I.

Medication Inhalation Devices

A. Metered-dose inhaler (MDI) - Uses a chemical propellant to push the medication out of the inhaler.
B. Dry powder inhaler (DPI) -Delivers medication without using chemical propellants, but it requires strong and fast inhalation
C. Nebulizer: Delivers fine liquid mists of medication through a tube or a mask that fits over the nose and mouth, using air or oxygen under pressure.
D. If 2 different inhaled medications are prescribed and 1 of the medications contains a glucocorticoid (corticosteroid), administer the bronchodilator first and the corticosteroid
second.

II. Bronchodilators

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name - Prevention of and maintenance
SALMETOROL Xinafoate therapy for bronchospasm in
select patients with asthma,
Brand name chronic obstructive pulmonary
Serevent Diskus disease, and exercise-induced
asthma
Classification Contraindication
Therapeutic: bronchodilators -Contraindicated with
Pharmacologic: adrenergic hypersensitivity to salmeterol,
acute asthma attack, worsening
Dosage or deteriorating asthma (life-
50 mcg (1 inhalation) orally twice a threatening), acute airway
-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.
CNS:
Headache, tremor  acute asthma attack, worsening asthma,
CV:
Tachycardia, palpitations,
hypertension
Respiratory: Worsening
of asthma, difficulty of breathing,
bronchospasm
Adverse reactions
Adverse reactions to salmeterol
are similar in nature to those
seen with other selective beta2-
adrenoceptor agonists,
e.g., tachycardia; palpitations;
-Assess allergy to salmeterol; pregnancy,
lactation
-Ensure that drug is not used to treat acute
asthma or with worsening or deteriorating
asthma (risk of death).
-Instruct in the proper use of diskus.
-Monitor use of inhaler; use of more than
4puffs/day may worsen asthma; obtain
evaluation by physician.
-Have patients who experience exercise-
induced asthma use it 30–60 min before
activity.
-Arrange for periodic evaluation
of respiratory
day, approximately 12 hours apart. obstruction. immediate hypersensitivity
-Use cautiously with pregnancy, reactions,
lactation. including urticaria, angioedema,
rash, bronchospasm;
route headache; tremor; nervousness;
-inhalation and paradoxical bronchospasm.

