Respiratory medications:
Beta2-adrenergic agonist – Inhaled albuterol
• MOA: stimulate beta-2 adrenergic receptors of the sympathetic nervous system in the lung à causing
bronchodilation
• Medication: Albuterol (SABA) treat acute asthma, prevent exercise-induced asthma and asthma
exacerbation (open the airway up to 4-6hr)
• Side e4ects: Tachycardia and palpitations, tremor. Chest pain (esp. in pt already with cardiovascular
issue). Rare but paradoxical bronchospasm also can occur (airway tightening à wheezing and SOB after
treatment)
• Intervention: Monitor tachycardia, palpitation, tremor, esp. chest pain and paradoxical bronchospasm
and report the findings. Assess lung sound. Closely monitor in pt with DM, heart disease, HTN, and
angina. And don’t give to patient with tachydysrhythmias or tachycardia due to digoxin toxicity.
• Educate: tell patient to not overuse rescue inhaler (if need to use more than twice a week à notify
provider), tell them to keep MDI away from heat and direct sunlight. Avoid caReine. Keep a symptom log
to identify and avoid trigger and notify changes in pattern of exacerbation of the asthma
• Administration: give SABA 30min before exercise. Inhale beta2-adrenergic agonist first before inhaled
glucocorticoids. Follow dosage limits and schedule. Know how to use inhalation form with inhalation
devices.
2nd generation Anti-histamine (non-sedation) – Cetirizine
• MAO: antagonize the histamine eRect at the H1 receptor sites without binding or inactivating the
histamine
• Medication: Cetirizine (less sedation eRect and less anticholinergic eRect) à for acute rhinitis and
chronic idiopathic urticaria
• Side e4ects: higher dose (ex: 10mg) can cause drowsiness and fatigue. Mild dry mouth, eye and throat.
• Intervention: monitor for drowsiness and fatigue, esp. in pt who takes higher dose. Tell them to avoid
driving and activities required mental alertness until eRects are known. Give them hard candy to suck on
and increase fluid intake (1.5-2L). For patient with compromised kidney or liver function à decrease
dosage due to delay of metabolism and excretion. Don’t give to patient with breastfeeding and infant
under 6 months
• Education: tell patient take cetirizine once a day due to long-lasting eRect and they can take it any time
with or without food. Tell them to avoid other OTC antihistamine when taking cetirizine, no alcohol and
other CNS suppression. Tell them to avoid driving and activities required mental alertness until eRects
are known. And increase fluid intake. Sips of water or suck on hard candy for dry mouth
1st generation anti-histamine (sedation) – diphenhydramine
• MAO: Bind to H1-receptors eRectively block the release of the histamine. Also a mild cholinergic blocker
producing anticholinergic eRects
• Medication: Diphenhydramine à for mild allergic reaction, anaphylaxis, motion sickness, and insomnia
• Side eRects: sedation eRects, dry mouth, constipation, and urinary hesitancy
• Intervention: monitor for drowsiness and dizziness, dry mouth, constipation, and urinary retention esp. in
patient with BPH and urinary hesitancy. Don’t give to children under 2 and breastfeeding woman, BPH,
acute glaucoma or narrow angle glaucoma, acute asthma attack.
, o Acute toxicity à administer activated charcoal to neutralize medication and laxative to eliminate
unabsorbed medication from intestinal tract.
o Fever à give acetaminophen and apply ice pack or give sponge bath.
o Seizure à give IV phenytoin
• Education: tell them not to drive and do activity that required mental alertness. Sips water and such on
hard candy for dry mouth. Take fiber supplement or food, laxative as needed for constipation. Take med
with food to minimize Gi discomfort. Take med at bedtime to avoid sedation eRect but 30min (ideally 1-
2hr) for motion sickness. Don’t take with other OTC antihistamine, alcohol, or CNS depression.
Sympathomimetic – phenylephrine
• MOA: mimic sympathetic nervous system activating the alpha 1 adrenergic à causing vasoconstriction
to open up the nasal passage
• Phenylephrine à for nasal congestion in allergic rhinitis (but not for chronic one), sinusitis, and
common cold
• Side e4ect: Prolonged intranasal use or overuse cause rebound congestion. Oral cause CNS stimulation
(insomnia, agitation, anxiety). Systemic vasoconstriction eRect cause hypertension, arrhythmias or
palpitation (indicate overdosage).
