NURS 309: MEDS TO TREAT LOWER RESPIRATORY DISORDERS

SABA – Class & Action

A client is prescribed albuterol for asthma. How does this medication work?

It is a short-acting beta2-adrenergic agonist that relaxes bronchial smooth muscle, causing bronchodilation & improving airflow.

SABA – Therapeutic Use

A client is using a SABA inhaler. What is the expected benefit?

Rapid relief of bronchospasm in asthma or COPD & prevention of exercise-induced bronchoconstriction.

SABA – Common Drugs

What are common SABA medications?

Albuterol, levalbuterol, terbutaline.

SABA – Nursing Assessment

Before administering a SABA, what should the nurse assess?

Lung sounds, RR, O2 sat, HR, & hx of CVD.

SABA – Administration (Inhalation)

What is important when teaching a client to use an inhaler?

Shake the inhaler, exhale completely, inhale slowly while pressing the canister, hold breath 5–10 seconds, & rinse mouth afterward.

SABA – Common Side Effects

A client reports tremors and a racing heart after using albuterol. Are these expected?

Yes, common side effects include:

• tremor

• nervousness

• headache

• palpitations

• increased HR

SABA – Adverse Effects

Which effects are more serious and require immediate attention?

• Chest pain

• severe palpitations

• HTN

• dysrhythmias

• paradoxical bronchospasm

SABA – Drug Interactions

What medications can interact with SABAs?

• Beta-blockers (may reduce effectiveness)

• MAOIs

• tricyclic antidepressants (may increase cardiovascular effects)

SABA – Precautions

Which clients require caution with SABAs?

Clients with:

• CVD

• HTN

• hyperthyroidism

• diabetes

• seizures

SABA – Client Teaching

What should the nurse teach a client using a SABA inhaler?

• Use as prescribed, not for daily control

• monitor for increased HR or tremors

• rinse mouth after use

• seek help if shortness of breath worsens despite inhaler use

Albuterol – Class & Action

A client is prescribed albuterol for asthma. How does this medication work?

It is a short-acting beta2-adrenergic agonist that binds to beta2 receptors in bronchial smooth muscle, causing relaxation & rapid bronchodilation.

Albuterol – Therapeutic Use

What is the primary use of albuterol?

Treatment & prevention of bronchospasm in asthma & COPD, including exercise-induced bronchoconstriction.

Albuterol – Nursing Assessment

Before giving albuterol, what should the nurse assess?

• Assess lung sounds, pulse, BP, O2 sat, sputum characteristics, & hx of CVD.

• Monitor for paradoxical bronchospasm & assess serum K+ if needed.

Albuterol – Administration (Inhaler)

How should the inhaler be used?

• Shake well, prime if required

• allow 1min b/t puffs

• use a spacer for children < 8

• follow prescribed dosing (every 20 min up to 4 hours or every 4–6 hours)

Albuterol – Administration (Nebulizer & Oral)

How is nebulized and PO albuterol given?

• Every 20 minutes for up to 3 doses, then every 1–8 hours or continuous; use oxygen/compressed air at 6–10 L/min.

• Oral liquid/tablets: give with meals 3–4 times/day.

Albuterol – Common Side Effects

What side effects may clients experience?

• Nervousness

• restlessness

• tremors

• palpitations

• chest pain

• N/V

• headache

• insomnia

• hyperactivity (esp. in children)

Albuterol – Adverse Effects

Which adverse effects require immediate attention?

• Angina

• arrhythmias

• paradoxical bronchospasm

• HTN

• hyperglycemia

• hypoK+

Albuterol – Drug Interactions

Which medications interact with albuterol?

• Other adrenergic agents (increase SNS effects)

• MAOIs (hypertensive crisis)

• beta-blockers (decrease effect)

• tricyclic antidepressants (increase cardiac effects)

• K+-losing diuretics (risk hypokalemia)

• digoxin (decreased levels)

• caffeine (CNS stimulation)

Albuterol – Contraindications

Which clients should avoid albuterol?

Those allergic to adrenergic amines & children < 2 years old.

Albuterol – Precautions

Which clients require caution?

• OAs

• CVD

• HTN

• hyperthyroidism

• diabetes

• glaucoma

• seizures

• excessive inhaler use

• pregnancy & breastfeeding (use only if benefits outweigh risks)

Albuterol – Client Teaching

What should the nurse teach a client about albuterol use?

