Polopot, Gerald R.

BSN-2C
 DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
ACTION RESPONSIBILITIES
GENERIC NAME: Stimulates B2 -Hypersensitivity to SIDE EFFECTS: Before:
SALBUTAMOL adrenergic receptors -Quick relief of salbutamol its in the -Feelings of -Assess vital
which are bronchospasm site content shakiness signs before
BRAND NAME: predominant induced through -Increased heartrate drug administration
-Tachyarrhythmias and
Ventolin receptors in bronchial both exercise and -Headaches -Check and verify with
tachycardia caused by
smooth muscle of the physiological -Cramps
CLASSIFICATION: lung. alterations. digitalis intoxication doctor’s order and
Bronchodilators -Cardiac disease Kardex.
It relaxes the smooth -To control and
muscles of the prevent reversible including coronary -Observe rights in
DOSAGE: insufficiency, a history ADVERSE
bronchioles allowing airway obstruction medication
Tablet: 2 mg,4mg maximum passage of caused by bronchial of stroke, coronary EFFECTS:
Syrup: 2 mg 5mg Tachycardia administration such as
air. It decreases asthma, chronic artery disease and
Aerosol – 90 -Nausea and giving the right drug to
intracellular calcium obstructive cardiac arrhythmias
mcg/actuation which will relax the throat irritation the right patient using
pulmonary diseases -Hypertension -Dizziness.
Solution for inhalation smooth muscles of the such as emphysema the right route and at
-Hyperthyroidism tremors,
– 0.021%, 0.042%, lungs by mobilizing and chronic
-Use cautiously with headache, the right time.
kinase through bronchitis as well as
0.083%, 0.5%
activation of cyclic- patients who have vomiting
other obstructive During:
3’5’-adenosine diabetes as this can -Lowers
ROUTE: pulmonary diseases. peripheral -Instruct patient
monophosphate Inhalation: treatment aggravate diabetes and
Oral vascular to contact health
(cAMP). of acute attacks of ketoacidosis ?
Nasal resistance care professional
bronchospasm -Glaucoma -Increase blood immediately if
FREQUENCY: -Unlabeled use: -Geriatric patients – pressure shortness
every 4 hours Adjunct in treating older individuals are at -Tends to of breath is not
moderate to severe higher risk for adverse increase blood relieved by
hyperkalemia in reactions and may glucose levels medication or is
dialysis patients; require lower dosage accompanied by
seems to lower -Pregnancy especially diaphoresis,
potassium dizziness
near term
concentrations when palpitations, or
Lactation
inhaled by patients chest pain
on hemodialysis
Children less than 2 -Monitor ECG, serum
years of age because electrolytes and
safety of its use has not thyroid function test
results.
been established
-Administer
-Excess inhaler use
accurately because
which may lead to adverse reactions
tolerance and and tolerance might
paradoxical occur.
bronchospasm disease; -Raise side rails up
Use cautiously in because client might
elderly because they be restless and
are more sensitive to drowsy because of
CNS effects this drug.
-Keep room well-lit
and see to it that
Use extended-release
client has a person
tablets cautiously in with him closely in
patients with GI case of vertigo.
narrowing. -Assess lung sounds,
PR and BP before
drug administration
and during peak of
medication.
-Assess pulse for
rhythm.

AFTER :
-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.
 DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
ACTION RESPONSIBILITIES
GENERIC NAME: Salmeterol belongs Salmeterol is a Hypersensitivity is a SIDE EFFECTS: Monitor respiratory
SALMETEROL to the group of drugs highly selective, contraindication for -headache, rate, oxygen
called beta-2 long-acting beta-2 salmeterol. It is -flu symptoms, saturation, and lungs
BRAND NAME: agonists. Beta-2 adrenergic agonist contraindicated in -joint or muscle pain, sounds before and
Serevent Diskus agonists are G indicated in the patients with a known -throat irritation, after administration. If
protein-linked treatment of asthma, hypersensitivity to any -cough, and more than one
CLASSIFICATION: maintenance of -stuffy or runny nose
second messengers. ingredient in the inhalation is ordered,
Bronchodilators airflow obstruction in
The Gs protein preparation, including wait at least 2 minutes
Beta2 Antagonist chronic obstructive ADVERSE
stimulates adenylyl lactose and milk protein. between inhalations.
pulmonary disease EFFECTS:
cyclase, which Use a spacer device to
DOSAGE: (COPD), and -hives,
converts ATP to prevention of Salmeterol is improve drug delivery,
Adult and pediatric -difficulty breathing,
cAMP. Subsequently, exercise-induced contraindicated in if appropriate.
dosage -swelling of the face,
cAMP activates bronchospasm (EIB). patients who have had lips, tongue, or
protein kinase A, Salmeterol is used in adverse reactions to Patients should remain
Powder throat,
inhibiting myosin combination with salmeterol in the past. It compliant with the
-worsening asthma
light chain kinase inhaled should not be used for medication dosing
50mcg/inhalation symptoms,
(present in smooth corticosteroids in the status asthmaticus or regimen. Individuals
Asthma Prevention other breathing
muscle). This cascade treatment of asthma. other acute asthma should contact their
and Maintenance problems,
results in the It can be useful in episodes. Salmeterol healthcare provider if
-severe headache,
relaxation of both the maintenance should not be used in they experience
Adult dosage of asthma and the -blurred vision,
bronchiolar smooth combination with other ongoing shortness of
prevention of asthma pounding in neck or
muscle, long-acting beta-agonists. breath unrelieved with
1 inhalation (50 mcg) attacks. It is usually ears,
bronchodilation, and Studies have shown an medication therapy. If
twice daily; not to prescribed for severe chest pain,
increased bronchiole increased risk for death in using an inhaler, the
exceed twice-daily persistent asthma not fast or irregular
airflow. asthma patients taking patient should be sure
administration properly controlled heartbeats,
salmeterol vs. placebo; to prime the inhaler
Pediatric dosage using a short-acting tremors,
In human lungs, this risk was highest for prior to administering
beta-adrenergic nervousness,
salmeterol also agonist and a African-American the dose of
Children below 4 increased thirst,
inhibits mast cell corticosteroid. patients. medication. The
years: Safety and increased urination,
mediators, including Salmeterol is not medication can cause
efficacy not dry mouth,
histamine, indicated in patients an unusual taste in the
established fruity breath odor,
leukotrienes, and with mild asthma mouth, so patients
Children above 4 prostaglandins; this who are well leg cramps, should rinse their
years: 1 inhalation (50 suppression leads to maintained on short- There is an FDA black box constipation, mouth with water
mcg) twice daily; not decreased acting beta-agonists. warning for asthma fluttering in the after each use.
to exceed twice-daily inflammation. Salmeterol patients due to the chest,
administration Bronchodilation monotherapy is a increased incidence of numbness or
ROUTE: remains the primary contraindication for asthma-related deaths tingling,
Nasal function of treating asthma with this medication. muscle weakness,
FREQUENCY: patients due to the Salmeterol should not be
salmeterol; its anti- and
Adult and pediatric increased risk of
inflammatory used as a monotherapy in limp feeling.
dosage
mortality. Salmeterol
properties are asthma patients.
administration with
present to a much concomitant inhaled Clinicians should only use
Powder lesser degree. it as an adjunct
corticosteroid (ICS)
has significantly medication in patients
50mcg/inhalation Salmeterol’s reduced asthma who have failed other
Asthma Prevention molecular structure mortality. Salmeterol asthma therapies such as
and Maintenance confers its can, however, be low to medium dose
characteristic, used as a inhaled steroids or those
Adult dosage extended duration of monotherapy in the with severe asthma
action. Its elongated treatment of COPD, necessitating two
1 inhalation (50 mcg) lipophilic side-chain particularly as a maintenance therapies.
twice daily; not to facilitates repeated maintenance
treatment. Salmeterol
exceed twice-daily activation of the
has been shown to
administration beta-2 receptor. The
side chain binds to increase FEV1 and
Pediatric dosage the FEV1/FVC ratio
the so-called
in both asthma and
Children below 4 “exosite” adjacent to
COPD patients.
years: Safety and beta-2 adrenergic
efficacy not receptors. The active
established portion of the
Children above 4 molecule is allowed
years: 1 inhalation to remain at the
(50 mcg) twice daily;
receptor site and
not to exceed twice-
continuously engage
and disengage with
daily administration
the receptor.Due to
this unique
molecular structure,
a single inhaled dose
of salmeterol lasts
approximately 12
hours compared to
salbutamol, which
lasts 4 to 6 hours.
Salmeterol given
twice daily in the
management of mild-
to-moderate asthma
has proven clinically
superior to albuterol
given either regularly
or intermittently as
needed.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG NURSING RESPONSIBILITIES
OF ACTION EFFECTS
GENERIC NAME: Formoterol, a -Maintenance The following are SIDE BEFORE
FORMOTEROL long-acting beta and treatment contraindications and EFFECTS:
of -nausea,
2-selective cautions when using History taking and physical examination
BRAND NAME: bronchospasm -vomiting,
adrenoceptor anticholinergics:
Perforomist for adults with -diarrhea, of patients taking bronchodilators or
agonist, COPD. - antiasthmatics.
CLASSIFICATION: produces dose- -Long-term, Co-morbidities. Caution nervousness,
Bronchodilators proportional once-daily should be used in any -trouble
Beta2 Antagonist bronchodilation maintenance condition that would • Assess for possible
sleeping,
DOSAGE: in patients with and treatment be aggravated by the -headache, contraindications or
20mcg/2mL obstructive
of
anticholinergic or -dizziness, cautions: any known
bronchospasm
airways disease associated with atropine-like effects of -tremor, allergies to prevent
ROUTE:
Nasal with a reversible COPD in the drug, such as -tiredness, hypersensitivity reactions;
component. A narrow-angle -muscle
adults. cigarette use which affects
significant effect glaucoma, bladder neck cramps, and
FREQUENCY:
-dry mouth. the metabolism of the
every 12 hours occurs within obstruction or prostatic drug; peptic ulcer, gastritis,
minutes of hypertrophy, and renal or hepatic
inhalation of a conditions aggravated
dysfunction, and coronary
therapeutic by dry mouth and ADVERSE
disease, all of which could
formoterol dose throat. EFFECTS:
and persists for Allergy. The use of -tremors, be exacerbated and
approximately ipratropium or - require cautious use; and
12 hours. Oral tiotropium is nervousness, pregnancy and lactation,
-chest pain, which are
formoterol has a contraindicated in the
-fast or
slower onset of presence of known contraindications because
pounding
action than the allergy to the drug or heartbeats, of the potential for adverse
inhaled to soy products or -wheezing, effects on the fetus or
formulations, peanuts to prevent choking, or nursing baby.
but also hypersensitivity other • Perform a physical
produces reactions. breathing examination to establish
prolonged problems,
baseline data for assessing
bronchodilatory Pregnancy and -worsening
breathing the effectiveness of the
effects. Inhaled lactation. These drugs
problems, drug and the occurrence of
formoterol has are not usually
absorbed
high blood any adverse effects
shown a
systematically, but as
sugar-- associated with drug
therapeutic increased
efficacy with all the drugs, therapy.
thirst,
equivalent to or caution should be used increased • Perform a skin
better than in pregnancy and urination, - examination, including
comparable lactation because of the dry mouth, color and the presence of
dosages of the potential for adverse fruity breath lesions, to provide a
conventional effects on the fetus or odor, and baseline as a reference for
beta 2-agonists nursing baby. low
drug effectiveness.
potassium
salbutamol, • Monitor blood pressure,
level--leg
fenoterol and pulse, cardiac auscultation,
cramps,
terbutaline in constipation, peripheral perfusion, and
short and long irregular baseline electrocardiogram
term trials, in heartbeats,
to provide a baseline for
both adults and fluttering in
children with the chest, effects on
asthma. Its numbness or the cardiovascular system.
prolonged tingling, • Assess bowel sounds and
duration of muscle do a liver evaluation and
action permits a weakness, or monitor liver and renal
limp feeling.
twice-daily function tests to provide a
dosage regimen baseline for renal and
and results in hepatic function tests.
improved • Evaluate serum
control of
theophylline levels to
nocturnal
provide a baseline
symptoms by reference and identify
reducing the conditions that may
'morning dip'. require caution in the use
Formoterol also of xanthines.
compares well
• Evaluate urinary output
with oral slow
and prostate palpation as
release
appropriate to monitor
theophylline. In
addition, anticholinergic effects.
significantly • Evaluate orientation, affect,
more patients and reflexes to evaluate
with chronic CNS effects.
obstructive Nursing Diagnosis and Care
airways disease
(COAD) had an
Planning
improvement in
Nursing diagnosis and care planning
symptoms when
treated with related to drug therapy include:
formoterol
compared with • Acute pain related to
salbutamol or headache and GI upset.
fenoterol. • Disturbed sensory
Noncomparative perception (kinesthetic,
studies indicate visual) related to CNS
formoterol also effects.
provides • Deficient
effective
knowledge regarding
prophylaxis of
drug therapy.
exercise-
induced asthma. • Increased cardiac
Development of output related to
tachyphylaxis sympathomimetic effects.
has not been • Disturbed thought
observed. processes related to CNS
Formoterol is effects.
generally well • Imbalanced nutrition:
tolerated.
less than body
Adverse effects
requirementsrelated to
observed
dry mouth and GI upset.
represent
predictable Nursing Implementation with
extensions of its Rationale
pharmacology.
Tremor and The nursing interventions for patients
palpitations are using bronchodilators or antiasthmatics
most frequently
include:
reported. The
incidence of
adverse events • Relieve GI
is dose- upset. Administer oral
proportional drug with food or milk to
and therefore relieve GI irritation if GI
related to the upset is a problem.
route of • Monitor drug
administration, response. Monitor patient
being more response to the drug (e.g.,
frequent relief of respiratory
following oral difficulty, improved
than inhalation
airflow) to determine the
therapy. The
effectiveness of the drug
long-acting beta
2-agonists, dose and to adjust dose as
including needed.
formoterol,
represent a • Provide comfort. Provide
significant comfort measures
advance over including rest periods,
current quiet environment, dietary
maintenance or
control of caffeine, and
prophylactic
headache therapy as
bronchodilator
needed, to help the patient
therapy with
intermediate- cope with the effects of
acting beta 2- drug therapy.
agonists such as • Provide follow-
salbutamol, ups. Provide periodic
fenoterol and follow-up, including blood
terbutaline, tests, to monitor serum
predominantly theophylline levels.
because of the • Individual drug
twice daily response. Reassure
administration
patient that the drug of
regimen.
choice will vary with each
However,
individual; these
comparisons
with other long- sympathomimetics are
acting beta 2- slightly different chemicals
agonists, such and are prepared in a
as salmeterol, variety of delivery systems;
evaluation of its a patient may have to try
role in several different
improving sympathomimetics before
symptom the most effective one is
control in found.
patients failing
• Proper administration
to respond to
and dosage. Advise the
prophylactic patient to use the minimal
therapy, and amount needed for the
clarification of shortest period necessary
the optimal role to prevent adverse effects
of beta 2-
and accumulation of drug
agonists in
levels.
asthma
• Proper use of
maintenance
therapy are sympathomimetics. Teach
required to fully the patients who use one
determine the of these drugs for
value of exercise-induced asthma
formoterol in to use it 30 to 60 minutes
the before exercising to ensure
management of peak therapeutic effects
obstructive when they are needed.
airways disease. • Use of adrenergic
blockers. Alert the patient
that long-acting
adrenergic blockers are
not for use during acute
attacks because they are
slower acting and will not
provide the necessary
rescue in a state of acute
bronchospasm.
• Increase oral fluid
intake. Ensure adequate
hydration and provide
environmental controls
such as the use of a
 humidifier, to make the
patient more comfortable.
• Encourage
voiding. Encourage the
patient to void before each
dose of medication to
avoid urinary
retention related to drug
effects.
• Small, frequent
meals. Provide small,
frequent meals and
sugarless lozenges to
relieve dry mouth and GI
upset.
• Use of inhalator. Review
the use of inhalator with
the patient; caution the
patient not to exceed 12
inhalations in 24 hours to
prevent serious adverse
effects.
• Educate the
patient. Provide thorough
patient teaching, including
the drug name and
prescribed dosage
measures to help avoid
adverse effects, warning
signs that may indicate
 problems, and the need for
periodic monitoring and
evaluation, to enhance
patient knowledge about
drug therapy and to
promote compliance.
• Provide patient
support. Offer support
and encouragement to
help the patient cope with
the disease and the drug
regimen.
Evaluation

