ATI PHARMACOLOGY DRUGS Respiratory System Drugs

What administration considerations apply to codeine, dextromethorphan?

Use only on a short-term basis.Use the lowest effective dose.Use only when needed.

What administration considerations apply to albuterol?

Follow manufacturer’s instructions for using delivery devices.Use short-acting preparations for acute exacerbations.Use long-acting preparations for long-term control.Inhale beta2-adrenergic agonists before inhaling glucocorticoids.Follow dosage limits and schedules.Watch for signs and triggers of impending exacerbations of asthma.Keep a log of the frequency and intensity of exacerbations.Notify the provider of changes in patterns of exacerbations.

What administration considerations apply to guaifenesin?

Notify provider if cough worsens or high fever develops.Use only when needed.Do not take with combination products for colds that also contain guaifenesin.Do not chew or crush sustained-release formulations.

What administration considerations apply to diphenhydramine?

Do not crush or chew enteric-coated formulations.Do not take with alcohol or other CNS depressants.Take 30 min to 2 hr before activity for motion sickness.

What administration considerations apply to beclomethasone dipropionate, fluticasone, and prednisone?

Inhaled:Use on a regular schedule rather than PRN.Do not use these drugs for an acute attack.When using concurrently with a beta2-adrenergic agonist inhaler, use the beta2 agonist first to dilate the airway before using the glucocorticoid.Oral:Use oral therapy twice daily for 5 to 10 days.For long-term use (10 days or more), take once daily using alternate-day dosing.Taper the dose slowly when symptoms are controlled to establish the lowest possible oral dose.Take supplemental doses as needed in times of stress (illness, surgery).Nasal:Use a nasal metered-dose spray device.Use the full dose initially and taper to the lowest effective dose. Expect the full therapeutic effect to take 2 to 3 weeks.Use a nasal decongestant first if the nares are completely blocked.

What administration considerations apply to ipratropium?

Follow manufacturer’s instructions for using delivery devices.Follow dosage limits and schedules.Allow the prescribed time between puffs.Delay use of other inhalants for 5 minutes.Do not use as an emergency rescue medication.Rinse the mouth after use to reduce unpleasant taste.

What administration considerations apply to montelukast?

Schedule montelukast once daily in the evening.Available as tablets, chewable tablets, and oral granules.Mix oral granules with applesauce, carrots, rice, or ice cream or place directly on the tongue.To prevent EIB, take at least 2 hr before exercising and do not repeat the dose for 24 hr.

What administration considerations apply to cromolyn?

Use with a nebulizer or metered-dose inhaler.Expect several weeks of use for full effects to become apparent.Administer four times daily on a fixed schedule.Use the inhaler 15 min before exercising to prevent exercise- induced bronchospasm.Do not use to relieve an acute asthma exacerbation.

What administration considerations apply to theophylline?

If a dose is missed, do not double the dose.Have the client chew the chewable tablets thoroughly.Do not crush or chew sustained-release or enteric-coated preparations.Maintain scheduled interval between doses.

What administration considerations apply to acetylcysteine?

Give via nebulizer that does not contain metal or rubber parts or direct instillation into tracheostomy tube.Clear the airway before aerosol administration.Assess the client’s ability to cough before administration.Expect a sulfur-like (rotten egg) odor.Have suction equipment available.Thoroughly clean equipment after treatment

What administration considerations apply to cetirizine?

May take with or without food.Do not take with other over-the-counter antihistamines.Expect dose to be lower in clients who have compromised renal or liver function.

What administration considerations apply to phenylephrine?

Do not exceed the recommended dose.Use topical decongestants no longer than 3 to 5 days to avoid rebound congestion.

What are adverse drug reactions associated with codeine, dextromethorphan?

CNS depression (drowsiness, sedation common with opioid antitussives; only occurs in non-opioid antitussives if you give large doses or other CNS-depressant drugs concurrently)Dizziness, lightheadedness (more common with opioid antitussives)Gastrointestinal distress (nausea, vomiting)Constipation (opioids only)Respiratory depression (opioids only)Potential for abuse

What are adverse drug reactions associated with albuterol?

Chest pain, palpitationsNervousness, restlessness, tremors

What are adverse drug reactions associated with guaifenesin?

