PYRAMID POINTS CHAPTER 58: RESPIRATORY MEDICATIONS.

PYRAMID POINTSPYRAMID POINTS

CHAPTER 58:CHAPTER 58:

RESPIRATORY RESPIRATORY MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH:Respiratory Medications

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I. BronchodilatorsI. Bronchodilators DescriptionDescription

• Should be used with caution in clients with hypertension, Should be used with caution in clients with hypertension, diabetes mellitus, narrow-angle glaucomadiabetes mellitus, narrow-angle glaucoma

• Theophylline increases risk of digitalis toxicity, decreases Theophylline increases risk of digitalis toxicity, decreases effects of lithium and phenytoin (Dilantin)effects of lithium and phenytoin (Dilantin)

• If theophylline and If theophylline and ββ blocker are administered together, blocker are administered together, cardiac dysrhythmias may resultcardiac dysrhythmias may result

• ββ Blockers, cimetidine (Tagamet), erythromycin increase Blockers, cimetidine (Tagamet), erythromycin increase effects of theophyllineeffects of theophylline

• Barbiturates, carbamazepine (Tegretol) decrease Barbiturates, carbamazepine (Tegretol) decrease effectiveness of theophyllineeffectiveness of theophylline



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I. Bronchodilators (continued) I. Bronchodilators (continued) Side effectsSide effects

• Palpitations, tachycardiaPalpitations, tachycardia

• HyperglycemiaHyperglycemia

• Decreased clotting timeDecreased clotting time

InterventionsInterventions• Monitor therapeutic serum theophylline level of 10 to 20 Monitor therapeutic serum theophylline level of 10 to 20

mcg/mLmcg/mL

• Intravenous- (IV-) administered aminophylline or Intravenous- (IV-) administered aminophylline or theophylline preparations administered slowly using theophylline preparations administered slowly using infusion pumpinfusion pump



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II. Glucocorticoids (Corticosteroids)II. Glucocorticoids (Corticosteroids) Anti-inflammatory agents; reduce airway edemaAnti-inflammatory agents; reduce airway edema See Module 54 for information on glucocorticoids See Module 54 for information on glucocorticoids

(corticosteroids)(corticosteroids)



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III. Inhaled Nonsteroidal Antiallergy AgentsIII. Inhaled Nonsteroidal Antiallergy Agents DescriptionDescription

• Antiasthmatic, antiallergic, mast cell stabilizers inhibit Antiasthmatic, antiallergic, mast cell stabilizers inhibit mast cell release after exposure to antigensmast cell release after exposure to antigens

• Used to treat allergic rhinitis, bronchial asthma, Used to treat allergic rhinitis, bronchial asthma, exercised-induced bronchospasmexercised-induced bronchospasm

Side effectsSide effects• Cough, bronchospasm following inhalationCough, bronchospasm following inhalation

InterventionsInterventions• Instruct client to drink few sips of water before, after Instruct client to drink few sips of water before, after

inhalationinhalation• Instruct client not to discontinue medication abruptlyInstruct client not to discontinue medication abruptly



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IV. Leukotriene ModifiersIV. Leukotriene Modifiers DescriptionDescription

• Used in prophylaxis and treatment of chronic bronchial asthma; Used in prophylaxis and treatment of chronic bronchial asthma; not used for acute asthmatic episodesnot used for acute asthmatic episodes

Side effectsSide effects• Headache; nausea and vomiting; dyspepsia; diarrhea; Headache; nausea and vomiting; dyspepsia; diarrhea;

generalized pain; fever; dizzinessgeneralized pain; fever; dizziness InterventionsInterventions

• Assess lung sounds for rhonchi, wheezing; assess liver function Assess lung sounds for rhonchi, wheezing; assess liver function studies as prescribedstudies as prescribed

• Instruct client to take medication 1 hour before or 2 hours after Instruct client to take medication 1 hour before or 2 hours after meals; instruct client not to discontinue medication, to take as meals; instruct client not to discontinue medication, to take as prescribedprescribed