• Intervention: prevent rebound congestion à use when only needed and no more than 3-5 days for the
spray. Use nasal glucocorticoid when d/c intranasal sympathomimetic. Report insomnia, agitation, and
anxiety. Patient may be prescribed with sleeping aid or mild hypnotic. Monitor heart rate and blood
pressure. Notify if hypertension, arrhythmias or palpitation occur and patient will need to d/c the med.
• Education: tell patient only take med or spray when needed but do not use exceed recommended
dosage.
Glucocorticoid – Inhaled Beclomethasone dipropionate (QVAR) and Prednisone (oral form)
• MOA:
o prevent the release of leukotriene, prostaglandin and histamine, which suppress inflammation.
o Prevent the action of WBC = suppress immune system = decrease inflammation à decrease
edema of the air way
• Inhaled beclomethasone dipropionate (QVAR) for long-term asthma and COPD maintenance
o Side eRect: Oral candidiasis or thrash (yeast infection), hoarseness and diRiculty speaking
o Intervention: watch for white patch in the mouth, initiate of antifungal therapy for oral
candidiasis. Minimizing contact of the med with the tissue of mouth or oropharynx by attaching a
spacer to MDI. Tell patient to rinse mouth and gargle after inhalation
o Administration: give them on schedule rather than needed for long-term maintenance. Give them
beta2 agonist first (albuterol) then inhale glucocorticoid.
• Oral prednisone for short-term management of post-exacerbation manifestation.
o Side eRect and intervention are:
§ Adrenal suppression à monitor plasma medication level and watch for manifestation
(hypotension, hypoglycemia, N/V, confusion) and report. Taper dose slowly when stop and
may need to increase dose in the time of stress or surgery. Take lowest eRective dose or
alternate-day dosing
§ Muscle wasting, bone demineralization cause osteoporosis à Tell patient to take calcium
and vitamin D, and perform weight-bearing exercise daily
Beta2-adrenergic agonist – Inhaled albuterol
• MOA: stimulate beta-2 adrenergic receptors of the sympathetic nervous system in the lung à causing
bronchodilation
• Medication: Albuterol (SABA) treat acute asthma, prevent exercise-induced asthma and asthma
exacerbation (open the airway up to 4-6hr)
• Side e4ects: Tachycardia and palpitations, tremor. Chest pain (esp. in pt already with cardiovascular
issue). Rare but paradoxical bronchospasm also can occur (airway tightening à wheezing and SOB after
treatment)
• Intervention: Monitor tachycardia, palpitation, tremor, esp. chest pain and paradoxical bronchospasm
and report the findings. Assess lung sound. Closely monitor in pt with DM, heart disease, HTN, and
angina. And don’t give to patient with tachydysrhythmias or tachycardia due to digoxin toxicity.
• Educate: tell patient to not overuse rescue inhaler (if need to use more than twice a week à notify
provider), tell them to keep MDI away from heat and direct sunlight. Avoid caReine. Keep a symptom log
to identify and avoid trigger and notify changes in pattern of exacerbation of the asthma
• Administration: give SABA 30min before exercise. Inhale beta2-adrenergic agonist first before inhaled
glucocorticoids. Follow dosage limits and schedule. Know how to use inhalation form with inhalation
devices.
2nd generation Anti-histamine (non-sedation) – Cetirizine
• MAO: antagonize the histamine eRect at the H1 receptor sites without binding or inactivating the
histamine
• Medication: Cetirizine (less sedation eRect and less anticholinergic eRect) à for acute rhinitis and
chronic idiopathic urticaria
• Side e4ects: higher dose (ex: 10mg) can cause drowsiness and fatigue. Mild dry mouth, eye and throat.
