Pharmacological Treatment for

Respiratory Disorders

Jude H. de Los Angeles

BSN - III
11/6/2017

Submitted to:

Ms. Juliet Batac, RN, MAN (NCM 103 Professor)

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Aminophylline is a To prevent and Severe hypertension, CNS: Monitor for S&S of
AMINOPHYLLINE salt of theophylline relieve symptoms of cardiac disease, Nervousness, toxicity (generally related
with effects similar to acute bronchial arrhythmias; impaired restlessness, to theophylline serum
Brand name: those of other asthma and treatment hepatic function; diabetes depression, levels over 20 mg/mL).
Theophylline xanthines (e.g., of bronchospasm mellitus; insomnia, Observe patients receiving
caffeine and associated with hyperthyroidism; irritability, parenteral drug closely for
ROUTE & DOSAGE: theobromine). Action chronic bronchitis glaucoma; prostatic headache, signs of hypotension,
IV Loading Dose 6 is dependent on and emphysema. hypertrophy; fibrocystic dizziness, muscle arrhythmias, and
mg/kg over 30 min IV theophylline content breast disease; history of hyperactivity, convulsions until serum
Maintenance (approximately 80%) peptic ulcer; neonates and convulsions. theophylline stabilizes
Dose nonsmoker, 0.5 and is measured as young children, patients CV: within the therapeutic
mg/kg/h; smoker, theophylline in the over 55 y; COPD, acute Cardiac range.
0.75 mg/kg/h; CHF or serum. influenza or patients arrhythmias,
cirrhosis, 0.25 receiving influenza tachycardia (with Monitor & record vital
mg/kg/h PO nonsmok immunization. rapid IV), signs and I&O. A sudden,
er, 0.5 mg/kg/h times hyperventilation, sharp, unexplained rise in
24 h in 4 divided chest pain, severe PR may indicate toxicity.
doses; smoker, 0.75 hypotension,
mg/kg/h times 24 h in cardiac arrest. Note: Older adults, acutely
4 divided doses; CHF GI: ill, and patients with
or cirrhosis, 0.25 Nausea, vomiting, severe respiratory
mg/kg/h times 24 h in anorexia, problems, liver
4 divided doses hematemesis, dysfunction, or pulmonary
diarrhea, edema are at greater risk
CLASSIFICATION: epigastric pain. of toxicity due to reduced
Bronchodilator drug clearance.
(respiratory smooth
muscle
relaxant); Xanthine
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Synthetic To relieve Pregnancy (category C), Body as a Monitor therapeutic
ALBUTEROL sympathomimetic bronchospasm lactation. Use of oral syrup Whole: effectiveness which is
amine and moderately associated with acute in children <2 yo. Hypersensitivity indicated by significant
Brand name: selective beta2- or chronic asthma, reaction. subjective improvement in
Ventolin adrenergic agonist bronchitis, or other CNS: pulmonary function within
with comparatively reversible obstructive Tremor, anxiety, 60–90 min after drug
ROUTE & DOSAGE: long action. Acts airway diseases. Also nervousness, administration.
Adult: more prominently on used to prevent restlessness,
PO 2–4 mg 3–4 beta2 receptors exercise-induced convulsions, Monitor for: S&S of fine
times/d, 4–8 mg (particularly smooth bronchospasm. weakness, tremor in fingers, which
sustained release 2 muscles of bronchi, headache, may interfere with
times/d Inhaled 1–2 uterus, and vascular hallucinations. precision handwork; CNS
inhalations q4–6h supply to skeletal CV: stimulation, particularly in
Child: muscles) than on Palpitation, children 2–6 y,
PO 2–6 y, 0.1–0.2 beta1 (heart) hypertension, (hyperactivity, excitement,
mg/kg t.i.d. (max: 4 receptors. Inhibits hypotension, nervousness, insomnia),
mg/dose); 6–12 y, 2 histamine release by bradycardia, tachycardia, GI symptoms.
mg 3–4 mast cells. Produces reflex Report promptly to
times/d Inhaled 6–12 bronchodilation, tachycardia. physician.
y, 1–2 inhalations q4– regardless of Special Senses:
6h administration route, Blurred vision, Lab tests: Periodic ABGs,
by relaxing smooth dilated pupils. pulmonary functions, and
CLASSIFICATION: muscles of bronchial GI: pulse oximetry.
Autonomic Nervous tree. Nausea,
System Agent; Beta- vomiting.
Adrenergic Agonist Other:
(Sympathomimetic); Muscle cramps,
Bronchodilator hoarseness.
(Respiratory Smooth
Muscle Relaxant)
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Synthetic adrenergic Orally or Known hypersensitivity to CNS: Assess vital signs:
TERBUTALINE stimulant with subcutaneously as a sympathomimetic amines; Nervousness, Baseline pulse and BP and
SULFATE selective beta2- and bronchodilator in severe hypertension and tremor, headache, before each dose. If
negligible beta1- bronchial asthma and coronary artery disease; light- significantly altered from
Brand name: agonist (cardiac) for reversible airway tachycardia with digitalis headedness, drow baseline level, consult
Bricanyl activity. Exerts obstruction intoxication; within 14 d of siness, fatigue, physician. Cardiovascular
preferential effect on associated with MAO inhibitor therapy; seizures. adverse effects are more
ROUTE & DOSAGE: beta2 receptors in bronchitis and angle-closure glaucoma. CV: apt to occur when drug is
Adult: bronchial smooth emphysema. Used only after evaluation Tachycardia, hyp given by SC route or it is
PO 2.5–5 mg t.i.d. at muscles, inhibits of risk-benefit ratio in otension or used by a patient with
6 h intervals (max: 15 histamine release pregnancy (category B) hypertension, pal cardiac arrhythmia.
mg/d) SC 0.25 mg from mast cells, and and lactation. pitation, maternal
q15–30min up to 0.5 increases ciliary and fetal Most adverse effects are
mg in 4 h Inhaled 2 motility. tachycardia. transient, however, rapid
inhalations separated GI: heart rate may persist for a
by 60 sec q4–6h Nausea, relatively long time.
vomiting.
Adolescent: Body as a Aerosolized drug produces
PO 12–15 y, 2.5 mg Whole: minimal cardiac
t.i.d. at 6 h intervals Sweating, muscle stimulation or tremors.
(max: 7.5 cramps.
mg/d) SC 0.25 mg Be aware that muscle
q15–30min up to 0.5 tremor is a fairly common
mg in 4 h Inhaled 2 adverse effect that appears
inhalations separated to subside with continued
by 60 sec q4–6h use.
Child:
PO <12 y, 0.05 mg/kg
q8h, gradually
increase up to 0.15
mg/kg q8h (max: 5
mg/d) SC 0.005–0.01
mg/kg (max: 0.4 mg)
q15–20min times 2
doses

