Respiratory Medications

Bronchodilators
A. Description
1. Symphathomimetic bronchodilators dilate the
airways of the respiratory tree, making air
exchange and respiration easier for the client,
and relax the smooth muscle of the bronchi.
2. Xanthine bronchodilators stimulate the central
nervous system and respiration, dilate coronary
and pulmonary vessels, cause diuresis, and
relax smooth muscle
3. Used to treat allergic rhinitis and sinusitis, acute
bronchospasm, acute and chronic asthma,
bronchitis, chronic obstructive pulmonary
disease, and emphysema
4. Contraindicated in individuals with hypersensitivity, peptic ulcer
disease, sever cardiac disease and cardiac dysrythmias,
hyperthyroidism, or uncontrolled seizure disorders
5. Used with caution in clients with hypertension, diabetes mellitus, or
narrow angle-glaucoma
6. Theophylline increases the risk of digitalis toxicity and decreases the
effects of lithium and phenytoin (Dilantin)
7. If theophylline and a beta-adrenergic agonist are administered
together, cardiac dysrhythmias may result
8. Betta blockers, cimetidine (Tagamet), and erythromycin increase the
effects of theophylline
9. Barbiturate carbamazepine (Tegretol) decrease the effects of
theophylline
 B. Side effects
1. Palpitations and tachycardia
2. Dysrhythmias
3. Restlessness, nervousness, tremors
4. Anorexia, nausea, and vomiting
5. Headaches and dizziness
6. Hyperglycemia
7. Decreased clotting time
8. Mouth dryness and throat irritation with inhalers
9. Tolerance and paradoxic bronchoconstriction
with inhalers
 C. Implementation

1. Asses vital signs

2. Monitor for cardiac dysrhythmias
3. Asses for cough, wheezing, decreased breath sounds, and
sputum production
4. Monitor for restlessness and confusion
5. Provide adequate hydration
6. Administer the medication at regular intervals around the clock to
maintain a sustained therapeutic level
7. Administer oral medications with or after meals to decrease
gastrointestinal (GI) irritation
8. Instruct the client not to rush enteric-coated or sustained-release
tablets or capsules
9. Instruct the client to avoid caffeine products, such as coffee, tea,
cola, and chocolate
10. Instruct the client in the side effects of bronchodilators
11. Instruct the client in how to monitor the pulse and to
report any abnormalities to the physician
12. Instruct the client in how to use an inhaler or nebulizer
and how to monitor the amount of medication remaining
in an inhaler canister
13. Instruct the client to avoid over-the-counter medications
14. Instruct the client to stop smoking and provide
information regarding support resources
15. Instruct the client with diabetes mellitus to monitor
blood glucose levels
16. Instruct the client with asthma to wear a Medic-Alert
bracelet
17. Monitor for a therapeutic serum theophylline level of 10
to 20 ug/mL
18. Note that toxicity is likely to occur when the serum level
is greater than 20 ug/mL
19. IV aminophylline or theophylline preparations should be
administered slowly and always via an infusion pump
Bronchodilators: Sympathomimetics
BETA-RECEPTOR AGONISTS
Albuterol (Proventil, Ventolin)
Bitolterol mesylate (Tornalate)
Ephedrine sulfate
Epinephrine (base) suspension (Sus-Phrine)
Epinephrine (AsthamaHaler Mist)
Epinephrine bitartrate (Bronkaid Suspension Mist)
Epinephrine (racemic) (Vaponefrin)
Epinephrine hydrochloride (Adrenalin Chloride)
Ethylnorepinephrine (Bronkephrine)
Isoetharine hydrochloride (Bronkosol)
Isoetharine mesylate (Bronkometer)
Isoproterenol hydrochloride (Isuprel Glossets, Isuprel
Mistometer)
Isoproterenol sulfate (Medihaler-Iso)
Metaproterenol sulfate (Alupent, Metaprel)
Pirbuterol acetate (Maxair, Autoinhaler)
Salmeterol (Serevent)
Terbutaline sulfate (Brethine, Bricanyl, Brethaire)

ANTICHOLINERGIC
Ipratropium bromide (Atrovent)
 Bronchodilators: Xanthines
• Aminophylline (generic, Truphylline
Phyllocontin)
• Theophylline
• Theophylline (Aerolate, Slo-Phyllin,
Theolair
• Theophylline (Theo Dur, Slo-Bid Theo-24,
Uni-Dur, Uniphyl)
• Oxtriphylline (Choledyl Choledyl-SA)
 II. Glucocorticoids
(Corticosteroids)

