Respiratory System NCLEX Medications

Respiratory System NCLEX Medications

Key points –

Bronchodilators An overview

β₂-adrenergic agonists
Inhaled, short-acting – Albuterol (Proventil, Ventolin)
Inhaled, long-acting Formoterol, salmeterol

Oral, long-acting Albuterol, terbutaline

Methylxanthines

Oral, long-acting – heophylline

Anti-cholinergics

Maintenance therapy – Ipratropium, inhaled (Atrovent)

Bronchodilators are oral or inhaled, for acute relief, short-term prophylaxis and long-term control. Anti-inflammatory are for long-acting prophylaxis.

Anti-inflammatory

Glucocorticoids

Inhaled medications
Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Flovent)
Triamcinolone (Azmacort)
Oral medications – Prednisone, prednisolone
Cromolyn & nedocromil (inhaled)
Leukotriene modifiers (Oral)
Montelukast (Singulair)
Zafirlukast (Accolate)

β₂-Adrenergic Agonists

Expected Action:

Selectively activate β₂ receptors resulting in bronchodilation: bronchospasm is relieved, histamine release is inhibited, and ciliary motility is increased.

Example: albuterol (Proventil) — Others: formoterol (Foradil), salmeterol (Serevent),terbutaline (Brethine)

Therapeutic Uses:

Albuterol: Inhaled, short-acting and oral, long-acting

Formoterol, salmeterol: Inhaled, long-acting

Terbutaline: Oral, L-A

Adverse Effects: Inhaled: Minimal adverse effects, Oral: Tachycardia/angina d/t β₁ in ♥/ tremors d/t β₂ in skeletal muscle

Contraindications/Precautions: Pregnancy (C), CI: tachydysrhythmias

Interactions:

β-blockers like propanolol leads to negate effects of both

TCAs and MAOIs leads to increased risk of tachycardia and angina

Education:

Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose

Use inhaled β₂-agonist before using inhaled glucocorticoid

Methylxanthines – Theophylline (Theolair)

Expected Action:

Theophylline relaxes bronchial smooth muscle leads to bronchodilation

Therapeutic Uses: Long-term control of asthma

Adverse Effects:

Mild toxicity leads to GI distress & restlessness. Severe reactions

Severe reactions can occur at ñ therapeutic levels and include dysrhythmias and seizures. Effects unlikely @ <20 mcg/mL. Activated charcoal ò absorption, lidocaine for dysrhythmias and diazepam for seizures.

Contraindications/Precautions: Pregnancy (C)

Interactions:

Caffeine: increased CNS/♥ effects of theophylline. Also increased [theophylline]

Phenobarbital, phenytoin: decrease [theophylline]

Cimetidine, ciprofloxacin: increase [theophylline]

Inhaled Anticholinergics

Expected Action:

Block muscarinic receptors on bronchi leads to bronchodilation

Example: ipratropium (Atrovent) — Others: tiotropium (Spiriva)

Therapeutic Uses:

Relief of bronchospasms associated with COPD

Relief of allergen-induced and exercise-induced asthma.

Adverse Effects:

Local anticholinergic effects

Contraindications/Precautions: Pregnancy (B), CI: Peanut allergy, Caution in narrow-angle glaucoma

Education:

Usual adult dose is 2 puffs (1 minute apart)

If taking two inhaled medications, separate by at least 5 minutes.

Glucocorticoids

Expected Action:

Prevent inflammation, suppress airway mucous production, and promote responsiveness of β₂-receptors in bronchial tree.

Example: beclomethasone (QVAR) — Others: budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort), prednisone (Deltasone)

Therapeutic Uses: Inhaled: Long-term asthma prophylaxis, S-T, oral: Treat symptoms following acute asthma., L-T, oral: Treat chronic asthma, 1º adrenocortical insufficiency, Promote lung maturity and decreased RDS in fetuses at risk for preterm birth.

Adverse Effects:

Inhaled: Dysphasia, candidiasis, bone loss

Oral (≥10d): decreased adrenal gland function / bone loss / hyperglycemia / glucosuria / / infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances.

Contraindications/Precautions: Pregnancy (?), CI: Live virus / systemic fungal infect.

Interactions: Diuretics: ñ hypokalemia, NSAIDs: ñ GI ulceration, Glucocorticoids counteract effects of insulin and oral hypoglycemics.

Education:

Oral are for short-term use, 3-10 days following acute attack

Mast Cell Stabilizers

Expected Action:

Anti-inflammatory: Stabilize mast cells, inhibiting histamine release.

Suppress inflammatory cells (e.g. eosinophils, macrophages)

Examples: Cromolyn (Intal) — Others: nedocromil (Tilade)

Therapeutic Uses:

Management of chronic asthma, Prophylaxis of exercise-induced and allergen-induced asthma attacks, Allergic rhinitis by intranasal route

Adverse Effects: Safest of all asthma meds / safe for kids

Contraindications/Precautions: Pregnancy (B), Propellant CI: CAD, dysrhythmias, and status asthmaticus

Leukotriene Modifiers

Expected Action:

Prevent effects of leukotrienes thus suppressing inflammation, airway edema, bronchoconstriction, and mucus production.

Examples: montelukast (Singulair) — Others: zileuton (Zyflo), zafirlukast (Accolate)

Therapeutic Uses: Long-term asthma therapy in folks ≥ 12 YO

Adverse Effects: Liver injury ĉ zileuton and zafirlukast. (nausea, anorexia, abdominal pain)

Contraindications/Precautions: Pregnancy (?)

Interactions:

Zileuton / zafirlukast inhibit warfarin metabolism leads to increase [warfarin]

Zileuton / zafirlukast inhibit theophylline metabolism leads to increase theophylline toxicity

Education:

Zileuton given without regard to food. Zafirlukast taken ŝ food

Antitussive – Opioids

Expected Action:

Suppresses cough center in the medulla oblongata.

Example : codeine — Others: hydrocodone

Therapeutic Uses: Chronic, non-productive cough

Adverse Effects:

GI distress (nausea, constipation) – take ĉ food, leads to fluid/fiber, CNS sedation effects: Respiratory depression (<12/min) – naloxone, Potential for abuse, schedule II.

Contraindications/Precautions: Pregnancy (C), CI: acute asthma, head trauma, liver/renal dysfunction, acute alcoholism

Mucolytics

Expected Action:

Enhance flow of secretions in the respiratory passages

Example: acetylcysteine (Mucomyst) — Others: hypertonic saline

Therapeutic Uses: Acute & chronic pulmonary disease ĉ increase secretions, Cystic fibrosis, Acetylcysteine is the antidote for acetaminophen poisoning

Adverse Effects: Aspiration and bronchospasm

Contraindications/Precautions: Pregnancy (B), CI: GI bleeding, Caution: Peptic ulcers / esophageal varices / severe liver disease

Education:

Has smell of rotten eggs, Dilute in fruit juice, IV: Loading dose, next dose over 4h, last dose over 16h.

Decongestants

Expected Action:

Stimulate α₁-adrenergic receptors leads to decreased inflammation of nasal membranes

Example: Phenylephrine Others: Ephedrine, naphazoline, phenylpropanolamine

Therapeutic Uses: Allergic rhinitis, sinusitis, and common cold

Adverse Effects: Rebound congestion (Max 3-5 days, taper down use), CNS stimulation (rare ĉ topical), Vasoconstriction

Contraindications/Precautions: Pregnancy (?), CI: Chronic rhinitis, Caution: CAD and hypertension

Education: Oral do not lead to rebound congestion