CLASSIFICATION:
Autonomic Nervous
System Agent; Beta-
Adrenergic
Agonist; Bronchodilat
or
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: A long-acting, Maintenance Hypersensitivity to Body as a Withhold drug and notify
TIOTROPIUM antispasmodic agent. treatment of tiotropium, atropine, or Whole: physician if S&S of
BROMIDE In the bronchial bronchospasm ipratropium; pregnancy Nonspecific chest angioedema occurs.
airways, it exhibits associated with (category C); children <18 pain, dependent
Brand name: inhibition of chronic obstructive yo. edema, infection, Monitor for
Spiriva muscarinic receptors pulmonary disease moniliasis, flu- anticholinergic effects
of the smooth muscle (COPD). like syndrome, (e.g., tachycardia, urinary
ROUTE & DOSAGE: resulting in cough, allergic retention).
Inhale the contents of bronchodilation. The reactions.
one capsule once drug effect can last up CNS :
daily using hand to 24 h. Dysphonia,
inhaler device paresthesia,
provided. depression.
GI :
CLASSIFICATION: Abdominal pain,
Autonomic Nervous constipation, dry
System mouth , dyspepsia
Agent; Anticholinergi , vomiting,
c; Parasympatholytic; reflux,
Antimuscarinic; Antis stomatitis.
pasmodic Metabolic :
Hypercholesterol
emia,
hyperglycemia.
Musculoskeletal
:
Myalgia, skeletal
pain.
Respiratory :
Epistaxis,
pharyngitis,
rhinitis,
laryngitis, sinusiti
s, upper
respiratory tract
infection .
Skin :
Rash.
Special Senses:
Cataract.
Urogenital :
Urinary tract
infection.
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: An isomer of Treatment or Hypersensitivity to Body as a Monitor for S&S of
LEVALBUTEROL albuterol with beta2- prevention of levalbuterol or albuterol; Whole: CNS or cardiovascular
HYDROCHLORIDE adrenergic agonist bronchospasm in angioedema; pregnancy Allergic reactions, stimulation (e.g., BP,
properties, drug acts patients with (category C); children <6 flu syndrome, HR, respiratory status).
Brand name: on the reversible yo; lactation. pain.
Xopenex beta2 receptors of obstructive airway CNS: Lab tests: Periodic
the smooth muscles disease. Migraine, serum potassium levels
ROUTE & DOSAGE: of the bronchial tree, dizziness,
Adult: especially with
thus resulting in nervousness, coadministered loop or
Inhalation 0.63 mg by
bronchodilation. tremor, anxiety. thiazide diuretics.
nebulization t.i.d.
CV:
every 6–8 h, may
Tachycardia.
increase to 1.25 mg Monitor diabetics for
t.i.d. if needed GI:
loss of glycemic control.
Child: Dyspepsia.
Inhalation 6–11 Respiratory:
y 0.31 mg by Increased cough,
nebulization t.i.d. viral infection,
every 6–8 h (max: rhinitis, sinusitis,
0.63 mg t.i.d.) turbinate
edema, paradoxic
CLASSIFICATION: al
Autonomic Nervous bronchospasm.
System Agent; Beta- Endocrine:
Adrenergic Agonist Increase in serum
(Sympathomimetic); glucose.
Bronchodilator
(Respiratory Smooth
Muscle Relaxant)
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Potent synthetic Bronchodilator in Sensitivity to other CNS: Monitor respiratory
METAPROTERENO sympathomimetic symptomatic relief of sympathomimetic agents; Nervousness, status. Auscultate lungs
L SULFATE amine similar to asthma and cardiac arrhythmias weakness, before and after
isoproterenol in reversible associated with drowsiness, trem inhalation to determine
Brand name: chemical structure bronchospasm tachycardia; or (particularly efficacy of drug in
Alupent and pharmacologic associated with hyperthyroidism; after PO decreasing airway
actions. Acts bronchitis and pregnancy (category C), administration), resistance.
ROUTE & DOSAGE:
selectively on beta2- emphysema. lactation. Safety in headache,
Adult:
adrenergic receptors children <12 yo (for fatigue. Monitor cardiac status.
PO 20 mg q6–
8h Metered Dose to relax smooth aerosol use) is not CV: Report tachycardia and
Inhaler 2–3 muscle of bronchi, established. Tachycardia, hyp hypotension.
inhalations q3–4h uterus, and blood ertension, cardia
(max: 12 vessels supplying c arrest,
inhalations/d) Nebuliz skeletal muscles. palpitation.
er 5–10 inhalations of GI:
undiluted 5% Nausea,
solution IPPB 2.5 mL vomiting, bad
of 0.4–0.6% solution taste.
q4–6h Urogenital:
Geriatric: Occasional
PO 10 mg 3–4 difficulty in
times/d, may increase micturition and
to 20 mg 3–4 times/d muscle cramps.
Respiratory:
Classification:
Throat irritation,
Autonomic Nervous
System Agent; Beta- cough,
Adrenergic exacerbation of
Agonist; Bronchodilat asthma.
or