Evaluation of a patient using

bronchodilators/antiasthmatics include
the following:

• Monitor patient response

to the drug (improved
airflow, ease of
respirations, improved
breathing).
• Monitor for adverse effects
(CNS effects, increased
pulse or blood pressure, GI
upset, dry skin, and
mucous membranes).
• Evaluate the effectiveness
of the teaching plan
 (patient can name drug,
dosage, adverse effects to
watch for, specific
measures to avoid them,
and measures to take to
increase the effectiveness
of the drug).
• Monitor the effectiveness
of other measures to ease
breathing.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Vilanterol is a BREO ELLIPTA active tuberculosis SIDE EFFECTS: Special nursing
VILANTEROL selective long-acting 100/25 is herpes simplex decreasing
Actions
beta2-adrenergic indicated for the infection of the eye effectiveness,
BRAND NAME: need for more ASseS
agonist. Its long-term, once- thrush
Anoro, Anoro Ellipta, pharmacological inhalations than Tor severe milk
daily, an infection due to a
Breo Ellipta, Trelegy effect is attributable
parasite
usual, allergies: mav De
Ellipta maintenance significant
to stimulation of
treatment of insufficiency of the allergic IC
decrease in lung
intracellular
airflow hypothalamus and function, futicasone vilanterol.
adenylyl cyclase
CLASSIFICATION:
which catalyzes the obstruction in pituitary gland increase in mucus Assess respiratory
Bronchodilators wide-angle glaucoma
conversion of patients with (sputum) Status rate, breath
adenosine chronic clouding of the lens of production, sounds.
DOSAGE:
obstructive the eye called cataracts change in mucus
degree or aysonea,
25mcg/100mcg triphosphate (ATP)
pulmonary osteoporosis, a color,
per actuation to cyclic-3',5'-
fever, pulse, belore
adenosine disease (COPD), condition of weak
ROUTE:
monophosphate bones chills, administration.
Nasal, oral including chronic
(cAMP). Increases in decreased calcification
increased cough, Putcasone
bronchitis and/or increased
FREQUENCY: cyclic AMP are or density of bone vlanterolis not to be
emphysema. breathing
once daily associated with
BREO ELLIPTA
thyrotoxicosis problems, used for acute
relaxation of diabetes symptoms or astma,
100/25 is also feeling tired,
bronchial smooth low amount of lack of energy, nont-acuina
muscle and indicated to
potassium in the blood weakness,
inhibition of release reduce Dronchoallator
high blood pressure nausea,
of hypersensitivity exacerbations of should also be
diminished blood flow vomiting,
mediators from mast COPD in patients prescribed. If
through arteries of the low blood
cells in the lungs. with a history of pressure, paradoxical
heart
exacerbations. tremor, bronchospasm
prolonged QT interval
BREO ELLIPTA nervousness,
on EKG (wheezina) occurs,
100/25 once daily rash,
abnormal EKG with QT discontinue
is the only hives,
changes from birth
strength asthma attack
indicated for the seizures swelling of your fluticasone
treatment of face, mouth or
vilanterolimmediatev
COPD. worsening chronic tongue,
and use short.
obstructive pulmonary breathing
disease problems, actin bronchodilator.
chest pain, May
increased blood cause decreased
pressure, and
fast or irregular
bone mineral densitv
heartbeat during
prolonged therapv.
Monitor patients
ADVERSE
EFFECTS: with Increased
upper respiratory risk (prolonged
tract infection, immobilization,
runny nose, family history of
sore throat,
headache, osteoporosis. Dost-
oral candidiasis menopausastatus,
(thrush in your use, advanced age,
mouth or throat), poor nutrition,
back pain,
pneumonia,
chronic use Ol
bronchitis, druas that can
sinus infection, reduce bone mass
cough, anticonvulsants
mouth pain,
oral corticosteroids)
joint pain,
influenza, for fractures.
sore throat, and Monitor tor sians
fever and sumntoms of
hunersensitivity
reactions (rash,
Druntis, Swellina or
face and neck
dyspnea)
periodically during
therapy.
If transterring
patient from
systemic
additional contro
needed; Receivina
mia-to-nn-dos
Corticosteroids- Une
unnaaior
(fluticasone 200
mcg/vilanterol 25
mca) once dailv
Inhalauor
Onset-within one
noul
Peak = 1-2 hours
Duration- 4 hours
Administer 1
inhalation once dailv
at the same time
each dav
Patient leachina
Instruct patient in
how
sA
it once
dailv at the same
time each dav and
not to stop
takin medication
witnout consulting
neahn care
professional Advise
patient to rinse
mouth withou
swallowing to
reduce risk or
oropnaryngeal
candidiasis. Instruct
patient to read
Medication
Guide prior to use or
nhaer and with each
«x ret
in case or changes.
Instruct patient in
need tor and use or
rescue
inhaler. Caution
patient to notity
health care
professional if
symptoms get
worse, need more
innaauons than
usual from rescue
inhaler.
decrease in lung
function as
described by neatn
care professional.
Increased use or
short-acuno
agent may signal
disease
deterioration.
Intorm patient of
increased risk of
pneumonia.
Advise patent to
nomy neath care
prolessionalI
†ever. Chills. change
in soutum color.
increased

