Transcript The Examination

PYRAMID POINTS
CHAPTER 58:
RESPIRATORY
MEDICATIONS
PYRAMID POINTS
I. Bronchodilators
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Description
• Should be used with caution in clients with hypertension,
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diabetes mellitus, narrow-angle glaucoma
Theophylline increases risk of digitalis toxicity, decreases
effects of lithium and phenytoin (Dilantin)
If theophylline and β blocker are administered together,
cardiac dysrhythmias may result
β Blockers, cimetidine (Tagamet), erythromycin increase
effects of theophylline
Barbiturates, carbamazepine (Tegretol) decrease
effectiveness of theophylline
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I. Bronchodilators (continued)
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Side effects
• Palpitations, tachycardia
• Hyperglycemia
• Decreased clotting time
Interventions
• Monitor therapeutic serum theophylline level of 10 to 20
mcg/mL
• Intravenous- (IV-) administered aminophylline or
theophylline preparations administered slowly using
infusion pump
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II. Glucocorticoids (Corticosteroids)
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Anti-inflammatory agents; reduce airway edema
See Module 54 for information on glucocorticoids
(corticosteroids)
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III. Inhaled Nonsteroidal Antiallergy Agents
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Description
• Antiasthmatic, antiallergic, mast cell stabilizers inhibit
mast cell release after exposure to antigens
• Used to treat allergic rhinitis, bronchial asthma,
exercised-induced bronchospasm
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Side effects
• Cough, bronchospasm following inhalation
Interventions
• Instruct client to drink few sips of water before, after
inhalation
• Instruct client not to discontinue medication abruptly
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IV. Leukotriene Modifiers
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Description
• Used in prophylaxis and treatment of chronic bronchial asthma;
not used for acute asthmatic episodes
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Side effects
• Headache; nausea and vomiting; dyspepsia; diarrhea;
generalized pain; fever; dizziness
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Interventions
• Assess lung sounds for rhonchi, wheezing; assess liver
function studies as prescribed
• Instruct client to take medication 1 hour before or 2 hours after
meals; instruct client not to discontinue medication, to take as
prescribed
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V. Monoclonal Antibodies
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Description
• Immunoglobulins that can be synthesized to have single
specificity for therapeutic regimens, such as
immunosuppression
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Side effects
• Immunosuppression
Interventions
• Instruct client to avoid others with infectious disorders
• Instruct client to eat well-balanced diet, get adequate rest
and sleep
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VI. Antihistamines
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Description
• Medications that compete with histamine for receptor
sites, thus preventing histamine response
• Diphenhydramine (Benadryl) has anticholinergic effects,
should be avoided by clients with narrow-angle glaucoma
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Side effects
• Drowsiness; urinary retention; blurred vision; wheezing;
constipation; dry mouth; gastrointestinal (GI) irritation;
hypotension; photosensitivity; nervousness
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VI. Antihistamines (continued)
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Interventions
• Instruct client to avoid hazardous activities, alcohol,
central nervous system (CNS) depressants
• Instruct client taking medication for motion sickness to
take 30 minutes before event, before meals, and at
bedtime during event
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VII. Nasal Decongestants
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Description
• Stimulate -adrenergic receptors, producing
vasoconstriction of the capillaries in nasal mucosa
• Used with extreme caution in clients with hypertension,
cardiac disease, hyperthyroidism, diabetes mellitus
• Can cause tolerance, rebound nasal congestion
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VII. Nasal Decongestants (continued)
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Side effects
• Tolerance, rebound nasal congestion
Interventions
• Monitor for cardiac dysrhythmias
• Monitor blood glucose levels
• Instruct client regarding importance of limiting use of
nasal sprays, drops
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VIII. Expectorants and Mucolytic Agents
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Description
• Expectorants loosen bronchial secretions; then they can be
eliminated with coughing
• Mucolytics thin out bronchial mucous
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Side effects
• GI irritation; rash; oropharyngeal irritation
Interventions
• Instruct client to take medication with full glass of water,
maintain adequate fluid intake
• Encourage client to cough and breathe deeply
• Acetylcysteine (Mucomyst) should not be mixed with other