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: H1-receptor Temporary Hypersensitivity to CNS: Monitor cardiovascular
DIPHENHYDRAMINE antagonist and symptomatic relief of antihistamines of similar Drowsiness, dizzi status especially with pre-
HYDROCHLORIDE antihistamine with various allergic structure; lower ness, headache, existing cardiovascular
significant conditions and to respiratory tract fatigue, disturbed disease.
anticholinergic treat or prevent symptoms (including acute coordination,
Brand name: activity. High motion sickness, asthma); narrow-angle tingling, Monitor for adverse
Benadryl
incidence of vertigo, and glaucoma; prostatic heaviness and effects especially in
drowsiness, but GI reactions to blood or hypertrophy, bladder neck weakness of children and the older
ROUTE & DOSAGE:
side effects are plasma in susceptible obstruction; GI hands, tremors, adult.
Adult:
minor. Effects in patients. Also used in obstruction or stenosis; euphoria,
PO 25 mg q4–6h
(max: 100 mg/d) parkinsonism and anaphylaxis as pregnancy (category C), nervousness, Supervise ambulation and
Child: drug-induced adjunct to lactation, premature restlessness, use side-rails as
PO 2–6 y, 6.25 mg extrapyramidal epinephrine and neonates, and neonates; insomnia; necessary. Drowsiness is
q4–6h (max: 25 symptoms are other standard use as nighttime sleep aid confusion; most prominent during
mg/24 h); 6–12 y, apparently related to measures after acute in children <12 yo. (especially in the first few days of
12.5 mg q4–6h (max: its ability to suppress symptoms have been children): therapy and often
50 mg/24 h) central cholinergic controlled; in excitement, disappears with continued
activity and to treatment of fever. therapy. Older adults are
Classification: prolong action of parkinsonism and CV: especially likely to
Antihistamine; H1- dopamine by drug-induced Palpitation, tachy manifest dizziness,
Receptor Antagonist inhibiting its reuptake extrapyramidal cardia, mild sedation, and
and storage. reactions; as a hypotension or hypotension.
nonnarcotic cough hypertension, car
suppressant; as a diovascular
sedative-hypnotic; collapse.
and for treatment of Special
intractable insomnia. Senses:
Tinnitus, vertigo,
dry nose, throat,
nasal stuffiness;
blurred vision,
diplopia,
photosensitivity,
dry eyes.
GI:
Dry
mouth, nausea,
epigastric
distress,
anorexia,
vomiting,
constipation, or
diarrhea.
Urogenital:
Urinary
frequency or
retention,
dysuria.
Body as a
Whole:
Hypersensitivity
(skin rash,
urticaria,
photosensitivity,
anaphylactic
shock).
Respiratory:
Thickened
bronchial
secretions,
wheezing,
sensation of
chest tightness.
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Acetylcysteine Adjuvant therapy in Hypersensitivity to CNS: During IV infusion,
ACETYLCYSTEINE probably acts by patients with acetylcysteine; patients at Dizziness, carefully monitor for
disrupting disulfide abnormal, viscid, or risk of gastric hemorrhage. drowsiness. fluid overload and signs
Brand name: linkages of inspissated mucous GI: of hyponatremia (i.e.,
Mucosol mucoproteins in secretions in acute Nausea, vomiting changes in mental
purulent and and chronic , stomatitis, status).
ROUTE & DOSAGE: nonpurulent bronchopulmonary hepatotoxicity
Adult: Inhalation 1– secretions. diseases, and in (urticaria).
10 mL of 20% solution Monitor for S&S of
pulmonary Respiratory: aspiration of excess
q4–6h or 2–20 mL of complications of Bronchospasm,
10% solution q4– secretions, and for
cystic fibrosis and rhinorrhea, bronchospasm
6h Direct surgery, burning
Instillation 1–2 mL of (unpredictable);
tracheostomy, and sensation in withhold drug and
10–20% solution q1– atelectasis. Also used upper respiratory
4h notify physician
in diagnostic passages,
Child: Inhalation 3–5 immediately if either
bronchial studies and epistaxis.
mL of 20% solution or occurs.
as an antidote for
6–10 mL of 10% acute
solution 3–4 times/d Lab tests: Monitor
acetaminophen
Infant: Inhalation 1–2 poisoning.
ABGs, pulmonary
mL 20% solution or 2– functions and pulse
4 mL of 10% solution oximetry as indicated.
3–4 times/d
Have suction apparatus
Classification: immediately available.
Skin And Mucous Increased volume of
Membrane respiratory tract fluid
Agent; Mucolytic; Ant may be liberated;
idote suction or endotracheal
aspiration may be
necessary to establish
and maintain an open
airway. Older adults and
debilitated patients are
particularly at risk.