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V. Monoclonal AntibodiesV. Monoclonal Antibodies DescriptionDescription

• Immunoglobulins that can be synthesized to have single Immunoglobulins that can be synthesized to have single specificity for therapeutic regimens, such as specificity for therapeutic regimens, such as immunosuppressionimmunosuppression

Side effectsSide effects• ImmunosuppressionImmunosuppression

InterventionsInterventions• Instruct client to avoid others with infectious disordersInstruct client to avoid others with infectious disorders• Instruct client to eat well-balanced diet, get adequate rest Instruct client to eat well-balanced diet, get adequate rest

and sleepand sleep



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VI. AntihistaminesVI. Antihistamines DescriptionDescription

• Medications that compete with histamine for receptor Medications that compete with histamine for receptor sites, thus preventing histamine responsesites, thus preventing histamine response

• Diphenhydramine (Benadryl) has anticholinergic effects, Diphenhydramine (Benadryl) has anticholinergic effects, should be avoided by clients with narrow-angle should be avoided by clients with narrow-angle glaucomaglaucoma

Side effectsSide effects• Drowsiness; urinary retention; blurred vision; wheezing; Drowsiness; urinary retention; blurred vision; wheezing;

constipation; dry mouth; gastrointestinal (GI) irritation; constipation; dry mouth; gastrointestinal (GI) irritation; hypotension; photosensitivity; nervousnesshypotension; photosensitivity; nervousness



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VI. Antihistamines (continued) VI. Antihistamines (continued) InterventionsInterventions

• Instruct client to avoid hazardous activities, alcohol, Instruct client to avoid hazardous activities, alcohol, central nervous system (CNS) depressantscentral nervous system (CNS) depressants

• Instruct client taking medication for motion sickness to Instruct client taking medication for motion sickness to take 30 minutes before event, before meals, and at take 30 minutes before event, before meals, and at bedtime during eventbedtime during event



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VII. Nasal DecongestantsVII. Nasal Decongestants DescriptionDescription

• Stimulate Stimulate -adrenergic receptors, producing -adrenergic receptors, producing vasoconstriction of the capillaries in nasal mucosavasoconstriction of the capillaries in nasal mucosa

• Used with extreme caution in clients with hypertension, Used with extreme caution in clients with hypertension, cardiac disease, hyperthyroidism, diabetes mellituscardiac disease, hyperthyroidism, diabetes mellitus

• Can cause tolerance, rebound nasal congestionCan cause tolerance, rebound nasal congestion



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VII. Nasal Decongestants (continued) VII. Nasal Decongestants (continued) Side effectsSide effects

• Tolerance, rebound nasal congestionTolerance, rebound nasal congestion

InterventionsInterventions• Monitor for cardiac dysrhythmiasMonitor for cardiac dysrhythmias

• Monitor blood glucose levelsMonitor blood glucose levels

• Instruct client regarding importance of limiting use of Instruct client regarding importance of limiting use of nasal sprays, dropsnasal sprays, drops



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VIII. Expectorants and Mucolytic AgentsVIII. Expectorants and Mucolytic Agents DescriptionDescription

• Expectorants loosen bronchial secretions; then they can be Expectorants loosen bronchial secretions; then they can be eliminated with coughingeliminated with coughing

• Mucolytics thin out bronchial mucousMucolytics thin out bronchial mucous Side effectsSide effects

• GI irritation; rash; oropharyngeal irritationGI irritation; rash; oropharyngeal irritation InterventionsInterventions

• Instruct client to take medication with full glass of water, Instruct client to take medication with full glass of water, maintain adequate fluid intake maintain adequate fluid intake

• Encourage client to cough and breathe deeplyEncourage client to cough and breathe deeply

