The Respiratory System
DRUG THERAPY FOR NONINFECTIOUS LOWER RESPIRATORY AIRFLOW DISORDERS
BETA2-ADRENERGIC AGONISTS: ALBUTEROL (PROVENTIL,
... [Show More] VENTOLIN)
● THERAPEUTIC USE:
○ Long term treatment of asthma
○ Prevention of exercise-induced bronchospasm
○ Treatment of ongoing asthma exacerbations ● PHARMACOLOGIC ACTION:
○ Adrenergic drugs stimulates the beta2-adrenergic receptors of the sympathetic nervous system, resulting in bronchodilation.
○ The primary pharmacologic action is to relieve bronchospasm of the bronchi and bronchioles of the lung ○ Valuable in the treatment of asthma because they help the airways of the lungs stay open.
○ Long acting beta2-adrenergic agonists are used in the treatment of client with stable COPD ●
CONTRAINDICATIONS: Allergy to albuterol or levalbuterol
● PRECAUTIONS:
○ Diabetes mellitus, hypothyroidism
○ Cardiovascular disease, hypertension, angina pectoris, tachydysrhythmias, tachycardia due to digitalis toxicity
● ADVERSE DRUG REACTIONS:
○ Hypotension or hypertension, vascular headache ○ Chest pain, palpitations
○ Nervousness, restlessness, tremors
● INTERACTIONS:
○ Beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists
○ MAOIs and tricyclic antidepressants increase the risk of hypertension, tachycardia and angina ○ Hypoglycemic (antidiabetic) drugs require increased dosing because of hyperglycemic effects
● INTERVENTIONS:
○ Monitor and report dizziness, heart palpitations, chest pain, and shortness of breath ○ Monitor and report tremors
● ADMINISTRATION:
○ Follow manufacturer’s instructions for using delivery devices
○ Use short-acting preparations for acute exacerbations
○ Use long-acting preparations for long term control
○ Inhale beta2-adrenergic agonists before inhaling glucocorticoids
○ Follow dosage limits and schedules
○ Watch for signs and triggers of impending exacerbations of asthma ○ Keep a log of frequency and intensity of exacerbations ○
Notify the provider of changes in patterns of exacerbations
● CLIENT INSTRUCTION:
○ Take as prescribed – avoid overuse of rescue inhalers
○ Report chest pain and heart palpitations
○ Avoid caffeine
○ Notify provider if tremors interfere with activities of daily living
INHALED ANTICHOLINERGICS: IPRATROPIUM (ATROVENT, ATROVENT HFA)
● THERAPEUTIC USE:
○ Relief of bronchoconstriction in clients with COPD ○ Decreases secretions in clients with COPD
● PHARMACOLOGIC ACTION:
○ Inhaled anticholinergics work by inhibiting the action of acetylcholine
○ Acetylcholine causes vasoconstriction of the bronchi and bronchioles, blocking stimulation of the parasympathetic
lOMoA RcP S D|8783322
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receptors results in bronchodilation
www.noteim.com
The Respiratory System
lOMoA RcP S D|8783322
● CONTRAINDICATIONS: Hypersensitivity to ipratropium, atropine, belladonna alkaloids or bromide
● PRECAUTIONS:
○ Glaucoma
○ Prostatic hypertrophy, bladder neck obstruction
● ADVERSE DRUG REACTIONS:
○ Dry mouth, irritation of the pharynx ○ Increased intraocular pressure
○ Urinary retention
● INTERACTIONS: Beta2-adrenergic agonists enhance bronchodilation
● INTERVENTIONS:
○ Provide water and hard candy to client
○ Schedule routine testings for glaucoma
○ Monitor urinary elimination patterns, especially in older adults
● ADMINISTRATION:
○ Follow manufacturer’s instructions for using delivery devices ○ Follow dosage limits and schedules
○ Allow the prescribed time between puffs
○ Delay use of other inhalants for 5 minutes
○ Do not use as an emergency rescue medication ○ Rinse
the mouth after taste to reduce unpleasant taste
● CLIENT INSTRUCTION: ○ Suck on hard candy
○ Sip water frequently
○ Have regular eye examinations to test for glaucoma ○ Report any changes in urinary elimination
METHYLXANTHINES: THEOPHYLLINE (THEOLAIR, THROCHRON, THEO-24)
● THERAPEUTIC USE: Long-term management of chronic asthma
● PHARMACOLOGIC ACTION: Methylxanthines exert their expected pharmacological action by relaxing smooth muscles
of bronchi
● CONTRAINDICATIONS:
○ Client with impaired metabolism
○ Tobacco or marijuana use
○ Caffeine
● PRECAUTIONS:
○ Heart disease
○ Liver dysfunction
○ Acute pulmonary edema
● ADVERSE DRUG REACTIONS: ○ Rare at therapeutic levels
○ When therapeutic levels are exceeded: restlessness, insomnia ○ Nausea, vomiting, diarrhea
○ When reaches toxic level: seizures
○ Dysrhythmias ●
INTERACTIONS:
○ Cimetidine (Tagamet), some fluoroquinolones, and caffeine increase the risk of toxicity ○
Phenobarbital, phenytoin (Dilantin), and nicotine increase metabolism of theophylline
● INTERVENTIONS:
○ Monitor plasma drug levels
○ Discontinue drug therapy if toxic levels are indicated www.noteim.com
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The Respiratory System
○ Give activated charcoal to decrease absorption
○ Prepare to initiate anticonvulsant therapy and institute seizure precautions ○ Monitor heart rate and rhythm
○ Give antidysrhythmics to restore heart rate and rhythm
● ADMINISTRATION:
○ If a dose is missed, do not double the dose
○ Have the client chew the chewable tablets thoroughly
○ Do not crush or chew sustained-release or enteric-coated preparations ○ Maintain schedules interval between doses
● CLIENT INSTRUCTION:
○ Reduce or eliminate caffeine intake
○ Have periodic laboratory testing of drug levels
○ Stop taking the drug and notify provider if experiencing seizures
○ Stop taking the drug and notify provider if experiencing dysrhythmias
GLUCOCORTICOIDS: INHALATION - BECLOMETHASONE DIPROPIONATE (QVAR), FLUTICASONE
(FLOVENT); ORAL - PREDNISONE; NASAL - FLTICASONE (FLONASE)
○ Long term management of chronic asthma
○ Short term management of post-exacerbation symptoms (oral) [Show Less]