• Take as prescribed

• do not double-dose

• use inhaler 1st if multiple inhalers

• rinse mouth after use

• wipe mouthpiece weekly

• report ineffective doses or worsening SOB

• expect unusual taste

• inform provider of herbal supplements

Anticholinergic – Class & Action

A client is prescribed ipratropium for COPD. How does this medication work?

It is an anticholinergic muscarinic antagonist that blocks Ach at muscarinic receptors in the airways, causing bronchodilation & reduced secretions.

Anticholinergic – Therapeutic Use

What is the primary use of anticholinergic inhalers?

Maintenance treatment of bronchospasm in COPD & asthma; can reduce airway secretions.

Anticholinergic – Common Drugs

What are common anticholinergic inhalers?

Ipratropium, tiotropium, aclidinium, umeclidinium.

Anticholinergic – Nursing Assessment

Before giving an anticholinergic, what should the nurse assess?

Lung sounds, RR, O2 sat, hx of glaucoma or urinary retention, & prior hypersensitivity to atropine derivatives.

Anticholinergic – Administration (Inhalation)

How should the inhaler be used?

Shake the inhaler, exhale completely, inhale while pressing canister, hold breath 5–10 secs, rinse mouth afterward, & use consistently for maintenance therapy.

Anticholinergic – Common Side Effects

What side effects might clients experience?

• Dry mouth

• cough

• hoarseness

• bitter taste

• throat irritation

• constipation

• urinary retention

Anticholinergic – Adverse Effects

Which adverse effects require attention?

Severe anticholinergic effects such as acute glaucoma, tachycardia, urinary retention, or paradoxical bronchospasm.

Anticholinergic – Drug Interactions

Which medications interact with anticholinergic inhalers?

Other anticholinergics (increased anticholinergic effects) & sometimes beta-agonists (used together for additive bronchodilation).

Anticholinergic – Contraindications

Which clients should avoid anticholinergics?

Clients with:

• hypersensitivity to atropine

• acute narrow-angle glaucoma

• urinary retention

Anticholinergic – Precautions

Which clients require caution?

• OAs (risk of confusion or urinary retention)

• bladder obstruction

• prostatic hypertrophy

• heart disease

• kidney or liver impairment

Anticholinergic – Client Teaching

What should the nurse teach a client using anticholinergic inhalers?

• Use consistently even when asymptomatic

• rinse mouth to reduce bitter taste

• report vision changes

• avoid spraying in eyes

• monitor for urinary retention or constipation

Ipratropium – Class & Action

A client is prescribed ipratropium for COPD. How does this medication work?

It is an anticholinergic muscarinic antagonist that blocks cholinergic receptors in bronchial smooth muscle, causing bronchodilation.

Ipratropium – Therapeutic Use

What is ipratropium primarily used for?

Maintenance therapy for reversible airway obstruction in COPD (like chronic bronchitis) & as an adjunct for asthma-induced bronchospasm.

Ipratropium – Nursing Assessment

Before giving ipratropium, what should the nurse assess?

Allergy to atropine or belladonna alkaloids, respiratory status (lung sounds, peak flow, vital signs), & S/S of urinary retention.

Ipratropium – Administration (Inhaler & Nebulizer)

How is ipratropium administered?

• MDI: Adults/children >12: max 12 inhalations/24 hrs, no more often than every 4 hrs. Children 5–12: same dosing.

• Nebulizer: Adults: 3–4 times daily; acute exacerbations every 30 min for 3 doses, then every 2–4 hrs PRN. Children 5–12: every 6 hrs; acute every 20 min ×3, then 2–4 hrs PRN.

• Rinse mouth after use; do not exceed recommended doses; space missed doses evenly

Ipratropium – Common Side Effects

What side effects may occur?

• HypoTN

• palpitations

• blurred vision

• sore throat

• GI irritation

• nervousness

• headache

• dizziness

Ipratropium – Adverse Effects

Which adverse effects require attention?

• Hypersensitivity

• paradoxical bronchospasm

• urinary retention

• glaucoma

• hypoTN

Ipratropium – Drug Interactions

Which drugs can interact with ipratropium?

Other anticholinergic medications such as antihistamines, phenothiazines, and disopyramide (may increase anticholinergic effects).

Ipratropium – Contraindications

Who should not take ipratropium?

Clients with hypersensitivity to ipratropium, atropine, belladonna alkaloids, bromide, or acute bronchospasm.

Ipratropium – Precautions

Which clients require caution?

