Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name  For use as an adjunct Cromolyn works at the surface of the  Monitor respirations and
Cromolyn Sodium, inhaled for asthma mast cell to inhibit its degranulation.  Cough, sneezing, nasal assess lung sounds for
maintenance. In vitro and in vivo animal studies sting, or bronchospasm rhonchi or wheezing.
 For exercise-induced have shown that cromolyn sodium following inhalation Client education 1.
bronchospasm inhibits the release of mediators  Unpleasant taste in the  To administer oral
prophylaxis or the from sensitized mast cells. Cromolyn mouth capsules at least 30
Brand name
prevention of sodium acts by inhibiting the release minutes before meals
bronchospasm induced of histamine and leukotrienes (SRS-  Not to discontinue
Crolom, Gastrocrom, Intal, by other known A) from the mast cell. Studies show the medication
Nasalcrom, Opticrom precipitating factors. that cromolyn sodium indirectly abruptly, because a
 Used to treat allergic blocks calcium ions from entering rebound asthmatic
rhinitis, bronchial the mast cell, thereby preventing attack can occur
asthma, mediator release. Cromolyn sodium
Classification has no intrinsic vasoconstrictor,
antihistamine, or glucocorticoid
Inhaled Nonsteroidal Anti-allergy activity. Cromolyn's beneficial
Agent effects when inhaled or used nasally
or in the eye are largely preventative.
Route Contraindication Continued use is needed to maintain Adverse reactions
benefits as a controller medication.
Oral Inhalation (nebulized solution)  Cromolyn sodium Inhaled cromolyn can be used before  anaphylactoid reactions
Dosage products are certain exposures to reduce  angioedema
contraindicated in those hyperreactivity to exercise, cold air,  laryngeal edema
Adults and children- 20mg 4 patients who have or antigenic challenge (e.g.,  seizures
times a day with interval shown hypersensitivity allergens, environmental pollutants).  pancytopenia
to cromolyn sodium. When used orally to manage  pericarditis
Severe anaphylactic cutaneous or systemic mastocytosis,  ventricular tachycardia
reactions may occur use results in a clinically significant  atrial tachycardia
rarely in association improvement in gastrointestinal
 lupus-like symptoms
with cromolyn sodium symptoms (diarrhea, abdominal
use.  exfoliative dermatitis
pain) and some improvement for
cutaneous manifestations (e.g.,

Name of drugs Indications
Generic name  XOLAIR is indicated
for patients 6 years of
Omalizumab
age and older with
moderate to severe
persistent asthma who
have a positive skin test
Brand name
or in vitro reactivity to
Xolair a perennial
aeroallergen and whose
Route symptoms are
Injection, for Subcutaneous Use inadequately controlled
with inhaled
corticosteroids.
 Chronic Idiopathic
Urticaria (CIU)
Classification Contraindication
Severe hypersensitivity
Monoclonal Antibody reaction to XOLAIR or any
ingredient of XOLAIR
Dosage
urticaria, pruritus, flushing) and
cognitive function.
Mechanism of action Side effects Nursing responsibilities
Asthma  Injection site reactions  Assess respiratory rate,
Omalizumab inhibits the binding of  Viral infections rhythm, and depth, and
IgE to the high-affinity IgE receptor  Upper respiratory auscultate lung sounds.
(FcεRI) on the surface of mast cells infections  Assess for allergies
and basophils. Reduction in surface-  Sinusitis and/or allergic reaction
bound IgE on FcεRI-bearing cells  Headache symptoms such as rash
limits the degree of release of  Pharyngitis or urticaria.
mediators of the allergic response.  Have medications for the
 Anaphylaxis
Treatment with XOLAIR also treatment of severe
 Malignancies
reduces the number of FcεRI hypersensitivity
receptors on basophils in atopic reactions available
patients. during initial
administration in case
Chronic Idiopathic Urticaria anaphylaxis occurs.
Omalizumab binds to IgE and lowers
free IgE levels. Subsequently, IgE Adverse reactions Client education
receptors (FcεRI) on cells down-  That respiratory
regulate. The mechanism by which  Injection site reactions
improvement will not be
these effects of omalizumab result in (45%)
immediate
an improvement of CIU symptoms is  Viral infections (23%)
 Not to stop taking or
unknown.
Dosage For Asthma
Administer XOLAIR 75 mg to 375
mg by subcutaneous injection every
2 or 4 weeks.
Dosage For Chronic Idiopathic
Urticaria
Administer XOLAIR 150 mg or
300 mg by subcutaneous injection
every 4 weeks.