cough, or increase in
breathing problems
Occur
 DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
ACTION RESPONSIBILITIES
GENERIC NAME: Ipratropium acts as Inhaled ipratropium Contraindications to SIDE EFFECTS: History:
IPRATROPIUM an antagonist of the is indicated in ipratropium inhaler use -Bronchitis Hypersensitivity to
muscarinic combination with include patients that are -Chronic obstructive atropine, soybeans,
BRAND NAME: acetylcholine inhaled beta-agonist hypersensitive to pulmonary disease peanuts (aerosol
Atrovent, Combivent, receptor.1 This effect systemic atropine; this is (COPD) exacerbation preparation); acute
Ipravent produces the corticosteroids for secondary to the -Sinus infection bronchospasm,
inhibition of the the management of similarity in structure to -Shortness of breath narrow-angle
parasympathetic severe exacerbations atropine. -Urinary tract glaucoma, prostatic
CLASSIFICATION: nervous system in of asthma flares infection (UTI) hypertrophy, bladder
Bronchodilators the airways and requiring treatment. Ipratropium aerosols can -Headache neck obstruction,
hence, inhibit their cause bronchospasms -Flulike symptoms pregnancy, lactation
DOSAGE: function. The Asthma (paradoxical), which -Back pain Physical: Skin color,
ROUTE: function of the exacerbations are usually happens upon the -Cough lesions, texture; T;
FREQUENCY: parasympathetic characterized by a initial use of this -Indigestion orientation, reflexes,
system in the airway progressive increase medication. Patients -Dry mouth bilateral grip strength;
500 mcg (1 is to generate in one or more of should understand this -Dizziness affect; ophthalmic
vial) via bronchial secretions asthma symptoms possibility. If this adverse -Nausea examination; P, BP; R,
nebulizer 3 and constriction and accompanied by a reaction occurs, then this -Dry nose adventitious sounds;
or 4 times hence, the inhibition decrease in medication should be -Nasal or throat bowel sounds, normal
per day of this action can expiratory flow. immediately irritation output; normal urinary
lead to discontinued. -Nosebleeds output, prostate
bronchodilation and As a single agent, -Bad taste in mouth palpation
fewer secretions. ipratropium was Previous severe allergic -Constipation Interventions
indicated for the reaction symptoms upon
At the cellular level, symptomatic relief of using ipratropium or Protect solution for
the diameter of the rhinorrhea atropine and its other inhalation from light.
airways is controlled associated with the derivatives, such as ADVERSE EFFECTS: Store unused vials in
by the release of common cold or angioedema, urticaria, -Cardiovascular: Low foil pouch.
acetylcholine into the seasonal allergic severe shortness of blood pressure Use nebulizer
muscle cells causing rhinitis for patients 5 breath, oropharyngeal (hypotension), mouthpiece instead of
them to contract and years or older. It edema, and ultimately palpitations, fast face mask to avoid
producing a narrow does not alleviate anaphylaxis is a heart rate blurred vision or
airway. Thus
administration of nasal congestion nor contraindication to -General: Dry throat, aggravation of narrow-
ipratropium stops the sneezing. ipratropium use. throat irritation angle glaucoma.
activity of Gastrointestinal (GI): Can mix albuterol in
acetylcholine in the Rhinorrhea refers to Caution is necessary for Constipation, nebulizer for up to 1
smooth muscle recurrent or chronic the use of inflammation and hr.
preventing the watery nasal intranasal/inhaled sores inside the Ensure adequate
contraction and discharge. This ipratropium in patients mouth, mouth hydration, control
producing relaxed condition is with hypertrophic swelling environmental
airways. debilitating and its prostate. -Sensory: Narrow- temperature to
pathogenesis and angle glaucoma, prevent hyperpyrexia.
etiology is complex Exercise caution with the glaucoma, halo Have patient void
and not very well use of intranasal/inhaled vision, conjunctival before taking
understood ipratropium in patients hyperemia, corneal medication to avoid
presenting very with obstruction of the edema, dilated urinary retention.
substantial cost bladder neck. pupils, acute eye
burden. pain, blurry vision Teach patient proper
Caution is recommended -Respiratory: use of inhaler
Additionally, in the use of Bronchospasm,
ipratropium is intranasal/inhaled including paradoxical Use this drug as an
indicated as a ipratropium in patients bronchospasm inhalation product.
bronchodilator for with closed-angle -Renal: Urinary Review the proper use
maintenance glaucoma. retention of inhalator; for nasal
treatment of spray, initiation of
bronchospasm pump requires 7
associated with Ipratropium is labeled as actuations; if not used
chronic obstructive category B regarding for 24 hours, 2
pulmonary disease pregnancy since there are actuations will be
including chronic no reports of needed before use.
bronchitis and teratogenesis in animals Protect from light; do
emphysema. or humans with not freeze.
ipratropium use (aerosols You may experience
or nasal spray), but these side effects:
studies in humans are Dizziness, headache,
limited. Ipratropium blurred vision (avoid
should only be used driving or performing
during pregnancy if the hazardous tasks);
mother's benefits nausea, vomiting, GI
outweigh possible fetus upset (proper nutrition
risks. is important; consult
with your dietitian to
maintain nutrition);
cough.

Report rash, eye pain,

difficulty voiding,
palpitations, vision
changes.
 DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
ACTION RESPONSIBILITIES
GENERIC NAME: Glucocorticoids inhibit -Systemic fungal infection SIDE EFFECTS: History (systemic
BETAMETHASONE neutrophil apoptosis As a member of the -Hypersensitivity to Common side effects administration):
and demargination, corticosteroid betamethasone of betamethasone Infections, fungal
and inhibit NF-Kappa family, -Traumatic brain injury include: infections, amebiasis,
BRAND NAME: B and other betamethasone is (high doses) vaccinia and varicella,
Betaderm, Betaloan inflammatory indicated for the -Untreated serious -abdominal bloating and antibiotic-
Suik, Beteflam, transcription factors. treatment of several infections -abdominal fat resistant infections;
They also inhibit inflammatory
Celestoderm deposits kidney or liver disease;
phospholipase A2, conditions. As
-Administration of live, -abnormal hair hypothyroidism;
CLASSIFICATION: topical
leading to decreased attenuated vaccines is growth ulcerative colitis with
Corticosteroids monotherapy,
formation of contraindicated in -abscess impending
betamethasone is
arachidonic acid patients receiving acne perforation;
DOSAGE: indicated to relieve
derivatives. In immunosuppressive -adrenal suppression diverticulitis; active or
pruritic and
Injectable addition, inflammatory doses of corticosteroids -blindness latent peptic ulcer;
Suspension glucocorticoids symptoms of -blot clots inflammatory bowel
-6 mg/ml promote anti- corticosteroid- -blurred vision disease; CHF;
inflammatory genes
Oral Solution responsive- -bowel/bladder hypertension;
like interleukin- dermatoses. -dysfunction thromboembolic
-0.6 mg/5 ml Betamethasone can -break in the disorders;
ROUTE: Corticosteroids like be used topically in stomach lining osteoporosis; seizure
Parenteral, oral betamethasone can act combination with a
FREQUENCY: -brittle disorders; diabetes
through nongenomic vitamin D analog -bones/fractures mellitus; lactation
Adult Dosage: such as calcipotriene
and genomic -bulging of the eyes Physical: Baseline
pathways. The to treat plaque calcium deposits in weight, T, reflexes and
0.6-7.2 mg orally psoriasis. The
genomic pathway is the skin grip strength, affect
divided twice corticosteroid is also
slower and occurs cardiac arrest and orientation, P, BP,
daily/four times daily available as an
when glucocorticoids peripheral perfusion,
or 0.6-9 mg/day injectable
intramuscularly each activate glucocorticoid suspension and can prominence of
day divided twice receptors and initiate be used to manage a ADVERSE EFFECTS: superficial veins, R and
daily downstream effects range of Sodium and fluid adventitious sounds,
Pediatric Dosage: that promote inflammatory retention, potassium serum electrolytes,
transcription of anti- conditions including and calcium blood glucose
 inflammatory genes endocrine disorders, depletion. Muscle Interventions
Children under 12 including gastrointestinal wasting, weakness,
years old: 0.0175-0.25 phosphoenolpyruvate disorders, and osteoporosis. GI Systemic use
mg/kg/day carboxykinase rheumatic disorders disturbances and
intramuscular/orally (PEPCK), IL-1- among other bleeding. Increased Give daily dose before
divided every 6-12 conditions. appetite and delayed 9 AM to mimic normal
receptor antagonist,
hours and tyrosine amino wound healing; peak corticosteroid
Children over 12 years transferase (TAT). On hirsutism, bruising, blood levels.
old: As in adults the other hand, the striae, acne; raised Increase dosage when
nongenomic pathway intracranial pressure, patient is subject to
is able to elicit a headache, stress.
quicker response by depression, Taper doses when
modulating T-cell, psychosis, menstrual discontinuing high-
platelet and monocyte irregularities. dose or long-term
activity through the Hyperglycaemia, DM. therapy.
use of existing Suppression of Do not give live virus
membrane-bound
pituitary- vaccines with
adrenocortical axis. immunosuppressive
receptors and second
Growth retardation doses of
messengers.
in children corticosteroids.
(prolonged therapy). Topical dermatologic
Increased preparations
susceptibility for
infections. Topical Examine area for
use: Dermal atrophy, infections and skin
local irritation, integrity before
folliculitis, application.
hypertrichosis. Administer cautiously
Inhalation: to pregnant patients;
Hoarseness, topical corticosteroids
candidiasis of mouth have caused
and throat. Topical teratogenic effects
application to the and can be absorbed
eye: Corneal ulcers, from systemic site.
raised IOP and
reduced visual WARNING: Use
acuity. Intradermal caution when
injection: Local occlusive dressings or
hypopigmentation of tight diapers cover
deeply pigmented affected area; these
skin. Intra-articular can increase systemic
injection: Joint absorption of the
damage, fibrosis, esp drug.
in load bearing Avoid prolonged use
joints. near eyes, in genital
Potentially Fatal: and rectal areas, and
Abrupt withdrawal in skin creases.
leading to acute Teaching points
adrenal insufficiency
manifesting as Systemic use
malaise, weakness,
mental changes, Do not stop taking the
muscle and joint oral drug without
pains, dystonia, consulting your health
hypoglycaemia, care provider.
hypotension, Take single dose or
dehydration and alternate-day doses
death. Rapid IV inj before 9 AM.
may cause CV Avoid exposure to
collapse. infections; ability to
fight infections is
reduced.
Wear a medical alert
tag so emergency care
providers will know
that you are on this
medication.
You may experience
these side effects:
Increase in appetite,
weight gain (counting
calories may help);
heartburn, indigestion
(eat frequent small
meals; take antacids);
poor wound healing
(consult with your care
provider); muscle
weakness, fatigue
(frequent rest periods
will help).

