GENERIC NAME MECHANISM OF ACTION
Albuterol plus ipratropium Ipratropium bromide is an
anticholinergic
(parasympatholytic) agent, which
blocks the muscarinic receptors of
acetylcholine, and, based on
animal studies, appears to inhibit
vagally mediated reflexes by
antagonizing the action of
acetylcholine, the transmitter agent
released from the vagus nerve
BRAND NAME: DuoNeb INDICATION
The combination of albuterol and
ipratropium is used to prevent
wheezing, difficulty breathing,
chest tightness, and coughing in
people with chronic obstructive
pulmonary disease (COPD; a
group of diseases that affect the
lungs and airways) such as chronic
bronchitis (swelling of the air
passages that lead to the lungs)
and emphysema (damage to the air
sacs in the lungs). Albuterol and
ipratropium combination is used
by people whose symptoms have
not been controlled by a single
inhaled medication.
DRUG ILLUSTRATION CONTRAINDICATION
SIDE EFFECTS
Common Side Effects:
Headache, dizziness, nausea,
dry mouth, shaking (tremors),
nervousness, or constipation
may occur.
Serious side effects, including:
difficult/painful urination,
muscle cramps.
chest pain,
fast/pounding/irregular
heartbeat, rapid breathing,
confusion, eye
pain/swelling/redness, vision
changes (such as seeing
rainbows around lights at night,
blurred vision).
ADVERSE REACTION
NURSING
RESPONSIBILITY
Follow and observe the 14
Rights in preparing and
administering medication.
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
Interventions
Protect solution for inhalation
from light. Store unused vials
  overactive thyroid gland
 diabetes
 a metabolic condition
where the body cannot
adequately use sugars
called ketoacidosis
 excess body acid
CLASSIFICATION
 low amount of potassium
Bronchodilators
in the blood
Dosage: 2.5 mg, 250 mcg  high blood pressure
Frequency: STAT  diminished blood flow
Route: PO through arteries of the
heart
 a low supply of oxygen
rich blood to the heart
 prolonged QT interval on
EKG
 abnormal heart rhythm
 abnormal EKG with QT
changes from birth
 seizures
 closed angle glaucoma
 blockage of the urinary
bladder
 enlarged prostate
 an inability to completely
empty the bladder
The most common adverse
reactions were bronchitis,
COPD exacerbation, dyspnea,
headache, throat irritation,
cough, dry mouth, gastro-
intestinal motility disorders
(including constipation, diarrhea
and vomiting), nausea, and
dizziness
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.
Teaching points
Use this drug as an inhalation
product.
Review the proper use of
inhalator; for nasal spray,
initiation of pump requires 7
actuations; if not used for 24
hours, 2 actuations will be
needed before use.
Protect from light; do not
freeze.
GENERIC NAME MECHANISM OF ACTION SIDE EFFECTS NURSING RESPONSIBILITY

Albuterol Stimulates beta2-adrenergic

Frequent (27%–4%): Follow and observe the 14 Rights
receptors Headache, restlessness, in preparing and administering
in lungs, resulting in relaxation of
nervousness, tremors, medication.
bronchial smooth muscle (little nausea, dizziness, throat
effect on HR). dryness and irritation, NURSING CONSIDERATIONS
pharyngitis, B/P changes BASELINE ASSESSMENT
Therapeutic Effect: Relieves including hypertension,
bronchospasm and reduces airway heartburn, transient Assess lung sounds, pulse, B/P,
resistance. color, characteristics of sputum
wheezing.
noted. Offer emotional support
Occasional (3%–2%): (high incidence of anxiety due to
Insomnia, difficulty in breathing and
asthenia, altered taste. sympathomimetic response to
Inhalation: Dry, irritated drug).
mouth or throat; cough,
BRAND NAME INDICATION
bronchial irritation.
INTERVENTION/
 Accuneb (nebulizer EVALUATION
indication for the treatment and Monitor rate, depth, rhythm, type
solution) Rare: Drowsiness, diarrhea,
prevention of bronchospasm (acute of
dry mouth, flushing,
 Proair digihaler or severe) in patients with respiration; quality and rate of
diaphoresis, anorexia.
(powder inhaler) reversible obstructive airway pulse;
disease, including exercise-
 Proair HFA ECG; serum potassium, glucose;
induced bronchospasm. ABG determinations. Assess lung
(inhaler)
sounds for wheezing
DRUG ILLUSTRATION CONTRAINDICATION ADVERSE REACTION
(bronchoconstriction), rales.
Hypersensitivity to albuterol. Excessive sympathomimetic
Severe hypersensitivity to milk stimulation may produce PATIENT/FAMILY TEACHING
protein (dry powder inhalation). palpitations, ectopy, • Follow guidelines for proper use
tachycardia, chest pain, of
slight increase in B/P
 followed by substantial
decrease, chills, diaphoresis,
CLASSIFICATION blanching of skin.