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

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

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name Bronchospasm due to reversible Levalbuterol binds to beta-2 adrenergic CNS: - Assess lung sounds, pulse, and BP
LEVALBUTEROL airway disease (short-term receptors in bronchial smooth muscle anxiety, dizziness, headache, before administration and during peak of
control agent) and activates intracellular adenyl nervousness. medication. Note amount, color, and
Brand name cyclase, an enzyme that catalyzes the Resp: PARADOXICAL character of sputum produced. Closely
Xopenex, Xopenex HFA conversion of adenosine triphosphate BRONCHOSPASM (excessive monitor patients on higher dose for
(ATP) to cyclic-3',5'-adenosine use of inhalers), increased adverse effects.
monophosphate (cAMP). cough, turbinate edema. -Monitor pulmonary function tests before
CV: tachycardia. initiating therapy and periodically during
GI: dyspepsia, vomiting. Endo: course to determine effectiveness of
hyperglycemia. medication.
F and E: hypokalemia. -Observe for paradoxical bronchospasm
Neuro: tremor. (wheezing, dyspnea, tightness in chest). If
Classification Contraindication Adverse reactions condition occurs, withhold medication, and
notify health care provider immediately.
Therapeutic: bronchodilators Contraindicated in:
-Lab Test Considerations: May cause
Pharmacologic: adrenergic Hypersensitivity to levalbuterol
serum glucose and serum potassium.
or albuterol. Use Cautiously in:
Dosage -Cardiovascular disorders
(including coronary insufficiency,
ADULT AND PEDIA:
hypertension, and arrhythmias);
0.31mg/3mL
History of seizures;
0.63mg/3mL
Hypokalemia; Hyperthyroidism;
1.25mg/3mL
Diabetes mellitus; Unusual
1.25mg/0.5mL
sensitivity to adrenergic amines;
route
OB, Lactation, Pedi: Pregnancy,
Inhalation 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 - Produces accumulation of cyclic CNS: headache, insomnia,  - Monitor signs of paradoxical
ARFORMOTEROL bronchospasm associated with adenosine monophosphate (cAMP) at nervousness, weakness.  bronchospasm (wheezing, cough,
chronic obstructive pulmonary beta-adrenergic receptors, resulting in Resp: PARADOXICAL dyspnea, tightness in chest and
Brand name
disease (COPD). relaxation of airway smooth muscle. BRONCHOSPASM.  throat), especially at higher or
Brovana Relatively specific for CV: ECG changes, tachycardia.  excessive doses. If condition
beta2 (pulmonary) receptors.  GI: vomiting.  occurs, advise patient to withhold
Derm: rash. medication and notify physician or
F and E: hypokalemia. other health care professional
Hemat: leukocytosis.  immediately.
MS: cramps.   Assess pulmonary function at rest
Neuro: tremor. and during to document
Misc: hypersensitivity reactions effectiveness of medication in
including anaphylaxis, fever. controlling bronchospasm.
 Monitor signs of hypersensitivity
Classification Contraindication Adverse reactions reactions and anaphylaxis,
Therapeutic: bronchodilators - BROVANA Inhalation Solution
Pharmacologic: adrenergic is contraindicated in patients
Dosage with a history of hypersensitivity
15 mcg/2 mL inhaled by nebulization to arformoterol, racemic
twice daily (morning and evening). formoterol or to any other
route components of this product.
Inhalation All LABA, including BROVANA
Inhalation Solution, are
contraindicated in patients with
asthma.
Name of drugs Indications
Generic name -Quick relief of bronchospasm
induced through both exercise
and physiological alterations.
SALBUTAMOL To control and prevent reversible
airway obstruction caused by
Brand name bronchial asthma, chronic
- 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
Mechanism of action Side effects
- CNS: Restlessness,
Pharmacokinetics: apprehension, anxiety, fear,
Oral route: onset – 30 minutes; peak – 2- CNS stimulation, vertigo,
2.5 hours; duration – 4-8 hours headache, weakness, tremors,
Inhalation route: onset – 5 minutes; peak – drowsiness,insomnia ,
1.5-2 hrs; duration – 3-8 hours hyperactivity, malaise
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).
Nursing responsibilities
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
Proventil, Vospira ER, Accuneb, Ventodisk, obstructive pulmonary diseases
Ventolin 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
Classification Contraindication
BRONCHODILATOR, Hypersensitivity to salbutamol?
Andregenic
it’s in the site content
Dosage& Route Tachyarrhythmias and
Oral – 2 or 4 mg (1-2 tsp syrup) three to four tachycardia caused by digitalis
times a day intoxication?
ER tablets – 4-8 mg every 12 hours Cardiac disease including
