BRONCHODILATORS

·         Used to prevent or terminate bronchospasms caused by pulmonary disease, allergy, exercise, or emotional factors.

SYMPATHOMIMETIC

·         Dilate the airways of the respiratory tree, making air exchange & respiration easier, relaxing the smooth muscle

·         Indications:

o    Bronchospasm associated with acute and chronic bronchial asthma, exercise-induced bronchospasm, bronchitis, emphysema, bronchiectasis, other obstructive pulmonary diseases

·         Contraindications:   

o     Hypersensitivity to the drug, cardiac arrhythmias, associated with tachycardia, organic brain damage, cerebral arteriosclerosis, narrow-angle glaucoma

o    Long acting not used alone to control

Example: (Bronchodilators: Sympathomimetics)

albuterol (Ventolin®)

ephinephrine  (Adrenalin®)

salmeterol (Serevent®)

terbutaline sulfate (Brethine®, Bricanyl®, Brethaire®)

metaproterenol sulfate (Medihaler-Iso®)

Adverse Reactions:

·         Tachycardia, palpitations, or cardiac arrhythmias

·         Nervousness, anxiety

·         Hypertension

·         Insomnia

Nursing Considerations:

ü  Assess the respiratory status before and after each dose.

ü  During attack or to prevent attack use albuterol as a rescue drug.

ü  To control asthma daily use salmeterol long acting.

ü  Wait at least one minute between puffs, use spacer.

XANTHINES

·         Stimulate the central nervous system, respiration, dilate coronary & pulmonary vessels, cause diuresis, and relax the smooth muscle

·         Indications:

o    Bronchospasm associated with acute and chronic bronchial asthma, allergic rhinitis, sinusitis

·         Contraindications:   

o    Hypersensitivity to the drug, peptic ulcer disease, severe cardiac disease or dysrhythmias, hyperthyroidism, chronic obstructive pulmonary disease, emphysema

Example: (Bronchodilators: Xanthines)

aminophylline (Truphylline®, Phyllocontin®)

theophylline (Aerolate®, Slo-Phyllin®, Theolair®)

theophylline (Theo-Dur®, Slo-Bid®, Theo-24®, Uni-Dur®, Uniphyl®)

oxtriphylline ( Choledyl®, Choledyl- SA®)

Adverse Reactions:

·         Anorexia	·         Nausea, vomiting
·         Gastric pain	·         Hypotension
·         Hyperreflexia	·         Seizures
·         Tachycardia, palpitations, cardiac dysrhythmias

 Nursing Considerations:

ü  Do not dissolve, crush, or chew enteric –coated or sustained-release products.  

ü  Follow instructions for drug administration and dosage schedule.

ü  Take the drug regularly and with a full glass of water.

ü  For a patient who can’t swallow the whole pill, sprinkle its contents over soft foods.

ü  Provide precautions and slowly administer IV aminophylline or theophylline preparations, or always an infusion pump.

ü  Teach the patient who missed a dose or vomits shortly after taking a dose to consult physician for instructions.

ü  Change position slowly and avoid hazardous activities during drug therapy.

ü  Avoid caffeine products such as coffee, tea, cola, and chocolate.

ü  Advise the patient to stop smoking and provide information regarding support resources.

ü  Monitor for a therapeutic serum theophylline level of 10-20 mg/mL. Note that toxicity is likely to occur when the serum is greater than the normal value. Notify physician if this occurs.

LEUKOTRIENES

·         Bronchoconstrictive substances released by the body during the inflammatory process wherein when production is inhibited, bronchodilation is facilitated.

·         Indications:

o    (Zileuton & montelukast): used in the prophylaxis and treatment of chronic asthma in adults and children older than 12 years old

o    (Zafirlukast): used in the prophylaxis and treatment of chronic asthma in adults and in children older than 5 years old

·         Contraindications:   

o    Hypersensitivity, bronchospasm in acute asthma attacks, or liver disease, pregnancy, lactation

Leukotriene Receptor Antagonists	Leukotriene Formation Inhibitors
montelukast sodium (Singulair®)	zileuton (Zyflo®)
zafirlukast (Accolate®)

Adverse Reactions:

·         Headache, dizziness	·         Nausea, vomiting
·         Dyspepsia	·         Flu symptoms, cough
·         Diarrhea, abdominal pain

Nursing Considerations:

ü  Assess for wheezing, decreased breath sounds, cough and sputum production.

