Respiratory Drug Table PDF

BRONCHODILATORS Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications BETA 2 ADRENERGIC AGONISTS (-terol) inhaled short acting: - sympathomimetic uses: - for albuterol...

BRONCHODILATORS Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications BETA 2 ADRENERGIC AGONISTS (-terol) inhaled short acting: - sympathomimetic uses: - for albuterol - avoid taking w/ beta albuterol - activate beta2 - most effective drugs for - tachycardia blocker and NSAIDs - levalbuterol adrenergic receptors acute bronchospasm - angina can cause - bronchodilation - PO: used on fixed - muscle tremors bronchospasms inhaled long acting: schedule for long-term - insomnia salmeterol control - anxiety arformoterol - inhaled long acting: - long acting- may formoterol used on fixed schedule increase risk of severe for long term control, asthma and asthma preferred over short related death when used acting for stable COPD as monotherapy - inhaled short acting: PRN, can be used to stop ongoing attack, but cannot be used for prolonged prophylaxis (excess use is dangerous) routes: - PO - inhaled short acting - inhaled long acting Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications EPINEPHRINE epinephrine uses: - therapeutic rescue - acute attack of effects in less than 5 bronchoconstriction minutes  routes: - inhalation - subQ Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications ANTICHOLINERGIC BRONCHODILATORS prototype: ipratropium - block muscarinic uses: - cough - glaucoma (paradoxical (Atrovent) receptors in bronchi - approved for COPD but - nervousness bronchospasm has - reduces used off label for - nausea occurred) tiotropium (Spiriva) bronchoconstriction asthma - GI upset and mucus secretion - dizziness Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications METHYLXANTHINES prototype: theophylline - relaxes bronchial - not commonly used - therapeutic range: 5-15 smooth muscles anymore but may be mcg/mL prescribed for severe - toxic above 20 COPD/bronchitis as mcg/mL - leads to second line drug if seizures, other prescribed meds tachycardia, aren’t working dysrhythmia - avoid cimetidine, ciprofloxacin, and caffeine ANTI-INFLAMMATORY DRUGS Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications GLUCOCORTICOIDS Inhaled: - reduces asthma uses: - oropharyngeal - rinse mouth w/ water prototype: symptoms by - prophylaxis of chronic candidiasis after use beclomethasone suppressing asthma - hoarseness inflammation - management: budesonide (pulmicort, - decreases synthesis and scheduled, not for PRN flexhaler, pulmicort release of - inhaled are first line respules) inflammatory therapy for mediators (e.g. management of fluticasone propionate leukotrienes, histamine, inflammatory (veramyst, flonase, prostaglandins) component of asthma flovent) - decrease infiltration and - oral route for activity of maintenance of mometasone furoate inflammatory cells moderate to severe (asmanex, nasonex) (eosinophils, persistent asthma leukocytes) PO: - decreased edema of prednisone airway mucosa methylprednisolone (secondary to decrease in vascular permeability) Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications LEUKOTRIENE MODIFIERS prototype: montelukast leukotrienes promote uses: BBW: (PO leukotriene receptor - smooth muscle - second line therapy neuropsychiatric events blocker) constriction (when inhaled - blood vessel glucocorticoid permeability contraindicated) and as - inflammatory responses add on therapy - recruitment of - route is PO (slow inflammatory cells acting) leukotriene modifiers - decrease  bronchoconstriction - decrease edema and mucus secretion Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications IMMUNOSUPPRESSANT MONOCLONAL ANTIBODIES prototype: omalizumab - Inhibits IgE binding to - BBW: anaphylaxis with IgE receptors on mast first injection, cells and basophils, anaphylaxis occurrence reducing allergic more than one year response after initial dose Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications MAST CELL STABILIZER prototype: cromolyn uses: sodium (nebulizer, - used when intranasal) glucocorticoids contraindicated or ineffective - not effective for acute attacks - administered by nebulizer for asthma - take when anticipating exertion DRUGS FOR URI ALLERGIC RESPONSE Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications GLUCOCORTICOIDS prototype: - suppresses congestion, routes: - dry nasal mucosa - 90% of people respond beclomethasone rhinorrhea, sneezing, - intranasal - burning or itching with proper use nasal itching, and sensation erythema - sore throat - epistaxis - headache Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications ANTIHISTAMINES prototype: - relieve sneezing, routes: - sedation w/ first first generation: rhinorrhea, and nasal - oral antihistamines generation but does diphenhydramine itching but NOT nasal (histamine1 [H1] work better second generation: congestion receptor antagonists) cetirizine third generation: fexofenadine Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications SYMPATHOMIMETICS (DECONGESTANTS) prototype: - reduce nasal congestion - rebound congestion - widespread - use topical agents for pseudoephedrine by activating alpha - CNS stimulation vasoconstriction can be only 3-5 days (Sudafed)- PO 1-adrenergic receptors - cardiovascular dangerous for pts with - body gets used to it and on nasal blood vessels - high potential for abuse hypertension, coronary then rebound phenylephrine → vasoconstriction → artery disease, cardiac congestion happens bc (Neo-Synephrine)- drops, decreased swelling and arrhythmias, med is not effective spray, oral drainage cerebrovascular disease anymore - some people may be oxymetazoline (Afrin)- addicted to it spray - all products containing epinephrine and  pseudoephedrine placed behind the counter - watch out for stimulants and other decongestants in combo drugs - sometimes nasal spray is used for nosebleeds DRUGS FOR COUGH Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications ANTITUSSIVES opioid: - numb stretch receptors uses: opioid: - codeine in lung to reduce - dry, hacking cough - sedation - hydrocodone cough (congestion and mucus - respiratory depression (Hycodan) need to be expelled) - death non-opioid non-opioid - prototype: - nausea dextromethorphan - drowsiness (Delsym, Robitussin) - rash - benzonatate (Tessalon, - difficulty breathing Zonatuss) DRUGS FOR CONGESTION Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications EXPECTORANTS prototype: guaifenesin - makes cough more - maintain patent airway (Mucinex, Humibid) productive by - monitor oxygenation stimulating flow of - encourage adequate respiratory tract fluid intake secretions - elevate HOB - auscultate lung sounds - assess characteristics of sputum - monitor for sedation and other adverse effects Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications MUCOLYTICS prototype: acetylcysteine - makes mucus more - maintain patent airway (Mucomyst)- inhalation watery to make cough - monitor oxygenation more productive - encourage adequate fluid intake - elevate HOB - auscultate lung sounds - assess characteristics of sputum - monitor for sedation and other adverse effects