ASSESSMENT DIAGNOSIS
Name of drugs Indications
Generic name Theophylline is used to treat
lung diseases such as asthma
and COPD (bronchitis,
theophylline
emphysema). It must be used
regularly to prevent wheezing
Brand name
and shortness of breath. This
Theo-24 (Pro), Uniphyl (Pro), medication belongs to a class
Theo-Dur, Elixophyllin (Pro) of drugs known as xanthines. It
works by relaxing the muscles
around the airways so that they
open up and you can breathe
more easily. It also decreases
the lungs' response to irritants.
Controlling symptoms of
breathing problems can
decrease time lost from work
or school.
 URI (20%)
 Sinusitis (16%)
 Headache (15%)
 Pharyngitis (11%)
PLANNING INTERVENTION RATIONALE
Mechanism of action Side effects
 Produces direct  Low doses - mild
bronchodilation and has cortical arousal &
some anti-inflammatory deferral of fatigue
actions in the airway.  High doses -
 At low therapeutic doses convulsions, cardiac
theophylline inhibits arrhythmias, death
adenosine receptors.  Because of the high
o Adenosine receptors morbidity and mortality
modulate adenyl associated with
cyclase activity theophylline-induced
o Adenosine can cause seizures, treatment of
contraction of airways seizures should be rapid
and provoke and aggressive.
histamine release The initial treatment for
from mast cells; seizures is i.v. diazepam.
theophylline Repetitive seizures are treated
antagonism of with phenobarbital.
adenosine receptors The doses of these drugs
may counteract these required to treat theophylline
decrease the currently
prescribed asthma
medications unless
instructed
 To avoid receiving live
virus vaccines for the
duration of treatment
EVALUATION
Nursing responsibilities
 Caution patient not to
chew or crush enteric-
coated timed-release
preparations.
 Give immediate release,
liquid dosage forms with
food if GI effects occur.
 Do not give timed-
release preparations with
food; these should be
given on an empty
stomach, 1 hr before or 2
hr after meals.
 Advise patients that this
drug should not be used
during pregnancy; using
barrier contraceptives is
recommended.
 WARNING: Monitor
 effects. induced seizures may be close results of serum
 At high concentrations to those causing respiratory theophylline level
methylxanthines can also arrest. determinations carefully,
inhibit phosphodiesterase, and reduce dosage if
thereby elevating cAMP. serum levels exceed
o While theophylline therapeutic range of 10–
has more than one 15 mcg/mL.
mechanism of action,  Monitor carefully for
inhibition of clinical signs of adverse
phosphodiesterase effects, particularly if
seems a likely serum theophylline
contributor to its levels are not available.
therapeutic effects in  WARNING: Keep
Classification Contraindication treating asthma. Adverse reactions diazepam readily
available to treat
 Before using Nausea, vomiting, abdominal seizures.
Bronchodilator, Methylxanthine theophylline, tell your pain, diarrhea, headache,
Dosage doctor or pharmacist if insomnia, dizziness, anxiety,
you are allergic to it; or restlessness, tremor,
to other xanthine drugs palpitations.
(such as aminophylline,
oxtriphylline, caffeine);
Route
or if you have any
other allergies. This
oral product may contain
inactive ingredients,
which can cause
allergic reactions or
other problems.
 Before using this
medication, tell your
doctor or pharmacist
your medical history,
especially of:
 stomach/intestinal
ulcer, seizures, thyroid
disease, heart problems
(such as heart failure,
irregular heartbeat),
liver disease, high
blood pressure.

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name  Symptomatic relief or a complex of theophylline and  Administer to pregnant
prevention of bronchial ethylenediamine and is given for its Nausea, vomiting, diarrhea, patients only when
asthma and reversible theophylline activity to relax smooth headache, insomnia, irritability clearly needed—
aminophylline (theophylline
bronchospasm muscle and to relieve bronchial (75% of patients): neonatal tachycardia,
ethylenediamine)
associated with chronic spasm. Theophylline is a smooth Hyperglycemia, hypotension, jitteriness, and
Brand name
bronchitis and muscle relaxant and it relaxes the cardiac arrhythmias, seizures, withdrawal apnea
emphysema smooth muscle of the bronchial tachycardia (> 10 mcg/mL in observed when mothers
Truphylline  Unlabeled uses: airways. premature newborns); brain received xanthines up
Respiratory stimulant damage until delivery.
in Cheyne-Stokes  Caution patient not to
respiration; treatment chew or crush enteric-
of apnea and coated timed-release
bradycardia in forms.
premature babies  Give immediate-release,
liquid dosage forms with
food if GI effects occur.
 Classification
Bronchodilator, Methylxanthine
Dosage
10–20 mcg/mL; base dosage on
lean body mass; 127 mg
aminophylline dihydrate = 100 mg
theophylline anhydrous.
Rectal- 500 mg q 6–8 hr by rectal
suppository or retention enema
Route
Oral-
Rectal- 500 mg q 6–8 hr by rectal
suppository or retention enema.
