Drugs for CHs 20 & 21, Respiratory

How is Budesonide classified?

inhaled corticosterioid, maintenance drug

pharmacological action of Budesonide

↓ inflammatory response in the airyways

therapeutic use of Budesonide

maintenance for COPD

maintenance & prevention for asthma (including chronic, steroid-dependent bronchial asthma)

treats bronchospasms

AEs of Budesonide

• sore throat

• hoarseness

• coughing

• dry mouth

• pharyngeal/laryngeal fungal infections****

• Muscle spasms

• tachycardia

• GI upset

• Pneumonia

what lab findings may appear with use of Budesonide?

serum glucose may ↑

serum potassium may ↓

How is budesonide administered?

as an inhalant, with 2 inhalations twice/day

Contraindications/Precautions for budesonide

known hypersensitivity

pregnancy/lactation

don’t use for emergency attack or status asthmaticus

Drug-Drug Interactions of budesonide

anticonvulsants and oral corticosteroids can ↑ risk of osteoporosis

nursing interventions for budesonide

• Assess LS, HR, & BP before administering and during peak

• note amount, color, and character of sputum

• withhold med if wheezing or hypersensitivity reaction occurs

Patient education for budesonide

• instruct to shake and prime with 4 sprays before use

• inhale 4x/day (2x morning, 2x evening)

• MUST rinse mouth after each use to avoid oral candida

what is being assessed to determine effectiveness of budesonide?

• bronchodilation

• ↓ airflow obstruction

How is pseudoephedrine classified?

oral decongestant

pharmacological action of pseudoephedrine

shrink nasal mucous membrane by stimulating alpa-adrenergic receptors in the nasal mucous membrane

therapeutic use of pseudoephedrine

↓ nasal congestion related to common cold, sinusitis, or allergic rhinitis by draining sinuses and improving airflow

AEs of pseudoephedrine

• rebound congestion: if overmedication occurs, body starts making way too much mucous to compensate for being too dried up

• SNS effects: anxiety, restlessness, HTN, tachycardia

how is pseudoephedrine administered?

orally, that gets well absorbed and only partially metabolizes in the liver and is excreted 55-75% unchanged in the urine

contraindications/precautions of pseudoephedrine

(C)

• HTN

• CAD

(P)

• hyperthyroidism

• diabetes mellitus

• prostate hyperplasia

• ischemic heart disease

• glaucoma

• pregnancy/lactation

Drug-Drug interactions of pseudoephedrine

using OTC products containing pseudoephedrine can cause serious AEs

nursing interventions for pseudoephedrine

• administer 2 hrs before bed to minimize insomnia

• don’t crush, break, or chew tablets, swallow whole

• contents of capsules can be mixed with jam/jelly if can’t be swallowed

patient education for pseudoephedrine

• take missed doses w/in 1 hr, but don’t double dose

• OD symptoms are anxiety, tachy/bradycardia, dyspnea, hallucinations, seizures

• call provider if symptoms don’t go away in 7 days

• fetal harm can occur if used during 1st trimester

• fetal/infant harm can occur if there is prolonged use in late pregnancy/breastfeeding

what is being assessed to determine effectiveness of pseudoephedrine?

• improved congestion

• LS

• viscosity of secretions

how is salmeterol classified?

sympathomimetic, LABA, maintenance for asthma

pharmacological action of salmeterol

specific to beta 2 receptors in bronchi and mimics effects of CNS stimulation

therapeutic action of salmeterol

maintenance drug for asthma

dilates bronchi

↑ rate and depth of inspiration

AEs of salmeterol

• CNS stimulation

• GI upset

• cardiac arrhythmias

• HTN

• angina

• sweating

• pallor

• flushing

• hypersensitivity

• life-threatening paradoxical bronchospasm

Contraindications/precautions of salmeterol

• cardiac/vascular disease

• diabetes

• hyperthyroidism

• pregnancy/lactation (only use if benefits to mom outweigh risks)

how is salmeterol administered?

an inhalant that should be taken on a regular basis to prevent acute attacks

drug-drug interactions of salmeterol

general anesthetics = ↑ cardiac complications

beta blockers ↓ effects of drug

nursing interventions for salmeterol

monitor with meds that ↑ HR & BP, monitor resp status, AEs, worsening symptoms, and educate about proper technique

patient education for salmeterol

• take 30-60 mins before exercise

• administer 1x/day, morning and evening

what is being assessed for effectiveness of salmeterol?

• improved breathing

• no wheezing

• no AEs

how is albuterol classified?

sympathomimetic, SABA

pharmacological action of albuterol

mimics SNS effects by acting as a beta 2 adrenergic agonist (mimics epinephrine) to dilate bronchi & ↑ rate/depth of respirations

therapeutic affects of albuterol

• acute asthma attacks

• prevention of exercise induced asthma

• bronchospasm in acute asthma

AEs of albuterol

CV

• chest pain/angina

• arrhythmias

• HTN

F&E

• hypokalemia

ENDO

• hyperglycemia

GI

• nausea/vomiting

RESP

• paradoxical bronchospasm

NEURO

• anxiety

• restlessness

• tremor

• headache

• insomnia

• hyperactivity (in kids)

OTHER

• pallor

• sweating

• flushing

how is albuterol administered?

orally or inhaled

contraindications/precautions for albuterol

• hyperthyroidism

• diabetes mellitus

• glaucoma

• seizure disorders

• pregnancy/lactation

• ↑ risk of AEs for geriatric

• no established safety for kids ↓ 2

drug drug interactions for albuterol

• general anesthetics

• other adrenergic agents

• beta blockers

• tricyclic antidepressants

• K+ losing diuretics

nursing interventions for albuterol

• observe for paradoxical bronchospasm or wheezing

• withhold med and notify provider if these occur

patient education for albuterol

• shake well

• prime w/4 short sprays

• wait 1 min between inhalations

• discard after 200 sprays

• may cause weird/bad taste so rinse mouth after

What is being assessed for effectiveness of albuterol?

prevention or relief of bronchospasm

reevaluate treatment if dose doesn’t work or if the contents is used up in <2 weeks

how is guaifensen classified?

expectorant

pharmacological action of guaifensen

enhances output of respiratory tract fluids by reducing adhesiveness and surface tension of fluids, allowing easier movement

therapeutic use of guaifensen

relieve symptoms of respiratory conditions characterize by dry, nonproductive cough (brings up secretions)

AEs of gauifensen

• GI upset

• headache

• dizziness

• mild rash

• prolonged use may mask a serious underlying disorder

contraindications/precautions of guaifensen

• allergy

• pregnancy/lactation

• persistent cough (may mean underlying condition)

how is guaifensen administered?

orally

drug drug interactions of guiafensen

OTC meds containing guaifensen (could cause overdose)

nursing interventions for guaifensen

• monitor for AEs

• do baseline to assess for effectiveness

• monitor temp to determine underlying infection

• asess LS

patient education for guaifensen

• shouldn’t use for >1 week

• eat small frequent meals to avoid GI upset

• avoid driving with drowsiness/dizziness

what should be assessed for effectiveness of gauifensen?

• improved cough