Dizziness, drowsiness, headacheGastrointestinal distress (nausea, diarrhea)Allergic reaction (rash)

What are adverse drug reactions associated with diphenhydramine?

Drowsiness, dizzinessAnticholinergic effects (dry mouth, constipation)

What are adverse drug reactions associated with beclomethasone dipropionate, fluticasone, and prednisone?

Inhaled: Oral candidiasisOral: Suppression of adrenal functionBone demineralization, muscle wastingHyperglycemiaPeptic ulcer diseaseInfectionFluid and electrolyte imbalancesNasal: Dry mucous membranes, epistaxis, sore throatHeadache

What are adverse drug reactions associated with ipratropium

Dry mouth, irritation of the pharynxIncreased intraocular pressureUrinary retention

What are adverse drug reactions associated with montelukast?

Leukotriene modifiers zileuton and zafirlukast can cause liver damage. Does not occur with montelukast.Neuropsychiatric effects such as suicidal ideations

What are adverse drug reactions associated with cromolyn?

Allergic reaction in clients with known allergy to cromolyn

What are adverse drug reactions associated with theophylline?

Rare at therapeutic levelsWhen therapeutic levels are exceeded: restlessness, insomniaNausea, vomiting, diarrheaWhen reaches toxic levels: seizuresDysrhythmias

What are adverse drug reactions associated with acetylcysteine?

BronchospasmGastrointestinal distress due to rotten-egg smell of drug and ingestion of secretions (nausea, vomiting)

What are adverse drug reactions associated with cetirizine?

Drowsiness and fatigue (normally in dosages higher than 10mg/day)Anticholinergic effects: dry mouth, nose, and throat (less than first-generation sedating antihistamines, but still a possible effect)

What are adverse drug reactions associated with phenylephrine?

CNS stimulation with oral agents (agitation, anxiety, insomnia)Increased blood pressureTachycardia/palpitationsOverdosage or systemic absorption: hypertension, tachycardia, and heart palpitationsRebound congestion with prolonged use of topical agents

What instructions should be provided for a client taking codeine, dextromethorphan?

Change positions gradually and sit or lie down if feeling lightheaded.Avoid alcohol and other CNS depressants when taking opioid antitussives.Do not take opioid antitussive before driving or activities requiring mental alertness.Take the drug with food or milk.Lie down when feeling nauseated.Increase fluid and dietary fiber intake.Take the drug only when needed and on a short-term basis.Remove triggers that precipitate coughing from environment.

What instructions should be provided for a client taking albuterol?

Take as prescribed – avoid overuse of rescue inhalersReport chest pain and heart palpitations.Avoid caffeine.Notify provider if tremors interfere with activities of daily living.

What instructions should be provided for a client taking guaifenesin?

Do not take before driving or activities requiring mental alertness.Sit or lie down if feeling lightheaded.Change positions gradually.Take the drug with food and/or 8 oz of water.Stop taking the drug and seek medical care if experiencing an allergic reaction.

What instructions should be provided for a client taking diphenhydramine?

Take the drug before or at bedtime.Avoid driving and activities that require mental alertness.Suck on hard candy.Take the drug with food.Increase fluid and fiber intake.Take laxative as neededReport difficulty urinating

What instructions should be provided for a client taking beclomethasone dipropionate, fluticasone, and prednisone?

Use a spacer (on most glucocorticoid metered-dose inhalers) to deposit less drug in the oropharynx.Rinse the mouth and/or gargle after using the glucocorticoid inhaler to prevent candidiasis.Explain the schedule of alternate-day therapy.Taper the dose before discontinuing it. NEVER stop abruptly.Take the drug on alternate days.Perform weight-bearing exercise daily.Consume adequate calcium and vitamin D.Avoid taking NSAIDs.Take the drug with food or meals.Use a humidifier during sleep.Increase fluid intake.Suck on hard candy or lozenges.Take over-the-counter, non-NSAID analgesics as needed.Report any of the following conditions immediately:Polyphagia, polydipsia, and polyuriaIndigestion or bloody vomitus as well as black, tarry stoolsSigns of infection, such as a sore throat, that may not be accompanied by fever or inflammationPainful mucous membranes with white patchesWeight gain or edemaWeakness

What instructions should be provided for a client taking ipratropium?

