RESPIRATORY MEDICATIONS

Bronchodilators
Prototype :
Symphatomimetic Xanthines
- albuterol, salbutamol - aminophylline
- isoproterenol, salmeterol - theophylline
- terbutaline

Mechanism of actions:
- sympathomimetic (b-receptor agonist) bronchodilators, dilate airways.
- xanthine bronchodilators, stimulate CNS for respiration.
Indications :
- bronchospasm, asthma, bronchitis, COPD.
Adverse effects :
- palpitations and tachycardia
- restlessness, nervousness, tremors
- anorexia, nausea and vomiting, headache, dizziness.
Nursing considerations :
- Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled seizure
disorder.
- Should be used with caution in patient with HPN and narrow-angle glaucoma.

Glucocorticoids (Corticosteroids)
Prototype :
- dexamethasone, budesonide, fluticasone, prednisone, beclomethasone.
Mechanism of actions :
- act as anti-inflammatory agents and reduce edema of the airways, as well as
pulmonary edema.
Adverse effects :
- Cushing’s syndrome, neutropenia. osteoporosis
Nursing considerations :
- Take drugs at meal time or with food.
- Eat foods high in potassium, low in sodium.
- Instruct client to avoid individuals with RTI.
- Instruct client not to stop medication abruptly, it should be tapered to prevent
adrenal insufficiency
- Avoid taking NSAID while taking steroids.
- Take inhaled bronchodilators first before taking inhaled steroids, and rinse mouth
after using.

Mast Cell Stabilizers
Prototype : cromolyn sodium (Intal)
Mechanism of action :
- stabilize mast cells that release histamine triggering asthmatic attacks.
Nursing Consideration:
- Should be given before asthmatic attacks.
- Administer oral capsule at least 30 mins before meals for better absorption.
- Drink a few sips of water before & after inhalation to prevent cough & unpleasant taste
- Assess for lactose-intolerance.


Anti-histamines (H-1 blockers)
Protoytype :
- Astemizole (Hismanal), Loratidine (Claritin),
Brompheniramine (Dimetapp),
Diphenhydramine (Benadryl),
Cetirizine (Iterax), Celestamine (Tavist).
Mechanism of action :
- decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine
in H1-receptor.
Indications :
- common colds, rhinitis, nausea and
vomiting, urticaria, allergies and as sleep aid.
Nursing Considerations :
- Administer with food and drink.
- Given IM via Z-track method or orally.
- Precautions in handling machine and driving while taking these drugs.
- Ice chips or candy for dry mouth



Anti-tuberculosis
Prototype :
First line Second line
- Isoniazid (INH) - Cycloserine
- Rifampicin (Rifadin) - Kanamycin
- Ethambutol - Ethonamide
- Pyrazinamide - Para-aminosalicylic acid
- Streptomycin

- active tuberculosis are treated with drug combination for 6-9 mos.
- multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years
- given before meals


Isoniazid
- should be given 1 hr before or 2 hrs after meals because food may delay absorption.
- should be given at least 1 hr before antacids.
- instruct to notify physician for signs of hepatoxicity (jaundice), and neurotoxicity
numbness of extremities.
- administer with Vitamin B6 to counteract the neurotoxic side effects.
- avoid alcohol.

Rifampicin
- given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours after meals
and avoid taking antacids with medications.
- hepatotoxic thus avoid alcohol.
- instruct the client that urine, feces, sweat, and tears will be red-orange in color.

Pyrazinamide
- given for 2 months.
- increase serum uric acid and cause photosensitivity.

Ethambutol
- contraindicated in children under 13 years old.
- obtain a baseline visual acuity because it can cause optic neuritis.
- Instruct the client to notify the physician immediately if any visual problems occurs.

Streptomycin
- aminoglycoside antibiotic given IM.
- nephrotoxic and ototoxic.
- obtain baseline audiometric test and repeat every 1-2 months because the
medications impairs the CN VIII.

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