Report unusual weight

gain, swelling of the
extremities, muscle
weakness, black or
tarry stools, fever,
prolonged sore throat,
colds or other
infections, worsening
of original disorder.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATI DRUG EFFECTS NURSING
OF ACTION ON RESPONSIBILITIES
GENERIC NAME: Dexamethasone Hypercalcemia Hypersensitivity; SIDE EFFECTS:
DEXAMETHASONE ’s effect on the associated with active untreated • upset stomach Before
cancer History for systemic
body occurs in infections;
BRAND NAME: Short-term • stomach
a variety of ophthalmic use in administration: Active
management of irritation
Baycadron Elixer
ways. It works
various viral, fungal disease infections; renal or hepatic
by suppressing
inflammatory of the eye. • vomiting disease; hypothyroidism,
the migration of and allergic ulcerative colitis;
Decadron
neutrophils and • headache
disorders, such diverticulitis; active or
Dekpak 13 Day Taperpak decreasing as rheumatoid latent peptic ulcer;
lymphocyte arthritis, • dizziness
inflammatory bowel
colony collagen diseases
proliferation. (SLE), • insomnia disease; CHF, hypertension,
CLASSIFICATION: thromboembolic disorders;
Corticosteroid, The capillary dermatologic
• restlessness
diseases osteoporosis; seizure
Glucocorticoid, Hormone membrane
becomes less (pemphigus), • depression disorders; diabetes
DOSAGE: permeable, as status mellitus; lactation
well.
asthmaticus, and • anxiety ▪ History for
ROUTE: autoimmune
FREQUENCY: Lysosomal ophthalmic
disorders • acne
membranes Hematologic preparations:
▪ 0.4–6 mg have increased disorders: • increased hair Acute superficial
(depending stability. There Thrombocytopen growth herpes simplex
on joint or are higher ic purpura, keratitis, fungal
concentrations erythroblastopen • easy bruising infections of
soft-tissue
ia ocular structures;
injection site). of vitamin A • irregular or
Trichinosis with
▪ Respiratory
compounds in
absent vaccinia,
the serum, neurologic or
inhalant myocardial menstrual varicella, and
prostaglandin, other viral
(dexamethaso involvement periods
and some
ne sodium Ulcerative diseases of the
cytokines
phosphate) colitis, acute cornea and
(interleukin-1,
▪ 84 mcg
exacerbations of conjunctiva;
interleukin-12, MS, and
released with interleukin-18, ocular TB
palliation in
 each tumor necrosis some leukemias ▪ Physical for
actuation. factor, and lymphomas ADVERSE EFFECTS: systemic
ADULTS interferon- Cerebral edema ▪ Growth administration:
▪ 3 inhalations gamma, and associated with retardatio Baseline body
brain tumor, n,
tid–qid, not to granulocyte- craniotomy, or weight, T;
exceed 12 macrophage
head injury
osteoporos reflexes, and grip
inhalations/d colony- Testing is, peptic strength, affect,
ay. stimulating adrenocortical ulcer, and orientation;
PEDIATRIC PATIENTS
factor) become hyperfunction glaucoma P, BP, peripheral
▪ 2 inhalations
inhibited. Unlabeled uses: and perfusion,
Increased
tid–qid, not to surfactant
Antiemetic for subcapsula prominence of
cisplatin-induced
exceed 8 r cataracts, superficial veins;
levels and vomiting,
inhalations/d improved diagnosis of vertebral R and
ay. depression compressi adventitious
pulmonary
▪ Intranasal Intra-articular or on sounds; serum
circulation have
(dexamethaso also been soft-tissue fractures. electrolytes,
ne sodium shown with
administration: Cushing- blood glucose
phosphate) dexamethasone.
Arthritis, like ▪ Physical for
psoriatic plaques
▪ Each spray Dexamethasone features, topical
Respiratory
delivers 84 is metabolized inhalant: Control pancreatic dermatologic
mcg by the liver and of bronchial dysfunctio preparations:
dexamethaso excreted in the asthma requiring n and Affected area for
ne. urine mainly. corticosteroids in pancreatiti infections, skin
ADULTS conjunction with s, GI injury
other therapy upsets,
▪ 2 sprays (168 Intranasal: Relief During
mcg) into increased
of symptoms of
each nostril seasonal or appetite, ▪ For systemic
bid–tid, not to perennial rhinitis increased administration,
exceed 12 that responds fragility of do not give drug
sprays (1,008 poorly to other the skin. to nursing
mcg)/day.
treatments Increased mothers; drug is
susceptibil secreted in
ity to breast milk.
infection. ▪ WARNING: Give
Topical daily doses
application before 9 AM to
: Dermal mimic normal
atrophy, peak
local corticosteroid
irritation, blood levels.
folliculitis, ▪ Increase dosage
delayed when patient is
wound subject to stress.
healing, ▪ Taper doses
systemic when
absorption discontinuing
and high-dose or
toxicity long-term
with therapy.
occlusive ▪ Do not give live
dressing virus vaccines
on with
application immunosuppress
to large ive doses of
areas of corticosteroids.
the body ▪ For respiratory
and inhalant,
broken intranasal
skin. preparation, do
Topical not use
application respiratory
to eye: inhalant during
Corneal an acute
ulcers, asthmatic attack
glaucoma or to manage
and
 reduced status
visual asthmaticus.
ability. ▪ Do not use
Inhalation: intranasal
Hoarsenes product with
s, untreated local
candidiasis nasal infections,
of mouth epistaxis, nasal
and throat. trauma, septal
Intra- ulcers, or recent
articular nasal surgery.
inj: Aseptic ▪ WARNING: Taper
necrosis of systemic steroids
bone and carefully during
joint transfer to
damage. inhalational
▪ Potentially steroids; adrenal
Fatal: HPA insufficiency
supression deaths have
; CV occurred.
collapse on ▪ For topical
rapid IV dermatologic
admin. preparations, use
caution when
occlusive
dressings, tight
diapers cover
affected area;
these can
increase systemic
absorption.
▪ Avoid prolonged
use near the eyes,
 in genital and
rectal areas, and
in skin creases.
After
Systemic administration
▪ Do not stop
taking the oral
drug without
consulting your
health care
provider.
▪ Avoid exposure
to infection.
▪ Report unusual
weight gain,
swelling of the
extremities,
muscle
weakness, black
or tarry stools,
fever, prolonged
sore throat, colds
or other
infections,
worsening of this
disorder.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Replacement Hypersensitivity, SIDE EFFECTS: Before
Prednisone
PREDNISONE
decreases
therapy in adrenal serious infections
cortical • Fluid History: Infections;
inflammation via (except tuberculous
BRAND NAME: insufficiency retention, renal or liver disease,
Apo-Prednisone suppression of the Hypercalcemia meningitis), varicella, causing hypothyroidism,
(CAN), Deltasone,
migration of associated with systemic fungal swelling in ulcerative colitis with
Liquid Pred,
polymorphonuclear cancer infections. your lower
leukocytes and impending
Meticorten, Novo- Short-term legs perforation,
reversing increased management of • High blood
Prednisone (CAN), capillary diverticulitis, active or
Orasone, Panasol-S, various pressure
permeability. It latent peptic ulcer,
inflammatory and • Problems with
Prednicen-M, also suppresses the inflammatory bowel
Prednisone Intensol allergic disorders, mood swings,
immune system by such as memory, disease, CHF,
Concentrate, reducing the hypertension,
rheumatoid behavior, and
Sterapred DS, activity and the thromboembolic
arthritis, collagen other
Sterapred (regular), volume of the diseases (eg, psychological disorders,
Winpred (CAN) immune system. SLE), effects, such osteoporosis, seizure
CLASSIFICATION: The antineoplastic dermatologic as confusion disorders, diabetes
Corticosteroid effects may diseases (eg, or delirium mellitus; hepatic
(intermediate correlate with the pemphigus), status • Upset disease; lactation
acting), inhibition of asthmaticus, and stomach Physical: Weight, T,
Glucocorticoid, glucose transport, autoimmune • Weight gain,
phosphorylation, or reflexes and grip
Hormone disorders with fat strength, affect and
induction of cell Hematologic deposits in
death in immature orientation, P, BP,
DOSAGE: disorders: your peripheral perfusion,
Tablets—1, 2.5, 5, 10, lymphocytes. It Thrombocytopenia abdomen,
may have prominence of
20, 50 mg; oral purpura, your face and
antiemetic effects superficial veins, R,
solution—5 mg/5 mL, erythroblastopenia the back of
by blocking the Ulcerative colitis, your neck adventitious sounds,
5 mg/mL; syrup—5 cerebral acute serum electrolytes,
mg/5 mL innervation of the exacerbations of blood glucose
ROUTE & emetic center via MS and palliation
FREQUENCY: inhibition of in some leukemias During
Individualize dosage prostaglandin. and lymphomas ADVERSE EFFECTS:
depending on
severity of condition Prednisone is a Trichinosis with Insomnia, nervousness, Administer once-a-day
and patient’s prodrug to neurologic or increased appetite, doses before 9AM to
response. prednisolone, myocardial indigestion, mimic normal peak
Administer daily which mediates its involvement dizziness/lightheadedness, corticosteroid blood
dose before 9 AM to glucocorticoid headache, hirsutism, levels.
effects. Prednisone
minimize adrenal hypopigmentation, Increase dosage when
is a synthetic
suppression. If long- diabetes mellitus, glucose patient is subject to
glucocorticoid that
term therapy is has both anti-
intolerance, stress.
needed, consider hyperglycaemia, WARNING: Taper
inflammatory and
alternate-day arthralgia, cataracts, doses when
immunomodulating
therapy. After long- properties. glaucoma, epistaxis, discontinuing high-
term therapy, diaphoresis, Cushing’s dose or long-term
After cell surface syndrome, edema, therapy to avoid
withdraw drug
receptor fractures, hallucinations, adrenal insufficiency.
slowly to avoid
attachment and hypertension, muscle- Do not give live virus
adrenal entry into the cell,
insufficiency. Initial wasting, osteoporosis, vaccines with
prednisone enters pancreatitis, pituitary- immunosuppressive
dose, 5–60 mg/day the nucleus, binds,
adrenal axis suppression, doses of
PO. For and activates
seizures. corticosteroids.
maintenance specific nuclear
therapy, reduce receptors, resulting
Teaching points
initial dose in small
in altered gene
increments at expression and
inhibition of Do not stop taking the
intervals until lowest
proinflammatory drug without
dose that maintains
cytokine consulting your health
satisfactory clinical
production. This care provider; take
response is reached.
agent decreases the once-daily doses at
PEDIATRIC PATIENTS number of about 9 AM.
circulating Avoid exposure to
Physiologic lymphocytes, infections.
replacement: 0.05–2 inducing cell
mg/kg/day PO or 4–5 differentiation, and Report unusual weight
mg/m2/day PO in stimulates gain, swelling of the
equal divided doses apoptosis in extremities, muscle
q 12 hr. weakness, black or
Other indications: sensitive tumor cell tarry stools, fever,
Individualize dosage populations. prolonged sore throat,
depending on The effects of
colds or other
severity of condition glucocorticoids are infections, worsening
and patient’s subject to of the disorder for
response rather mediation which the drug is
than by strict by mechanisms being taken.
adherence to that alter DNA
formulae that replication within
correct adult doses the nucleus.
for age or body
weight. Carefully
observe growth and
development in
infants and children
on prolonged
therapy.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG NURSING RESPONSIBILITIES
OF ACTION EFFECTS
GENERIC NAME: Anti- Inhalation: Use of aerosol (because SIDE Before
CROMOLYN inflammatory; Prophylaxis of fluorocarbon EFFECTS:
inhibits release (long-term propellants) in patients • Assess for possible
BRAND NAME: with coronary artery -Cough
of inflammatory control) of contraindications and
Apo-Cromolyn, Intal, mediators (e.g., bronchial disease or history of -Hoarseness
Gastrocrom, arrhythmias; dyspnea, -Bitter taste cautions: acute
histamine, asthma.
NasalCrom Prevention of acute asthma, status -Mild burning / asthmatic attacks
leukotrienes)
exercise- asthmaticus; patients stinging upon and allergy to the
CLASSIFICATION: from mast cells unable to coordinate instillation
Cromoglycates induced drugs, which are
actions or follow
bronchospasm.
instructions, pregnancy ADVERSE contraindications; and
DOSAGE: Intranasal: systemic infections,
(category B), lactation. EFFECTS:
Prevention and
20 mg/2 mL
treatment of
Safe use in children <6 y pregnancy, or lactation,
solution for not determined; use of which require cautious
seasonal and CNS: dizziness,
nebulization; 800 capsule not
mcg spray; 40 perennial headache. use.
recommended for
mg/mL nasal allergic rhinitis. children.
Derm: rash, • Perform a physical
solution; 4% ophth PO: urticaria, examination to
solution; 100 mg/5 Mastocytosis. angioedema.
establish baseline data
mL oral concentrate Treatment of EENT:
intranasal: for assessing the
ampules food allergy.
ROUTE: Treatment of nasal irritation, effectiveness of the
Nasal inflammatory nasal drug and the
Oral bowel disease. congestion, occurrence of any
FREQUENCY: sneezing. Resp:
adverse effects
Adults and children inhalation:
12 years of age and irritation of the associated with drug
older take four times throat and therapy.
a day, thirty minutes trachea, • Assess temperature to
before meals and at cough, monitor for possible
bedtime. wheezing, infections.
bronchospasm.
GI: nausea, • Monitor blood pressure,
unpleasant pulse, and auscultation
taste. Misc:
to evaluate
ALLERGIC
REACTIONS, cardiovascular
INCLUDING response.
ANAPHYLAXIS • Assess respirations and
OR adventitious sounds to
WORSENING
monitor drug
OF
CONDITIONS effectiveness.
BEING • Examine the nares to
TREATED. evaluate for any lesions
that might lead to
systemic absorption of
the drug.