Contraindication Adverse reactions
 Contraindicated with  CNS: Irritability
hypersensitivity to any (especially children);
xanthine or to restlessness, dizziness,
ethylenediamine, peptic muscle twitching,
ulcer, active gastritis; seizures, severe
rectal or colonic depression, stammering
irritation or infection speech; abnormal
(use rectal behavior characterized
preparations). by withdrawal, mutism,
 Use cautiously with and unresponsiveness
cardiac arrhythmias, alternating with
acute myocardial hyperactive periods
injury, CHF, cor  CV: Palpitations, sinus
pulmonale, severe tachycardia, ventricular
hypertension, severe tachycardia, life-
hypoxemia, renal or threatening ventricular
hepatic disease, arrhythmias, circulatory
hyperthyroidism, failure
alcoholism, labor,  GI: Loss of appetite,
lactation, pregnancy. hematemesis, epigastric
pain, gastroesophageal
reflux during sleep,
increased AST
 Do not give timed-
release forms with food;
these should be given on
an empty stomach 1 hr
before or 2 hr after
meals.
 Maintain adequate
hydration.
 Monitor results of serum
theophylline levels
carefully, and arrange
for reduced dosage if
serum levels exceed
therapeutic range of 10–
20 mcg/mL.
 Take serum samples to
determine peak
theophylline
concentration drawn 15–
30 min after an IV
loading dose.
 Monitor for clinical
signs of adverse effects,
particularly if serum
theophylline levels are
not available.
 Name of drugs Indications
Generic name used to control and prevent
symptoms (wheezing and
shortness of breath) caused by
Ipratropium
ongoing lung disease (chronic
obstructive pulmonary disease-
COPD which includes
bronchitis and emphysema). It
works by relaxing the muscles
around the airways so that they
Brand name open up and you can breathe
more easily.
Apo-Ipravent (CAN), Atrovent,
Atrovent HFA, Novo-Ipramide
(CAN), ratio-Ipratropium (CAN)
Classification Contraindication
Anticholinergics Contraindicated with
hypersensitivity to atropine or
its derivatives, soy bean or
Mechanism of action
an acetylcholine antagonist via
blockade of muscarinic cholinergic
receptors. Blocking cholinergic
receptors decreases the production of
cyclic guanosine monophosphate
(cGMP). This decrease in the lung
airways will lead to decreased
contraction of the smooth muscles
Side effects
Dizziness, nausea, stomach
upset, dry mouth, or
constipation may occur. If any
of these effects persist or
worsen, tell your doctor or
pharmacist promptly.
Remember that your doctor has
prescribed this medication
because he or she has judged
that the benefit to you is greater
than the risk of side effects.
Many people using this
medication do not have serious
side effects.
Rarely, this medication may
cause severe sudden worsening
of breathing problems right
after use. If you have sudden
worsening of breathing, use
your quick-relief medication
and get medical help right
away.
Adverse reactions
eye pain/swelling/redness,
vision changes (such as seeing
rainbows around lights at night,
Nursing responsibilities
Assessment
 History:
Hypersensitivity to
atropine, soybeans,
peanuts (aerosol
preparation); acute
bronchospasm, narrow-
angle glaucoma,
prostatic hypertrophy,
bladder neck
obstruction, pregnancy,
lactation
 Physical: Skin color,
lesions, texture; T;
orientation, reflexes,
bilateral grip strength;
affect; ophthalmic
examination; P, BP; R,
adventitious sounds;
bowel sounds, normal
output; normal urinary
output, prostate
palpation
Intervention:
 Protect solution for
inhalation from light.
Store unused vials in foil
pouch.
 Dosage peanut allergies (aerosol).
one 3 mL vial administered 4 times
Use cautiously with narrow-
per day via nebulization with up to
angle glaucoma, prostatic
2 additional 3 mL doses allowed
hypertrophy, bladder neck
per day,
obstruction, pregnancy,
route
lactation.
Inhaled
Name of drugs Indications
Generic name  Prevention of nausea,
vomiting, and dizziness
tiotropium
associated with motion
sickness.
 Adjunctive therapy for
Brand name
blurred vision).
A very serious allergic reaction
to this product is rare.
However, get medical help
right away if you notice any
symptoms of a serious allergic
reaction, including: rash,
itching/swelling (especially of
the face/tongue/throat), severe
dizziness, trouble breathing.
Mechanism of action Side effects
an antagonist of muscarinic receptors  dry mouth.
M1 to M5. Inhibition of the M3  sore throat.
receptor in the smooth muscle of the  cough.
lungs leads to relaxation of smooth  sinus problems.
muscle and bronchodilation. 33% of  constipation.
