Respiratory Medications NCELX

Respiratory Meds

Today we’re going to deep dive a bit into respiratory medications. The topic below mentions boxes – those boxes can be found in the Saunders NCLEX Book.

Respiratory Medications

Medication Inhalation Devices

Metered-dose inhaler (MDI)
Dry powder inhaler (DPI)
Nebulizer
If two medications prescribed, administer bronchodilator first and corticosteroid second.

Bronchodilators

Description
Should be used with caution in clients with hypertension, diabetes mellitus, narrow-angle glaucoma
Theophylline increases risk of digitalis toxicity, decreases effects of lithium and phenytoin.
If theophylline and beta-blocker are administered together, cardiac dysrhythmias may result.
Beta-blockers, cimetidine, erythromycin increase effects of theophylline.
Barbiturates, carbamazepine decrease effectiveness of theophylline.
Side/adverse effects
Palpitations, tachycardia, dysrhythmias
Hyperglycemia
Mouth dryness and throat irritation with inhalers
Interventions
Monitor therapeutic serum theophylline level of 10 to 20 mcg/mL.
Intravenously administered theophylline preparations administered slowly using infusion pump
Client teaching
Not to crush enteric-coated or sustained-release tablets or capsules
About side/adverse effects of bronchodilators
Wear a Medic-Alert bracelet.

III. Anticholinergics

Inhaled medications improve lung function.
Effective for treating COPD, allergy-induced asthma, and exercise-induced bronchospasm
Side effects: dry mouth, irritation of pharynx

I Glucocorticoids (Corticosteroids) (see Box 55-1)

Antiinflammatory agents; reduce airway edema
See Chapter 51 for information on glucocorticoids (corticosteroids).

Leukotriene Modifiers (see Box 55-1)

Description
Used in prophylaxis and treatment of chronic bronchial asthma; not used for acute asthmatic episodes
Side effects
Headache, nausea, vomiting, dyspepsia, diarrhea, generalized pain, fever, dizziness
Interventions
Assess lung sounds for rhonchi, wheezing; assess liver function studies as prescribed.
Instruct client to take medication 1 hour before or 2 hours after meals; instruct client not to discontinue medication, to take as prescribed.

Inhaled Nonsteroidal Antiallergy Agents (see Box 55-1)

Description
Antiasthmatic and antiallergic agents, mast cell stabilizers inhibit mast cell release after exposure to antigens.
Used to treat allergic rhinitis, bronchial asthma, exercise-induced bronchospasm
Side effects
Cough, sneezing, nasal sting, bronchospasm following inhalation
Interventions
Administer oral capsules at least 30 minutes before meals.
Instruct client not to discontinue medication abruptly.

VII. Monoclonal Antibodies

Description
Used to treat allergy-related asthma, administered subcutaneously every 2-4 weeks
Side effects
Viral infections, sinusitis, pharyngitis, malignancies
Interventions
Assess respiratory rate, rhythm, and depth.
Assess for allergies and/or allergic reaction symptoms.

VIII. Antihistamines (see Box 55-2)

Description
Medications that compete with histamine for receptor sites, thus preventing histamine response
Diphenhydramine has anticholinergic effects, should be avoided by clients with narrow-angle glaucoma.
Side effects
Drowsiness, urinary retention, blurred vision, wheezing, constipation, dry mouth, gastrointestinal (GI) irritation, hypotension, photosensitivity, nervousness
Interventions
Instruct client to avoid hazardous activities, alcohol, central nervous system (CNS) depressants.
Instruct client taking medication for motion sickness to take 30 minutes before event, before meals, and at bedtime during event.

Nasal Decongestants (see Box 55-3)

Description
Stimulate a-adrenergic receptors, producing vasoconstriction of the capillaries in nasal mucosa
Used with extreme caution in clients with hypertension, cardiac disease, hyperthyroidism, diabetes mellitus
Used for allergic rhinitis, hay fever, and acute coryza
Side effects
Tolerance, rebound nasal congestion
Interventions
Monitor for cardiac dysrhythmias.
Monitor blood glucose levels.
Instruct client regarding importance of limiting use of nasal sprays, drops.

