RESPIRATORY

1. DRUGS FOR UPPER RESPIRATORY DISORDERS

A. Antihistamine
 FIRST GENERATION
- ALKYLAMINE Derivatives

Brand Name: Bioflu

Generic Name: Phenylephrine hydrochloride+ Chlorpheniramine maleate+Paracetamol

Classification: Nasal and systemic decongestants/Antihistamine/Analgesic

Recommended Dosage, Route, and Frequency:

- Adults and children 12 years and older: 1 tablet or 15mL q6h

- Children 7 to 12 years old: 10mL q6h
- Children 2 – 6 years old: 5mL q6h
- Or as prescribed by the doctor.

Drug Action: ADME, Onset, Peak, Duration:

- A: Minimal absorption after intranasal, ophthalmic administration.

- M: Metabolized in liver, GI tract.
- E: Primarily excreted in urine. Half-life: 2.5 hours.

Drug-Drug and Drug-Food Interactions:

- MAOIs (e.g., phenelzine, selegiline) may increase vasopressor effects.

- Tricyclic antidepressants (e.g., amitriptyline, doxepin) may increase cardiovascular effects.

Indications:

- For the relief of clogged nose, runny nose, postnasal drip, itchy and watery eyes, sneezing, headache,
body aches, and fever associated with the common cold, allergic rhinitis, sinusitis flu, and other minor
respiratory tract infections.

Contraindications:

- Hypersensitivity to phenylephrine. Injection: Severe hypertension, ventricular tachycardia. Oral: Use

within 14 days of MAOI therapy.
- Severe hypertension
- Ventricular tachycardia
- Angle-closure glaucoma
- During intraocular surgery when corneal epithelial barrier has been disturbed
- Elderly patients with severe arteriosclerotic or cerebrovascular disease
- Some low-birth-weight infants

Side Effects:

- Respiratory: Rebound nasal congestion due to overuse, esp. when used longer than 3 days.

Adverse Reaction:
 - Central Nervous System: Headache, weakness, anxiety, restlessness, tremor, light-headedness,
dizziness,drowsiness,insomnia,hallucinations,nervousness,restlessness, giddiness, prolonged psychosis,
orofacial dystonia
- Cardiovascular: Hypertension, palpitations, tachycardia, bradycardia, arrhythmias
- EENT: With ophthalmic solution— transient pigment floaters in aqueous humor;rebound miosis; rebound
hyperemia (with prolonged use);light sensitivity;photophobia;blurred vision;allergic conjunctivitis; eye
burning, stinging, and irritation; transient epithelial keratitis; decreased IOP;with nasal solution—rebound
congestion, burning, stinging, sneezing,dryness,local irritation
- Gastrointestinal: Nausea, vomiting, gastric irritation, anorexia
- Genitourinary: urinary retention (in males with prostatitis)
- Hematologic: Leukopenia, agranulocytosis, thrombocytopenia
- Musculoskeletal: Brow ache (with ophthalmic solution)
- Respiratory: Asthmatic episodes
- Skin: Sweating, rash, urticaria,contact dermatitis,necrosis and sloughing (with extravasation at I.V.site)

Nursing Responsibilities:

- A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma,
recent use of MAOI therapy.
- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
 Monitor B/P, heart rate.
 For severe hypotension or shock states, monitor central venous pressure noninvasive hemodynamic
monitoring systems.
- E: Improved breathing pattern.

- ETHANOLAMINE Derivatives

Brand Name:

Generic Name: Clemastine Fumarate

Classification: Ethanolamine Derivatives

Recommended Dosage, Route, and Frequency:

- Clemastine Fumarate Tablets 1.34 mg The recommended starting dose is one tablet twice daily. Dosage
may be increased as required, but not to exceed six tablets daily.
- Clemastine Fumarate Tablets 2.68 mg The maximum recommended dosage is one tablet three times daily.
Many patients respond favorably to a single dose which may be repeated as required, but not to exceed
three tablets daily.

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly and nearly completely absorbed from the gastrointestinal tract, peak plasma concentrations
are attained in 2-4 hours
- M: Extensively metabolized in the liver
- E: Urinary excretion is the major mode of elimination.

Drug-Drug and Drug-Food Interactions:

 - MAO inhibitors prolong and intensify the anticholinergic (drying) effects of antihistamines

Indications:

- For the relief of symptoms associated with allergic rhinitis such as sneezing, rhinorrhea, pruritus, and
lacrimation.
- For the relief of symptoms associated with allergic rhinitis such as sneezing, rhinorrhea, pruritus, and
lacrimation.

Contraindications:

- Pregnancy and lactation

- Patients with lower respiratory disease

Side Effects:

- Central Nervous System: Drowsiness

Adverse Reaction:

- EENT: Dry mouth, fixed and dilated pupils

- Gastrointestinal: Vomiting, nausea, epigastric distress, anorexia, diarrhea, constipation
- Cardiovascular System: Hypotension, headache, palpitations, tachycardia, extrasystole
- Hematologic System: Hemolytic anemia, thrombocytopenia, agranulocytosis
- Nervous System: Sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness,
excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesias, blurred vision, diplopia,
vertigo, tinnitus, acute labyrinthitis, hysteria, neuritis, convulsions.
- Genitourinary: Urinary frequency, difficult urination, urinary retention, early menses
- Respiratory System: Thickening of bronchial secretions, tightness of chest and wheezing, nasal stuffiness

Nursing Responsibilities:

- A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma,
recent use of MAOI therapy.
- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
 Monitor B/P, heart rate, respiration rate.
- E: Improved breathing pattern.