• Bladder neck dysfunction

• prostatic hyperplasia

• glaucoma

• urinary retention

• OAs

• breastfeeding (safety not established)

Ipratropium – Client Teaching

What should clients be taught?

• Use inhaler/nebulizer as instructed

• rinse mouth after use

• use sugar-free gum/candy for dry mouth

• do not exceed 12 doses in 24 hrs

• take missed doses as soon as remembered

• report persistent dry mouth or lack of improvement within 30 mins

Leukotriene Modifier – Class & Action

A client is prescribed montelukast for asthma. How does this medication work?

It blocks leukotriene receptors in the lungs & airways, preventing inflammation, bronchoconstriction, mucus production, & airway edema.

Leukotriene Modifier – Therapeutic Use

What is the primary use of leukotriene modifiers?

Long-term management of asthma, prevention of exercise-induced bronchoconstriction, & relief of allergic rhinitis symptoms.

Leukotriene Modifier – Common Drugs

What are common leukotriene modifiers?

Montelukast, zafirlukast, zileuton.

Leukotriene Modifier – Nursing Assessment

Before giving a leukotriene modifier, what should the nurse assess?

Respiratory status (lung sounds, peak flow), allergy & asthma hx, liver function tests (esp. w zafirlukast/zileuton), & hx of depression or suicidal thoughts.

Leukotriene Modifier – Administration

How should leukotriene modifiers be administered?

• PO, usually once daily in the evening (montelukast), w or w/o food

• Follow dosing carefully, & do not use for acute asthma attacks.

Leukotriene Modifier – Common Side Effects

What side effects may occur?

• Headache

• dizziness

• N/D

• abdominal pain

• cough

• nasal congestion

• fatigue

Leukotriene Modifier – Adverse Effects

Which adverse effects require immediate attention?

• Mood changes

• suicidal thoughts

• liver dysfunction (esp. w zafirlukast/zileuton)

• severe allergic rxs

Leukotriene Modifier – Drug Interactions

Which medications interact with leukotriene modifiers?

Phenobarbital, rifampin, & other drugs that induce or inhibit liver enzymes (CYP450), which may alter drug levels.

Leukotriene Modifier – Contraindications

Who should avoid leukotriene modifiers?

Clients w hypersensitivity to the specific drug or active liver disease (for zileuton or zafirlukast).

Leukotriene Modifier – Precautions

Which clients require caution?

• OAs

• clients w liver impairment

• depression or suicidal ideation

• breastfeeding (use only if benefits outweigh risks)

Leukotriene Modifier – Client Teaching

What should clients be taught?

• Take med as prescribed in the evening

• not for acute attacks

• report mood changes or suicidal thoughts

• notify provider of liver-related symptoms (dark urine, jaundice);

• maintain regular follow-up to assess asthma control

Montelukast – Class & Action

A client is prescribed montelukast for asthma prevention. How does this medication work?

It is a leukotriene modifier that blocks leukotriene effects, preventing airway inflammation, bronchoconstriction, & mucus production.

Montelukast – Therapeutic Use

What is montelukast used for?

Preventative treatment of chronic asthma & reduction of asthma exacerbations; also used to prevent exercise-induced bronchospasm.

Montelukast – Nursing Assessment

Before giving montelukast, what should the nurse assess?

• Lung sounds, respiratory function, hx of hypersensitivity, behavioral changes, depression, or suicidal thoughts

• monitor periodically during therapy.

Montelukast – Administration

How should montelukast be administered?

• PO, once daily in the evening

• take at least 2 hrs before exercise if used for prevention of exercise-induced bronchospasm

Montelukast – Common Side Effects

What side effects may occur?

• Abdominal pain

• N/D

• cough

• runny nose

Montelukast – Adverse Effects

Which adverse effects require immediate attention?

• SJS

• toxic epidermal necrolysis

• suicidal behavior

• eosinophilic conditions

• severe allergic rxs

Montelukast – Drug Interactions

Which drugs interact with montelukast?

Meds that induce CYP3A4 or CYP2C9 enzymes may decrease its effectiveness.

Montelukast – Contraindications

Who should avoid montelukast?

Clients w hypersensitivity to montelukast or acute asthma attacks.

Montelukast – Precautions

Which clients require caution?

• Phenylketonuria (due to aspartame in chewables)

• hepatic impairment

• children < 6 y/o

• behavioral or psychiatric conditions

Montelukast – Client Teaching

What should clients be taught?