Expectorants and Mucolytic Agents (see Box 55-4)

Description
Expectorants loosen bronchial secretions; then they can be eliminated with coughing.
Mucolytics thin out bronchial mucus.
Side effects
GI irritation, rash, oropharyngeal irritation
Interventions
Instruct client to take medication with full glass of water, maintain adequate fluid intake.
Encourage client to cough and breathe deeply.
Acetylcysteine should not be mixed with other medications if given via nebulizer.

Antitussives (see Box 55-5)

Description
Act on cough center in medulla to suppress cough reflex
Side effects
Constipation
Respiratory depression
Interventions
Instruct client if cough lasts longer than 1 week, should notify health care provider.
Encourage client to maintain adequate fluid intake.
Encourage client to sleep with HOB elevated.

XII. Opioid Antagonists (see Box 55-6)

Description
Reverses respiratory depression in opioid overdose
Side effects
Nausea, vomiting, tremors, diaphoresis, hypertension, tachycardia
Interventions
Assess vital signs, especially respirations.
Have oxygen, resuscitation equipment available during administration.

XIII. Tuberculosis Medications (see Box 55-7)

Description
Use of multidrug regimen destroys organisms as quickly as possible, minimizing emergence of medication-resistant organisms.
Individuals with active TB should be treated for 6 to 9 months (longer if HIV positive).
After infected individual has received medication for 2 to 3 weeks, risk of transmission greatly reduced.
Most clients have negative sputum cultures after 3 months’ compliance with medication therapy.
Individuals exposed to active TB treated with preventive isoniazid for 9 to 12 months.

XIV. First-Line Medications for Tuberculosis (see Box 55-7)

Isoniazid
Contraindicated in clients with hypersensitivity, acute liver disease
Use with caution in clients with chronic liver disease, alcoholism, renal impairment, or taking hepatotoxic medications.
May decrease ketoconazole (Nizoral) concentration
Assess for hepatic dysfunction.
Monitor liver function test results.
Monitor for signs of hepatitis.
Monitor for tingling, numbness, burning extremities.
Monitor for visual changes; notify health care provider if they occur.
Monitor complete blood count (CBC), blood glucose level.
Administer 1 hour before or 2 hours after meal.
Administer at least 1 hour before antacids.
Instruct client not to skip doses, to take medication for full length of prescribed therapy.
Instruct client to avoid tyramine-containing foods.
Instruct client in signs of neurotoxicity, hepatitis, hepatoxicity.
Rifampin
Side effects include vision changes, hepatotoxicity, hepatitis, increased uric acid levels, blood dyscrasias, colitis.
Assess for hypersensitivity.
Evaluate CBC, uric acid, liver function test results.
Assess for signs of hepatitis.
Instruct client not to skip dose, to take medication for full length of prescribed therapy.
Advise client to keep all health care provider appointments, appointments for laboratory work.
Advise client to take medication on empty stomach with 8 oz water 1 hour before or 2 hours after meal.
Advise client to avoid taking medication with antacids.
Instruct client that bodily fluids will be red-orange.
Instruct client to report signs of jaundice to health care provider.
Ethambutol
Use with caution in clients with renal dysfunction, gout, ocular defects, retinopathy, cataracts, ocular inflammatory disorders, or taking neurotoxic medications.
Side effects include hypersensitivity reactions, dermatitis, optic neuritis, peripheral neuritis.
Determine baseline visual acuity, color discrimination.
Monitor for visual changes; notify health care provider if they occur.
Administer once every 24 hours with food.
Monitor uric acid concentrations; assess for painful, swollen joints.
Monitor intake and output (I&O), renal function.
Monitor for dizziness; initiate safety precautions.
Assess for peripheral neuritis.
Instruct client not to skip doses, to take medication for full length of prescribed therapy.
Pyrazinamide
Use with at least one other antitubercular medication.
Side effects include increased liver function, uric acid levels, photosensitivity, hepatotoxicity.
Evaluate CBC, liver function test results, uric acid levels.
Observe for hepatotoxic effects.
Evaluate blood glucose levels.
Instruct client to take medication with food.
Instruct client to avoid sunlight, ultraviolet light.
Advise client to keep all health care provider appointments, appointments for laboratory work.