During

• Note for immediate

relief. Do not
administer inhaled
steroids to treat an
acute asthma attack or
status asthmaticus
because these drugs
are not intended for the
treatment of acute
attack and will not
provide the immediate
relief needed.
• Proper tapering of
steroids. Taper
systemic steroids
carefully during the
transfer to inhaled
steroids; deaths have
occurred from
adrenaline insufficiency
with
sudden withdrawal.
• Use decongestant
drops. Have the patient
use decongestant drops
before using the
inhaled steroid to
facilitate penetration of
the drug if nasal
congestion is a
problem.
• Oral care. Have the
patient rinse
the mouth after using
the inhaler because this
will help to decrease
systemic absorption
and decrease GI upset
and nausea.
• Monitor for signs of
infection. Monitor the
patient for any sign of
 respiratory infection;
continued use of
steroids during acute
infection can lead to
serious complications
related to the
depression of the
inflammatory and
immune responses.
• Educate the
client. Provide patient
teaching, including the
drug name and
prescribed dosage,
measures to help avoid
adverse effects, warning
signs that may indicate
problems, and the need
for periodic monitoring
and evaluation, to
enhance patient
knowledge about drug
therapy and to promote
compliance.
• Ensure the
effectiveness of the
drug. Instruct the
patient to continue to
take the drug to reach
and then maintain
 effective levels (drug
takes 2 to 3 weeks to
reach effective levels).
• Provide support. Offer
support and
encouragement to help
the patient cope with
the disease and the
drug regimen.