• A. Act as antiinflammatory agents and

reduce edema of the airways
• B. Refer to Chapter 52 for information on
glucocorticoids
 Glucocorticoids
(Corticosteroids)
• Beclomethasone dipropionate (Vanceril,
Beclovent)
• Triamcinolone (Azmacort)
• Fluticasone (Flonase, Flovent)
• Flunisolide (AeroBid)
 III. Inhaled Nonsteroidal Antiallergy
Agents
A. Description

1. Antiasthmatic, antiallergic, and mast cell

stabilizers that inhabit mast cell release
after exposure to antigens
2. Used for the treatment of allergic rhinitis,
bronchial asthma, and exercised-induced
bronchospasm
3. Contraindicated in clients with known
hypersensitivity
 B. Side Effects
1. Cough or bronchospasm following
inhalation
2. Nasal sting or sneezing following
inhalayion
3. Unpleasant taste in the mouth
 C. Implementation
1. Monitor vital signs
2. Monitor respirations and assess lung sounds
for rhonchi, wheezing, and rales
3. Instruct the client to drink a few sips of water
before and after inhalation to prevent cough
and unpleasant taste in the mouth
4. Administer oral capsules (cromolyn sodium) at
least 30 minutes before meals
5. Instruct the client not to discontinue the
medication abruptly because a rebound
asthmatic attack can occur
 Inhaled Nonsteroidal Antiallergy
Agents

MAST-CELL STABILIZERS

• Cromolyn sodium (Intal)

