Therapeutic Use
What are the therapeutic uses of ipratropium?
Relief of bronchoconstriction in clients who have COPD
Decrease secretions in clients with COPD
Complications from using
phenylephrine (Neo-Synephrine)- Sympathomimetics
CNS Stimulation with oral agents (agitation, anxiety, insomnia)
^ BP
Tachycardia/ Palpitations
Overdosage or systemic absorption: hypertension, tachycardia, heart palpitations
Rebound congestion with prolonged use of topical agents.
What is the medication administration of cromoyln?
Use with a nebulizer or metered-dose inhaler
Expect to several weeks of use for full effects to become apparent
Administer 4 times daily on a fixed schedule
Use the inhaler 15 minutes before exercising to prevent exercise-induced bronchospasm
Do not use to relive an acute asthma exacerbation
What are the contraindications/ precautions for codeine and dextromethorphan?
Known sensitivity to the drug
MAOI or SSRIs
Prostatic hypertrophy
Reduce respiratory reserve (emphysema, chronic asthma)
History of substance abuse
Use cautiously in children and older adults
What should the RN include in client education for 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 are the nursing interventions for montelukast?
Monitor liver function with periodic testing
Observe for behavioral changes
What is the therapeutic use of cromoyln?
Long-term treatment of allergy-related asthma
Prophylaxis for exercise-induced bronchospasm
Prophylaxis for seasonal allergy symptoms
Management of allergic rhinitis (intranasally)
What are the complications to codeine and dextromethorphan?
CNS depression (drowsiness, sedation)
Dizziness, lightheadedness (opioid)
GI distress (nausea, vomiting)
Constipation (opioids)
Respiratory depression (opioids)
Potential for abuse
What are the medication administrations for albuterol?
Follow manufacturers instructors 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 glucococorticoids
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 change in patterns of exacerbations
What are the contraindications for theophylline?
Contraindications:
Clients with impaired metabolism
Tobacco, MJ use
Caffeine
Precautions:
Heart disease
Liver dysfunction
Acute pulmonary edema
What should the RN include in patient teaching about acetylcysteine?
Report any difficulty breathing or worsening cough
Expectorate cough
Take antiemetics as needed
Proper use and cleaning of nebulizer
Consume 2,000 to 3,000 mL of water daily
What is the client education for certirizi?
Take once-daily dose at desired time
Avoid driving and activities that require mental alertness until effects are known
Take frequent sips of water
Suck on hard candy
What is the therapeutic use of diphenhydramine?
Management of
Mild allergic reaction- seasonal allergies, cough, urticaria, mild transfusion reaction
Anaphylaxis- hypotension, bronchospasm, acute laryngeal edema
Motion sickness
Insomnia- Short-term use no longer than 2 weeks
What are the complications of ipratropium?
Dry Mouth, irritation of the pharynx
Increased intraocular pressure
Urinary retention
What is the medication administration for certirizi?
May take with or without food
Do not take with other OTC antihistamines
Expect dose to be lower in clients who have compromised renal or liver function
What are the contraindications/precautions for ipratropium?
Contraindications: hypersensitivity to ipratropium, atropine, belladonna, alkaloids, or bromide, history of sensitivity to soy or peanuts- avoid Combivent (ipratropium/albuterol combo) MDI form of drug
Precautions: Glaucoma, prostatic hypertrophy, bladder neck obstruction
Client Education for
phenylephrine (Neo-Synephrine)- Sympathomimetics
Report excessive CNS symptoms (stimulation)
Consult regarding alternative therapy, withdrawal of drug
Report prolonged tachycardia or heart palpitations
Have BP checked while on meds if hypertensive
Do not use more than 3 to 5 days
Taper and discontinue the drug using one nostril at a time
What are the RN interventions for cromoyln?
Administer epinephrine and/or antihistamines to reverse anaphylaxis
Therapeutic Use
albuterol (Proventil HFA and Ventolin HFA)
Long term management of asthma
Prevention of exercise- induced bronchospasm
Treatment of ongoing asthma exacerbations
What are the adverse effects for diphenhydramine?
Drowsiness, dizziness
Anticholinergic effects (dry mouth, constipation)
Follow dosage limits and schedules
Allow prescribed time between puffs
Delay use of other inhalants for 5 minutes
Do not use an emergency rescue medication
Rinse mouth after use for taste
Follow manufactures instructions for using delivery device
What are the contraindications of acetylcysteine?
Contraindications:
Risk of or actual gastric bleeding
Precautions:
Anaphylactic reaction when giving IV
Asthma
History of bronchospasm
Severe respiratory insufficiency
What things should the nurse educate the client on about montelukast?
Report abdominal tenderness, nausea, anorexia
Report behavioral changes such as agitation, insomnia, anxiety, irritability
What are the complications of beclomethasone dipropionate?
F- fluid/electrolyte imbalance
I- infection
S- suppression of adrenal function
H- hyperglycemia
B- bone demineralization
U- peptic ulcer disease
M- muscle wasting
Oral:
Suppression of adrenal function
Bone demineralization
Muscle wasting
Hyperglycemia
Peptic ulcer disease
Infection
Fluid and electrolyte imbalances
Nasal: Dry mucous membranes, Epistaxis, Sore throat, Headache
Inhaled: Oral candidiasis
What is the therapeutic use of acetylcysteine?
Decrease viscosity of mucous secretions
Reverse acetaminophen (Tylenol) overdose
What are the complications of albuterol?
Chest pain/ palpitations
Nervousness, restlessness, tremors
What is the expected pharmacological action of diphenhydramine?
What is the expected pharmacological action of codeine and dextromethorphan (Antitussives)
Suppresses the cough reflex in the brain
What should the RN include in the client education regarding 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 are the adverse effects associated with theophylline?
Rare at therapeutic levels
When therapeutic levels are exceeded: restlessness, insomnia
Nausea, vomiting, diarrhea
When reaches toxic level: seizures
Dysrhythmias
What is the therapeutic use of certirizi?
Management of:
Allergic rhinitis
Chronic idiopathic urticaria
Neuropsychiatric effects such as suicidal ideations.
What is the expected pharmacological action of ipratropium?
Inhibits the action of acetylcholine. Because acetylcholine causes vasoconstriction of bronchi and bronchioles blocking stimulation of parasympathetic receptors results in bronchodilation.
cough is more productive and mucous is easier to expectorate
Chest congestion is decreased
What should an RN include in the client education regarding beclomethasone dipropionate?
Use a spacer to deposit less drug in the oropharynx
Rinse/gargle mouth after use to avoid thrush
Explain alternative day dosing
Taper-dose, NEVER stop abruptly
Perform weight bearing exercise daily
Consume adequate calcium and Vitamin D
Avoid NSAIDs
Take with food and water
Use a humidifier during sleep
What is the expected pharmacological action of guaifenesin (Mucinex)?
The expected pharmacologic action of expectorants is a reduction in the surface tension of secretions. This thins thick mucus, making it easier to cough out of the lungs and drain out of the nose and sinuses.