• Acetylcysteine (Mucomyst) should not be mixed with other Acetylcysteine (Mucomyst) should not be mixed with other medications if given via nebulizermedications if given via nebulizer



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IX. AntitussivesIX. Antitussives DescriptionDescription

• Act on cough center in medulla to suppress cough reflexAct on cough center in medulla to suppress cough reflex Side effectsSide effects

• ConstipationConstipation• Respiratory depressionRespiratory depression

InterventionsInterventions• Instruct client if cough lasts longer than 1 week, should Instruct client if cough lasts longer than 1 week, should

notify physiciannotify physician• Encourage client to maintain adequate fluid intakeEncourage client to maintain adequate fluid intake• Encourage client to sleep with HOB elevatedEncourage client to sleep with HOB elevated



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X. Narcotic AntagonistX. Narcotic Antagonist DescriptionDescription

• Reverses respiratory depression in narcotic overdoseReverses respiratory depression in narcotic overdose

Side effectsSide effects• CNS depression; nausea and vomiting; tremors; CNS depression; nausea and vomiting; tremors;

diaphoresis; hypertension; tachycardiadiaphoresis; hypertension; tachycardia

InterventionsInterventions• Assess vital signs, especially respirationsAssess vital signs, especially respirations

• Have oxygen, resuscitation equipment available during Have oxygen, resuscitation equipment available during administrationadministration



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XI. Use of an InhalerXI. Use of an Inhaler If two different inhaled medications prescribed, If two different inhaled medications prescribed,

administer bronchodilator first, corticosteroid nextadminister bronchodilator first, corticosteroid next Wait 5 minutes following bronchodilator before Wait 5 minutes following bronchodilator before

inhaling corticosteroidinhaling corticosteroid Client should take in one deep breath before Client should take in one deep breath before

activating inhaler, hold breath activating inhaler, hold breath

10 to 15 seconds before breathing out slowly10 to 15 seconds before breathing out slowly



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XII. Tuberculosis (TB) MedicationsXII. Tuberculosis (TB) Medications DescriptionDescription

• Use of multidrug regimen destroys organisms as quickly Use of multidrug regimen destroys organisms as quickly as possible, minimizing emergence of medication-as possible, minimizing emergence of medication-resistant organismsresistant organisms

• Individuals with active TB should be treated for Individuals with active TB should be treated for 6 to 9 months (longer if HIV-positive)6 to 9 months (longer if HIV-positive)

• After infected individual has received medication for 2 to After infected individual has received medication for 2 to 3 weeks, risk of transmission greatly reduced 3 weeks, risk of transmission greatly reduced

• Most clients have negative sputum cultures after Most clients have negative sputum cultures after 3months’ compliance with medication therapy3months’ compliance with medication therapy

• Individuals exposed to active TB treated with Individuals exposed to active TB treated with prophylactic isoniazid (INH) for 9 to 12 monthsprophylactic isoniazid (INH) for 9 to 12 months



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XIII. First-line Medications for TBXIII. First-line Medications for TB Isoniazid (INH, Laniazid, Nydrazid)Isoniazid (INH, Laniazid, Nydrazid)

• INH contraindicated in clients with hypersensitivity, acute INH contraindicated in clients with hypersensitivity, acute liver diseaseliver disease

• Use INH with caution in clients with chronic liver disease, Use INH with caution in clients with chronic liver disease, alcoholism, renal impairment, or taking hepatotoxic alcoholism, renal impairment, or taking hepatotoxic medicationsmedications

• INH may decrease ketoconazole (Nizoral) concentrationINH may decrease ketoconazole (Nizoral) concentration• Assess for hepatic dysfunctionAssess for hepatic dysfunction• Monitor liver function test resultsMonitor liver function test results• Monitor for signs of hepatitisMonitor for signs of hepatitis• Monitor for tingling, numbness, burning extremitiesMonitor for tingling, numbness, burning extremities