Inhalation – 1 or 2 inhalation/s every 4-6 coronary insufficiency, a history
hours (1 aerosol dispenser = 90 mcg) of stroke, coronary artery
Prevention of exercise-induced disease and cardiac arrhythmias
bronchospasms – 2 inhalations 15 minutes
Hypertension
prior to exercise Hyperthyroidism
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.
CV: Cardiac arrhythmias,
palpitations, tachycardia,chest
pain, hypertension
Adverse reactions
EENT: dry and irritated nose and
throat with inhaled form, nasal
congestion, epistaxis,
hoarseness
Dermatologic: Sweating, pallor,
flushing
GI: Nausea, vomiting, heartburn,
unusual or bad taste in the
mouth
Metabolic: hypokalemia
the right route and at the right
time.
Monitor ECG, serum electrolytes
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 unpleasant aftertaste of the
inhalation.
Auscultate lungs for presence of
adventitious breath sounds that
may signal pulmonary edema,
airway resistance or
bronchospasm.
Inspect client’s nail bed and oral
mucosa for pallor.
Place client in position of comfort
to facilitate optimum rest and
sleep.
Name of drugs Indications Mechanism of action Side effects Nursing responsibilities
 Generic name Theophylline is used to treat lung
diseases such as asthma and COPD
(bronchitis, emphysema). It must be
theophylline used regularly to prevent wheezing
and shortness of breath. This
Brand name medication belongs to a class of
drugs known as xanthines. It works
Theo-24 (Pro), Uniphyl (Pro), by relaxing the muscles around the
Theo-Dur, Elixophyllin (Pro) 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.
Classification Contraindication
 Before using theophylline,
tell your doctor or
Bronchodilator, Methylxanthine
pharmacist if you are
Dosage allergic to it; or to other
xanthine drugs (such as
aminophylline, oxtriphylline,
 Produces direct bronchodilation
and has some anti-inflammatory
actions in the airway.
 At low therapeutic doses
theophylline inhibits adenosine
receptors.
o Adenosine receptors
modulate adenyl cyclase
activity
o Adenosine can cause
contraction of airways and
provoke histamine release
from mast cells;
theophylline antagonism of
adenosine receptors may
counteract these effects.
 At high concentrations
methylxanthines can also inhibit
phosphodiesterase, thereby
elevating cAMP.
o While theophylline has
more than one mechanism
of action, inhibition of
phosphodiesterase seems
a likely contributor to its
therapeutic effects in
treating asthma.
 Low doses - mild cortical
arousal & deferral of fatigue
 High doses - convulsions,
cardiac arrhythmias, death
 Because of the high
morbidity and mortality
associated with theophylline-
induced seizures, treatment
of seizures should be rapid
and aggressive.
The initial treatment for seizures is i.v.
diazepam. Repetitive seizures are
treated with phenobarbital.
The doses of these drugs required to
treat theophylline induced seizures
may be close to those causing
respiratory arrest.
Adverse reactions
Nausea, vomiting, abdominal pain,
diarrhea, headache, insomnia,
dizziness, anxiety, restlessness,
tremor, palpitations.
 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 results of
serum theophylline level
determinations carefully, and
reduce dosage if serum levels
exceed therapeutic range of
10–15 mcg/mL.
 Monitor carefully for clinical
signs of adverse effects,
particularly if serum
theophylline levels are not
available.
 WARNING: Keep diazepam
readily available to treat
seizures.
 caffeine); or if you have any
other allergies. This product
route may contain inactive
ingredients, which can
oral 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 Nausea, vomiting, diarrhea, patients only when clearly
ethylenediamine and is given for its headache, insomnia, irritability (75% needed—neonatal
asthma and reversible theophylline activity to relax
aminophylline (theophylline bronchospasm associated of patients): Hyperglycemia, tachycardia, jitteriness, and
ethylenediamine) with chronic bronchitis smooth muscle and to relieve hypotension, cardiac arrhythmias, withdrawal apnea observed
bronchial spasm. Theophylline is a seizures, tachycardia (> 10 mcg/mL in when mothers received
Brand name and emphysema premature newborns); brain damage xanthines up until delivery.
 Unlabeled uses: smooth muscle relaxant and it  Caution patient not to chew or
Respiratory stimulant in relaxes the smooth muscle of the crush enteric-coated timed-
Truphylline Cheyne-Stokes bronchial airways. release forms.
respiration; treatment of  Give immediate-release, liquid
apnea and bradycardia in dosage forms with food if GI