Suck on hard candy.Sip water frequently.Have regular eye examinations to test for glaucoma.Report any changes in urinary elimination.

What instructions should be provided for a client taking montelukast?

Report abdominal tenderness, nausea, or anorexia.Report behavioral changes such as agitation, insomnia, anxiety or irritability.

What instructions should be provided for a client taking cromolyn?

Seek medical care immediately for sudden rash, swelling of the mouth or throat, or wheezing after use.

What instructions should be provided for a client taking theophylline?

Reduce or eliminate caffeine intake.Have periodic laboratory testing of drug levels.Stop taking the drug and notify provider if experiencing seizure.Stop taking the drug and notify provider if experiencing dysrhythmias.

What instructions should be provided for a client taking acetylcysteine?

Report any difficulty breathing or worsening cough.Expectorate secretions.Take antiemetic as needed.Proper use and cleaning of nebulizer.Consume 2,000 to 3,000 mL of water daily

What instructions should be provided for a client taking cetirizine?

Take once-daily dose at time desired.Avoid driving and activities that require mental alertness until the drug’s effects are known.Take frequent sips of water.Suck on hard candy.

What instructions should be provided for a client taking phenylephrine?

Notify provider of excessive symptoms of CNS stimulation.Consult provider regarding alternative therapy or withdrawal of drug.Report prolonged tachycardia or heart palpitations.Have blood pressure checked while on medication if previously diagnosed with hypertension.Do not use for more than 3 to 5 days.Taper and discontinue the drug using one nostril at a time.

What contraindications are there for the use of codeine, dextromethorphan?

Known sensitivity to the drugMAO inhibitors or SSRIsProstatic hypertrophyReduced respiratory reserve (emphysema, chronic asthma)History of substance abuseUse cautiously in children and older adults.

What contraindications are there for the use of albuterol?

Allergy to albuterol or levalbuterol

What contraindications are there for the use of guaifenesin?

Known sensitivityPhenylketonuria (aspartame content).Diabetes (sugar content)Concurrent use with disulfiram (alcohol content).

What contraindications are there for the use of diphenhydramine?

Newborns and children under 2 yrBreastfeeding womenNarrow-angle glaucomaProstatic hypertrophyAcute asthma exacerbation

What contraindications are there for the use of beclomethasone dipropionate, fluticasone, and prednisone?

Recent live virus immunizationSystemic fungal infectionOral candidiasis

What contraindications are there for the use of ipratropium?

Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide;History of sensitivity to soy or peanuts _- avoid Combivent (ipratropium/albuterol combination) MDI form of drug

What contraindications are there for the use of montelukast?

Liver dysfunction (zileuton and zafirlukast), not montelukastAcute asthma exacerbationsStatus asthmaticus

What contraindications are there for the use of cromolyn?

Allergy to cromolyn

What contraindications are there for the use of theophylline?

Clients with impaired metabolismTobacco or marijuana useCaffeine

What contraindications are there for the use of acetylcysteine?

Risk of or actual gastric bleeding

What contraindications are there for the use of cetirizine?

Infants under 6 moBreastfeeding womenAllergy to H1-receptor antihistamines or hydroxyzine

What contraindications are there for the use of phenylephrine?

Chronic rhinitisNarrow angle glaucomaUncontrolled heart disease, dysrhythmia, or hypertension

What are potential interactions for codeine, dextromethorphan?

With opioids, alcohol, and other CNS depressants, increase CNS depression.Nonopioid antitussives increase the analgesic effects of opioids.St. John’s wort may increase sedation.

What are potential interactions for albuterol?

Beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists.Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risk of hypertension, tachycardia, and angina.Hypoglycemic (antidiabetic) drugs require increased dosing because of hyperglycemic effects.

What are potential interactions for guaifenesin?

No significant drug-drug interactions

What are potential interactions for diphenhydramine?

Alcohol and other CNS depressants increase depressant effects of antihistamines.

What are potential interactions for beclomethasone dipropionate, fluticasone, and prednisone?

Potassium-depleting diuretics, such as furosemide (Lasix) increase risk of hypokalemia.NSAIDs increase risk of gastrointestinal bleeding.Effects of insulin and oral hypoglycemics are decreased.

