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Selective beta2-adrenergic agonists - Bronchodilators
- Terbutaline (Brethine)
- Metaproterenol (Alupent)
What is the MOA for Terbutaline (Brethine) & Metaproterenol (Alupent)?
- relaxes smooth muscle of bronchi
- keep from going into labor (Brethine)
How is Terbutaline (Brethine) & Methaproterenol (Alupent) administered ?
What are side effects of Terbutaline (Brethine) and Methaproterenol (Alupent)?
tremors, restlessness, anxiety, headaches, nervousness, tachycardia, palpitations, dysrhythmias, hyperglycemia
Anticholinergics – bronchodilator
Is an Alternative bronchodilator but SABA first choice
Names of anticholinergics
- Ipratropium bromide (Atrovent)
- ipratropium (Combivent)
Action of anticholinergics?
How is anticholinergic bronchodilator administered?
- aerosol inhaler
- Caution : Narrow-angle glaucoma
Methylxanthine (Xanthine) derivatives are:
- Aminophylline (Somophyllin)
- theophylline (Theo-Dur)
Action of Methylxanthine (Xanthine) derivatives?
- relaxes smooth muscle of bronchi
- bronchioles increasing cAMP promoting bronchodilation
What is the use for methylxanthine?
maintenance therapy for chronic stable asthma
What is the therapeutic range for methylxanthine (Xanthine)?
- Therapeutic range: 10-20 mcg/ml
- (toxicity greater than 20)
Aminophylline (Somophyllin), theophylline (Theo-Dur) Contraindications
seizure, cardiac, renal, or liver disorders
Administration of Aminophylline (Somophyllin), theophylline (Theo-dur)
Side effects of Aminophylline (Somophyllin) & theophylline (Theo-Dur)
dysrhythmias, nervousness, irritability, insomnia, dizziness, flushing, dizziness, hypotension, seizures, GI distress, intestinal bleeding, hyperglycemia, tachycardia, palpitations, cardiorespiratory collapse
Leukotriene Receptor Antagonists
Zafirlukast (Accolate), montelukast (Singulair)
Action of Leukotriene Receptor Antagonists
- reduce inflammatory process
- decrease bronchoconstriction
Use of Leukotriene Receptor Antagonists
- maintenance for chronic asthma
Side effects of Leukotriene Receptor Antagonists
dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis
- Beclomethasone (Beclovent, Vanceril)
- dexamethasone (Decadron)
Action of Glucocorticoids
how is the Glucocorticoids fluticasone (Flovent) administered?
How is the glucocorticoid triamcinolone (Aristocort) administered?
How is dexamethasone (Decadron) (glucocorticoid) administered?
Cromolyn and Nedocromil is used as
- Prophylactic treatment of bronchial asthma
- Not to be used for acute asthmatic attack
Action of Cromolyn and Nedocromil?
antiinflammatory effect and suppresses the release of histamine
Administration of cromolyn and nedocromil?
Side effects of Cromolyn and Nedocromil?
- bad taste
- rebound bronchospasm
What is the MOA of acetylcysteine (Mucomyst)
liquefies and loosens thick mucus secretions
Administration of acetylcysteine (Mucomyst)?
- Administer 5 minutes after a bronchodilator
- Should not be mixed with other drugs
- Also an antidote for acetaminophen overdose if within 12-24 hours
- Give orally diluted in juice or soft drink
A client with COPD is admitted to the hospital for exacerbation. The client has severe dyspnea.
- A selective beta2-adrenergic agonist, albuterol (Proventil) is ordered to increase airway patency.
- Critical Thinking
- Compare the action and side effects of albuterol with isoproterenol and metaproterenol.
Practice Question #1
- When ipratropium, a bronchodilator, and a glucocorticoid inhaler are ordered together, the:
- (Select all that apply.)
- a. bronchodilator is given 5 minutes before a glucorticoid.
- b. combination is more effective than when given alone.
- c. glucocorticoid is administered 10 minutes before the bronchodilator.
- d. glucocorticoid should be administered immediately after the bronchodilator.
Answer: A, B. Rationale: When a bronchodilator and a glucocorticoid inhaler are given together, the bronchodilator is given first. The nurse should wait for 5 minutes before administering the
glucocorticoid. This drug combination is more effective than when given alone.
General Nursing Implications of Metered Dose Inhalers (MDI’s)
Hand held pressurized devices that deliver a measured dose of drug with each “puff”
When two “puffs” are needed, how much time should elapse between the two “puffs”
- 1 minute
- A spacer may be used to increase the delivery of the medication
- Metered-dose inhaler (MDI)
- Dry powdered inhaler (DPI)
Frequent dosing cause
- Tremors, nervousness, tachycardia
- Teach client to use inhaler correctly and take care of equipment correctly