Drug therapy for Non-infection Lower respiratory Airflow disorders

Beta 2 adrenergic agonists, Generic Name 

Albuterol 

Beta 2 adrenergic agonists used for

Asthma and COPD 

Beta 2 adrenergic agonist MOA

Binds to Beta 2 receptors in the lungs, causing bronchodilation.

Beta 2 adrenergic agonists side effects

Chest pain, tachycardia, heart palpitations, tremors, and anxiety.

Adverse reactions of Beta 2 adrenergic agonists

chest pain, worsening of chest problem, sever allergic rxn

Beta 2 adrenergic agonists nursing considerations and pt education

If using with inhaled glucocorticoid use a bronchodilator first, wait 5 min, then use the glucocorticoid (B comes before G). Albuterol is the only treatment for acute asthma attacks. Salmeterol should be taken daily for long-term control of asthma.

Counterindications with Beta 2 adrenergic agonists

Use cautiously with patients with cardiovascular disease, hypertension, diabetes, and/or patients taking antidepressants. inform P.T. to avoid caffeine with use and to report tremors impacted ADLs

Anticholinergics (inhaled/nasal) generic name

Ipratropium. 

Anticholinergics (inhaled/nasal) used for

COPD, rhinitis and asthma (off-label)

Anticholinergics (inhaled/nasal) MOA

inhibit/block ACh receptors in lungs, causing bronchodilation. Effective since ACh typically works to vasoconstrict bronchi and bronchioles. 

Anticholinergics (inhaled/nasal) side effects 

Dry mouth, sore throat, tachycardia, urinary retention, obstipation, visual and neuroligical disturbances 

Anticholinergics (inhaled/nasal) adverse effects

Increased intraocular pressure (risk of glaucoma) and avoid if P.T. has active glaucoma.

Nursing considerations for Anticholinergics (inhaled/nasal)

Increase fluids, suck on candy or chew gum to help decrease dry mouth, routine eye exams.

counterindications for Anticholinergics (inhaled/nasal)

Not recommended for patients with existing glaucoma and/or urinary retention.

Methylxanthines Generic protoype

Theophylline

Methylxanthines MOA

Relaxation of bronchial smooth muscle. increases cAMP, causing bronchodilatation.

Methylxanthines (theophylline) Used for

Long-term control of asthma and COPD. (Used to be first line use for asthma but lost favor as they have a narrow margin of safety)

Methylxanthines (theophylline) Side FX

GI upset and headache

Methylxanthines (theophylline) Adverse effects

CNS stimulation, dysrhythmias, nervousness, insomnia and seizure.

Methylxanthines (theophylline) counterindications

In coronary artery disease, angina, severe renal or liver disorders, peptic ulcers, BPH, diabetes.

Methylxanthines (theophylline) Caution warning

Use with caution in the elderly and children, not recommended for breastfeeding women.

Nursing considerations in Methylxanthines (theophylline)

Assess vital signs, cardiac rhythm, lung sounds, respiratory effort, skin color, and spO2 level.

Glucorticoids Types 

Inhaled long-term management- beclomethasone

Oral short-term/post-exacerbation- prednisone

IV- emergency and acute- solumedrol

Glucorticoids Uses

Asthma and Rhinitis

Glucorticoids MOA 

Prevent the release of prostaglandins and histamine which cause inflammation

Glucorticoids adverse rxns

Oral candidiasis, impaired adrenal functioning, osteoporosis, hyperglycemia, and PUD.

Glucorticoids side FX

Pharyngitis, immunosuppression.

For inhalation of Glucorticoids

A spacer is recommended as well as rinsing of the mouth.

Contraindications for Glucorticoids

Use cautiously in patients who have already existing PUD, diabetes, renal dysfunction, or take NSAIDs regularly. DO NOT ADMINISTER TO PATIENTS TAKING K+ DEPLETING DIURETIC i.e. LASIKS DUE TO HYPOKALEMIA RISK. DO NOT STOP ABRUPTLY. TAPER OFF.

Leukotriene Modifiers Generic

Montelukast (singulair)

Montelukast (singulair) Uses

Asthma, prevention of exercise-induced bronchoconstriction, think Lou (lu) cast (Kast) a spell on me and relieved my ASTHMA!

Montelukast (singulair) MOA

Decreases the effect of leukotrienes, which decreases airway inflammation and bronchoconstriction.

Montelukast (singulair) counterindications

Liver disease

Montelukast (singulair) side FX

Hepatoxicity, serious mental health side effects i,e, suicidal ideation.

Montelukast (singulair) nursing considerations/pt education

Monitor liver enzyme, take montelukast 2 hours before exercise.