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XIII. First-line Medications for TB (continued) XIII. First-line Medications for TB (continued) Isoniazid (INH, Laniazid, Nydrazid) (continued) Isoniazid (INH, Laniazid, Nydrazid) (continued)

• Monitor for visual changes; notify physician if they occurMonitor for visual changes; notify physician if they occur• Monitor complete blood count (CBC), blood glucose levelMonitor complete blood count (CBC), blood glucose level• Administer INH 1 hour before or 2 hours after mealAdminister INH 1 hour before or 2 hours after meal• Administer INH at least 1 hour before antacidsAdminister INH at least 1 hour before antacids• Instruct client not to skip doses, to take medication for full Instruct client not to skip doses, to take medication for full

length of prescribed therapylength of prescribed therapy• Instruct client to avoid tyramine-containing foodsInstruct client to avoid tyramine-containing foods• Instruct client in signs of neurotoxicity, hepatitis, Instruct client in signs of neurotoxicity, hepatitis,

hepatoxicityhepatoxicity



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XIII. First-line Medications for TB (continued) XIII. First-line Medications for TB (continued) Rifampin (Rifadin)Rifampin (Rifadin)

• Side effects include vision changes, hepatotoxicity, Side effects include vision changes, hepatotoxicity, hepatitis, increased uric acid levels, blood dyscrasias, hepatitis, increased uric acid levels, blood dyscrasias, colitiscolitis

• Assess for hypersensitivityAssess for hypersensitivity

• Evaluate CBC, uric acid, liver function test resultsEvaluate CBC, uric acid, liver function test results

• Assess for signs of hepatitisAssess for signs of hepatitis

• Instruct client not to skip dose, to take medication for full Instruct client not to skip dose, to take medication for full length of prescribed therapylength of prescribed therapy



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XIII. First-line Medications for TB (continued) XIII. First-line Medications for TB (continued) Rifampin (Rifadin) (continued) Rifampin (Rifadin) (continued)

• Advise client to keep all physician appointments, Advise client to keep all physician appointments, appointments for laboratory workappointments for laboratory work

• Advise client to take medication on empty stomach with 8 Advise client to take medication on empty stomach with 8 oz water 1 hour before or 2 hours after mealoz water 1 hour before or 2 hours after meal

• Advise client to avoid taking medication with antacidsAdvise client to avoid taking medication with antacids

• Instruct client that bodily fluids will be red-orangeInstruct client that bodily fluids will be red-orange

• Instruct client to report signs of jaundice to physicianInstruct client to report signs of jaundice to physician



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XIII. First-line Medications for TB (continued) XIII. First-line Medications for TB (continued) Ethambutol (Myambutol)Ethambutol (Myambutol)

• Use with caution in clients with renal dysfunction, gout, Use with caution in clients with renal dysfunction, gout, ocular defects, retinopathy, cataracts, ocular ocular defects, retinopathy, cataracts, ocular inflammatory disorders, or taking neurotoxic medicationsinflammatory disorders, or taking neurotoxic medications

• Side effects include hypersensitivity reactions, dermatitis, Side effects include hypersensitivity reactions, dermatitis, optic neuritis, peripheral neuritisoptic neuritis, peripheral neuritis

• Determine baseline visual acuity, color discriminationDetermine baseline visual acuity, color discrimination

• Monitor for visual changes; notify physician if they occurMonitor for visual changes; notify physician if they occur



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XIII. First-line Medications for TB (continued) XIII. First-line Medications for TB (continued) Ethambutol (Myambutol) (continued) Ethambutol (Myambutol) (continued)

• Administer once every 24 hours with foodAdminister once every 24 hours with food

• Monitor uric acid concentrations; assess for painful, Monitor uric acid concentrations; assess for painful, swollen jointsswollen joints

• Monitor intake and output (I&O), renal functionMonitor intake and output (I&O), renal function

• Monitor for dizziness; initiate safety precautionsMonitor for dizziness; initiate safety precautions