 Use nebulizer
mouthpiece instead of
face mask to avoid
blurred vision or
aggravation of narrow-
angle glaucoma.
 Can mix albuterol in
nebulizer for up to 1 hr.
 Ensure adequate
hydration, control
environmental
temperature to prevent
hyperpyrexia.
 Have patient void before
taking medication to
avoid urinary retention.
 Teach patient proper use
of inhaler.
Nursing responsibilities
 Do not allow powdered
medication to contact the
eyes, as this may cause
blurring of vision and
pupil dilation.
 treatment of GI ulcers an inhaled solution reaches systemic  fast heart rate.  Tiotropium bromide is
Spiriva  Decrease secretions circulation, while oral solutions have  blurred vision or vision intended as a once-daily
before anesthesia or a bioavailability of 2-3%. changes. maintenance treatment.
intubation  pain with urination. It is not useful for
 Maintenance treatment treatment of acute
of bronchospasm episodes of
associated with COPD. bronchospasm (i.e.,
 Treatment of irritable rescue therapy).
or hyperactive bowel in  Withhold drug and
adults. notify physician if
Classification Contraindication Adverse reactions swelling around the face,
mouth, or neck occurs.
Anticholinergics  Allergy to any  CNS:  Report any of the
component of the blurred vision, pupil dilati following: constipation,
drug. To prevent on, photophobia, increased heart rate,
hypersensitivity reaction cycloplegia, increased blurred vision, urinary
Dosage  Glaucoma. Can be intraocular pressure, difficulty.
exacerbated by blockade weakness, dizziness,  Do not breast feed while
2.5 mcg (2 actuations; 1.25mcg
of PNS. insomnia taking this drug without
actuation) inhaled PO OD.
 Intestinal atony,  CV: tachycardia, consulting physician.
Route paralytic ileus, GI palpitation
obstruction. Can be  GI: dry mouth,
Inhaled exacerbated with further altered taste perception,
slowing of GI activity. nausea, heartburn,
 Pregnancy. Potential constipation
adverse effects on the  GU: urinary hesitancy
fetus. and retention, heat
prostration

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name -Expectorants loosen bronchial -
 Fluimucil
Brand name
acetylcysteine (oral)
Classification
Expectorants and Mucolytic
Agents
Dosage& Route
Adults: 1 sachet of Acetylcysteine
(Fluimucil) 200 mg or 2 sachets
of Acetylcysteine (Fluimucil) 100
mg 2-3 times a day.
Name of drugs
secretions so that
they can be eliminated with
coughing; they are
used for a dry unproductive cough
and to stimulate bronchial secretion
-Mucolytic agent’s thin mucous
secretions to help
make the cough more productive.
3. Mucolytic agents with
dextromethorphan should
not be used by clients with chronic
obstructive pulmonary disease
because they suppress the cough.
Contraindication
Hypersensitivity, phenylketonuria,
should be use cautiously in
asthmatic patients, It should be use
with patient with history of peptic
ulceration both because drug
induced nausea and vomiting may
increase the GI hemorrhage in
patients. Predisposed to the
condition and because of a
theoretical risk that mucolytics may
disrupt the gastric mucosal barrier.
Indications
In particular, when inhaled, Gastrointestinal irritation 1. Acetylcysteine, administered by
acetylcysteine (and its 2. Rash nebulization, should not be mixed
metabolic byproduct 3. Oropharyngeal irritation with another medication.
cysteine) exerts its 2. If acetylcysteine is administered
mucolytic action through its with a bronchodilator, the
free sulfhydryl group, which bronchodilator should be
reduces the disulfide bonds administered 5 minutes before the
in the mucus matrix and acetylcysteine.
lowers mucus viscosity. 3. Monitor for side effects of
This action increases with acetylcysteine such
increasing pH and is most as nausea and vomiting, stomatitis,
significant at pH 7 to 9. and runny
nose
Pharmacodynamics: Adverse reactions
Acetylcysteine, active To take the medication with a full
Summary of the safety profile:
ingredient of FLUIMUCIL, glass of water
The most frequent adverse
exerts an intensive to loosen mucus
events associated with the oral
mucolytic-fluidifying action 2. To maintain adequate fluid intake
administration of acetylcysteine
on the mucous and 3. To cough and deep breathe
are gastrointestinal in nature.
mucopurulent secretions by
Hypersensitivity reactions
depolymerizing the
including anaphylactic shock,
mucoproteic complexes and
anaphylactic/anaphylactoid
the nucleic acids which
reaction, bronchospasm,
confer viscosity to the
angioedema, rash and pruritus
vitreous and purulent
have been reported less
component of the sputum
frequently.
and other secretions.