medications if given via nebulizer
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IX. Antitussives
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Description
• Act on cough center in medulla to suppress cough reflex
 Side effects
• Constipation
• Respiratory depression
 Interventions
• Instruct client if cough lasts longer than 1 week, should
notify physician
• Encourage client to maintain adequate fluid intake
• Encourage client to sleep with HOB elevated
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X. Narcotic Antagonist
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Description
• Reverses respiratory depression in narcotic overdose
Side effects
• CNS depression; nausea and vomiting; tremors;
diaphoresis; hypertension; tachycardia
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Interventions
• Assess vital signs, especially respirations
• Have oxygen, resuscitation equipment available during
administration
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XI. Use of an Inhaler
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If two different inhaled medications prescribed,
administer bronchodilator first, corticosteroid next
Wait 5 minutes following bronchodilator before
inhaling corticosteroid
Client should take in one deep breath before
activating inhaler, hold breath
10 to 15 seconds before breathing out slowly
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XII. Tuberculosis (TB) Medications
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Description
• Use of multidrug regimen destroys organisms as quickly
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as possible, minimizing emergence of medicationresistant organisms
Individuals with active TB should be treated for
6 to 9 months (longer if HIV-positive)
After infected individual has received medication for 2 to
3 weeks, risk of transmission greatly reduced
Most clients have negative sputum cultures after
3months’ compliance with medication therapy
Individuals exposed to active TB treated with prophylactic
isoniazid (INH) for 9 to 12 months
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XIII. First-line Medications for TB
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Isoniazid (INH, Laniazid, Nydrazid)
• INH contraindicated in clients with hypersensitivity, acute
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liver disease
Use INH with caution in clients with chronic liver disease,
alcoholism, renal impairment, or taking hepatotoxic
medications
INH may decrease ketoconazole (Nizoral) concentration
Assess for hepatic dysfunction
Monitor liver function test results
Monitor for signs of hepatitis
Monitor for tingling, numbness, burning extremities
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XIII. First-line Medications for TB (continued)
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Isoniazid (INH, Laniazid, Nydrazid) (continued)
• Monitor for visual changes; notify physician if they occur
• Monitor complete blood count (CBC), blood glucose level
• Administer INH 1 hour before or 2 hours after meal
• Administer INH at least 1 hour before antacids
• Instruct client not to skip doses, to take medication for full
length of prescribed therapy
• Instruct client to avoid tyramine-containing foods
• Instruct client in signs of neurotoxicity, hepatitis,
hepatoxicity
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XIII. First-line Medications for TB (continued)
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Rifampin (Rifadin)
• Side effects include vision changes, hepatotoxicity,
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hepatitis, increased uric acid levels, blood dyscrasias,
colitis
Assess for hypersensitivity
Evaluate CBC, uric acid, liver function test results
Assess for signs of hepatitis
Instruct client not to skip dose, to take medication for full
length of prescribed therapy
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XIII. First-line Medications for TB (continued)
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Rifampin (Rifadin) (continued)
• Advise client to keep all physician appointments,
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appointments for laboratory work
Advise client to take medication on empty stomach with 8
oz water 1 hour before or 2 hours after meal
Advise client to avoid taking medication with antacids
Instruct client that bodily fluids will be red-orange
Instruct client to report signs of jaundice to physician
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XIII. First-line Medications for TB (continued)
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Ethambutol (Myambutol)
• Use with caution in clients with renal dysfunction, gout,
ocular defects, retinopathy, cataracts, ocular
inflammatory disorders, or taking neurotoxic medications
• Side effects include hypersensitivity reactions, dermatitis,
optic neuritis, peripheral neuritis
• Determine baseline visual acuity, color discrimination
• Monitor for visual changes; notify physician if they occur
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XIII. First-line Medications for TB (continued)
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Ethambutol (Myambutol) (continued)
• Administer once every 24 hours with food
• Monitor uric acid concentrations; assess for painful,
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swollen joints