What are potential interactions for ipratropium?

Beta2-adrenergic agonists enhance bronchodilation.

What are potential interactions for montelukast?

Concurrent use with phenobarbital (Luminal), rifampin (Rifadin) and phenytoin (Dilantin) may necessitate higher dosages.

What are potential interactions for cromolyn?

none known

What are potential interactions for theophylline?

Cimetidine (Tagamet), some fluoroquinolones, and caffeine increase the risk of toxicity.Phenobarbital, phenytoin (Dilantin), and nicotine increase metabolism of theophylline.

What are potential interactions for acetylcysteine?

activated charcoal

What are potential interactions for cetirizine?

Theophylline (Theo-24) can reduce clearance and lead to toxicity.Concurrent use with sedative/hypnotics, opioid analgesics, or alcohol can potentiate CNS depression.

What are potential interactions for phenylephrine?

MAOI antidepressants potentiate the effects; do not use within 3 weeks of each other.Beta2-adrenergic agonists and other stimulants potentiate hypertensive effects of drug.

What interventions should be planned for a client taking codeine, dextromethorphan?

Monitor clients when changing positions or ambulating.Administer drug with food or milk.Encourage diet high in fluids and fiber.Administer stool softener such as docusate sodium (Colace) and stimulant laxatives such as bisacodyl (Dulcolax).Monitor respirations.For respiratory rates below 12/min, stimulate breathing.Administer an opioid antagonist such as naloxone (Narcan) to restore respiratory rate.Give drug only when needed.

What interventions should be planned for a client taking albuterol?

Monitor and report dizziness, heart palpitations, chest pain, and shortness of breath.Monitor and report tremors.

What interventions should be planned for a client taking guaifenesin?

Monitor clients when changing positions or ambulating.Give drug with food and/or 8 oz of water.Stop drug and recommend alternative therapy.Encourage fluid intake of 1,500 to 2,000 mL daily

What interventions should be planned for a client taking diphenhydramine?

Monitor the client when ambulating.Advise against driving or operating machinery requiring mental alertness.Recommend switching client to a nonsedating antihistamine if sedation is excessive.Encourage sips of water or sucking on hard candy.Give with food.Encourage high intake of fluids.Recommend selecting high fiber foods on menu and provide fiber supplement or laxative as needed.Monitor for urinary retention.

What interventions should be planned for a client taking beclomethasone dipropionate, fluticasone, and prednisone?

Provide/prescribe a spacer.Initiate antifungal therapy as needed.Observe for suppression of adrenal function.Monitor plasma drug levels.Recommend alternate-day dosing.Monitor for signs of bone demineralization, muscle wasting.Recommend the lowest possible effective dose and alternate-day dosing.Monitor blood glucose levels, especially for clients who have diabetes mellitus.Recommend adjust of dosages of insulin/hypoglycemic drugs accordingly.Observe for gastrointestinal bleeding (bloody vomitus; black, tarry stools).Implement gastric protective measures.Give drug with food or meals.Recommend analgesic substitute if NSAID is prescribed.Observe for signs of infection that may not include fever or inflammation (sore throat, fatigue, tachycardia, and discharge from a wound).Recommend initiation of appropriate antimicrobial therapy.Monitor for weight gain or edema (hypernatremia).Monitor for generalized weakness (hypokalemia).Recommend initiation of appropriate fluid and electrolyte replacement therapy.Provide client with water and hard candy or throat lozenges to suck on.Provide humidified air for epistaxis and sore throat.Administer non-NSAID analgesic such as acetaminophen.

What interventions should be planned for a client taking ipratropium?

Provide water and hard candy to clientSchedule routine testing for glaucoma.Monitor urinary elimination patterns, especially in older adults.

What interventions should be planned for a client taking montelukast?

Monitor liver function with periodic testing.Observe for behavioral changes

What interventions should be planned for a client taking cromolyn?

Administer epinephrine and/or antihistamines to reverse anaphylaxis.

What interventions should be planned for a client taking theophylline?

Monitor plasma drug levels.Discontinue drug therapy if toxic levels are indicated.Give activated charcoal to decrease absorption.Prepare to initiate anticonvulsant therapy and institute seizure precautions.Monitor heart rate and rhythm.Give antidysrhythmics to restore heart rate and rhythm.