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.
premature babies
Contraindication
 Contraindicated with
hypersensitivity to any
xanthine or to
ethylenediamine, peptic
ulcer, active gastritis;
rectal or colonic irritation
or infection (use rectal
preparations).
 Use cautiously with
cardiac arrhythmias,
acute myocardial injury,
CHF, cor pulmonale,
severe hypertension,
severe hypoxemia, renal
or hepatic disease,
hyperthyroidism,
alcoholism, labor,
lactation, pregnancy.
Adverse reactions
 CNS: Irritability (especially
children); restlessness,
dizziness, muscle twitching,
seizures, severe depression,
stammering speech;
abnormal behavior
characterized by withdrawal,
mutism, and
unresponsiveness alternating
with hyperactive periods
 CV: Palpitations, sinus
tachycardia, ventricular
tachycardia, life-threatening
ventricular arrhythmias,
circulatory failure
 GI: Loss of appetite,
hematemesis, epigastric
pain, gastroesophageal
reflux during sleep,
increased AST
effects occur.
 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.
III. Anticholinergics
Name of drugs Indications
Generic name used to control and prevent
symptoms (wheezing and shortness
of breath) caused by ongoing lung
Ipratropium disease (chronic obstructive
pulmonary disease-COPD which
includes bronchitis and emphysema).
It works by relaxing the muscles
around the airways so that they open
up and you can breathe more easily.
Brand name
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
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,
Apo-Ipravent (CAN), Atrovent,
Atrovent HFA, Novo-Ipramide
(CAN), ratio-Ipratropium (CAN)
Classification
Anticholinergics
Dosage
one 3 mL vial administered 4
times per day via nebulization
with up to 2 additional 3 mL
doses allowed per day,
route
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.
Contraindication Adverse reactions
Contraindicated with hypersensitivity eye pain/swelling/redness, vision
to atropine or its derivatives, soy changes (such as seeing rainbows
bean or peanut allergies (aerosol). around lights at night, blurred vision).
Use cautiously with narrow-angle A very serious allergic reaction to this
glaucoma, prostatic hypertrophy, product is rare. However, get medical
bladder neck obstruction, pregnancy, help right away if you notice any
lactation. symptoms of a serious allergic
reaction, including: rash,
itching/swelling (especially of the
face/tongue/throat), severe dizziness,
trouble breathing.
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.
 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.