• Assess for peripheral neuritisAssess for peripheral neuritis

• Instruct client not to skip dose, to take medication for full Instruct client not to skip dose, to take medication for full length of prescribed therapylength of prescribed therapy

• Advise client to keep all physician appointments, Advise client to keep all physician appointments, appointments for laboratory workappointments for laboratory work



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XIII. First-line Medications for TB (continued)XIII. First-line Medications for TB (continued) PyrazinamidePyrazinamide

• Use with at least one other antitubercular medicationUse with at least one other antitubercular medication• Side effects include increased liver function, uric acid Side effects include increased liver function, uric acid

levels, photosensitivity, hepatotoxicitylevels, photosensitivity, hepatotoxicity• Evaluate CBC, liver function test results, uric acid levelsEvaluate CBC, liver function test results, uric acid levels• Observe for hepatotoxic effectsObserve for hepatotoxic effects• Evaluate blood glucose levelsEvaluate blood glucose levels• Instruct client to take medication with foodInstruct client to take medication with food• Instruct client to avoid sunlight, ultraviolet lightInstruct client to avoid sunlight, ultraviolet light• Advise client to keep all physician appointments, Advise client to keep all physician appointments,

appointments for laboratory workappointments for laboratory work



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XIV. Second-line Medications for TuberculosisXIV. Second-line Medications for Tuberculosis Capreomycin sulfate (Capastat Sulfate)Capreomycin sulfate (Capastat Sulfate)

• Do not administer to clients receiving streptomycinDo not administer to clients receiving streptomycin

Kanamycin (Kantrex) and amikacin (Amikin)Kanamycin (Kantrex) and amikacin (Amikin)• Contraindicated in clients with hypersensitivity, Contraindicated in clients with hypersensitivity,

neuromuscular disorders, eighth cranial nerve damageneuromuscular disorders, eighth cranial nerve damage

• Risk of toxicity increases when taken with other Risk of toxicity increases when taken with other aminoglycosides, nephrotoxic, ototoxic drugsaminoglycosides, nephrotoxic, ototoxic drugs



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XIV. Second-line Medications for TB XIV. Second-line Medications for TB (continued) (continued) Kanamycin (Kantrex) and amikacin (Amikin) Kanamycin (Kantrex) and amikacin (Amikin)

(continued) (continued) • Monitor for ototoxic, neurotoxic, nephrotoxic adverse Monitor for ototoxic, neurotoxic, nephrotoxic adverse

effectseffects• Monitor liver, renal function test resultsMonitor liver, renal function test results• Assess hydration status; maintain hydrationAssess hydration status; maintain hydration• Advise client to keep all physician appointments, Advise client to keep all physician appointments,

appointments for laboratory workappointments for laboratory work• Advise to notify physician if hearing loss, changes in Advise to notify physician if hearing loss, changes in

vision, urinary problems occurvision, urinary problems occur



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XIV. Second-line Medications for TB (continued) XIV. Second-line Medications for TB (continued) StreptomycinStreptomycin

• Contraindicated in clients with hypersensitivity, myasthenia Contraindicated in clients with hypersensitivity, myasthenia gravis, parkinsonism, eighth cranial nerve damagegravis, parkinsonism, eighth cranial nerve damage

• Risk of toxicity increases when taken with other Risk of toxicity increases when taken with other aminoglycosides or nephrotoxic, ototoxic medicationsaminoglycosides or nephrotoxic, ototoxic medications

• Monitor liver, renal function test resultsMonitor liver, renal function test results

• Monitor for ototoxic, neurotoxic, nephrotoxic reactionsMonitor for ototoxic, neurotoxic, nephrotoxic reactions

• Assess hydration status; maintain hydration during therapyAssess hydration status; maintain hydration during therapy

• Advise client to keep all physician appointments, appointments Advise client to keep all physician appointments, appointments for laboratory workfor laboratory work