After

• Monitor patient
response to the drug
(improved breathing).
• Monitor for adverse
effects (nasal
irritation, fever, GI
upset).
• Evaluate the
effectiveness of the
teaching plan (patient
can name drug, dosage,
adverse effects to watch
for, specific measures to
avoid them, and
measures to take to
increase the
effectiveness of the
drug).
• Monitor the
effectiveness of other
measures to ease
breathing.
 DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
ACTION RESPONSIBILITIES
GENERIC NAME: Cromoglicate For the management Contraindica ted in SIDE EFFECTS: Before:
CROMOGLICIC inhibits of patients with patients with a known -Assess vital
ACID degranulation of bronchial asthma. hypersensitiv ity to -Burning/stinging signs before
Also used in the sensation of the eye drug administration
mast cells, sodium cromoglicate or
subsequently treatment of vernal
to any of the excipients.
-Eye irritation -Check and verify with
BRAND NAME: keratoconjunctivitis, -Temporary blurry
preventing the doctor’s order and
Gastrocrom, vernal conjunctivitis, vision
release of histamine Kardex.
Nalcrom, Nasalcrom and vernal keratitis.
and slow-reacting -Observe rights in
substance of medication
CLASSIFICATION: anaphylaxis (SRS- ADVERSE
EFFECTS: administration such as
Cromoglycates A), mediators of
type I allergic giving the right drug to
reactions. the right patient using
Nausea, headache,
DOSAGE: Cromoglicate also dizziness, unpleasant the right route and at
ROUTE: may reduce the taste, joint pain and the right time.
FREQUENCY: release of swelling, skin rashes,
inflammatory aggravation of
Nasal leukotrienes. asthma, pulmonary Monitor respiratory
Allergic rhinitis Cromoglicate may infiltrates with rate, oxygen
Adult: 2.5 or 5 mg act by inhibiting eosinophilia, saturation, and lungs
of a 2% or 4% soln calcium influx. urticaria. sounds before and
is admin as drops Bronchospasm, after administration. If
wheezing, cough, more than one
or spray into each
nasal congestion and inhalation is ordered,
nostril 4 times wait at least 2 minutes
throat irritation
daily. following inhalation between inhalations.
of dry powder. Use a spacer device to
Ophthalmic Intranasal use: improve drug delivery,
Allergic Transient irritation if appropriate.
conjunctivitis of nasal mucosa.
Sneezing and Patients should remain
epistaxis compliant with the
Adult: Instill 2 (occasional). Eye medication dosing
drops of a 4% soln drops: Transient regimen. Individuals
4-6 times daily or burning and stinging. should contact their
healthcare provider if
apply a 4% oint
they experience
bid-tid.
ongoing shortness of
breath unrelieved with
Oral medication therapy. If
Food allergy, using an inhaler, the
Mastocytosis patient should be sure
Adult: 200 mg four to prime the inhaler
times daily. May prior to administering
double the dose if the dose of
medication.
effect is not
satisfactory within
2-3 wk. Max: 40
mg/kg/day.
Child: 100 mg four
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG NURSING
OF ACTION EFFECTS RESPONSIBILITIES
GENERIC NAME: Zafirlukast is a indicated for the SIDE EFFECTS: Before
ZAFIRLUKAST selective and prophylaxis and is contraindicated in - nausea, -History: Hypersensitivity
competitive chronic treatment -diarrhea, to zafirlukast; impaired
BRAND NAME: receptor antagonist of asthma in adults patients who are -stomach pain, renal or hepatic function;
Accolate of leukotriene D4 and children 5 hypersensitive to -headache, and
pregnancy, lactation;
and E4 (LTD4 and years of age and cold symptoms
CLASSIFICATION: zafirlukast or any of its acute asthma or
LTE4), components older. (stuffy nose,
Leukotriene bronchospasm
of slow-reacting inactive ingredients. sneezing, sore
Receptor ▪ Physical: T;
substance of throat)
Antagonists contraindicated in orientation,
anaphylaxis (SRSA).
Cysteinyl patients with hepatic reflexes; R,
DOSAGE:
leukotriene impairment including ADVERSE adventitious
10 and 20 mg production and EFFECTS: sounds; GI
tablets for oral hepatic cirrhosis. hives,
receptor occupation evaluation;
administration. have been -blisters,
LFTs, renal
ROUTE: correlated with the -severe itching,
function tests
Oral pathophysiology of -difficulty
FREQUENCY: asthma, including breathing,
airway edema, -swelling of your
▪ Administer on
adults and children smooth muscle face, lips, tongue,
an empty
12 years and older constriction, and or throat,
altered cellular -depressed mood,
stomach 1 hr
is 20 mg twice before or 2 hr
activity associated -unusual thoughts
daily. after meals.
with the or behavior,
inflammatory -severe sinus ▪ Ensure that
children 5 through process, which pain, drug is taken
11 years of age is contribute to the -sinus congestion, continually for
10 mg twice daily. signs and symptoms optimal effect.
of asthma.
-numbness or ▪ WARNING: Do
tingly feeling in not administer
your arms or legs, for acute
-worsening or no asthma attack
improvement in or acute
your -asthma,
bronchospasm.
-nausea,
-upper stomach After
pain,
▪ Take this drug
on an empty
stomach, 1
hour before or
2 hours after
meals.
▪ Take this drug
regularly as
prescribed; do
not stop taking
it during
symptom-free
periods; do not
stop taking it
without
consulting your
health care
provider.
▪ Do not take
this drug for
acute asthma
attack or acute
bronchospasm;
this drug is not
a
 bronchodilator;
routine
emergency
procedures
should be
followed
during acute
attacks.
▪ Avoid use of
over-the-
counter
medications
while using this
drug; many of
them contain
products that
can interfere
with drug or
cause serious
side effects. If
you think that
you need one
of these
products,
consult your
health care
provider.
▪ You may
experience
these side
effects:
Dizziness (use
caution when
 driving or
performing
activities that
require
alertness);
nausea,
vomiting (eat
frequent small
meals);
headache
(analgesics
may be
helpful).
▪ Report fever,
acute asthma
attacks, severe
headache.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Antagonizes the Prevention and Hypersensitivity to SIDE EFFECTS: Monitor
MONTELUKAST montelukast; severe Headache effectiveness
effects of chronic treatment
asthma attacks; carefully when used
BRAND NAME: leukotrienes, of asthma. bronchoconstriction due Cough in combination with
which mediate Management of to asthma or NSAIDs; phenobarbital or
the following: seasonal allergic status asthmaticus; Nasal other potent
CLASSIFICATION: lactation. congestion cytochrome P450
Leukotriene Airway edema, rhinitis. Prevention
enzyme inducers.
Receptor Smooth muscle of exercise-induced Nausea
Lab test: Periodic
Antagonists constriction, bronchoconstriction liver function tests.
Hepatotoxicity
Altered cellular in patients 15 yr and Patient & Family
DOSAGE:
activity. Result older. ADVERSE Education

5 mg, 10 mg tablets; is decreased

EFFECTS:
Do not use for
4 mg chewable inflammatory upper respiratory
reversal of an acute
tract infection,
tablets; 4 mg oral process, which asthmatic attack.
granules runny nose,
is part of sore throat, Inform physician if
ROUTE: short-acting inhaled
FREQUENCY: asthma and headache,
bronchodilators are
Adult: PO 10 mg q.d. allergic rhinitis. oral candidiasis
needed more often
in evening (thrush in your
than usual with
Child: PO 12 mo–5 y, mouth or throat),
montelukast.
4 mg q.d. in evening; back pain,
Use chewable
6–14 y, 5 mg pneumonia,
tablets (contain
chewable tablet q.d. bronchitis,
phenylalanine) with
in evening sinus infection,
caution with PKU.
cough,
mouth pain,
Do not breast feed
joint pain, while taking this
influenza,
drug.
sore throat, and
 fever

DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG EFFECTS NURSING

OF ACTION RESPONSIBILITIES
GENERIC NAME: Dextromethorphan Dextromethorphan Avoid simultaneous use SIDE EFFECTS: High dosage can
DEXTROMETHORPHAN is an agonist of is indicated in with nonselective cause
NMDA and sigma-1 combination with monoamine oxidase
BRAND NAME: brompheniramine • nausea hallucinations
receptors. It is also inhibitors (MAO
an antagonist of and • vomiting and
Auvelity, Benylin DM, inhibitors) – serotonin
α3/β4 nicotinic pseudoephedrine
syndrome. • constipation disassociation
Bromfed DM, Broncotron, receptors. However, in the treatment of • drowsiness • Avoid irritants
Cepacol Sore Throat Plus coughs and upper
the mechanism by • dizziness that
Cough, Cheracol D, which respiratory
• sedation stimulate more
Children's Nyquil Cold dextromethorphan's symptoms
associated with • confusion coughing
and Cough receptor agonism
• nervousness
and antagonism allergies or the • Teaching
CLASSIFICATION: common cold.
Cough Preparation
translates to a related to
clinical effect is not Dextromethorphan
is also used in possible
well understood.
DOSAGE: combination with multiple
Tablet (adult and guaifenesin as an ADVERSE EFFECTS:
drugs in one
pediatric) over-the-counter over
product to relieve
a cough.
• Confusion the counter
15 mg
Dextromethorphan • constipation medication
Capsule (adult) in combination • dizziness needs to
with quinidine is (mild) be addressed for
15 mg indicated in the • drowsiness example
Capsule (pediatric) treatment of (mild)
pseudobulbar acetaminophen
• headache
affect.
15 mg
25 mg • nausea or If symptoms
vomiting
Gel, oral (adult and persist
•
pediatric) stomach
more than 3-5
pain
days
7.5 mg/5 ml seek medical
ROUTE:
Oral
FREQUENCY:
assessment
Children 4-6 years old: 7.5 again
mg every 6-8 hours, not to
exceed 30 mg per day
Children 6-12 years old: 15
mg orally every 6-8 hours,
not to exceed 60 mg per
day
Children over 12 years: 10-
20 mg orally every 4 hours
or 30 mg every 6-8 hours
not to exceed 120 mg per
day
Gel
Children over 12 years: 30
mg every 6-8 hours, not to
exceed 120 mg per day
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Bromhexine is Bromohexine is Bromhexine is SIDE EFFECTS: • Assess blood
BROMHEXINE mucolytic agent used alone or with contraindicated for use pressure (BP) and
other ingredients • Irritation of ear
used for a variety in patients with known compare to
BRAND NAME:
of respiratory
conditions
such as
diphenhydramine,
hypersensitivity or • ☞ Allergic normal values
MUCOHEX idiosyncratic reaction to skin rash
associated with dextromethorphan, Report changes in
bromhexine
CLASSIFICATION:
Cough Preparation
increased mucus
secretion. It is
and guaifenesin to
reduce mucus hydrochloride (or any • ☞ Dizziness BP, either a
of the other ingredients problematic

DOSAGE:
derived from the
Adhatoda vasica
viscosity and clear
mucus in conditions in the product). • ☞ Headache decrease in BP
ROUTE:
FREQUENCY:
plant and aids in
the clearance of
associated with
mucus • ☞ Nausea
(hypotension) or
a sustained

Oral
excess mucus,
improving
hypersecretion,
including the • ☞ Vomiting increase in BP
(hypertension).
☞
Mucolytic breathing and common cold,
Adult: For the influenza, • Diarrhea • Assess heart rate,
reducing cough.
☞
treatment of It was
respiratory tract ECG, and heart
bronchopulmonary infections, or other • Difficulty
introduced into sounds,
diseases or conditions conditions while breathing
the market in especially during
associated with
excessive mucous
1963, and is
widely available
• ☞ Rash exercise Report
secretion: 8 mg tid as
needed, may be
as an over-the-
counter drug in
• ☞ Sweating
any rhythm
disturbances or
☞
increased to 16 mg
many countries. • Vomiting symptoms of
tid for the 1st 7 days.
Recently, increased
☞
Child: 2-5 years 2 mg
bromhexine and •
tid or 4 mg bid (Max: Headache arrhythmias,
its metabolite
8 mg daily); 6-11
ambroxol have
including
years 4-8 mg tid palpitations,
 ☞
(Max: 24 mg daily); garnered interest chest discomfort,
≥12 years Same as for the potential • Respiratory
shortness of
adult dose. prevention and tract infection
breath, fainting,
☞
Treatment or dosage treatment of
recommendations COVID-19 due • Throat and
may vary among to their infection fatigue/weakness.
countries and interactions with • Monitor signs of
individual products cell receptors in
(refer to detailed hypersensitivity
the lungs
product guideline). ADVERSE EFFECTS: reactions during
Other reported and after IV
adverse effects include
headache, vertigo administration.
(dizziness), sweating Signs include
and allergic reactions. pulmonary
symptoms
(tightness in the
throat and chest,
wheezing, cough,
dyspnea) or skin
reactions (rash,
pruritus,
urticaria). Notify
physician or
nursing staff
immediately if
these reactions
occur.
• Monitor
symptoms of
nasal allergies
(sneezing, rhinitis,
 itching eyes,
cough) or chronic
urticaria (rash,
hives, itching) to
help document
benefits of this
drug in treating
these disorders.
• When treating
anaphylaxis:
assess for signs of
successful
treatment,
including
decreased skin
reactions (rash,
urticaria) and
increased airway
patency and
ventilation
(decreased
dyspnea,
wheezing, and so
forth).
• Assess dizziness
and drowsiness
that might affect
gait, balance, and
other functional
 activities. Report
balance problems
and functional
limitations to the
physician, and
caution the
patient and
family/caregivers
to guard against
falls and trauma.
• Monitor signs of
increased
excitation in
children. Severe
or problematic
excitation may
require a change
in dose or drug.

