Note Card - Mosby's - Pharmacology 2019 pdf-299-311 PDF

Pulmonary
Important nursing implications Serious/life-threatening implications

Most frequent side effects Patient teaching
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What You Need to Know
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Antihistamines
Actions
Competitively block the H1-receptor sites and impede histamine-mediated responses. Second-
generation antihistamines cause less drowsiness.
Uses
• Prevent and treat seasonal allergies; decrease itching (pruritus)
• Are adjuncts used with epinephrine for severe allergic reactions (anaphylaxis)
• Prevent and treat motion sickness and insomnia
Precautions
• Asthma—acute or chronic; chronic obstructive pulmonary disease (COPD)
• Pregnancy and lactation; hypertension
• Conditions resulting in urinary retention and obstruction
Side Effects
• First generation: Frequently cause sedation and anticholinergic effects.
• Benadryl: side effects include sedation, thickening of bronchial secretions, dry
mouth, drowsiness, dizziness, and muscular weakness; may cause paradoxical
reaction in children—restlessness, anxiety
• Other examples: chlorpheniramine, promethazine
• Second generation: Minimal side effects occur—drowsiness, dry mouth, constipation, urinary
retention, and headache.
• Zyrtec: may cause paradoxical reaction in children—restlessness, anxiety; more
sedative effect than the other second-generation drugs
• Allegra: certain fruit juices (apple, orange, and grapefruit) can reduce the
absorption of the medication
• Claritin: may cause photosensitivity reactions (avoid direct exposure to sunlight)
Nursing Implications
1. Caution patient not to take antihistamines with alcohol.
2. Caution patient about drowsiness because of safety concerns.
3. Do not administer antihistamines within 4 days of skin testing.
4. Teach patient to take with food if gastrointestinal (GI) upset occurs.
5. Advise patient to exercise extreme caution when driving or performing other hazardous
activities.
6. Dry mouth can be reduced by sucking on hard candy or taking frequent sips of water.
7. Teach patient to avoid certain fruit juices in the interval between 4 hours before dosing and
1 to 2 hours after dosing if taking Allegra.
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Bronchodilators
Actions
Beta2-agonists are sympathomimetic agents that relax the smooth muscles in the bronchioles,
producing dilation and relieving bronchospasm.
Types
• Inhaled short-acting preparations (SABAs): albuterol, levalbuterol
• Inhaled long-acting preparations (LABAs): salmeterol, formoterol
• Oral agents: albuterol, terbutaline
Uses
• SABAs: treat acute exacerbations of asthma; prevent exercise-induced bronchospasm (EIB)
• LABAs: preferred for patients with COPD; in patients with asthma they are not first-line
therapy, but must be combined with a glucocorticoid
• Oral agents: long-term control for asthma; not first-line therapy
Side Effects
• Headache, nausea, restlessness, nervousness, tremors
• Increased blood pressure (BP), heartburn, insomnia, bronchial irritation
Adverse or Toxic Effects (Excessive Sympathomimetic

Stimulation)
• Palpitations, tachycardia, chest pain, seizures, tremor (oral preparations)
1. Evaluate patient’s respiratory status and vital signs.
2. Explain to patient which type of medication is for long-term control and which one is for
short-term response. Short-term preparations are used to treat and/or to prevent immediate
problems; long-term preparations are given on a schedule for maintenance.
3. LABA preparations are not recommended for aborting an ongoing asthmatic attack, but are
used when asthma is severe and are combined with a glucocorticoid, preferably in the same
inhalation device.
4. Advise patient not to use more doses than ordered.
5. Check with health care provider before using over-the-counter medicine.
6. Teach patient the correct use of inhalation devices—metered-dose inhalers (MDIs), dry
powder inhalers (DPIs), and nebulizers.
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Advair and Spiriva
Fluticasone/Salmeterol (Advair)
Classification
Long-acting beta2-agonist and glucocorticoid
Actions
Provides antiinflammatory and bronchodilator actions
Dose
Administered by Advair Diskus dry powder inhaler (DPI), one inhalation each morning and
evening, or as Advair HFA with a metered-dose inhaler (MDI), two inhalations each morning and
evening.
Tiotropium (Spiriva)
Classification
Anticholinergic bronchodilator
Actions
Blocks muscarinic (cholinergic) receptors in the lung. Therapeutic effects begin in approximately 30
minutes, peak in 3 hours, and persist about 24 hours.
Dose
Administered by HandiHaler DPI in two inhalations (to ensure drug delivery of the entire contents
of the capsule) once daily
Uses
• Long-term control and maintenance treatment for prevention of bronchospasm and airway
inflammation associated with asthma, chronic bronchitis, and chronic obstructive
pulmonary disease (COPD)
Side Effects
• Throat irritation, dry mouth, angioedema

• Corticosteroids—increased incidence of oropharyngeal fungal infections
1. Medications are to be taken every day as directed with an inhaler, even on days when
patients feel they are breathing better.
2. Medications are not for rescue in acute episodes.
3. Patients should carry a rescue inhaler, such as albuterol.
4. Encourage patient to rinse mouth to decrease infection (Spiriva) and to decrease throat and
mouth irritation.
5. Full effects of Spiriva make take several weeks to be felt; however, lung function
improvements may occur after the first dose.
6. Teach patient how to use an inhaler.
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Antitussives, Expectorants, and Mucolytics
Action
Antitussives act either centrally (central nervous system [CNS]) or locally in the peripheral nervous
system to decrease irritation and suppress the cough response. Expectorants decrease the thickness
of sputum and increase the ease of its removal for a productive cough. Mucolytics react directly with
respiratory secretions to liquefy or make the mucus more watery, making the cough more
productive.
Uses
• Antitussives suppress cough.
• Expectorants decrease viscosity (stickiness of mucus) and promote a more productive
cough.
• Mucolytics break down mucus and make cough more productive.
Precautions
• Dextromethorphan is used in many over-the-counter (OTC) cough preparations.
• Origin of chronic cough should be investigated.
• Codeine is a very effective antitussive; is considered a Schedule V drug in cough
medications and can depress respirations.
• Codeine is not recommended for children under 12 years of age or for all pediatric patients
undergoing tonsillectomy and/or adenoidectomy.
• Avoid OTC cold remedies in children younger than 4 years of age.
Side Effects
• Antitussives: dextromethorphan—euphoria (may be abused); codeine—drowsiness,
constipation, gastrointestinal (GI) upset, suppression of respirations
• Expectorants: nausea and vomiting, GI upset
• Mucolytics: nausea, rhinorrhea, dizziness, may trigger bronchospasms
1. Evaluate patient’s respiratory status and response to medication.
2. Warn patient to avoid driving and operating machinery when taking codeine cough
suppressant.
3. Mucomyst has a short-term disagreeable odor (rotten eggs).
4. Teach patient to read labels; cold remedies are frequently combined with other drugs and
may contain 2 or more of the following: nasal decongestant, antitussive, analgesic,
antihistamine, and caffeine.
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Pulmonary

Important nursing implications Serious/life-threatening implications

Adverse or Toxic Effects (Excessive Sympathomimetic

• Throat irritation, dry mouth, angioedema

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