instruct to take medications at the same time each day and at least two hours prior to exercise
- Do not discontinue medications without notifying the healthcare provider
Xanthine Derivatives
- Example: Theophylline
- Action: Relax bronchial smooth muscle by inhibiting the enzyme phosphodiesterase and suppresses airway responsiveness to stimuli that cause bronchoconstriction
- Use: Long-term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids
- Administration: PO and extended release PO once a day dosage -Side Effects: Nausea, vomiting, CNS stimulation, nervousness, and insomnia
Other Considerations
- Further research is indicated for long term use of these drugs in childhood asthma
- Take medications as prescribed and at appropriate intervals
- Avoid irritants and drink fluids to help thin secretions (2-3 L of water per day)
- Serum blood levels tested every six to twelve months
Summary
- Respiratory medications are often given to alleviate allergies or cold symptoms, or to decrease/eliminate shortness of breath (SOB)
- An important piece of your nursing assessment should be to assess the client's respiratory status before and after medication administration
- Respiratory Medications examples:
- Antihistamines - allergy relief
- Decongestants - nasal obstruction due to inflammation
- Antitussives - cold and flu symptoms, some medications have controlled substances such as codeine and a prescription is required
- Expectorants - productive cough ex. Guaifenesin
- Beta-2 Agonist - short-acting - prevent and treat acute asthma attack
- Anticholinergics - Maintenance therapy of bronchoconstriction
- Corticosteroids - Long-term control of asthma
- Leukotriene Receptor Antagonists - Long-term control of asthma
- Xanthine Derivatives - Long-term management of persistent asthma
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