Second-Line Medications for Tuberculosis (see Box 55-7)

Rifabutin
Inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis
Used to prevent disseminated Mycobacterium avium complex (MAC) disease in clients with advanced HIV infection
Used to treat active MAC disease and tuberculosis in clients with HIV infection
Can affect blood levels of some medications
Side effects: rash, GI disturbances, uveitis, arthralgia, hepatitis
Observe for hepatotoxic effects.
Assess for painful or swollen joints and ocular pain or blurred vision.
Rifapentine
Used only for pulmonary tuberculosis
Side effects: red-orange body sections, hepatotoxicity
Observe for hepatotoxic effects and without medications if they occur.
Capreomycin sulfate
Risk of nephrotoxicity, ototoxicity, and neuromuscular blockade is increased with use of aminoglycosides or loop diuretics.
Do not administer to clients receiving streptomycin.
Side effects: nephrotoxicity, ototoxicity, neuromuscular blockade
Assess renal, hepatic, and electrolyte levels before administration.
Antibiotics
Aminoglycoside antibiotics or fluoroquinolones
Contraindicated in clients with hypersensitivity, neuromuscular disorders, eighth cranial nerve damage
Risk of toxicity increases when taken with other aminoglycosides, nephrotoxic, ototoxic drugs.
Monitor for ototoxic, neurotoxic, nephrotoxic adverse effects.
Monitor liver, renal function test results.
Assess hydration status; maintain hydration.
Advise client to keep all health care provider appointments, appointments for laboratory work.
Advise to notify health care provider if hearing loss, changes in vision, urinary problems occur.
Ethionamide
Used with caution in clients with diabetes mellitus or renal dysfunction
Side effects: metallic taste, jaundice, peripheral neuritis
Monitor glucose levels in client with DM.
Administer pyridoxine as prescribed to reduce risk of neurotoxicity.
Aminosalicylic acid
Contraindicated with hypersensitivity to aminosalicylates, salicylates, or compounds containing the para-aminophenol group
Assess for hypersensitivity.
Encourage fluid intake to prevent crystalluria.
Cycloserine
Side effects include CNS reactions, neurotoxicity, altered level of consciousness.
Monitor for changes in mental status, thought processes.
Monitor serum drug level; peak, 2 hours after dosing, 25 to 35 mcg/mL.
Advise client of need for weekly serum drug levels as prescribed.
Teach client about signs indicating adverse effects.
Streptomycin
Contraindicated in clients with hypersensitivity, myasthenia gravis, parkinsonism, eighth cranial nerve damage
Risk of toxicity increases when taken with other aminoglycosides or nephrotoxic, ototoxic medications.
Monitor liver, renal function test results.
Monitor for ototoxic, neurotoxic, nephrotoxic reactions.
Monitor for visual changes.
Assess hydration status; maintain hydration during therapy.
Advise client to keep all health care provider appointments, appointments for laboratory work.

XVI. Influenza Medications

Vaccines (see Box 55-9)
Administered annually
Contraindicated in hypersensitivity, chicken egg allergy, active infection or illness, Guillain-Barré syndrome, pregnancy (live activated vaccine), age younger than 6 months
Antiviral medications (see Box 55-1)
Administered as prophylaxis but do not replace vaccine or prevent transmission
Administered within 24 to 48 hours of onset of symptoms
Contraindicated in hypersensitivity, pregnancy

XVII. Pneumococcal Conjugate Vaccine

Used for prevention of invasive pneumococcal disease in infants and children
Used for adults and high-risk children greater than 2 years of age
Side effects: erythema, swelling, pain, and tenderness at the injection site, fever, irritability, drowsiness, reduced appetite

A pretty good review I think – next week we’ll have some study questions and videos / flashcards to help you study.