• Intervention: monitor for drowsiness and fatigue, esp. in pt who takes higher dose. Tell them to avoid
driving and activities required mental alertness until eRects are known. Give them hard candy to suck on
and increase fluid intake (1.5-2L). For patient with compromised kidney or liver function à decrease
dosage due to delay of metabolism and excretion. Don’t give to patient with breastfeeding and infant
under 6 months
• Education: tell patient take cetirizine once a day due to long-lasting eRect and they can take it any time
with or without food. Tell them to avoid other OTC antihistamine when taking cetirizine, no alcohol and
other CNS suppression. Tell them to avoid driving and activities required mental alertness until eRects
are known. And increase fluid intake. Sips of water or suck on hard candy for dry mouth
1st generation anti-histamine (sedation) – diphenhydramine
• MAO: Bind to H1-receptors eRectively block the release of the histamine. Also a mild cholinergic blocker
producing anticholinergic eRects
• Medication: Diphenhydramine à for mild allergic reaction, anaphylaxis, motion sickness, and insomnia
• Side eRects: sedation eRects, dry mouth, constipation, and urinary hesitancy
• Intervention: monitor for drowsiness and dizziness, dry mouth, constipation, and urinary retention esp. in
patient with BPH and urinary hesitancy. Don’t give to children under 2 and breastfeeding woman, BPH,
acute glaucoma or narrow angle glaucoma, acute asthma attack.
, o Acute toxicity à administer activated charcoal to neutralize medication and laxative to eliminate
unabsorbed medication from intestinal tract.
o Fever à give acetaminophen and apply ice pack or give sponge bath.
o Seizure à give IV phenytoin
• Education: tell them not to drive and do activity that required mental alertness. Sips water and such on
hard candy for dry mouth. Take fiber supplement or food, laxative as needed for constipation. Take med
with food to minimize Gi discomfort. Take med at bedtime to avoid sedation eRect but 30min (ideally 1-
2hr) for motion sickness. Don’t take with other OTC antihistamine, alcohol, or CNS depression.
Sympathomimetic – phenylephrine
• MOA: mimic sympathetic nervous system activating the alpha 1 adrenergic à causing vasoconstriction
to open up the nasal passage
• Phenylephrine à for nasal congestion in allergic rhinitis (but not for chronic one), sinusitis, and
common cold
• Side e4ect: Prolonged intranasal use or overuse cause rebound congestion. Oral cause CNS stimulation
(insomnia, agitation, anxiety). Systemic vasoconstriction eRect cause hypertension, arrhythmias or
palpitation (indicate overdosage).
• Intervention: prevent rebound congestion à use when only needed and no more than 3-5 days for the
spray. Use nasal glucocorticoid when d/c intranasal sympathomimetic. Report insomnia, agitation, and
anxiety. Patient may be prescribed with sleeping aid or mild hypnotic. Monitor heart rate and blood
pressure. Notify if hypertension, arrhythmias or palpitation occur and patient will need to d/c the med.
• Education: tell patient only take med or spray when needed but do not use exceed recommended
dosage.
Glucocorticoid – Inhaled Beclomethasone dipropionate (QVAR) and Prednisone (oral form)
• MOA:
o prevent the release of leukotriene, prostaglandin and histamine, which suppress inflammation.
o Prevent the action of WBC = suppress immune system = decrease inflammation à decrease
edema of the air way
• Inhaled beclomethasone dipropionate (QVAR) for long-term asthma and COPD maintenance
o Side eRect: Oral candidiasis or thrash (yeast infection), hoarseness and diRiculty speaking
o Intervention: watch for white patch in the mouth, initiate of antifungal therapy for oral
candidiasis. Minimizing contact of the med with the tissue of mouth or oropharynx by attaching a
spacer to MDI. Tell patient to rinse mouth and gargle after inhalation
o Administration: give them on schedule rather than needed for long-term maintenance. Give them
beta2 agonist first (albuterol) then inhale glucocorticoid.
• Oral prednisone for short-term management of post-exacerbation manifestation.
o Side eRect and intervention are:
§ Adrenal suppression à monitor plasma medication level and watch for manifestation
(hypotension, hypoglycemia, N/V, confusion) and report. Taper dose slowly when stop and
may need to increase dose in the time of stress or surgery. Take lowest eRective dose or
alternate-day dosing
§ Muscle wasting, bone demineralization cause osteoporosis à Tell patient to take calcium
and vitamin D, and perform weight-bearing exercise daily
