Respiratory Medications, Doses, Side Effects, Contraindications and Considerations
Respiratory Problems and Medication Data Sheets
|Drug Name(Trade and Generic) & Classification||Common Dose & Frequency||Reason for Med & How does it work?||Side Effects/Adverse Reactions||Contraindications, Precautions, & Interactions||Nursing Considerations/ Implications|
|PrednisoneBrand names: Meticorten, Deltasone, SterapredClassification: Corticosteroid (immunosuppressant and Anti-inflammatory) and antiasthmatic.||5-60mg QD||COPD, asthma, and allergic disorders.Prednisone is a corticosteroid that inhibits accumulation of leukocytes at the site of inflammation and increases capillary permeability; thus reduces swelling and pain associated with the injury. Decrease in leukocytes and lymphatic system activity also suppresses immune response due to allergic reaction.||Salt and fluid retention, hypertension and increase ICP. Muscle weakness and osteoporosis. Peptic ulcer, esophagitis and abdominal distention. Impaired wound healing and glaucoma. Endocrine disorders requiring higher insulin dose or irregular menstruation.||Use of hepatic enzyme drugs could lower the effectiveness. It can both mask as well as make prone to new infection. Immunization vaccines should be carefully considered. Precaution in patients with herpes due to risk for cornmeal perforation.||Do not stop taking suddenly, withdrawal should be done gradually. Take with or after meals, but not on empty stomach. Monitor daily input and output along with BP. Can cause unusual, bad taste.|
|AtroventGeneric: IpratorpiumClassification: Anticholinergics||2 puffs of MDI QID500mcg/neb Q6-8hr||COPD, bronchitis, emphysyma and symptomatic relief of rhinorrhea. It dilates the bronchial smooth muscle by blocking the concentration of cGMP and cholinergic action of acetylcholine. It also decrease the secretion by nasal glands.||Blurred vision, sore throat, epistaxis and nasal irritation. Bronchospasm/cough. Hypotension, GI upset and UTI.||Maintenance treatment rather than for acute episodes. Aerosol sprays cautioned with glaucoma and bladder neck obstruction. Contraindicated when hypersensitive to atropine.||Assess respiration. Check for history of allergies to anticholinergic drugs. If giving concurrently with adrenergics, give atrovent next and corticosteroids last.|
|VentolinGeneric Name: AlbuterolClassification: adrenergics||2 puffs of MDI Q4-6hr2-4mg PO TID-QID||COPD and bronchodilator. It binds to beta2 adrenergic receptors which eventually decrease the intracellular calcium to relax smooth muscles.||CNS effects of nervousness, restlessness and tremor. Cardiovascular actions rise higher. Hyperglycemia. Hypokalemia associated with fluid and electrolyte balances from vomiting and nausea and such.||Contraindicated when hypersensitivity to adnergics and fluorocarbons (in some inhalers). Beta blockers will negate the effect. Concurrent use with MAO can cause hypertensive problem.||Assess lung sounds and other vital signs before administration. Observe for paradoxical bronchospasm. Do not use more than recommended. When missed, take as soon as remember.|
|Theo-durBrand Name: (Theophylline)Classification: bronchodilators/ xanthines||0.4mg/kg/hr IV PO dose-divide by 4 and give every 6 hours||COPD, chronic asthma and bronchitis. It relaxes smooth muscles as well as suppresses the responsiveness of the airways to the histamine and allergen stimuli.||Irritability, flushing, palpitations, convulsions, hair loss, and frequent urination.||Contraindicated in peptic ulcer and coronary artery disease.||Tablets shouldn’t be crushed or chewed. Serum concentration should be measured before making a dose increase.|
|GuaifenesinBrand Names: Mucinex and RobitussinClassification: expectorants||300-600mg Q 4 hoursPRN (max 2400)||COPD and cough associated with viral upper respiratory infection. It loosens the viscosity of the phlegm and increase the mobilization of respiratory fluid.||Side effects are dizziness, excitability, nausea, weakness, insomnia and rash.||Contraindicated in patients with hypersensitivity and consuming alcohol products with intolerance.||Do not chew, crush or break extended release tablets. Take with water and as prescribed. Drink plenty of water to relieve congestion.|
|Insoniazid (INH)Nydrazid as Brand name.||5mg/kg (max 300mg/d ) IM 300mg PO QD (may be in divided doses)||TB, first line therapy for active TB. It inhibits the cell wall synthesis of mycobacterium and interferes with metabolism.||Hypertension, tachycardia, pscyhosis, vision problems, anorexia, slurred speech, hyperglycemia, metabolic acidosis, peripheral neuropathy and anemia.||Caution with patients who have kidney or liver disease and malnourished. Inhibits the metabolism of phenytoin and concurrent use of pyridoxine may prevent neuropathy.||Lab test of ALT, AST and albumin is necessary to evaluate the toxicity. The missed dose should be taken as soon as possible. Alcohol should also be avoided to prevent hepatic toxicity.|