Too-frequent or excessive
PHARMACOTHERAPE use may lead to decreased
UTIC: Sympathomimetic bronchodilation
(adrenergic beta2- effectiveness and severe,
agonist). paradoxical
bronchoconstriction
CLINICAL:
Bronchodilator.
Dosage: 250 mcg
inhaler.
Frequency: q6h
Route: PO • A healthcare provider will
show you know to properly
prepare and use your medication.
You must demonstrate correct
preparation and injection
techniques before using
medication.
• Increase fluid intake (decreases
lung secretion viscosity).

• Do not take more than 2

inhalations at any one time

GENERIC NAME MECHANISM OF ACTION SIDE EFFECTS NURSING

Metaproterenol sulfate RESPONSIBILITY
Metaproterenol is a moderately Common Side Effects:
selective beta- adrenergic agonist Follow and observe the 14
 that stimulates receptors of the
smooth muscle in the lungs,
uterus, and vasculature supplying
skeletal muscle, with minimal or
no effect on alpha-adrenergic
receptors. Intracellularly, the
actions of metaproterenol are
mediated by cAMP, the production
of which is augmented by beta
stimulation.
BRAND NAME: Alupent INDICATION
Alupent (metaproterenol sulfate
USP) is indicated as a
bronchodilator for bronchial
asthma and for reversible
bronchospasm which may occur in
association with bronchitis and
emphysema.
DRUG ILLUSTRATION CONTRAINDICATION
Use in patients with cardiac
arrhythmias associated with
 nervousness,
 headache,
 dizziness,
 drowsiness,
 nausea,
 diarrhea,
 upset stomach,
 dry mouth,
 tiredness, and
 sleep problem
(insomnia)
Serious side effects including:
 hives,
 difficulty breathing,
 swelling of your face,
lips, tongue, or throat,
 chest pain,
 fast heart rate,
 pounding heartbeats,
 fluttering in your chest,
 lightheadedness,
 tremors, and
 worsening or no
improvement in your
symptoms
ADVERSE REACTION
Adverse reactions are similar to
those noted with other
Rights in preparing and
administering medication.
Examination and Evaluation
Watch for signs of
paradoxical bronchospasm,
including wheezing, cough,
dyspnea, shortness of breath,
and tightness in chest and
throat. These signs are more
common at higher doses or
during excessive use of the
inhaler. If condition occurs,
advise patient to withhold
medication and notify
physician or other health care
professional immediately.
Assess pulmonary function at
rest and during exercise (See
Appendices I, J, K) to
document effectiveness of
medication in controlling
bronchospasm.
Assess heart rate, ECG, and
heart sounds, especially
during exercise (See
Appendices G, H). Report any
rhythm disturbances or
symptoms of increased
arrhythmias, including
palpitations, chest pain,
shortness of breath, fainting,
CLASSIFICATION tachycardia is contraindicated.
Beta2 Agonists
Although rare, immediate
Dosage: 0.4% (10 mg/2.5 ml) hypersensitivity reactions can
Frequency: q3h occur. Therefore, Alupent
Route: PO (metaproterenol sulfate USP)
Inhalation Aerosol is
contraindicated in patients with a
history of hypersensitivity to any
of its components.
sympathomimetic agents. The
most frequent adverse reaction
to Alupent (metaproterenol
sulfate USP) administered by
metered-dose inhaler among
251 patients in 90-day
controlled clinical trials was
nervousness. This was reported
in 6.8% of patients. Less
frequent adverse experiences,
occurring in 1-4% of patients
were headache, dizziness,
palpitations, gastrointestinal
distress, tremor, throat irritation,
nausea, vomiting, cough and
asthma exacerbation.
Tachycardia occurred in less
than 1% of patients.
and fatigue/weakness.
Assess blood pressure (BP)
periodically and compare to
normal values (See Appendix
F). Report a sustained
increase in BP (hypertension).
Monitor and report signs of
CNS toxicity, including
nervousness, restlessness, or
tremor. Sustained or severe
CNS signs may indicate
overdose or excessive use of
this drug.
Be alert for signs of
hyperglycemia, including
confusion, drowsiness,
flushed/dry skin, fruit-like
breath odor, rapid/deep
breathing, polyuria, loss of
appetite, and unusual thirst.
Patients with diabetes mellitus
should check blood glucose
levels frequently.
Interventions
When implementing airway
clearance techniques or
respiratory muscle training,
attempt to intervene when the
airway is maximally
bronchodilated. Peak
responses typically occur
about 1 hr after inhalation or
oral administration.