Mechanism of action Side effects Nursing responsibilities
 Generic name
SALBUTAMOL
Brand name
Proventil, Vospira ER, Accuneb,
Ventodisk, Ventolin
Classification
BRONCHODILATOR,
Andregenic
Dosage& Route
Oral – 2 or 4 mg (1-2 tsp syrup)
three to four times a day
ER tablets – 4-8 mg every 12
hours
Inhalation – 1 or 2 inhalation/s
every 4-6 hours (1 aerosol
dispenser = 90 mcg)
Prevention of exercise-induced
bronchospasms – 2 inhalations 15
minutes prior to exercise
-Quick relief of bronchospasm
induced through both exercise and
physiological alterations.
To control and prevent reversible
airway obstruction caused by
bronchial asthma, chronic
obstructive pulmonary diseases such
as emphysema and chronic
bronchitis as well as other
obstructive pulmonary diseases.
Inhalation: treatment of acute
attacks of bronchospasm
Unlabeled use: Adjunct in treating
moderate to severe hyperkalemia in
dialysis patients; seems to lower
potassium concentrations when
inhaled by patients on hemodialysis
Contraindication
Hypersensitivity to salbutamol? it’s
in the site content
Tachyarrhythmias and tachycardia
caused by digitalis intoxication?
Cardiac disease including coronary
insufficiency, a history of stroke,
coronary artery disease and cardiac
arrhythmias
Hypertension
Hyperthyroidism
- CNS: Restlessness,
Pharmacokinetics:
Oral route: onset – 30
minutes; peak – 2-2.5 hours;
duration – 4-8 hours
Inhalation route: onset – 5
minutes; peak – 1.5-2 hrs;
duration – 3-8 hours
Metabolism: Hepatic
Half-life: 2-4 hours
Distribution: Crosses
placenta, enters breastmilk
Excretion: Urine
Drug Interactions
CNS stimulants: May
increase CNS stimulation.
Avoid using together
Digoxin: May decrease
digoxin level. Monitor
digoxin level closely.
MOA inhibitors tricycling
antidepressants: May
increase adverse CV effects.
Monitor patient closely.
Propanolol and other beta-
blockers: May cause mutual
antagonism. Monitor patient
carefully.
apprehension, anxiety, fear,
CNS stimulation, vertigo,
headache, weakness, tremors,
drowsiness,insomnia ,
hyperactivity, malaise
CV: Cardiac arrhythmias,
palpitations, tachycardia,chest Monitor ECG, serum electrolytes
pain, hypertension
Adverse reactions
EENT: dry and irritated nose
and throat with inhaled form,
nasal congestion, epistaxis,
hoarseness
Dermatologic: Sweating, pallor, unpleasant aftertaste of the
flushing
GI: Nausea, vomiting,
heartburn, unusual or bad taste adventitious breath sounds that may
in the mouth
Metabolic: hypokalemia
Check and verify with doctor’s order
and Kardex.
Observe rights in medication
administration such as giving the
right drug to the right patient using
the right route and at the right time.
and thyroid function test results.
Administer accurately because
adverse reactions and tolerance
might occur.
Raise side rails up because client
might be restless and drowsy
because of this drug.
Keep room well-lit and see to it that
client has a person with him closely
in case of vertigo.
Assess lung sounds, PR and BP
before drug administration and
during peak of medication.
Assess pulse for rhythm.
Provide oral care or let patient gurgle
after inhalation to get rid of the
inhalation.
Auscultate lungs for presence of
signal pulmonary edema, airway
resistance or bronchospasm.
Inspect client’s nail bed and oral
mucosa for pallor.
Place client in position of comfort to

Name of drugs Indications
Generic name -As an anti-inflammatory
medication. Prednisone relieves
Deltasone
inflammation in various parts of the
body.
Brand name
To treat or prevent allergic
Prednisolone reactions.
As treatment of certain kinds of
autoimmune diseases, skin
conditions, asthma and other lung
conditions.
As treatment for a variety of
cancers, such as leukemia,
lymphoma, and multiple myeloma.
To treat nausea and vomiting
associated with some chemotherapy
drugs.
Used to stimulate appetite in cancer
patients with severe appetite
problems.
Classification Contraindication
Corticosteroids Drug interactions may change how
your medications work or increase
Dosage& Route your risk for serious side effects.
This document does not contain all
possible drug interactions. Keep a
5 mg to 60 mg of prednisone per
list of all the products you use
day, oral
(including
Mechanism of action
- Nausea, heartburn, headache,
The pharmacokinetic
interactions listed below are
potentially clinically
important. Drugs that induce
hepatic enzymes such as
phenobarbital, phenytoin
and rifampin may increase
the clearance of
corticosteroids and may
require increases in
corticosteroid dose to
achieve the desired
response. Drugs such as
oleandomycin and
ketoconazole may inhibit
the metabolism of
corticosteroids and thus
decrease their clearance.
