Review of beta-2 agonists, anticholinergics, and corticosteroids for respiratory
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| Albuterol Drug Class | Beta-2 agonist
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| Albuterol Mechanism of Action | Stimulation of SNS beta-2 receptors
Smooth muscle relaxation of bronchioles
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| Albuterol Adverse Effects | Tachycardia, palpitations, restlessness
H/A
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| Albuterol Contraindications | Cardiac disease, hyperthyroidism
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| Albuterol Interactions | Beta blockers
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| Albuterol Nursing Indications | Monitor HR, respiratory status
Teach regarding rescue inhaler use
Use 30-60 minutes before exercise
Avoid caffeine
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| Ipratropium Drug Class | Anticholinergic
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| Ipratropium Mechanism of Action | Increased PNS stimulation on CN X
Antagonizes muscarinic receptors
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| Ipratropium Adverse Effects | Dry mouth, blurry vision, tachycardia, urinary retention, constipation
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| Ipratropium Contraindications | Narrow angle glaucoma
Bladder neck obstruction/BPH
Allergy to soy or peanuts (propellant sensitivity)
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| Ipratropium Interactions | Other anticholinergics
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| Ipratropium Nursing Indications | Monitor VS, respiratory status
Monitor UOP
Teach to void prior to drug administration
Lozenges
Fiber/fluids
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| Budesonide Drug Class | Corticosteroid
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| Budesonide Mechanism of Action | Inhibition of inflammatory response
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| Budesonide Adverse Effects | Sore throat
Xerostomia
Oral candidiasis
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| Budesonide Contraindications | Active infections
Oral lesions increase systemic absorption
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| Budesonide Nursing Indications | Monitor respiratory status, oral mucosa
Taper the dose
Rinse mouth after inhalation
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| Drug of choice for rescue inhaler | SABA - albuterol
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| Theophylline Drug Class | Methylxanthines
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| Theophylline Mechanism of Action | Smooth muscle relaxation via mobilization of calcium and activation of prostaglandins
Inhibition histamine
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| Theophylline Adverse Effects | Typically only associated with toxicity
20-25 mcg/mL: N/V/D, insomnia, diaphoresis, H/A and irritability
>30-35 mcg/mL: hyperglycemia, hypokalemia, hypotension, dysrhythmias, tachycardia, seizures, brain damage and death
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| Theophylline Interactions | Multiple interactions – including caffeine
Smoking increases metabolism of theophylline
With smoking cessation – toxicity!
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| Theophylline Contraindications | Caution with cardiac disease, hyperthyroidism
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| Theophylline Nursing Indications | Monitor VS, lung sounds
Serum drug level
Decrease caffeine intake
Toxicity treatment
Activated charcoal, lidocaine, benzodiazepines
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| Montelukast Drug Class | Leukotriene receptor antagonist
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| Montelukast Mechanism of Action | Decreases: neutrophil, eosinophil migration, aggregation, leukocyte adhesion, capillary permeability, smooth muscle contraction
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| Montelukast Adverse Effects | H/A, dizziness
Elevated LFTs
Suicidal ideation
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| Montelukast Interactions | Increases toxicity of theophylline, warfarin
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| Montelukast Nursing Indications | Monitor respiratory status
Take on empty stomach
Taper dose
Avoid triggers
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