• Nedocromil (Tilade)
 IV. Leukotriene Modifiers
A. Description
1. Used in the prophylaxis and treatment of chronic
bronchial asthma
2. Not used for acute asthma episodes
3. Inhibit bronchoconstriciton caused by specific antigens
4. Reduce airway edema and smooth muscle constriction
5. Contraindicated with hypersensitivity and in breast-
feeding mothers
6. Used with caution in clients with impaired hepatic
function
7. Coadministration of inhaled glucocorticoids increases
the risk of upper respiratory infection
 B. Side Effects
1. Headache
2. Nausea and Vomting
3. Dyspepsia
4. Diarrhea
5. Generalized pain, myalgia
6. Fever
7. Dizziness
 C. Implementation
1. Monitor vital signs
2. Assess lung sounds for rhonchi, wheezing,
and rales
3. Assess liver function laboratory values
4. Monitor for cyanosis
5. Instruct the client to take medication 1 hour
before or 2 hours after meals
6. Instruct the client to increase fluid intake
7. Instruct the client not to discontinue medication
and to take as prescribed even during
symptomfree periods
 Leukotriene Modifiers
• Montelukast (Singulair)
• Zafirlukast (Accolate)
• Zileuton (Zyflo)
 V. Antihistamines
A. Description
1. Called histamine antagonists or H1 blockers; these medications
compete with histamine for receptor sites, thus preventing a
histamine response
2. When the H1 receptor is stimulated, the extravascular smooth
muscles, including those lining the nasal cavity, are constricted
3. Decrease nasopharyngeal secretions by blocking the H1 receptor
and decrease nasal itching that causes sneezing
4. Used for the common cold, rhinitis, nausea, and vomiting, motion
sickness, urticaria, and as a sleep aid
5. Can cause central nervous system (CNS) depression if taken with
alcohol, narcotics, hypnotics, or barbiturates
6. Used with caution in clients with chronic obstructive pulmonary
disease (COPD) because of the drying effects
7. Diphenhydramine (Benadryl) has an anticholinergic effect and
should be avoided in clients with narrow-angle glaucoma
 B. Side Effects
1. Drowsiness and fatigue
2. Dizziness
3. Urinary retention
4. Blurred vision
5. Wheezing
6. Constipation
7. Dry mouth
8. GI Irritation
9. Hypotension
10. Hearing disturbances
11. Photosensitivity
12. Nervousness and irritability
13. Confusion
14. Nightmares
 C. Implementation
1. Monitor vital signs
2. Monitor for signs of urinary dysfunction
3. Administer with food or milk
4. Avoid subcutaneous (SC) injection and administer
intramuscular (IM) injection in a large muscle if the IM
route is prescribed
5. Instruct the client to avoid hazardous activities, alcohol,
and other CNS depressants
6. Instruct the client taking medication for motion sickness
to take the medication 30 minutes before the event, and
then before meals, and at bedtime during the event
7. Instruct the client to suck on hard candy or ice chips for
dry mouth
 Antihistamines
• Astemizole (Hismanal)
• Azatadine maleate (Optimine)
• Azelastine hydrochloride (Astelin)
• Brompheniramine maleate (Dimetane)
• Cetirizine hydrochloride (Zyrtec)
• Chlorpheniramine maleate (Aller-Chlor, Chlor-
Trimeton)
• Clemastine fumarate (Tavist)
• Cyproheptadine hydrochloride (Periactin)
• Dexchlorpheniramine meleate (Polarmine)
• Diphenhydramine (Benadryl)
• Doxylamine succinate (Unisom)
• Fexofenadin (Allegra)
• Loratadine (Claritin)
• Methdilazine hydrochloride (Tacaryl)
• Phenindamine tartrate (Nolahist)
• Pyrilamine maleate (Nisaval)
• Trimeprazine tartrate (Temaril)
• Tripelennamine citrate or hydrochloride (PBZ-SR)
• Triprolidine hydrochloride (Myidil)
 VI. Nasal Decongestants
A. Description
1. Stimulate the alpha-adrenergic receptors, thus producing
vasoconstriction of the capillaries within the nasal
mucosa
2. Shrink nasal mucosal membranes and reduce fluid
secretion
3. Used for allergic rhinitis, hay fever, and acute coryza
(profuse nasal discharge)
4. Contraindicated for used with extreme caution in clients
with hypertension, cardiac disease, hyperthyroidism, or
diabetes mellitus
5. Nasal decongestants can cause tolerance and rebound
nasal congestion (vasodilation), caused by irritation of
the nasal mucosa, and should not be used for more than
48 hours
 Side Effects
1. Frequent use of decongestants,
especially nasal sprays or drops, can
result in tolerance and rebound nasal
congestion (vasodilation), caused by
irritation of the nasal mucosa
2. Nervousness
3. Restlessness
4. Hypertension
5. Hyperglycemia
 C. Implementation
1. Assess the client for existing medical disorders
2. Monitor for cardiac dysrhythmias
3. Monitor blood glucose levels
4. Instruct the client to avoid caffeine in large
amounts because it can increase restlessness
and palpitations
5. Instruct the client in the importance of limiting
the use of nasal sprays and drops
 Nasal Decongestants
• Oxymetazoline hydrochloride (Afrin)
• Phenylephrine hydrochloride (Neo-
Synephrine)
• Phenylpropanolaminen hydrochloride
(Dimetapp)
• Pseudoephedrine hydrochloride (Sudafed)
• Xylometazoline hydrochloride (Otrivin)
VII. Expectorants and Mucolytic Agents
A. Description
1. Loosen bronchial secretions so that they can
be eliminated with coughing
2. Used for dry, unproductive cough and to
stimulate bronchial secretions
3. Mucolytic agents with dextromethorphan
should not be used by clients with COPD
because they suppress the cough
4. Acetylcysteine (Mucomyst) can increase
airway resistance and should not be used in
clients with asthma
 Side Effects
1. GI Irritation
2. Skin rash
3. Oropharyngeal irritation
 Implementation
1. Instruct the client to take medication with a full glass of
water loosen mucus
2. Instruct the client to maintain an adequate fluid intake
3. Encourage the client to cough and deep breathe
4. Acetylcysteine (Mucomyst), administered by
nebulization, should not be mixed with another
medication
5. If acetylcysteine (Mucomyst), is administered with a
brochondilator, the brochondilator should be
administered 5 minutes before the acetylcysteine
6. Monitor for side effects of acetylcysteine (Mucomyst),
such as nausea and vomiting, stomatitis, and runny
nose
 Expectorants and Mucolytic Agents

EXPECTORANTS
Guaifenesin (glycerylguaiacolate) (Anti-
Tuss, Glycotuss, Humibid, Robitussin)

MUCOLYTIC
Acetylcysteine (Mucomyst)
 VIII. Antitussives
A. Description

1. Act on the cough control center

in medulla to suppress the
cough reflex
2. Used for a cough that is
nonproductive and irritating
 Side Effects
1. Dizziness, drowsiness, sedation
2. GI irritation, nausea
3. Dry mouth
4. Constipation
5. Respiratory depression
 Implementation
1. Instruct the client that if the cough lasts longer than 1 week a
fever or rash occurs, the physician should be notified
2. Encourage the client to take adequate fluids with medication
3. Encourage the client to sleep with the head of the bed elevated
4. Instruct the client to avoid hazardous activities
5. Note that drug dependency can occur
6. Avoid administration to the client with a head injury or
postoperative cranial surgery
7. Avoid administration to the client using narcotics, sedative,
hypnotics, barbiturates, or antidepressants, because CNS
depression can occur
8. Instruct the client to avoid the use of alcohol