Therefore, the dose of
corticosteroid should be
titrated to avoid steroid
toxicity. Corticosteroids
may increase the clearance
of chronic high dose aspirin.
This could lead to decreased
salicylate serum levels or
increase the risk of
Side effects
dizziness, menstrual period
changes, trouble sleeping,
increased sweating, or acne
may occur. If any of these
effects persist or worsen, tell
your doctor or pharmacist
prompt
Adverse reactions
Because this drug works by
weakening the immune system,
it may lower your ability to
fight infections. This may make
you more likely to get a serious
(rarely fatal) infection or make
any infection you have worse.
facilitate optimum rest and sleep.
Nursing responsibilities
Assessment
History: Infections; renal or liver
disease, hypothyroidism, ulcerative
colitis with impending perforation,
diverticulitis, active or latent peptic
ulcer, inflammatory bowel disease,
CHF, hypertension, thromboembolic
disorders, osteoporosis, seizure
disorders, diabetes mellitus; hepatic
disease; lactation
Physical: Weight, T, reflexes and
grip strength, affect and orientation,
P, BP, peripheral perfusion,
prominence of superficial veins, R,
adventitious sounds, serum
electrolytes, blood glucose
Interventions
Administer once-a-day doses before
9AM to mimic normal peak
corticosteroid blood levels.
Increase dosage when patient is
subject to stress.
WARNING: Taper doses when
discontinuing high-dose or long-term
therapy to avoid adrenal
insufficiency.
Do not give live virus vaccines with
prescription/nonprescription drugs
and herbal products) and share it
with your doctor and pharmacist.
Do not start, stop, or change the
dosage of any medicines without
your doctor's approval.
Some products that may
interactwith this drug include:
aldesleukin, other drugs that weaken
the immune system (such as
azathioprine, cyclosporine, cancer
chemotherapy), mifepristone, drugs
that can cause bleeding/bruising
(including antiplatelet drugs such as
clopidogrel, "blood thinners" such
as dabigatran/warfarin, NSAIDs
such as
aspirin/celecoxib/ibuprofen).
salicylate toxicity when
corticosteroid is withdrawn
Tell your doctor right away if immunosuppressive doses of
you have any signs of infection corticosteroids.
(such as cough, sore throat,
fever, chills). Use of this
medication for prolonged or
repeated periods may result in
oral thrush or a yeast infection.
Contact your doctor if you
notice white patches in your
mouth or a change in vaginal
discharge
 Name of drugs Indications
Generic name Expectorants loosen bronchial
secretions so that
GUAIFENESIN
they can be eliminated with
Brand name
coughing; they are
used for a dry unproductive cough
MUCINEX and to stimulate bronchial
secretions. Mucolytic agents’ thin
mucous secretions to help
make the cough more productive.
3. Mucolytic agents with
dextromethorphan should
not be used by clients with chronic
obstructive pulmonary disease
because they suppress the cough.
4. Acetylcysteine can increase
airway resistance and
should not be used in clients with
asthma.
Classification Contraindication
his medication contains guaifenesin.
Do not take Mucinex, Bidex 400, or
EXPECTORANTS Organidin NR if you are allergic to
guaifenesin or any ingredients
contained in this drug.
Contraindications
Hypersensitivity to guaifenesin
Mechanism of action
-
Guaifenesin is used to treat
coughs and congestion
caused by the common cold,
bronchitis, and other
breathing illnesses.
Guaifenesin is usually not
used for ongoing cough
from smoking or long-term
breathing problems (such as
chronic bronchitis,
emphysema) unless directed
by your doctor. Guaifenesin
is an expectorant. It works
by thinning and loosening
mucus in the airways,
clearing congestion, and
making breathing easier.
Products that include
guaifenesin do not cure or
shorten the length of the
common cold. To decrease
the risk for side effects,
carefully follow all dosage
directions. Do not give other
cough-and-cold medication
that might contain the same
Side effects
Dizziness, drowsiness, nausea,
and vomiting may occur.
Gastrointestinal irritation
2. Rash
3. Oropharyngeal irritation
Adverse reactions
A very serious allergic reaction
to this drug is unlikely but seek
immediate medical attention if
it occurs. Symptoms of a
serious allergic reaction may
include: rash, itching/swelling
(especially of the
face/tongue/throat), severe
Nursing responsibilities
Client education
1. To take the medication with a full
glass of water
to loosen mucus
2. To maintain adequate fluid intake
3. To cough and deep breathe
Assessment
History: Allergy to guaifenesin;
persistent cough due to smoking,
asthma, or emphysema; very
productive cough; pregnancy
Physical: Skin lesions, color; T;
orientation, affect; R, adventitious
sounds
Interventions
WARNING: Monitor reaction to
drug; persistent cough for more than
1 wk, fever, rash, or persistent
headache may indicate a more
serious condition.