|Rifampin||600mg IV QD||TB and elimination of meningococcal carriers.||Stomach upset, nausea, heartburn, dizziness, sore throat, yellow skin or eyes, dark urine or reddish orange colored,||Contraindicated with delavirdine. It can cause liver dysfunction.||Take on empty stomach 1 or 2 hours before or after meals with water. Rifampin can enhance the metabolism of adrenal and thyroid hormones and the vitamin D.|
|StreptomycinClassifcation: anti-infectives||15mg/kg (up to 1000mg/d) IM QDGeriatric dose: 10mg/kg (max 750mg)||TB and other bacterial infections. It works by inhibiting the protein synthesis necessary for these pathogens to survive.||GI distress, fever, weird skin sensation around face, fever, swelling, rash, hearing loss, drowsiness and muscle weakness.||Do not use with nondepoliarizing muscle relaxant. It can also interact with loop diuretics causing cranial nerve damage.||Can only be administerd via IM injection. Do no discontinue until through with the regimen. Drink extra fluids while taking it.|
|EthambutolBrand name: myabutolClassification: antibiotic||15mg/kg PO QD||TB. It prevents the growth of tuberculosis bacteria along with other drugs.||GI distress, red-green color blindness, myocarditis, fever, confusion, rash, acute gout, nephritis and hyperurecemia.||Contraindicated with optic neuritis condition. Caution with renal and hepatic disorder. Decreased absorption with aluminium hydroxide.||Ethambutol is always prescribed along with another antibiotic, whether it is initial treatment or the retreatment. Often the tests include opthalmoscopy, color testing and finger perimetry.|
|Pyrazinamide (PZA)Classification: anti- tuberculosis||20-25mg/kg QD||TB. It is converted to pyrazinoic acid which lowers the pH of the mycobaterium environment and produce bacteriostatic action.||GI distress, malaise, hepatoxicity, dysuria, gout, photosensitivity and anemia.||Cross sensitivity to isoniazid, niacin or nicotinic acid may exist. Caution when diabetic and active gout is present. Concurrent use with rifampin can cause severe hepatic toxicity.||Test baseline liver function and monitor serum uric acid level. Take as prescribed and for the full course.|
|Vitamin B6Generic name: pyridoxineClassification: water soluble vitamins||50-10mg QD||TB and neuropathy from isoniazid, penicillamine, or hydrolazine therapy. Also for synthesis of neurotransmitters serotonin and norepinephrine and for myelin formation.||Sensory neuropathy, poor coordination, numbness, ticking and burning sensation of the feet, weakness, sore mouth, irritability and confusion.||Vitamin B6 breaks down Dilantin, levodopa and phenobarbital and makes them less effective. So use cautiously in Parkinson’s disease treatment.||Do not take more than prescribed. Store in a container at room temperature away from excess moisture or heat.|
|EpinephrineClassification: adrenergics||0.3-1mg, initial dose, repeat PRN||Asthma Staticus, rapid relieve of hypersensitivity reactions and mucosal congestions. It stimulates beta adrenergic receptors to produce smooth muscle relaxation.||GI distress, tremor, weakness, pale skin, dizziness, vasoconstriction, increase aqueous secretion and decrease production, tachycardia, and anxiety.||Caution when using with drugs that can sensitize arrhythmias such as digitalis. Potentiation occurs when used with tricyclic antidepressant or monoamine oxidase inhibitors.||Assess lung sounds and vital signs before administration. Monitor for chest pain and other toxicity symptoms. Epi is sensitive to light and air.|
|SingulairGeneric name: montelukastClassification: leukotrine antagonist||4-10mg QD||COPD-Asthma and management of seasonal allergy rhinitis. Singulair inhibits leukotrines that are released when our body experiences allergens, which causes tightening of lungs and airway passages.||GI distress, heartburn, toothache, weakness, sore throat, stuffy nose, dizziness, and hallucination.||Use caution in acute attacks of asthma and hepatic impairment.Effects decreased by phenobarbital and rifampin use.||Assess respiratory functions prior to use. Lab test for AST and ALT. Do not double dose but always take as prescribed in the evening.|
|Flovent/ FlonaseClassification: corticosteroids||Initially, 200mcg (2 sprays in each nostril once a day or 1 spray in each nostril Q 12hours). Maintenance, 1 spray in each nostril QD||COPD-Asthma, immunosuppressant and anti-inflammatory.It acts locally.||Weakness, rash, blurred vision, seeing halos around lights, wheezing, upper respiratory infection, rhinitis, dry eye, increased intraocular pressure and easily glaucoma.||Flovent doesn’t work fast enough to prevent asthma attack. May produce corticosteroid related adverse effects such as that of prednisone.||Rinse the device with water to prevent yeast infection. Do not use extra dose to compensate for the missed dose. Monitor for (hypothalamic pituitary adrenal) suppression.|
What are the risk factors for catching TB?