Because of the risk of

cardiovascular stimulation,
use caution during aerobic
exercise and endurance
conditioning. Cardiac effects
should be minimal at lower
doses or occasional inhaled
use. Cardiovascular effects
such as arrhythmias, angina
pectoris, or increased BP may
occur at higher doses or
during excessive use, and are
caused by inadvertent
stimulation of beta receptors
on the heart.

Patient/Client-Related
Instruction
Advise patient to not exceed
the recommended dose or
frequency of inhalations.
Contact physician
immediately if bronchospasm
is not relieved by medication
or is accompanied by
diaphoresis, dizziness, or
other symptoms.

Counsel patient on proper use

of inhaler; observe use of this
 device whenever possible to
ensure proper technique.

GENERIC NAME MECHANISM OF ACTION SIDE EFFECTS NURSING RESPONSIBILITY

Fluticasone
The mechanism of action of Common Side Effects: Follow and observe the 14 Rights
fluticasone is as a Corticosteroid in preparing and administering
Hormone Receptor Agonist.  headache medication.
Works by reducing swelling  dryness, stinging,
(inflammation) in the nasal burning or irritation Examination and Evaluation
passages. in the nose Be alert for signs of allergic
 nausea blood vessel reactions (Churg-
 vomiting Strauss syndrome). Early signs
BRAND NAME: Flovent INDICATION include allergic rhinitis, sinusitis,
 diarrhea
Maintenance and prophylactic asthma, or hay fever–like
treatment of asthma. May decrease  bloody mucus in
nose reactions. Symptoms can increase
requirement for or avoid use of to include fever, skin rash, joint
systemic corticosteroids and delay  dizziness
pain, severe pain and numbness
pulmonary damage that occurs Serious Side effects: (peripheral neuropathy),
from chronic asthma. shortness of breath, coughing up
 severe face pain
 thick nasal blood, bloody urine, chest pain,
discharge arrhythmias, and GI problems
 fever, sore throat, (diarrhea, nausea, vomiting, GI
chills, cough, and bleeding). Notify physician
other signs of immediately for further
infection evaluation of any signs listed
above.
 whistling sound
from the nose Assess pulmonary function
 hives periodically by measuring lung
 rash volumes, breath sounds,
 itching respiratory rate, and other
 swelling of the

 hoarseness
 difficulty breathing
DRUG ILLUSTRATION CONTRAINDICATION ADVERSE REACTION
 active tuberculosis.
 inactive tuberculosis.
 herpes simplex infection of
the eye.
 a nasal fungal infection
due to Candida.
 an infection due to a
parasite.
 decreased function of the
adrenal gland.
 increased pressure in the
CLASSIFICATION eye.
Therapeutic: anti-  wide-angle glaucoma.
inflammatories (steroidal)
Pharmacologic: corticosteroids
Dosage:
Frequency: PRN
Route: PO, IV
symptoms (wheezing, dyspnea,
shortness of breath) (See
Appendices I, J, K). Report
changes in pulmonary function to
help document the effects of drug
therapy in treating asthma.
face, throat, tongue,
lips, eyes, hands, Observe for paradoxical
feet, ankles, or bronchospasm (cough, wheezing,
lower legs dyspnea), especially at higher or
excessive doses. If condition
occurs, advise patient to withhold
medication and notify physician
immediately.
NOT KNOWN
Assess muscle strength
periodically during long-term
use. Although inhalation reduces
the risk of systemic
musculoskeletal damage, some
degree of weakness and bone loss
may still occur during prolonged,
extensive use.
Assess any muscle pain to rule
out musculoskeletal pathology;
that is, try to determine if pain is
drug induced rather than caused
by anatomic or biomechanical
problems.
Report signs of adrenal
suppression, including
hypotension, weight loss,
weakness, nausea, vomiting,
anorexia, lethargy, confusion,
and restlessness.

Assess growth rate in children

receiving chronic therapy; report
delayed or stunted growth to the
physician.

Interventions
Implement resistive exercises and
weight-bearing activities to
minimize muscle wasting and
osteoporosis. Use caution to
prevent musculoskeletal damage
in patients with preexisting
muscle and bone loss.

Design and implement

appropriate aerobic exercise and
respiratory muscle–training
programs to maintain optimal
cardiovascular and pulmonary
function. Work with patient and
family/caregivers to find forms of
exercise (e.g., swimming) that
can help improve respiratory
function without triggering
asthma attacks.

Protect skin from breakdown,

especially over bony
prominences.

Patient/Client-Related Instruction
Counsel patient on proper use of
metered-dose inhaler or dry-
powder inhaler; observe use of