Teaching points
Some extended-release formulations
may be cut in half but cannot be
crushed or chewed. Mucinex cannot
be crushed, chewed, or cut.
Do not take for longer than 1 week;
 Dosage& Route
Effects of Drug Abuse
TABLET 200 TO 400 MG
Name of drugs Indications
Generic name - Prevention of and
maintenance therapy
SALMETOROL Xinafoate
for bronchospasm in select
Brand name patients with asthma, chronic
Serevent Diskus obstructive pulmonary
disease, and exercise-induced
asthma
Classification Contraindication
or similar ingredients (see dizziness, trouble breathing.
also Drug Interactions
section). Ask the doctor or
pharmacist about other ways
to relieve cough and cold
symptoms (such as drinking
enough fluids, using a
humidifier or saline nose
drops/spray).
Mechanism of action
-Long-acting agonist that binds to
beta2receptors in the lungs,
causing bronchodilation; also
inhibits the release
of inflammatory mediators in the
lung, blocking swelling and
inflammation.
if fever, rash, or headache occur,
consult your health care provider.
You may experience these side
effects: Nausea, vomiting (eat
frequent small meals); dizziness,
headache (avoid driving or operating
dangerous machinery).
Report fever, rash, severe vomiting,
persistent cough
Side effects Nursing responsibilities
CNS: -Assess allergy to salmeterol;
Headache, tremor  pregnancy, acute asthma attack,
worsening asthma, lactation
CV: -Ensure that drug is not used to treat
Tachycardia, palpitations, acute asthma or with worsening
hypertension or deteriorating asthma (risk of death).
-Instruct in the proper use of diskus.
Respiratory: Worsening -Monitor use of inhaler; use of more
of asthma, difficulty of than 4puffs/day may worsen asthma;
breathing, bronchospasm obtain evaluation by physician.
-Have patients who experience
Adverse reactions exercise-induced asthma use it 30–60
Therapeutic: bronchodilators -Contraindicated with Adverse reactions to min before activity.
Pharmacologic: adrenergic hypersensitivity to salmeterol are similar in -Arrange for periodic evaluation
salmeterol, acute asthma nature to those seen with of respiratory
Dosage attack, worsening other selective beta2-
or deteriorating asthma (life- adrenoceptor agonists,
50 mcg (1 inhalation) orally twice threatening), acute airway e.g., tachycardia; palpitations;
a day, approximately 12 hours obstruction. immediate hypersensitivity
apart. -Use cautiously with reactions,
pregnancy, lactation. including urticaria, angioede
ma, rash, bronchospasm;
headache; tremor;
Route nervousness; and paradoxical
-inhalation bronchospasm.

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name Indicated for long-term - Inhaled formoterol works like -Body aches or pain -Monitor cardiovascular status with
maintenance treatment of other β2 agonists, causing -chills periodic ECG, BP, and HR
FORMOTEROL Fumarate
bronchoconstriction in bronchodilation by relaxing the -cough determinations.
Inhalation Powder
patients with COPD smooth muscle in the airway to -difficulty with breathing -Withhold drug and notify physician
Brand name
treat the exacerbation of asthma. -ear congestion immediately of S&S of bronchospasm.
Foradil certihaler -fever -Lab tests: Monitor serum potassium
-headache and blood glucose periodically.
-hoarseness -Monitor diabetics closely for loss of
-loss of voice glycemic control.
-runny or stuffy nose Patient & Family Education
-sneezing -Do not take this drug more frequently
-sore throat than every 12 h.
-unusual tiredness or -Use a short-acting inhaler if
 weakness symptoms develop between doses of
formoterol.
Classification Contraindication Adverse reactions -Seek medical care immediately if a
previously effective dosage regimen
Therapeutic: bronchodilators -Formoterol Fumarate is -Hypertension o hypotension, fails to provide the usual response, or
Pharmacologic: adrenergic contraindicated in patient angina, tachycardia, if swelling about the face and neck and
Dosage with a history of palpitations, and arrythmias, difficulty breathing develop.
hypersensitivity to formoterol hyperglycemia rash, muscle
20mcg/2mL inhaled via nebulizer -Report any of the following
fumarate or to any cramps, dry mouth, nausea,
q12hr immediately to the physician: Rash,
components of this products. headache, nervousness,
Route hives, palpitations, chest pain, rapid
dizziness, tremor, insomnia, heart rate, tremor or nervousness.
inhalation hypokalemia, metabolic -Note to diabetics: Monitor blood
acidosis, bronchitis, chest glucose levels carefully since
infections, dyspnea, tonsilitis, hyperglycemia is a possible adverse
and dysphonia, reaction.
hypersensitivity reactions. -Do not breast feed while taking this
drug.

