| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Albuterol (Ventolin)—PO 2–6 mg 3–4 times/day; inhalation q4–6h or 2 puffs 15 min before exercise | Bronchodilator | Results in accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors | Nervousness, restlessness, tremor, hypertension, nausea |
| NURSING IMPLICATIONS: Give with meals; allow 1 min between inhalations; rinse mouth with water after inhalation | |||
| Aminophylline—PO 250 mg 2–4 times daily; rectal 250–500 mg; IV 250–500 mg over 10–20 min | Rapid relief of bronchospasm; asthma; pulmonary edema | Relaxes smooth muscles and increases cardiac contractility; interferes with reabsorption of Na+ and Cl– in proximal tubules | Nausea, vomiting; cardiac arrhythmias; intestinal bleeding; insomnia, restlessness; rectal irritation from suppository |
| NURSING IMPLICATIONS: Give oral with or after meals; monitor vital signs for changes in BP and pulse; weigh daily; IM injections are painful | |||
| Ephedrine SO4—PO, Subcu, IM 25 mg 3 or 4 times daily | Asthma: allergies; bradycardia; nasal decongestant | Relaxes hypertonic muscles in bronchioles and GI tract | Wakefulness, nervousness, dizziness, palpitations, hypertension |
| NURSING IMPLICATIONS: Monitor vital signs; avoid giving dose near bedtime; check urine output in older adults | |||
| Ipratropium (Atrovent)—1–4 inhalations | Emphysema | Inhibits cholinergic receptors in bronchial smooth muscle | Nasal dryness, epistaxis; fluorocarbon toxicity when used with other inhalants |
| NURSING IMPLICATIONS: Instruct in proper use of inhaler; do not use more than 12 metered doses in 12 hr; if severe bronchospasm occurs, consult physician/nurse practitioner | |||
| isoproterenol HCl (Isuprel)—inhalation of 1:100 or 1:200 solution | Mild to moderately severe asthma attack; bronchitis; pulmonary emphysema | Relaxes hypertonic bronchioles | Nervousness, tachycardia; hypertension; insomnia |
| NURSING IMPLICATIONS: Monitor vital signs before and after treatment; teach client how to use nebulizer | |||
| Metaproterenol (Alupent)—PO 20 mg 3–4 times/day; inhalation 2–3 metered-dose inhalations | Asthma | Bronchodilation | Nervousness, restlessness, tremor, paradoxical bronchospasm |
| NURSING IMPLICATIONS: Assess lung sounds, observe for wheezing (paradoxical bronchospasm); observe clients’ respiratory signs and symptoms; refer to health-care professional if symptoms persist or shortness of breath continues | |||
| Salmeterol (Serevent)—inhalation 50 mcg twice a day (2 inhalations) | Asthma | Produces accumulation of cAMP at beta-adrenergic receptors | Headache, palpitations, abdominal pain; avoid use when on beta-adrenergic agents (decreases effectiveness) |
| NURSING IMPLICATIONS: Assess lung sounds; monitor pulmonary function; do not use for acute symptoms | |||
| Terbutaline (Brethine)—PO 2.5–5.0 mg q6h ( not to exceed 20 mg/24 hr); Subcu 0.25 mg, repeat 15–30 min (not to exceed 0.5 mg/hr); inhalation 2 puffs (0.2 mg each) q4–6h | Bronchospasm Obstetric use: may be used for premature labor; not Food and Drug Administration (FDA) approved for use as tocolytic agent, but widely used | See Isoproterenol | See Isoproterenol If used in pregnancy: maternal and fetal tachycardia |
| NURSING IMPLICATIONS: See Isoproterenol | |||
| Theophylline—PO 400 mg/day in divided doses; max. adult dose: 900-mg divided dose | Treatment/prevention of emphysema, asthma (bronchoconstriction); chronic bronchitis | Bronchodilation | Restlessness; increased respiration, heart rate; palpitations, arrhythmias; nausea, vomiting; increased urine output → dehydration |
| NURSING IMPLICATIONS: Monitor theophylline levels: 10–20 mcg/mL; monitor signs of toxicity; take with 8 oz water or with meals to decrease GI symptoms | |||
| Zafirlukast (Accolate)—PO 20 mg twice daily | Asthma | Antagonizes the effects of leukotrienes | Headache, fever, infection, pain |
| NURSING IMPLICATIONS: Monitor lung sounds, respiratory function | |||
| Zileuton (Zyflo)—PO 600 mg 4 times daily | Asthma | Enzyme inhibitor | Headache, dizziness; chest pain; increases blood level of theophylline, propranolol, warfarin |
| NURSING IMPLICATIONS: Assess lung sounds; do not discontinue or reduce dosage without consulting health-care professional; not used to treat acute attack | |||