Monitor intake and output (I&O), renal function
Monitor for dizziness; initiate safety precautions
Assess for peripheral neuritis
Instruct client not to skip dose, to take medication for full
length of prescribed therapy
Advise client to keep all physician appointments,
appointments for laboratory work
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XIII. First-line Medications for TB (continued)
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Pyrazinamide
• Use with at least one other antitubercular medication
• Side effects include increased liver function, uric acid
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levels, photosensitivity, hepatotoxicity
Evaluate CBC, liver function test results, uric acid levels
Observe for hepatotoxic effects
Evaluate blood glucose levels
Instruct client to take medication with food
Instruct client to avoid sunlight, ultraviolet light
Advise client to keep all physician appointments,
appointments for laboratory work
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XIV. Second-line Medications for Tuberculosis
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Capreomycin sulfate (Capastat Sulfate)
• Do not administer to clients receiving streptomycin
Kanamycin (Kantrex) and amikacin (Amikin)
• Contraindicated in clients with hypersensitivity,
neuromuscular disorders, eighth cranial nerve damage
• Risk of toxicity increases when taken with other
aminoglycosides, nephrotoxic, ototoxic drugs
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XIV. Second-line Medications for TB (continued)
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Kanamycin (Kantrex) and amikacin (Amikin)
(continued)
• Monitor for ototoxic, neurotoxic, nephrotoxic adverse
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effects
Monitor liver, renal function test results
Assess hydration status; maintain hydration
Advise client to keep all physician appointments,
appointments for laboratory work
Advise to notify physician if hearing loss, changes in
vision, urinary problems occur
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XIV. Second-line Medications for TB (continued)
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Streptomycin
• Contraindicated in clients with hypersensitivity, myasthenia
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gravis, parkinsonism, eighth cranial nerve damage
Risk of toxicity increases when taken with other
aminoglycosides or nephrotoxic, ototoxic medications
Monitor liver, renal function test results
Monitor for ototoxic, neurotoxic, nephrotoxic reactions
Assess hydration status; maintain hydration during therapy
Advise client to keep all physician appointments, appointments
for laboratory work
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XIV. Second-line Medications for TB (continued)
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Ethionamide (Trecator-SC)
• Side effects include metallic taste in mouth, orthostatic
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hypotension, jaundice, peripheral neuritis
Administer pyridoxine as prescribed
Instruct client to take medication with food, meals
Instruct client to change position slowly
Instruct client to report signs of rash
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XIV. Second-line Medications for TB (continued)
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Para-aminosalicylic acid (Paser)
• Contraindicated with hypersensitivity
• Side effects include hypersensitivity, bitter taste in mouth, blood
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dyscrasias, crystalluria
Assess for hypersensitivity
Offer clear water to rinse mouth, chewing gum, hard candy
following medication
Encourage fluid intake
Instruct client to take medication with food
Instruct client not to take over-the-counter aspirin without
physician’s approval
Instruct client to report immediately signs of blood dyscrasia
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XIV. Second-Line Medications for TB
(continued)
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Cycloserine (Seromycin)
• Side effects include CNS reactions, neurotoxicity, altered
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level of consciousness
Monitor for changes in mental status, thought processes
Monitor serum drug level; peak, 2 hours after dosing, 25
to 35 mcg/mL
Advise client of need for weekly serum drug levels
Teach client about signs indicating adverse effects
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XV. Influenza Medications (see Module 57, Influenza)
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Vaccines
• Administered annually
• Contraindicated in hypersensitivity, chicken egg allergy, active
infection or illness, Guillain-Barré syndrome, pregnancy (live
activated vaccine), age younger than
6 months
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Antivirals
• Administered as prophylaxis but do not replace vaccine or
prevent transmission
• Administered within 24 to 48 hours of onset of symptoms
• Contraindicated in hypersensitivity, pregnancy
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The client taking oral theophylline has a serum theophylline
level of 15 mcg/mL. The nurse interprets that this result is:
1.
2.
3.
4.
Below the therapeutic range
In the middle of the therapeutic range
Near the top of the therapeutic range
In excess of the therapeutic range
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