HFHS Orientation - Respiratory Drugs PDF

# Respiratory Tract Drugs ## **A. General Information:** Side effects of respiratory drugs include: - **Cardiac:** Tachycardia, arrhythmias, increased blood pressure, palpitations - **Nervous system:** Increased anxiety, disorientation, restlessness, dizziness, headache - **GI:** Nausea, vomiting...

# Respiratory Tract Drugs ## **A. General Information:** Side effects of respiratory drugs include: - **Cardiac:** Tachycardia, arrhythmias, increased blood pressure, palpitations - **Nervous system:** Increased anxiety, disorientation, restlessness, dizziness, headache - **GI:** Nausea, vomiting ## **B. Sympathomimetic Bronchodilators:** - Albuterol (Proventil) - Metaproterenol sulfate (Alupent) - Terbutaline (Brethine) - Salmeterol (Serevent) - Combivent (albuterol/ipratoprium) ### **1. Indications:** These agents are used to relax the bronchial smooth muscle, thus reducing airway resistance and improving airflow. The non-catecholamine sympathomimetic agents listed above are longer lasting and evoke less severe side effects. ### **2. Adverse Reactions:** - Tachycardia - Insomnia - Arrhythmias - Palpitations - Nausea - Restlessness - Anxiety ### **3. Patient Teaching:** - Instruct patient on how to use, care for, and maintain the inhaler. - Instruct patient to inhale drug slowly and hold in for as long as possible. - Emphasize the importance of cleaning the inhaler to avoid infection (mouthpiece and spacer must be rinsed after each use). ## **C. Parasympathetic Blockers:** - Ipratropine (Atrovent) - Tiotropium (Spiriva) ### **1. Indications:** In some patients, bronchospasm is caused less by adrenergic dysfunction than by excessive parasympathetic influence on the bronchioles. Inhaled anticholinergic drugs decrease activity of the parasympathetic nervous system on bronchial smooth muscle, resulting in bronchodilation. ### **2. Adverse Reactions:** - Dry mouth - Nausea and GI upset - Cough ### **3. Nursing Considerations:** - Use in caution with patients who have glaucoma or urinary retention. - Assess breath sounds for wheezing or other adventitious sounds. - Check for hypersensitivity and overdose symptoms such as cough, headache, GI upset, irritated throat, tachycardia, or tremor. ### **4. Patient Education:** - Instruct patient not to use this drug alone against acute bronchospasm but to administer with sympathomimetic bronchodilators. - This medication may be supplied as a powder-containing capsule; instruct patient not to swallow capsule and use with the inhaler. - Warn patient not to spray MDI into eyes. - Caution patient against mixing with Cromolyn to prevent precipitate. ## **D. Phosphodieterase Inhibitors (Methylxanthine Agents)** - Theophylline derivatives (Slo-bid, Theo-Dur) - Singulair ### **1. Indications:** Used as a maintenance drug by asthmatics to control mild to moderate bronchospasm. It is also prescribed for patients with COPD and cystic fibrosis. ### **2. Adverse Reactions:** - Caffeine-like symptoms that may include nervousness, insomnia, jitteriness, headache, frequent urination, and palpitations. - As serum levels increase, adverse effects become more severe such as nausea, vomiting, and tachycardia. ### **3. Nursing Indications:** - Monitor heart rate and blood pressure. - Monitor for toxicity such as nausea, insomnia, seizures, and restlessness. - Assess breath sounds for decreased wheezing and improved aeration. ### **4. Patient Education:** - Advise patient that if they smoke, the dosage will need to be adjusted. - Instruct patient not to crush SR tablets as this will release full dose immediately. - Instruct patient to take drug around the clock as ordered. ## **E. Non-Steroidal Anti-inflammatory Respiratory Drugs:** - Cromolyn Sodium (Intal, Nasalcrom) ### **1. Indications:** These agents prevent airway inflammation from occurring. They are particularly effective for the allergic asthmatic patients. These drugs reduce both the frequency and intensity of asthma attacks. ### **3. Adverse Reactions:** Reactions are generally mild and rare, but may include irritated throat, dry mouth, cough, unpleasant taste, and headache. ### **3. Nursing Indications:** - Record frequency and severity of asthma attacks. - Assess breath sounds and for reflex bronchospasm after treatment. ### **4. Patient Education:** - Instruct patient not to swallow capsules. - Advise patient drug may take two to four weeks before producing results. - Tell patient to rinse mouth after administration of drug. - Advise patient to use bronchodilator prior to Cromolyn to maximize Cromolyn inhalation. ## **F. Inhaled Steroids:** - Advair diskus - Budesonide (Pulmacort) - Fluticasone (Flovent) ### **1. Indications:** Inhaled steroids are indicated for use by patients with asthma, chronic bronchitis, COPD, cystic fibrosis, or lung disease characterized by chronic or acute inflammation. Inhaled steroids are not useful in acute exacerbations of asthma and may aggravate symptoms. These agents are not bronchodilators and are ineffective against acute bronchospasm. Severe exacerbations of either asthma or COPD may require additional dosing with systemically administered steroids. ### **2. Adverse Reactions:** - Oropharyngeal irritation - Sore throat - Sinusitis - Oral fungal infections ### **3. Nursing Indications:** - Assess for bronchospasm and do not administer if suspected. Notify physician. - Check for sore throat and signs of oral candidiasis. - Monitor sputum color and viscosity. - Watch for new signs of systemic absorption in long-term user. ### **4. Patient Education:** - Instruct patient to rinse mouth thoroughly to avoid Candida overgrowth. - Take medication regularly as ordered, not on a PRN basis. - Clean inhaler daily. - Do not use during acute wheezing.