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Respiratory Meds

[q] Beta2-adrenergic agonists :albuterol, Formoterol,Salmeterol,Terbutaline

[a] activating the beta2-receptors in the bronchial smooth muscle, resulting in bronchodilation

[q] Albuterol

[a] Inhaled (short acting), Oral (long acting). Used for prevention of exercise induced asthma

[q] Albuterol side effect

[a] tachycardia, tremors

[q] DPI (Dry powder Inhaler) use – Correct technique

[a] Don’t shake before use,Dont tilt the disc. Inspiration should be deep and rapid ,No spacer needed- no need for coordinating with inhalation as its rapid dispersion,Rinse mouth afterwards

[q] Bronchodilator and glucocorticoid inhaler?

[a] Take bronchodialator first, wait for 5 minutes, take sterod second, rinse mouth after.

[q] Salmeterol

[a] Long acting (not a rescure inhaler)

[q] Theophylline

[a] Causes relaxation of bronchial smooth muscle, resulting in bronchodilation

[q] Theophylline Toxicity

[a] Mild (GI distress), Severe – dysrhythmias and seizures- Advice client to report nausea, diarrhea, or restlessness.

[q] Therapeutic range Theophylline

[a] 5 to 15 mcg/mL

[q] Theophylline and food

[a] Caffeine can increase theophylline levels.

[q] Inhaled Anticholinergics

[a] Ipratropium (atrovent) and Tiotropium (spiriva)

[q] Inhaled Anticholinergics side effects

[a] Local anticholinergic effects (dry mouth hoarseness) – Advise clients to sip fluids and suck on sugar-free hard candies to control dry mouth

[q] Inhaled Anticholinergics and interaction

[a] Contraindicated in clients who have an allergy to peanuts (med has soy lecithin). Caution for narrow-angle glaucoma and benign prostatic hyperplasia (anticholinergic effect makes these conditions worse)

[q] Inhaled Anticholinergics notes

[a] Rinse the mouth after inhalation to decrease unpleasant taste. Wait at least 5 min between two medications.

[q] Glucocorticoids

[a] Beclomethasone, Prednisone

[q] Beclomethasone Side Effect

[a] Difficulty speaking, hoarseness, and candidiasis : rinse mouth or gargle with water or salt water after use, monitor for redness, sores, or white patches and to report

[q] Prednisone when used for 10 days or more (Adverse effect)

[a] Suppression of adrenal gland function (monitor blood glucose, taper dose). Bone loss ( perform weight-bearing exercises, diet rich in calcium and vit D), Hyperglycemia and glucosuria, Myopathy, Peptic ulcer disease ( report black, tarry stools), Infection, hypokalemia

[q] Glucocorticoids interaction

[a] Contraindicated in clients who have received a live virus vaccine and those with systemic fungal infections.

[q] Glucocorticoids Respi notes

[a] Use glucocorticoid inhalers on a regular, fixed schedule for long-term therapy, not to be used to treat an acute episode.

[q] Montelukast, Zileuton and zafirlukast

[a] Prevent the effects of leukotrienes, thereby suppressing inflammation,bronchoconstriction, airway edema, and mucus production.

[q] Dextromethorphan- Antitussive

[a] suppresses cough. Can cause high fever when used within 2 weeks of MAOI antidepressants

[q] Guaifenesin – Expectorant

[a] Decrease chest congestion by coughing out secretions. Advise to increase fluid intake when taking guaifenesin

[q] Guaifenesin side effect and management

[a] GI upset (take with food), › Drowsiness, dizziness, Allergic reaction (rash)

[q] Mucolytic

[a] Acetylcysteine : enhance the flow of secretions in the respiratory passages

[q] Mucolytic side effect

[a] Aspiration and bronchospasm. Not be used in clients at risk for GI hemorrhage. Use cautiously in clients who have peptic ulcer disease, esophageal varices, and severe liver disease.

[q] Phenylephrine – decongestant – side effect

[a] Rebound congestion with long use (use only for short-term therapy 3- 5 days), CNS stimulation (agitation, nervousness, uneasiness), Vasoconstriction

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