Oral Inhalation

Name of drugs Indications Mechanism of action Side effects Nursing responsibilities

Generic name  Prevention of nausea, an antagonist of muscarinic receptors M1 to  dry mouth.  Do not allow powdered
vomiting, and dizziness M5. Inhibition of the M3 receptor in the  sore throat. medication to contact the
tiotropium associated with motion smooth muscle of the lungs leads to eyes, as this may cause
sickness. relaxation of smooth muscle and blurring of vision and pupil
 Brand name  Adjunctive therapy for
treatment of GI ulcers
 Decrease secretions before
Spiriva anesthesia or intubation
 Maintenance treatment of
bronchospasm associated
with COPD.
 Treatment of irritable or
hyperactive bowel in adults.
Classification Contraindication
Anticholinergics  Allergy to any
component of the
drug. To prevent
hypersensitivity reaction
Dosage  Glaucoma. Can be
exacerbated by blockade
2.5 mcg (2 actuations; 1.25mcg of PNS.
actuation) inhaled PO OD.  Intestinal atony,
route paralytic ileus, GI
obstruction. Can be
exacerbated with further
Oral Inhalation slowing of GI activity.
 Pregnancy. Potential
adverse effects on the
fetus.
bronchodilation. 33% of an inhaled solution  cough.
reaches systemic circulation, while oral  sinus problems.
solutions have a bioavailability of 2-3%.  constipation.
 fast heart rate.
 blurred vision or vision
changes.
 pain with urination.
Adverse reactions
 CNS:
blurred vision, pupil dilatio
n, photophobia,
cycloplegia, increased
intraocular pressure,
weakness, dizziness,
insomnia
 CV: tachycardia,
palpitation
 GI: dry mouth,
altered taste perception,
nausea, heartburn,
constipation
 GU: urinary hesitancy
and retention, heat
prostration
dilation.
 Tiotropium bromide is
intended as a once-daily
maintenance treatment. It is
not useful for treatment of
acute episodes of
bronchospasm (i.e., rescue
therapy).
 Withhold drug and notify
physician if swelling around
the face, mouth, or neck
occurs.
 Report any of the following:
constipation, increased heart
rate, blurred vision, urinary
difficulty.
 Do not breast feed while
taking this drug without
consulting physician.
IV: INHALED NONSTEROIDAL ANTIALLERGY AGENT
Name of drugs Indications
Generic name  For use as an adjunct for
Cromolyn Sodium, inhaled asthma maintenance.
 For exercise-induced
bronchospasm
prophylaxis or the
prevention of
Brand name
bronchospasm induced
by other known
Crolom, Gastrocrom, Intal, Nasalcrom, precipitating factors.
Opticrom
Mechanism of action Side effects Nursing responsibilities
Cromolyn works at the surface of the  Monitor respirations and
mast cell to inhibit its degranulation. In  Cough, sneezing, nasal assess lung sounds for
vitro and in vivo animal studies have sting, or bronchospasm rhonchi or wheezing.
shown that cromolyn sodium inhibits the following inhalation Client education 1.
release of mediators from sensitized  Unpleasant taste in the  To administer oral
mast cells. Cromolyn sodium acts by mouth capsules at least 30
inhibiting the release of histamine and minutes before meals
leukotrienes (SRS-A) from the mast cell.  Not to discontinue the
Studies show that cromolyn sodium medication abruptly,
  Used to treat allergic
rhinitis, bronchial asthma,
Classification
Inhaled Nonsteroidal Anti-allergy Agent
Route Contraindication
Oral Inhalation (nebulized solution)  Cromolyn sodium
products are
Dosage
contraindicated in those
Adults and children- 20mg 4 times a patients who have shown
day with interval hypersensitivity to
cromolyn sodium. Severe
anaphylactic reactions
may occur rarely in
association with cromolyn
sodium use.
indirectly blocks calcium ions from because a rebound
entering the mast cell, thereby asthmatic attack can
preventing mediator release. Cromolyn occur
sodium has no intrinsic vasoconstrictor,
antihistamine, or glucocorticoid activity.
Cromolyn's beneficial effects when
inhaled or used nasally or in the eye are
largely preventative. Continued use is
needed to maintain benefits as a
Adverse reactions
controller medication. Inhaled cromolyn
can be used before certain exposures to  anaphylactoid reactions
reduce hyperreactivity to exercise, cold  angioedema
air, or antigenic challenge (e.g.,  laryngeal edema
allergens, environmental pollutants).  seizures
When used orally to manage cutaneous  pancytopenia
or systemic mastocytosis, use results in  pericarditis
a clinically significant improvement in
 ventricular tachycardia
gastrointestinal symptoms (diarrhea,
 atrial tachycardia
abdominal pain) and some improvement
for cutaneous manifestations (e.g.,  lupus-like symptomS
urticaria, pruritus, flushing) and cognitive
function.