Nausea and vomiting

may occur, particularly
when face mask is used,
due to unpleasant odor
of drug and excess
volume of liquefied
bronchial secretions.
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Enhances reflex To combat dry, Hypersensitivity to GI: Monitor for therapeutic
GUAIFENESIN outflow of nonproductive cough guaifenesin; pregnancy Low incidence of effectiveness. Persistent
respiratory tract associated with colds (category C), lactation. nausea. cough may indicate a
Brand name:
fluids by irritation of and bronchitis. A CNS: serious condition
Robitussin
gastric mucosa. common ingredient Drowsiness. requiring further
ROUTE & DOSAGE: in cough mixtures. diagnostic work.
Adult: PO 200–400
mg q4h up to 2.4 g/d Notify physician if high
Child: PO <2 y: 12 fever, rash, or
mg/kg/d in 6 divided headaches develop.
doses; 2–5 y: 50–100
mg q4h up to 600
mg/d; 6–11 y, 100–
200 mg q4h up to 1.2
g/d

Classification:
Antitussive; Expector
ant
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: A macrolide Pneumonia, lower Hypersensitivity to CNS: Monitor for and report
AZITHROMYCIN antibiotic that respiratory tract azithromycin, Headache, loose stools or diarrhea,
reversibly binds to infections, erythromycin, or any of dizziness. since
Brand name:
the 50S ribosomal pharyngitis/tonsillitis, the macrolide antibiotics. GI: pseudomembranous
Zithromax / Zmax
subunit of gonorrhea, Nausea, colitis (see Appendix F)
ROUTE & DOSAGE: susceptible nongonococcal vomiting, must be ruled out.
Adult: PO 500 mg on organisms and urethritis, skin and diarrhea,
day 1, then 250 mg consequently inhibits skin structure abdominal Monitor PT and INR
q24h for 4 more protein synthesis. infections due to pain; hepatotoxic closely with concurrent
d IV 500 mg q.d. for susceptible ity, mild warfarin use.
at least 2 d, organisms, otitis elevations in liver
administer 1 mg/mL media, Mycobacteriu function tests.
over 3 h or 2 mg/mL m avium–
over 1 h intracellulare comple
Child: PO 6 mo, 10 x infections, acute
mg/kg on day 1, then bacterial
5 mg/kg for 4 more d sinusitis. Zmax: acute
(max: 250 mg/d) bacterial sinusitis and
community acquired
Classification: pneumonia.
Antiinfective; Macroli
de Antibiotic