Interventions
• Guard against
falls and trauma
(hip fractures,
head injury, and
so forth).
Implement fall-
prevention
strategies,
 especially in older
adults or if
balance is
impaired
(See Appendix E).
• Because of an
increased risk of
arrhythmias and
abnormal BP
responses, use
caution during
aerobic exercise
and other forms
of therapeutic
exercise Assess
exercise tolerance
frequently (BP,
heart rate, fatigue
levels), and
terminate
exercise
immediately if
any untoward
responses occur

Patient/Client-
Related Instruction
• Advise patient
about the risk of
daytime
drowsiness and
decreased
attention and
mental focus.
These problems
can be severe in
certain people.
Use care ...
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATIO DRUG EFFECTS NURSING
OF ACTION N RESPONSIBILITIES
GENERIC NAME: Diphenhydramin Diphenhydramin Hypersensitivity ; SIDE EFFECTS: Before
DIPHENHYDRAMINE e predominantly e is a first- neonates, lactation. • dry mouth,
works via the generation nose, and ▪ History: Allergy
BRAND NAME: antagonism of H1 histamine H1 throat to any
(Histamine 1) receptor antihistamines,
Acetadryl, Advil PM, Aleve receptors . Such antagonist (H1 • drowsiness narrow-angle
PM, Allegra Cooling Relief H1 receptors are antihistamine) glaucoma,
Anti-itch, Banophen, that is widely • dizziness
located on stenosing
Benadryl respiratory available as a peptic ulcer,
• nausea
non-prescription,
CLASSIFICATION: smooth muscles, symptomatic
vascular over-the-counter • vomiting
Cough Preparation (OTC) prostatic
endothelial cells,
DOSAGE:
medication. As • loss of hypertrophy,
the
ROUTE:
an OTC appetite asthmatic
FREQUENCY: gastrointestinal
medication, attack, bladder
Oral tract (GIT),
• constipatio neck
diphenhydramine
▪ 25–50 mg q 4– cardiac tissue,
is typically n obstruction,
8 hr PO. immune cells, the
formulated as pyloroduodena
▪ Motion uterus, and the • increased
central nervous
tablets and l obstruction,
sickness: Give chest
system (CNS)
creams indicated
congestion
third trimester
full dose for use in of pregnancy,
neurons . When
prophylacticall treating sneezing, • headache lactation
the H1 receptor is
y 30 min before runny nose,
▪ Physical: Skin
stimulated in
exposure to these tissues it
itchy/watery • muscle
color, lesions,
motion, and produces a variety
eyes, itching of weakness
texture;
repeat before nose or throat,
of actions
insomnia, • excitement orientation,
meals and at including reflexes, affect;
pruritis, urticaria, (especially
bedtime. increased vascular vision
insect in children)
permeability, bites/stings, examination; P,
 ▪ Nighttime sleep promotion of allergic rashes, • nervousnes BP; R,
aid: 25–50 mg vasodilation and nausea s adventitious
PO at bedtime. causing flushing, sounds; bowel
▪ Cough decreased sounds;
suppression: atrioventricular prostate
(AV) node
25 mg q 4 hr palpation; CBC
conduction time,
PO, not to ADVERSE with
stimulation of
exceed 150 mg EFFECTS: differential
sensory nerves of
in 24 hr. During
airways
Parenteral producing • dry mouth,
▪ 10–50 mg IV or nose, and
▪ Administer
coughing, smooth
deep IM or up throat. with food if GI
muscle
to 100 mg if • drowsiness. upset occurs.
contraction of
required. • dizziness.
▪ Administer
bronchi and the
Maximum daily syrup form if
GIT, and • nausea.
dose is 400 mg. eosinophilic
patient is
• vomiting.
chemotaxis that unable to take
• loss of
promotes the tablets.
appetite.
allergic immune ▪ Monitor
• constipation.
response patient
response, and
arrange for
adjustment of
dosage to
lowest possible
effective dose.
Teaching points
▪ Take as
prescribed;
avoid excessive
dosage.
▪ Take with food
if GI upset
occurs.
▪ Avoid alcohol;
serious
sedation could
occur.
▪ These side
effects may
occur:
Dizziness,
sedation,
drowsiness
(use caution
driving or
performing
tasks requiring
alertness);
epigastric
distress,
diarrhea or
constipation
(take drug with
meals); dry
mouth (use
frequent
mouth care,
suck sugarless
lozenges);
thickening of
bronchial
secretions,
dryness of
 nasal mucosa
(use a
humidifier).
▪ Report
difficulty
breathing,
hallucinations,
tremors, loss of
coordination,
unusual
bleeding or
bruising, visual
disturbances,
irregular
heartbeat.
 DRUG ORDER MECHANIS INDICATIO CONTRAINDICATI DRUG EFFECTS NURSING RESPONSIBILITIES
M OF N ON
ACTION
GENERIC Oxymetazoline Oxymetazoli Nasal SIDE EFFECTS: • Assess for possible cautions
NAME: binds to α1- ne is Nasal congestion • burning and contraindications: any
OXYMETAZOLI and α2-
Adult: For the
indicated for
• stinging history of allergy to the
NE adrenoceptors, the topical symptomatic relief
which are Gq- drug or a component of the
protein-
treatment of of congestion • increased nasal drug vehicle;
persistent associated with discharge
BRAND NAME: coupled
facial
glaucoma; hypertension; dia
upper respiratory
Afrin, Dristan 12- receptors that
erythema • dryness inside betes; thyroid disease;
hour Nasal Spray, promote allergies, hay fever,
associated the nose coronary disease; and
Kovanaze vascular common cold,
with rosacea prostate problems;
smooth muscle sinusitis, and otitis • sneezing
CLASSIFICATI contraction by in adults. pregnancy and lactation,
media: As 0.05%
ON: increasing
nasal spray: Usual • nervousness and acute infections, all of
Nasal intracellular Ophthalmic
dose: 1-2 sprays which could be exacerbated
decongestant calcium levels oxymetazoli • nausea
into each nostril 2- by the sympathomimetic
in response to ne is
DOSAGE: ligand 3 times daily as • dizziness effects and which require
indicated for
ROUTE: activation. necessary. Max cautious use of the drug.
the • headache
FREQUENCY:
treatment of treatment • Perform a physical
Nasal acquired duration: 5-7 examination to establish
Rosacea is a
Nasal congestion blepharoptos consecutive days. baseline data for assessing
condition
Adult: For the is in adults. Alternatively, 2-3 the effectiveness of the
characterized
symptomatic relief sprays into each ADVERSE EFFECTS: drug and the occurrence of
by transient
of congestion and persistent When used nostril bid for up to Significant: Exacerbate any adverse effects
associated with facial in 3 days. Max: 2 d vascular
upper respiratory combination doses per 24 hours.
allergies, hay erythema. By with As 0.05% nasal insufficiency, acute associated with drug
fever, common stimulating tetracaine drops: Usual dose: angle-closure therapy.
cold, sinusitis, and α1A- Instill 1-2 drops glaucoma; local nasal
intranasally, • Assess skin color and
otitis media: As adrenoceptors oxymetazoli into each nostril 2- effects (e.g. burning, temperature to assess the
0.05% nasal spray: and causing ne is 3 times daily. Max stinging, sneezing, sympathetic response.
Usual dose: 1-2 vasoconstrictio indicated for treatment increased nasal
sprays into each n, regional
• Evaluate orientation and
duration: 5-7 discharge), rhinitis
nostril 2-3 times oxymetazoline
anesthesia reflexes to evaluate the
daily as necessary. consecutive days. medicamentosa and
is believed to
when central nervous system
Max treatment Child: As 0.01% rebound nasal
diminish the
performing a (CNS) effects of the drug.
duration: 5-7 symptoms of nasal drops: ≤4 congestion (frequent
restorative • Monitor pulse, blood
consecutive days. erythema.In weeks Instill 1 drop or long-term use).
Alternatively, 2-3 blepharoptosis,
procedure on
into each nostril 2- Cardiac pressure, and cardiac
sprays into each it is Teeth 4-13
3 times daily; 5 disorders: Rarely, auscultation to assess
nostril bid for up hypothesized and A-J in
weeks to 1 year tachycardia, cardiovascular and
to 3 days. Max: 2 adults and
that Instill 1-2 drops palpitations. sympathomimetic effects.
doses per 24 children who
hours. As 0.05%
oxymetazoline
into each nostril 2- Eye disorders: Rarely, • Evaluate respirations and
works by weigh 40 kg
nasal drops: Usual 3 times daily. Max eye irritation, dryness, adventitious breath sounds
stimulating α- or more.
dose: Instill 1-2
adrenergic
treatment redness or to assess the effectiveness
drops into each
receptors on Oxymetazoli duration: 5-7 discomfort. of the drug and the
nostril 2-3 times consecutive days. Gastrointestinal
the Müller ne can be potential excess effect.
daily. Max
muscle that found in As 0.025% nasal disorders: Dry mouth • Evaluate nasal mucous
treatment
elevates the over-the- drops: 1-6 or throat. Rarely, membrane to monitor for
duration: 5-7
consecutive days. upper eyelid, counter nasal years Usual dose: nausea. lesions that could lead to
Child: As 0.01% causing muscle products as a Instill 1-2 drops Injury, poisoning and systemic absorption and to
contraction. nasal into each nostril 2- procedural
nasal drops: ≤4
Oxymetazoline evaluate the decongestant
weeks Instill 1 decongestant 3 times daily. Max complications: Applicat
is used in effect.
drop into each . treatment ion site reactions (e.g.
combination • Monitor urinary output to
nostril 2-3 times duration: 5-7 dermatitis, pruritus,
daily; 5 weeks to 1 with tetracaine evaluate for urinary
consecutive days. erythema, pain).
year Instill 1-2 for local
As 0.05% nasal Investigations: Rarely, retention.
drops into each anesthesia in
dentistry. Such drops: >6 increased blood
nostril 2-3 times
daily. Max combination years Same as adult pressure. • Monitor temperature to
treatment use adds dose. As 0.05% Nervous system monitor for the possibility
duration: 5-7 beneficial nasal spray: >12 disorders: Rarely, of acute infection.
consecutive days. effects: the years Usual dose: headache.
As 0.025% nasal vasoconstrictor
1-2 sprays into Psychiatric
drops: 1-6 years counteracts the
Usual dose: Instill each nostril 2-3 disorders: Rarely,
local anesthetic
1-2 drops into agent's
times daily as insomnia, anxiety.
each nostril 2-3 vasodilatory necessary. Max Respiratory, thoracic
times daily. Max action, thereby treatment and mediastinal
treatment constricting duration: 5-7 disorders: Rarely,
duration: 5-7 dilated consecutive days. nasal dryness,
consecutive days. arterioles and discomfort or
As 0.05% nasal reducing blood irritation; epistaxis.
drops: >6 years flow to the Skin and subcutaneous
Same as adult application
dose. As 0.05% tissue
area.
nasal spray: >12 disorders: Worsening
Oxymetazoline
years Usual dose: inflammatory lesions
relieves nasal
1-2 sprays into of rosacea (topical).
congestion by
each nostril 2-3
vasoconstrictin Vascular
times daily as disorders: Rarely,
g the
necessary. Max
respiratory reactive hyperaemia.
treatment
microvasculatu
duration: 5-7
re, in both
consecutive days.
resistance and
capacitance
blood vessels
on the human
nasal mucosa,
leading to
decreased nasal
mucosal blood
flow, edema,
 and airflow
resistance.