ü  Monitor vital signs and instruct patient how to monitor pulse rate.

ü  Maintain adequate hydration.

ü  Administer zafirlukast 1 hour before or 2 hours after meals for best absorption while montelukast is best absorbed when given at night.

ü  Encourage the use of rescue medication for acute attacks or when a short acting inhaled medication is needed but avoid to taking OTC preparations without prescription.

ü  Stress the importance of continuous use of the prescribed drug for optimal effects.

MAST-CELLS STABILIZERS

·         Mechanism of action is not fully understood, but these drugs are thought to stabilize the mast cell membrane, possibly preventing calcium ions from entering mast cells, therefore, hindering the release of inflammatory mediators.

·         Indications:

o    Used in combination with other drugs in the treatment of asthma and allergic disorders, rhinitis

·         Contraindications:   

o    Hypersensitivity to the drugs, asthma, pregnancy, lactation, patients with impaired renal or hepatic function

       

Example:

cromolyn Sodium (Intal®)

nedocromil (Tilade®)

Adverse Reactions:

·         Headache

·         Pharyngeal, trancheal irritation 

·         Wheezing, bronchospasm, cough

Nursing Considerations:

ü  Monitor respiratory status before therapy and regularly thereafter.

ü  Avoid use of these drugs for reversing bronchospasm during an acute asthma attack.

ü  Monitor for adverse effects of therapy.

ü  Notify physician if condition worsens.

ANTIHISTAMINES (histamine antagonists or H₁ blockers)

·         Prevent histamine from binding to histamine (H1) receptors, thereby blocking the histamine reaction.

·         Indications:

o    Relief of symptoms of seasonal and perennial allergies, common colds, allergic & vasomotor rhinitis, allergic conjunctivitis, mild and uncomplicated angioneurotic edema, urticaria, adjunctive therapy in anaphylactic shock, treatment of parkinsonism, nausea, vomiting , motion sickness, sleep aid, and adjuncts to analgesics

·         Contraindications:   

o    Hypersensitivity, severe liver disease, narrow-angle glaucoma, pregnancy, newborn or premature infant, breastfeeding, angle-closure glaucoma, stenosing peptic ulcer,  urinary retention, patients undergoing monoamine oxidase inhibitor therapy

(First-Generation Antihistamines)

astemizole ( Hismanal®)

azatadine maleate (Optimine®)

bronpheniramine maleate (Dimetane®)

chlorpheniramine maleate ( Aller-Chlor®, Chlor-Trimeton®)

clemastine fumarate ( Tavist ®)

cyproheptadine hydrochloride (Periactin®)

diphenhydramine (Benadryl ®)

doxylamine succinate (Unisom®)

methdilazine hydrochloride (Tacaryl®)

pyrilamine maleate (Nisaval®)

trimeprazine tartrate (Temaril®)

(Second-Generation Antihistamines)

ceritizine hydrochloride ( Zyrtec®)

azelastine hydrochloride (Astelin®)

fexofenadine (Allegra®)

loratadine (Claritin®)

desolaratidine (Larinex®)

Side Effects:

·         Drowsiness, dizziness	·         Fatigue
·         Constipation	·         Blurred vision
·         Skin rashes	·         Disturbed coordination
·         Photosensitivity	·         Dry mouth
·         Urinary retention	·         Wheezing
·         Nervousness, irritability

Nursing Considerations:

ü  Monitor vitals signs & urinary dysfunction.

ü  Administer with food to decrease gastric distress.

ü  Avoid subcutaneous (SC) injection and administer intramuscularly in a large muscle if it is prescribed.

ü  Avoid alcohol and other central nervous system depressants.

ü  Do not drive or perform any hazardous activities if drowsiness occurs.

ü  For motion sickness, take the drug at least 30 minutes before the event, and then before meals and at bedtime during the event.

ü  Provide hard candy, or ice chips to suck on for dry mouth.