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Introduction to Respiratory Drugs

This guide provides an overview of respiratory drugs with a focus on bronchodilators. Understanding these medications is crucial in managing respiratory conditions like asthma and COPD (Chronic Obstructive Pulmonary Disease). Two main categories of respiratory drugs are outlined:

Two Main Teams of Drugs:

  • BAM Team: Bronchodilators

  • SLAM Team: Anti-inflammatory agents

Bronchodilators - BAM Team

Beta Two Agonists

Drugs: Commonly have names ending in 'butyrol' (e.g., albuterol, levalbuterol).

  • Key Concept: These agents are the first line of defense in treating acute asthma attacks due to their rapid onset and effectiveness. They are classified as fast-acting bronchodilators, making them essential during asthma exacerbations.

  • Important NCLEX Tip: Albuterol is the only rescue inhaler approved for acute asthma attacks, and it should be administered before any steroids to maximize efficacy.

  • Selumetrol: This drug is categorized as a slower-acting beta-two agonist, typically used for long-term management and not suitable for immediate relief.

Treatment Sequence for Acute Asthma Attack

Memory Trick: A simple way to remember the treatment sequence is AIM:

  • A: Albuterol (Administer first for immediate relief)

  • I: Ipratropium (Administer second for additive effect)

  • M: Methylprednisolone (Administer third for anti-inflammatory effect)

Mechanism of Action

Beta-two agonists activate beta-two receptors in the bronchial muscles, leading to relaxation and bronchodilation. They can also activate beta-one receptors in the heart, which may increase heart rate, highlighting the importance of monitoring during use.

Expected Side Effects of Albuterol

Common Effects:

  • Tachycardia and Palpitations: Patients may experience an increased heart rate.

  • Tremors: Particularly of the hands.

  • Insomnia: Patients may find it difficult to sleep, leading to sleep disturbances.

Memory Trick: Remember the "Three T's" associated with albuterol:

  • Tachycardia

  • Tremor

  • Tossing and Turning (insomnia)

Patient Teaching

  • Advise patients to avoid taking albuterol before bedtime to minimize insomnia.

  • Caution against combining beta blockers (LOL) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, as these can exacerbate asthma symptoms.

  • During acute attacks, instruct patients to take 2-4 puffs every 20 minutes, with a maximum of three rounds, for effective relief.

Evaluation of Effectiveness

The treatment's success can be evaluated by observing a decrease in the respiratory rate and ensuring that oxygen saturation levels are maintained at or above 90%.

Common Findings Post-Treatment

After administering bronchodilators, expect:

  • An increased productive cough as secretions are loosened.

  • A decrease in anxiety levels due to improved breathing.

  • Mild bilateral hand tremors as a common side effect.

Inhaler Administration

  • Always advise patients to shake the inhaler well before use.

  • When administering medications, it’s important to provide albuterol first, followed by steroids, for optimal therapeutic effect.

  • Cleaning the Inhaler: Patients should be instructed to clean the mouthpiece 1-2 times a week using warm water to maintain hygiene and device function.

Anticholinergics - Second Line Treatment

Drugs: End in 'tropium' (e.g., ipratropium, teotropium).

  • Key Features: These are longer-acting bronchodilators used primarily in moderate to severe cases of asthma and COPD.

  • Mechanism of Action: They work by blocking acetylcholine, leading to bronchodilation and a reduction in secretions.

  • Common Side Effects: Patients might experience dry mouth and hoarseness, which can be managed by staying hydrated and using gum or candy.

  • Patient Teaching: Instruct patients not to swallow inhaler capsules but to use the inhaler device correctly. Anticholinergics are contraindicated in patients with conditions like glaucoma, urinary retention, or bowel obstructions due to the potential for exacerbation of these conditions.

Methylxanthines - Last Bronchodilator

Drugs: End in 'phyllin' (e.g., theophylline, aminophylline).

  • Effects: Methylxanthines have a mechanism similar to caffeine, which can lead to elevated heart rates and a risk of toxicity if not monitored closely.

  • Key Points: They have a narrow therapeutic range (10-20 mcg/mL), making toxicity a significant concern. Patients should be aware of signs of toxicity, such as anorexia, nausea, vomiting, restlessness, and insomnia.

  • First Priority: Monitor for tonic-clonic seizures as a severe sign of toxicity.

Patient Education

Encourage patients to:

  • Avoid beta blockers, as they can lower heart rate, and be vigilant about reporting any tachycardia.

  • Be aware of drugs that increase the risk of toxicity, including certain medications like cimetidine (H2 blocker) and ciprofloxacin (an antibiotic).

  • Take their doses in the morning and avoid caffeine or stimulant use at that time.

  • Cease use of these medications prior to any cardiac stress tests.

Review Questions

  1. What medication should be questioned for asthma?

    • Naproxen: Yes, because NSAIDs are contraindicated for asthma.

    • Ipratropium for glaucoma: No, as it may be appropriate depending on the patient's condition.

  2. Patient teaching with a new albuterol prescription:

    • Expected side effects: Tachycardia.

    • Side Effect Reporting: Dark stool from NSAID use should be monitored.

    • Dry Mouth Treatment: Yes, advise on hydration and oral care.

    • Ipratropium order: No, as it is not the first-line treatment in this scenario.

  3. Medication causing tachycardia and dysrhythmias?

    • Correct Answer: Aminophylline due to its caffeine-like effects and potential for causing increased heart rate.

Conclusion

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