DRUG ORDER MECHANIS INDICATIO CONTRAINDICATI DRUG EFFECTS NURSING RESPONSIBILITIES

M OF N ON
ACTION
GENERIC NAME: Phenylephrine Used for the Contraindica ted for SIDE EFFECTS: Assess blood pressure
Phenylephrine is an agonist of temporary the patient with: when patient is lying down.
relief of - Feeling of restless
α1- - Overactive thyroid Compare to normal values,
BRAND NAME: congestion or - Flushing (warmth,
adrenoceptors. gland
Silfedrine stuffiness in redness, or tingly feeling) and and report a sustained
Nasal - Coronary artery - loss of
CLASSIFICATION decongestant the nose
disease
increase in blood pressure
action is caused by (hypertension) to the
:
hay fever or - Partial heart block
Nasal mediated by
other - Slow heartbeat ADVERSE EFFECTS: physician.
Decongestant activation of α1- - Sleep problem - Monitor signs of peripheral
adrenoceptors allergies,
- Chronic heart – Severe dizziness
DOSAGE: in the arterioles
colds, or
- Blurred vision
vasoconstriction, such as
sinus trouble failure extreme coldness in the
ROUTE: of the nasal - Severe headache
FREQUENCY: mucosa. This hands and feet, cyanosis,
- Increased blood
causes
pressure and muscle cramping.
10mg PO Q4 vasoconstriction
Notify physician of severe
, which leads to
decreased or prolonged signs of
edema and vasoconstriction.
increased - Assess symptoms of
drainage of the respiratory distress
sinus cavities.
including dyspnea,
For the
treatment of shortness of breath,
anastomosis andcyanosis
related faecal
incontinence, - Assess administration site
phenylephrine and report signs of irritation,
causes α1-
skin damage, or phlebitis
adrenoceptor- (local pain, swelling,
mediated
inflammation).
constriction of
smooth muscle
of the internal
anal sphincter,
which helps
lessen
incontinence.
 DRUG ORDER MECHANISM INDICATION CONTRAINDICATION DRUG EFFECTS NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Fluticasone Fluticasone
Hypersensitivity to the
SIDE EFFECTS: Monitor rate,
FLUTICASONE propionate is
propionate medication. Many depth,
PROPIONATE works through indicated as an • minor nosebleed,
inhaler for the
formulations contain milk
• burning or
rhythm, type of
an unknown proteins or lactose, and
BRAND NAME: mechanism to treatment and those with known itching in your respiration;
Advair, Airduo, affect the action
management of allergies to these nose, quality rate of
Airduo Respiclick, asthma by pulse.
of various cell substances should not use • sores or white
prophylaxisLabelas this medication.
CLASSIFICATION: types and well as patches inside or Assess lung
Intranasal mediators of inflammatory and Fluticasone is around your sounds
corticosteroids inflammation. pruritic contraindicated as a nose, for rhonchi,
primary treatment of
Fluticasone dermatoses. • cough, wheezing, rales.
DOSAGE: acute bronchospasm
propionate Fluticasone • trouble Assess oral
activates propionate nasal breathing,
ROUTE:
glucocorticoid spray is indicated mucous
• headache,
receptors and for managing membranes for
FREQUENCY: • back pain,
inhibits lung allergic and
• sinus pain,
evidence of
eosinophilia in nonallergic rhinitis.
• sore throat,
rats candidiasis.
• fever,
• nausea, and
• vomiting
ADVERSE EFFECTS:

• severe or
ongoing
nosebleeds,
• noisy breathing,
• runny nose,
• crusting around
your nostrils,
• redness, sores or
white patches in
your mouth or
throat,
• fever,
• chills,
• body aches,
• blurred vision,
• eye pain,
• seeing halos
around lights,
 DRUG ORDER MECHANISM OF INDICATION CONTRAINDICATI DRUG EFFECTS NURSING
ACTION ON RESPONSIBILITIES
GENERIC NAME: Beclomethasone Beclomethasone is Contraindica ted for SIDE EFFECTS: Do not give live
BECLOMETHASO dipropionate is a used to prevent and the patient with: virus vaccines
NE Headache - Sore throat -
corticosteroid and control symptoms - Active tuberculosis with
Nausea
prodrug that is (wheezing and - Inactive
BRAND NAME: - Cough immunosuppress
Alanase, rapidly activated by shortness of breath) tuberculosis - - Runny or stuffy nos
hydrolysis to the Measles
ive doses of
Beconase, caused by asthma. corticosteroids.
Propaderm, active monoester, 17 - Injury to the nose
This medication belo
Qnasl, Qvar, monopropionate (17-
ADVERSE EFFECTS: - Give daily dose
ngs to a class of - Nosebleed CNS: headache. EENT: catar
Rivanase AQ BMP), which before 9 AM to
drugs known as acts, dysphonia,
mediates anti- mimic normal
inflammatory corticosteroids. It oropharyngeal fungal
works by reducing infections, pharyngitis, peak
CLASSIFICATIO actions. 17-BMP has
N: been shown in the swelling of the rhinitis, corticosteroid
vitro to exhibit a airways in sinusitis. Resp: bronchospas blood levels.
Intranasal m, cough, - Increase dosage
binding affinity for the lungs to make
corticosteroid wheezing. Endo:adrenal
the human breathing easier.This when patient is
suppression (increased dose,
DOSAGE:
glucocorticoid medication must be long-term therapy only), subject to stress.
ROUTE: receptor which is used regularly to decreased growth
FREQUENCY: approximately 13 prevent breathing (children). MS: back pain. - Taper doses
times that of
problems (attacks when
40-80 mcg to 2 oral dexamethasone and
of wheezing/shortnes discontinuing
25 times that of
inhalations of 40 beclomethasone s of breath). It does high- dose or
mcg/actuation) BID, dipropionate.11 Upon not work right away long-term therapy
approximately 12 binding of the and should not be
hours apart ligand, the used to relieve
glucocorticoid an asthma attack. If
receptors dimerize
an attack occurs, use
and translocate into
your quick-
the nucleus, where
they subsequently
relief inhaleras
bind to prescribed.
glucocorticoid
response elements
(GRE) on
glucocorticoid-
responsive genes,
leading to changes in
transcription. There
are several proposed
mechanisms for the
anti-inflammatory
action of
corticosteroids.
Corticosteroids may
work by increasing
the transcription of
genes coding for
anti-inflammatory
proteins, including
lipocortin-1 and
interleukin-
10.4 Corticosteroids
were also shown to
inhibit the
expression of
multiple genes that
encode pro-
inflammatory
factors, such as
cytokines,
chemokines, and
adhesion molecules,
that are activated
during the chronic
inflammatory
process.5 This is
thought to be due to
the direct inhibitory
interaction between
activated
glucocorticoid
receptors and
activated pro-
inflammatory
transcription factors,
such as nuclear
factor-kappa B and
activator protein-
1.4 Chronic
inflammation is
often characterized
by enhanced
expression of these
transcription factors
that bind to and
activate coactivator
molecules, which
then acetylate core
histones to switch on
gene transcription to
further amplify the
inflammatory
process.5 Corticostero
ids suppress the
multiple
inflammatory gene
expression by
promoting histone
deacetylation,
resulting in tighter
coiling of DNA and
reduced access of
transcription factors
to their binding
sites.4