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XIV. Second-line Medications for TB XIV. Second-line Medications for TB (continued) (continued) Ethionamide (Trecator-SC)Ethionamide (Trecator-SC)

• Side effects include metallic taste in mouth, orthostatic Side effects include metallic taste in mouth, orthostatic hypotension, jaundice, peripheral neuritishypotension, jaundice, peripheral neuritis

• Administer pyridoxine as prescribedAdminister pyridoxine as prescribed

• Instruct client to take medication with food, mealsInstruct client to take medication with food, meals

• Instruct client to change position slowlyInstruct client to change position slowly

• Instruct client to report signs of rashInstruct client to report signs of rash



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XIV. Second-line Medications for TB (continued) XIV. Second-line Medications for TB (continued) Para-aminosalicylic acid (Paser)Para-aminosalicylic acid (Paser)

• Contraindicated with hypersensitivityContraindicated with hypersensitivity• Side effects include hypersensitivity, bitter taste in mouth, blood Side effects include hypersensitivity, bitter taste in mouth, blood

dyscrasias, crystalluriadyscrasias, crystalluria• Assess for hypersensitivityAssess for hypersensitivity• Offer clear water to rinse mouth, chewing gum, hard candy Offer clear water to rinse mouth, chewing gum, hard candy

following medicationfollowing medication• Encourage fluid intakeEncourage fluid intake• Instruct client to take medication with foodInstruct client to take medication with food• Instruct client not to take over-the-counter aspirin without Instruct client not to take over-the-counter aspirin without

physician’s approvalphysician’s approval• Instruct client to report immediately signs of blood dyscrasiaInstruct client to report immediately signs of blood dyscrasia



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XIV. Second-Line Medications for TB XIV. Second-Line Medications for TB (continued) (continued) Cycloserine (Seromycin)Cycloserine (Seromycin)

• Side effects include CNS reactions, neurotoxicity, altered Side effects include CNS reactions, neurotoxicity, altered level of consciousnesslevel of consciousness

• Monitor for changes in mental status, thought processesMonitor for changes in mental status, thought processes

• Monitor serum drug level; peak, 2 hours after dosing, 25 Monitor serum drug level; peak, 2 hours after dosing, 25 to 35 mcg/mLto 35 mcg/mL

• Advise client of need for weekly serum drug levelsAdvise client of need for weekly serum drug levels

• Teach client about signs indicating adverse effectsTeach client about signs indicating adverse effects



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XV. Influenza Medications (see Module 57, Influenza)XV. Influenza Medications (see Module 57, Influenza) VaccinesVaccines

• Administered annuallyAdministered annually

• Contraindicated in hypersensitivity, chicken egg allergy, active Contraindicated in hypersensitivity, chicken egg allergy, active infection or illness, Guillain-Barré syndrome, pregnancy (live infection or illness, Guillain-Barré syndrome, pregnancy (live activated vaccine), age younger than activated vaccine), age younger than

6 months6 months AntiviralsAntivirals

• Administered as prophylaxis but do not replace vaccine or Administered as prophylaxis but do not replace vaccine or prevent transmissionprevent transmission

• Administered within 24 to 48 hours of onset of symptomsAdministered within 24 to 48 hours of onset of symptoms

• Contraindicated in hypersensitivity, pregnancyContraindicated in hypersensitivity, pregnancy



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The client taking oral theophylline has a serum theophylline The client taking oral theophylline has a serum theophylline level of 15 mcg/mL. The nurse interprets that this result is:level of 15 mcg/mL. The nurse interprets that this result is:

1.1. Below the therapeutic range Below the therapeutic range2.2. In the middle of the therapeutic range In the middle of the therapeutic range3.3. Near the top of the therapeutic range Near the top of the therapeutic range4.4. In excess of the therapeutic range In excess of the therapeutic range

PYRAMID POINTS CHAPTER 58: RESPIRATORY MEDICATIONS.

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