V. MONOCLONAL ANTIBODY
Name of drugs Indications
Generic name  XOLAIR is indicated for
patients 6 years of age
Omalizumab
and older with moderate
to severe persistent
asthma who have a
Mechanism of action
Asthma
Omalizumab inhibits the binding of IgE to
the high-affinity IgE receptor (FcεRI) on
the surface of mast cells and basophils.
Reduction in surface-bound IgE on
Side effects Nursing responsibilities
 Injection site reactions  Assess respiratory rate,
 Viral infections rhythm, and depth, and
 Upper respiratory infections auscultate lung sounds.
 Sinusitis  Assess for allergies and/or
 Headache allergic reaction symptoms
 Brand name positive skin test or in FcεRI-bearing cells limits the degree of  Pharyngitis such as rash or urticaria.
vitro reactivity to a release of mediators of the allergic  Anaphylaxis  Have medications for the
Xolair
perennial aeroallergen response. Treatment with XOLAIR also  Malignancies treatment of severe
and whose symptoms are reduces the number of FcεRI receptors hypersensitivity reactions
Route
inadequately controlled on basophils in atopic patients. available during initial
Injection, for Subcutaneous Use
with inhaled administration in case
corticosteroids. Chronic Idiopathic Urticaria anaphylaxis occurs.
 Chronic Idiopathic Omalizumab binds to IgE and lowers
Urticaria (CIU) free IgE levels. Subsequently, IgE Client education
Classification Contraindication receptors (FcεRI) on cells down-regulate. Adverse reactions  That respiratory
The mechanism by which these effects improvement will not be
Severe hypersensitivity reaction to of omalizumab result in an improvement  Injection site reactions
immediate
Monoclonal Antibody XOLAIR or any ingredient of of CIU symptoms is unknown. (45%)
 Not to stop taking or
XOLAIR  Viral infections (23%)
decrease the currently
Dosage  URI (20%) prescribed asthma
Dosage For Asthma  Sinusitis (16%) medications unless
Administer XOLAIR 75 mg to 375 mg  Headache (15%) instructed
by subcutaneous injection every 2 or 4  Pharyngitis (11%)  To avoid receiving live virus
weeks. vaccines for the duration of
Dosage For Chronic Idiopathic Urticaria treatment
Administer XOLAIR 150 mg or 300 mg
by subcutaneous injection every 4
weeks.
VI. EXPECTORANTS AND MUCOLYTIC AGENTS
Name of drugs Indications
Generic name - -
Expectorants loosen bronchial
GUAIFENESIN secretions so that
Brand name they can be eliminated with
MUCINEX coughing; they are
used for a dry unproductive
cough 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.
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
Side effects
Dizziness, drowsiness, nausea,
and vomiting may occur.
Gastrointestinal irritation
2. Rash
3. Oropharyngeal irritation
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
 4. Acetylcysteine can increase
airway resistance and
should not be used in clients with section)
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
Dosage& Route Effects of Drug Abuse
TABLET 200 TO 400 MG
that might contain the same or similar
ingredients (see also Drug Interactions
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 dizziness, trouble
breathing.
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; if fever, rash, or headache
occur, consult your health care
provider.
 Name of drugs Indications
Generic name -Expectorants loosen bronchial
secretions so that
Fluimucil they can be eliminated with
coughing; they are
used for a dry unproductive
Brand name cough and to stimulate bronchial
secretion
-Mucolytic agent’s thin mucous
acetylcysteine (oral)
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.
Classification Contraindication
Expectorants and Mucolytic Agents Hypersensitivity,
phenylketonuria, should be use
Dosage& Route
cautiously in asthmatic patients,
It should be use with patient with
Adults: 1 sachet of Acetylcysteine history of peptic ulceration both
(Fluimucil) 200 mg or 2 sachets of because drug induced nausea
Acetylcysteine (Fluimucil) 100 mg 2-3 and vomiting may increase the
times a day. GI hemorrhage in patients.
Predisposed to the condition and
because of a theoretical risk that
mucolytics may disrupt the
gastric mucosal barrier.
Mechanism of action
-
In particular, when inhaled, acetylcysteine
(and its metabolic byproduct cysteine)
exerts its mucolytic action through its free
sulfhydryl group, which reduces the
disulfide bonds in the mucus matrix and
lowers mucus viscosity. This action
increases with increasing pH and is most
significant at pH 7 to 9.
Pharmacodynamics: Acetylcysteine, active
ingredient of FLUIMUCIL, exerts an
intensive mucolytic-fluidifying action on the
mucous and mucopurulent secretions by
depolymerizing the mucoproteic complexes
and the nucleic acids which confer viscosity
to the vitreous and purulent component of
the sputum and other secretions.
Side effects
Gastrointestinal irritation
2. Rash
3. Oropharyngeal irritation
Adverse reactions
Summary of the safety profile:
The most frequent adverse
events associated with the oral
administration of acetylcysteine
are gastrointestinal in nature.
Hypersensitivity reactions
including anaphylactic shock,
anaphylactic/anaphylactoid
reaction, bronchospasm,
angioedema, rash and pruritus
have been reported less
frequently.
Nursing responsibilities
Interventions
1. Acetylcysteine, administered by
nebulization,
should not be mixed with another
medication.
2. If acetylcysteine is administered
with a bronchodilator, the
bronchodilator should be
administered 5 minutes before the
acetylcysteine.
3. Monitor for side effects of
acetylcysteine such
as nausea and vomiting,
stomatitis, and runny
nose
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
VII. GLUCOCORTICOIDS
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
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
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
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
 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
Dosage& Route increase your risk for serious
side effects. This document does
not contain all possible drug
5 mg to 60 mg of prednisone per day, oral interactions. Keep a list of all the
products you use (including
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.
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 salicylate toxicity
when corticosteroid is withdrawn
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.
Tell your doctor right away if you
have any signs of infection (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
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 immunosuppressive doses of
corticosteroids.