Risk factors for getting infected with TB include:
- Weak immune system – there are many factors that lead to weakened immune system such as old age, malnutrition, HIV/ AIDS disease, diabetes, liver and kidney dysfunction, and cancer.
- Close airborne contact – tuberculosis transmission take place through airbone contact. Often time this happens when the people live in a crowded place together with poor cleaning conditions; a refugee camp or shelter is a good example.
- Lack of medical health care – tuberculosis is not only preventable but also easily treatable if caught in its early stage of infection. Often time both money and lack of access to health care play the role in this.
- People from poor countries – people who are from poor countries have all the problems listed above.
- Substance abuse – drug use not only make our immune system weak, but sharing them also make us more susceptible to infection.
TB is considered to a “reportable disease” and state and county health services generally become involved when a person is diagnosed because of medication compliance issues with a complex regime. Discuss why this is important beyond the curative issue for the patient diagnosed.
Health care workers are obligated to report mandated TB infection if they see any. In addition, the community health services usually gets involved in thoroughly helped the infected person get the proper treatment to an extent where they send a health care worker to watch the tuberculosis infected patient take all his or her TB medications as prescribed. This is done via DOTS (Direct Observed Therapy, Short-course) program often during first six months, when the patient is going through incubation and prodromal stages in which the patient’s TB is considered highly contagious. If the community doesn’t take these actions, there is high likelihood of other people getting infected as well since TB is a very easily communicable disease via air and droplets. This step is a preventative measure that will stop the chain of infection.
List some reasons why tuberculosis is on the rise in the United States.
There was an article called Trends in Tuberculosis – United States 2008 published by CDC in March 20, 2009 in its Morbidity and Mortality Weekly. According to that report, TB rate in the United States in 2008 reached the lowest rate since 1953; it declined 3.8% from 2007 to 4.2 cases per 100,000 populations. However, some of the reasons why tuberculosis cases have been on the rise in the United States are:
- There have been surge in immigration population rates since the early 1990s, especially from poor countries where most population has been infected with TB at one point in their life.
- Secondly, there haven’t been enough research done on the tuberculosis by research scientists and pharmaceutical companies to find a highly effective and short course treatment regimen since most of the tuberculosis patients turn out to be from poor families, refugees and foreigners. Majority of the native populations didn’t have TB illnesses and thus there wasn’t enough incentive for the scientists to study the treatment at its best.
- It was only until 2000s when United States started to aggressively pursue preventative measures such as DOTS program to fight against TB infection. So when infected people aren’t following (or not able to follow) the proper treatment regimen, a new set of bacterial pathogens start to grow that are resistant to the current antibiotics.
What infection control precautions are essential when taking care of a patient with active tuberculosis?
Infection control precautions that are necessary when taking care of patient with active tuberculosis are proper hand washing before and after coming in contact with the patient, wearing masks if coming in close contacts along with face shields if the patient is coughing out droplets, providing separate negative airway pressure room for patients with highly active in its initial stage and proper disposal of collected sputum samples as well as the instruments used for his or her treatment.
How does the nurse care for a patient in a negative pressure room?
Patients who are in a negative pressure room are able to breathe in air from his room and surrounding, but the air from the room doesn’t go out in the hallways. Instead the air in his room gets special filtration treatment and sent out of the building directly. This is because the air patient is breathing out is contagious and is capable of infecting anyone who comes in contact. Therefore, the nurse has to use special protective equipment devices such as masks, face shields, goggles and gloves while caring for the patient. The nurse also follows the standard precaution measure of washing hands before and after the treatment so that neither the nurse gets infected and spreads it and nor the patients gets more sick.
Textbook of Basic Nursing, 9th Edition by Caroline Bunker Rosdahl and Mary T. Kowalski.
Davis’s Drug Guide for Nurses, 11th Edition by Judith Hopfer Deglin and April Hazard Vallerand.
Essentials of Pharmacology for Health Occupations, 5th Edition by Ruth Woodrow.