8/22/2011

Bronchodilators Respiratory Medications

Rachel Joy R. Rosale, RN, RM, MAN

Sympathomimetics Xanthine IND: allergic rhinitis, sinusitis, acute bronchospasm, acute and chronic asthma, bronchitis, COPD, emphysema C/I: hypersensitivity, PUD, severe cardiac disease, cardiac dysrhythmias, hyperthyroidisim, uncontrolled seizures Caution: hypertension, DM, narrow-angle glaucoma

Bronchodilators
Examples: Sympathomimetics
- Receptor Agonists Albuterol (Proventil, Ventolin) Epinephrine (AsthmaHaler mist) Formoterol fumarate (Foradil) Isopretenerol (Isuprel) Terbutaline sulfate (Brethrine, Brethaire)

Bronchodilators
Examples: Xanthines
Aminophylline (Truphylline_ Oxtriphylline (Choledyl) Theophylline (TheoDur)

Anticholinergic Ipratropium bromide (Atrovent, Combivent)

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Bronchodilators
Side Effects:
Palpitations and tachycardia Dysrhythmias Restlessness, nervousness, tremors Anorexia, nausea and vomiting Headaches and dizziness Hyperglycemia Decreased clotting time Mouth dryness and throat irritation with inhalers

Glucocorticoids (Corticosteroids)
Anti-inflammatory agents and reduce edema of the airways Produce sodium and water retention and potassium excretion

Glucocorticoids (Corticosteroids)
Examples:
Beclomethasone diproprionate (Beclovent) Budesonide (Pulmicort) Flunisonide (Aerobid) Fluticasone (Flonase, Flovent) Fluticasion and salmetrol (Advair, Diskus) Mometasone intranasal (Nasonex) Triamcinolone (Azmacort)

Inhaled Non-steroidal Anti-allergy Agents

Anti-asthmatic, antiallergic and mast cell stabilizers IND: Allergic rhinitis, bronchial asthma, exercise-induced bronchospasm Examples:
Cromolyn sodium (Intal) Nedocromil (Tilade)

Side effects:
Cough or bronchospasm Nasal sting or sneezing Unpleasant taste in the mouth

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Leukotriene Modifiers
Reduce and prevent the swelling inside the airways before it starts, stop the mucus from forming and lessen the muscle tightening around the airways IND: Mild asthma Side Effects: Headache, stomachache, flu-like Sx for children Examples:
Singulair (Montelukast Sodium) age 2 above Accolate (Zafirlukast) age 7 above Zyflo (Sileuton) Not approved for children

Anti-histamines
Histamine antagonists or H1 blockers; compete with histamine for receptor sites, preventing histamine response Decrease nasopharyngeal secretions and decrease itching that cause sneezing IND: Common cold, rhinitis, nausea and vomiting, motion sickness, urticaria and as sleep aid C/I: COPD; should not be taken with alcohol, narcotics, hypnotics or barbiturates = CNS depression

Anti-histamines
Side Effects:
Drowsiness and fatigue Dizziness Urinary retention Blurred vision Wheezing Constipation Dry mouth GI irritation Hypotension Hearing disturbances Photosensitivity Nervousness and irritability Confusion Nightmares

Anti-histamines
Examples:
Astemizole Azatadine maleate Azelastine hydrochloride Brompheniramine maleate Cetirizine hydrochloride* Chlorpheniramine maleate Clemastine fumarate Cyproheptadine hydrochloride Dexchlorpheniramine maleate* Dimenhydrinate Diphenhydramine* Doxylamine succinate Fexofenadine Loratadine* Phenindamine tartrate Tripelannamine Triprolidin hydrochloride

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Anti-histamines
Side Effects:
Drowsiness and fatigue Dizziness Urinary retention Blurred vision Wheezing Constipation Dry mouth GI irritation Hypotension Hearing disturbances Photosensitivity Nervousness and irritability Confusion Nightmares

Nasal Decongestants
Stimulate the - adrenergic receptors = vasoconstriction of the capillaries within the nasal mucosa IND: Allergic rhinitis, hay fever, acute coryza C/I: Hypertension, nasal congestion, irritation of nasal mucosa, use for more than 48 hours = rhinitis medicamentosa Side Effects:
Nervousness Restlessness Hypertension Hyperglycemia Tolerance and rebound nasal congestion

Nasal Decongestants
Examples:
Oxymetazoline hydrochloride Phenylephrine hydrochloride Phenylpropanolamine hydrochloride* Pseudoephedrine hydrochloride Xylometazoline hydrochloride

Expectorants and Mucolytic Agents

Loosen bronchial secretions IND: Dry, unproductive cough C/I: Those containing dextromethorphan are CI with COPD; acetylcysteine with asthma Side Effects: GI irritation Skin rash Oropharyngeal irritation

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Expectorants and Mucolytic Agents

Examples:
Expectorants Dornase alfa (Pulmozyme) Guaifenesin (Robitussin) Mucolytic Acetylcysteine (Mucomyst)

Antitussives
Suppresses cough reflex IND: Non-productive and irritating cough Side Effects:
Dizziness, drowsiness, sedation GI irritation, nausea Dry mouth Constipation Respiratory depression

Antitussives
Examples:
Narcotics Codeine Codeine phosphate Codeine sulfate Hydrocodone bitartrate (Hycodan) Non-Narcotics Dextromethorphan hydrochloride (Benylin DM, Robitussin) Diphenhydramine hydrochloride (Benylin Cough Syrup, Benadryl)

Narcotic Antagonist
Reverses respiratory depression in narcotic overdose Example:
Naloxone hydrochloride (Narcan)

Side Effects:
CNS depression Nausea, vomiting Tremors Sweating Increased blood pressure Tachycardia

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Tuberculosis Medications
Multiple medication regimen destroys organisms as quickly as possible and minimizes the emergence of medication-resistant organism Active PTB, usually 6-9 months treatment

Inhaler
Should not be put in mouth but held about 2 fingerwidths (1 inch) in front of mouth Breathe deeply once before activating inhaler then continue breathing in for about 5 seconds; then hold breath for 10-15 seconds If second dose is needed, patient should wait 1 to 2 minutes If 2 meds are prescribed: administer bronchodilator first, then glucocorticoid after 5 minutes

After treatment of 2-3 weeks, risk of transmission reduces greatly Multi Drug Resistant Strain
Occurs when client taking two meds discontinues one drug w/o physicians order

Tuberculosis Medications
First Line
Ethambutol Isoniazid Pyrazinamide Rifampin Streptomycin

Other medications
Aminosalicylate sodium pulmo and extrapulmo TB Rifabutin antimycobacterial as prophylaxis Rifampin and Isoniazid

Second Line
Capreomycin Cycloserine Ethionamide Kanamycin Para-aminosalicylic acid