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name Bronchospasm due to Levalbuterol binds to beta-2 CNS: - Assess lung sounds, pulse, and BP
reversible airway disease adrenergic receptors in bronchial anxiety, dizziness, headache, before administration and during peak
LEVALBUTEROL
(short-term control agent) smooth muscle and activates nervousness. of medication. Note amount, color,
Brand name intracellular adenyl cyclase, an Resp: PARADOXICAL and character of sputum produced.
Xopenex, Xopenex HFA enzyme that catalyzes the BRONCHOSPASM Closely monitor patients on higher
conversion of adenosine (excessive use of inhalers), dose for adverse effects.
triphosphate (ATP) to cyclic-3',5'- increased cough, turbinate -Monitor pulmonary function tests
 adenosine monophosphate edema. before initiating therapy and
(cAMP). CV: tachycardia. periodically during course to
GI: dyspepsia, vomiting. determine effectiveness of medication.
Endo: hyperglycemia. -Observe for paradoxical
F and E: hypokalemia. bronchospasm (wheezing, dyspnea,
Neuro: tremor. tightness in chest). If condition occurs,
Classification Contraindication Adverse reactions withhold medication, and notify health
care provider immediately.
Therapeutic: bronchodilators Contraindicated in: -Lab Test Considerations: May cause
Pharmacologic: adrenergic Hypersensitivity to serum glucose and serum potassium.
levalbuterol or albuterol. Use
Dosage Cautiously in:
-Cardiovascular disorders
ADULT AND PEDIA:
(including coronary
0.31mg/3mL
insufficiency, hypertension,
0.63mg/3mL
and arrhythmias); History of
1.25mg/3mL
seizures; Hypokalemia;
1.25mg/0.5mL
Hyperthyroidism; Diabetes
Route mellitus; Unusual sensitivity
Inhalation to adrenergic amines; OB,
Lactation, Pedi: Pregnancy,
lactation, or children 6 yr (for
nebulized solution) or 4 yr
(for metered-dose inhaler)
(safety not established).

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name - Long-term management of
bronchospasm associated
ARFORMOTEROL
with chronic obstructive
Brand name pulmonary disease (COPD).
- Produces accumulation of cyclic CNS: headache, insomnia,  - Monitor signs of paradoxical
adenosine monophosphate (cAMP) nervousness, weakness.  bronchospasm (wheezing,
at beta-adrenergic receptors, Resp: PARADOXICAL cough, dyspnea, tightness in
resulting in relaxation of airway BRONCHOSPASM.  chest and throat), especially at
Brovana
for beta2 (pulmonary) receptors.  tachycardia.  condition occurs, advise patient
Classification Contraindication
Therapeutic: bronchodilators - BROVANA Inhalation
Pharmacologic: adrenergic Solution is contraindicated in
Dosage patients with a history of
hypersensitivity to
15 mcg/2 mL inhaled by
arformoterol, racemic
nebulization twice daily (morning
formoterol or to any other
and evening).
components of this product.
Route All LABA, including
Inhalation BROVANA Inhalation
Solution, are contraindicated
in patients with asthma.
smooth muscle. Relatively specific CV: ECG changes,
GI: vomiting.  to withhold medication and
Derm: rash.
F and E: hypokalemia.
Hemat: leukocytosis.  
MS: cramps.  rest and during to document
Neuro: tremor.
Misc: hypersensitivity
reactions including
anaphylaxis, fever.
Adverse reactions
- Most common adverse
reactions (≥2% incidence and
more common than placebo)
are pain, chest pain, back
pain, diarrhea, sinusitis, leg
cramps, dyspnea, rash, flu
syndrome, peripheral edema
and lung disorder
higher or excessive doses. If
notify physician or other health
care professional immediately.
Assess pulmonary function at
effectiveness of medication in
controlling bronchospasm.
 Monitor signs of
hypersensitivity reactions and
anaphylaxis, including
pulmonary symptoms
(bronchospasm, wheezing,
cough, dyspnea) or skin
reactions (rash, pruritus,
urticaria). Notify physician
immediately if these reactions
occur.
 Assess heart rate, ECG, and
heart sounds, especially during
exercise. Report tachycardia or
symptoms of other
arrhythmias, including
palpitations, chest pain,
shortness of breath, fainting,
and fatigue/weakness.
 Monitor and report signs of
CNS toxicity, including
nervousness, sleep loss, or
tremor. Sustained or severe
CNS signs may indicate
overdose or excessive use of
 this drug.
 Monitor and report any muscle
weakness, aches, or cramps
that might indicate low
potassium levels
(hypokalemia).