What interventions should be planned for a client taking acetylcysteine?

Monitor respiratory status. Administer bronchodilator as needed.Have suction available.Administer antiemetic as needed.Give client tissues and paper sack and encourage client to expectorate secretions.

What interventions should be planned for a client taking cetirizine?

Monitor the client when ambulating.Provide water and encourage frequent sips.Encourage intake of 1,500 to 2,000 mL dailyProvide hard candy to suck on.

What interventions should be planned for a client taking phenylephrine?

Monitor for agitation, anxiety, and insomnia.Administer a mild hypnotic or sleep aid.Monitor blood pressure and heart rate.Administer only when needed.Recommend a nasal glucocorticoid to minimize symptoms while discontinuing phenylephrine after prolonged use.

What precautions are there for the use of codeine, dextromethorphan?

Known sensitivity to the drugMAO inhibitors or SSRIsProstatic hypertrophyReduced respiratory reserve (emphysema, chronic asthma)History of substance abuseUse cautiously in children and older adults.

What precautions are there for the use of albuterol?

Diabetes mellitusHyperthyroidismCardiovascular diseaseHypertensionAngina pectorisTachydysrhythmiasTachycardia due to digitalis toxicity

What precautions are there for the use of guaifenesin?

Cough lasting more than one week

What precautions are there for the use of diphenhydramine?

ChildrenOlder adultsHistory of asthmaUrinary retentionOpen-angle glaucomaHypertensionImpaired kidney or liver function

What precautions are there for the use of beclomethasone dipropionate, fluticasone, and prednisone?

Peptic ulcer diseaseDiabetes mellitusHypertensionRenal dysfunctionUse of NSAIDs

What precautions are there for the use of ipratropium?

GlaucomaProstatic hypertrophyBladder neck obstruction

What precautions are there for the use of montelukast?

Severe asthma

What precautions are there for the use of cromolyn?

allergy to the drug

What precautions are there for the use of theophylline?

Heart diseaseLiver dysfunctionAcute pulmonary edema

What precautions are there for the use of acetylcysteine?

Anaphylactic reaction when giving IVasthma, history of bronchospasm, or severe respiratory insufficiency

What precautions are there for the use of cetirizine?

Impaired kidney or liver function

What precautions are there for the use of phenylephrine?

Coronary artery diseaseHypertensionOlder adults

What are the therapeutic uses for codeine, dextromethorphan?

Suppression of chronic, nonproductive cough

What are the therapeutic uses for albuterol?

Long-term management of asthmaPrevention of exercise-induced bronchospasmTreatment of ongoing asthma exacerbations

What are the therapeutic uses for guaifenesin?

Coughs related to viral upper respiratory tract infections

What are the therapeutic uses for diphenhydramine?

Management of:Mild allergic reactions (seasonal allergic rhinitis, cough, urticaria, mild transfusion reaction)Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm)Motion sicknessInsomnia. Short-term use: no longer than 2 consecutive weeks (first-generation H1 antagonists)

What are the therapeutic uses for beclomethasone dipropionate, fluticasone, and prednisone?

Long-term management of chronic asthma. Short-term management of post-exacerbation symptoms (oral).

What are the therapeutic uses for ipratropium?

Relief of bronchoconstriction in clients who have COPD. Decreases secretions in clients with COPD.

What are the therapeutic uses for montelukast?

Adjunctive therapy in the treatment of allergic rhinitis, asthma, and exercise induced bronchospasm

What are the therapeutic uses for cromolyn?

Long-term treatment of allergy-related asthmaProphylaxis for exercise-induced bronchospasmProphylaxis for seasonal allergy symptomsManagement of allergic rhinitis (intranasally)

What are the therapeutic uses for theophylline?

Long-term management of chronic asthma

What are the therapeutic uses for acetylcysteine?

Decrease viscosity of mucous secretions. Reverse acetaminophen (Tylenol) overdose.

What are the therapeutic uses for cetirizine?

Management of allergic rhinitis and chronic idiopathic urticaria

What are the therapeutic uses for phenylephrine?

Allergic rhinitis, sinusitis, and the common cold