• Take once daily in the evening, or 2 hrs before exercise for prevention

• monitor for skin rashes, angioedema, mood changes, or suicidal thoughts

• report any unusual symptoms to the provider

• not for acute asthma attacks

Salmeterol – Class & Action

A client is prescribed salmeterol for asthma prevention. How does this medication work?

It is a long-acting beta2 agonist (LABA) that binds to beta2 receptors in bronchial smooth muscle, causing prolonged bronchodilation.

Salmeterol – Therapeutic Use

What is salmeterol used for?

Prevention of exercise-induced asthma, long-term control of asthma, & prevention of bronchospasm in COPD. Not for acute attacks.

Salmeterol – Nursing Assessment

Before giving salmeterol, what should the nurse assess?

Lung sounds, respiratory status, pulse, BP, hx of hypersensitivity, & monitor for paradoxical bronchospasm.

Salmeterol – Administration

How is salmeterol administered?

• Dry powder inhaler (Diskus) twice daily or q12 hrs; do not use more than prescribed

• Keep mouthpiece dry; do not wash

• Not for acute symptoms

Salmeterol – Common Side Effects

What side effects may occur?

• Palpitations

• tachycardia

• nervousness

• tremors

• headache

• abdominal pain

• N/D

• muscle cramps or soreness

Salmeterol – Adverse Effects

Which adverse effects require attention?

• Paradoxical bronchospasm

• persistent agitation

• chest pain

• dizziness

• hyperglycemia

• hypoK+

• tachyarrhythmias

• seizures

• persistent trembling

• vomiting

Salmeterol – Drug Interactions

Which medications interact with salmeterol?

• Beta-blockers (may reduce effect)

• MAOIs & tricyclic antidepressants (enhanced cardiac effects)

• strong CYP3A4 inhibitors (risk of toxicity)

Salmeterol – Contraindications

Who should avoid salmeterol?

Clients with:

• hypersensitivity to salmeterol or milk proteins

• acute asthma attacks

• not using inhaled corticosteroids

• CVD

• seizure disorders

• diabetes

• glaucoma

• pheochromocytoma

• children < 4 years

Salmeterol – Precautions

Which clients require caution?

• Hyperthyroidism

• diabetes

• CVD

• seizure disorders

• OAs

• clients on corticosteroids

Salmeterol – Client Teaching

What should clients be taught?

• Do not exceed prescribed dose

• use on schedule

• not for acute symptoms

• keep inhaler dry

• notify provider if symptoms persist

• rinse mouth if using multiple inhalers

• report palpitations, chest pain, or severe tremors

Theophylline – Class & Action

A client is prescribed theophylline for asthma management. How does this medication work?

It is a methylxanthine that relaxes the smooth muscles around the airways, causing bronchodilation.

Theophylline – Therapeutic Use

What is theophylline used for?

Prevention of SOB & wheezing; long-term management of chronic asthma & sometimes COPD.

Theophylline – Nursing Assessment

Before giving theophylline, what should the nurse assess?

V/S, hx of hypersensitivity, GI function, sleep patterns, & S/S of toxicity (N/V, tremors, irritability).

Theophylline – Administration

How is theophylline administered?

• PO, 1–2 times daily depending on formulation.

• Pills or capsules must not be crushed.

• Take at the same time each day.

Theophylline – Common Side Effects

What side effects may occur?

• N/V/D

• stomach pain

• trouble sleeping

• irritability

• nervousness

• shaking

Theophylline – Adverse Effects

Which adverse effects require immediate attention?

• Allergic rxs (hives, throat swelling)

• severe toxicity, which can be life-threatening (arrhythmias, seizures, or death)

Theophylline – Drug Interactions

Which medications interact with theophylline?

Cimetidine, disulfiram, fluvoxamine, interferon, mexiletine, rifampin, carbamazepine, cannabis, St. John’s wort, caffeine, ETOH. Interactions can increase toxicity risk or reduce effectiveness.

Theophylline – Contraindications

Who should avoid theophylline?

Clients w a hx of hypersensitivity to theophylline.

Theophylline – Precautions

Which clients require caution?

• Those at risk for toxicity

• OAs

• clients w CVD, liver impairment, or seizure disorders

Theophylline – Client Teaching

What should clients be taught?

• Take exactly as prescribed

• do not crush or chew

• avoid excessive caffeine or ETOH

• report nausea, tremors, palpitations, or insomnia

• monitor for S/S of allergic reaction