- PIPERIDINE Derivatives

Brand Name:

Generic Name: Cyproheptadine hydrochloride

Classification: Piperidine Derivatives - Antihistamine

Recommended Dosage, Route, and Frequency:

 - Adults: Initially,4 mg PO q8h. Maintenance dosage is 4 to 20 mg/day in three divided doses,to a maximum
dosage of 0.5 mg/kg/day.
- Children ages 7 to 14: 2 to 4 mg PO BID. Don’t exceed 16 mg/day.
- Children ages 2 to 6: 2 mg PO BID.Don’t exceed 12 mg/day.

Drug Action: ADME, Onset, Peak, Duration:

- M: Extensively metabolized in the liver

- E: Excreted through urine and feces.

Drug-Drug and Drug-Food Interactions:

- CNS depressants (including opioid analgesics,sedative-hypnotics): Increased CNS depression

- MAO inhibitors: Intensified,prolonged anticholinergic effects

Indications:

- Allergy symptoms caused by histamine release (including seasonal and perennial allergic rhinitis)
- Chronic urticarial, angioedema, dermographism, cold urticarial
- Adjunctive therapy for anaphylactic reactions

Contraindications:

- Hypersensitivity to drug
- Alcohol intolerance (syrup only)
- Bladder neck obstruction
- Angle-closure glaucoma
- Ulcer disease
- Symptomatic prostatic hypertrophy
- MAO inhibitor use within past 14 days

Side Effects:

- GI: Nausea and vomitnig

Adverse Reaction:

- CNS: Drowsiness, dizziness, excitation (especially in children), fatigue, sedation, hallucinations,

disorientation, tremor
- CV: Palpitations ,hypotension, arrhythmias
- EENT: blurred vision, nasal dryness and congestion, dry throat
- GI: Constipation, dry mouth
- GU: Urinary retention, urinary frequency, ejaculatory inhibition, early menses
- Respiratory: thickened bronchial secretions
- Skin: Rash, photosensitivity
- Metabolism: weight gain

Nursing Responsibilities:

- A: Assess for excessive CNS depression.

- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
  Monitor patient for excessive anticholinergic effects.
 Discontinue drug 4 days before diagnostic skin testing.
- E: Improved breathing pattern

- Piperazine Derivatives

Brand Name: Krka

Generic Name: Levocetirizine

Classification: Piperazine derivative – Antihistamine

Recommended Dosage, Route, and Frequency:

- Adults and children ages 12 and older: 5 mg PO daily in evening

- Children ages 6 to 11:2.5 mg PO daily in evening. Don’t exceed recommended dosage.

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly and extensively absorbed following oral administration. In adults, peak plasma concentrations
are achieved 0.9 hour after administration of the oral tablet.
- D: The mean plasma protein binding of levocetirizine in vitro ranged from 91 to 92%, independent of
concentration in the range of 90-5000 ng/mL, which includes the therapeutic plasma levels observed.
- M: The extent of metabolism of levocetirizine in humans is less than 14% of the dose and therefore
differences resulting from genetic polymorphism or concomitant intake of hepatic drug metabolizing
enzyme inhibitors are expected to be negligible.
- E: The plasma half-life in adult healthy subjects was about 8 to 9 hours after administration of oral tablets
and oral solution. Excretion via feces and urine.

Drug-Drug and Drug-Food Interactions:

- Ritonavir: Increased levocetirizine blood level and half-life, decreased clearance Drug-behaviors.

Indications:

- Symptoms of allergic rhinitis (seasonal and perennial)

- Uncomplicated skin manifestations of chronic idiopathic urticaria

Contraindications:

- If you are allergic to levocetirizine dihydrochloride or to any other antihistamine or to any of the other
ingredients of this medicine
- If you have severe impairment of kidney function (severe renal failure with creatinine clearance below 10
ml/min)

Side Effects:

- Gastrointestinal: Nausea

Adverse Reaction:

- CNS: somnolence,fatigue,asthenia
- EENT: epistaxis (children), nasopharyngitis,pharyngitis
- GI: dry mouth
 - Respiratory: cough (children)
- Other: pyrexia (children)

Nursing Responsibilities:

- A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma.
- D: Ineffective airway clearance
- P: Patient will have an enhanced patency in breathing.
- I:
 Stay alert for excessive CNS depression.
 Closely monitor renal function tests in patients with renal impairment.
- E: Improved breathing pattern

 SECOND GENERATION

Brand Name:

Generic Name: Loratadine

Classification: 2nd Generation Antihistamine

Recommended Dosage, Route, and Frequency:

- Seasonal allergies; chronic idiopathic urticarial:

 Adults and children ages 6 and older: 10 mg P.O.daily
 Children ages 2 to 5:5 mg P.O.daily

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly, almost completely absorbed from GI tract.

- D: Protein binding: 97%; metabolite, 73%–77%. Distributed mainly to liver, lungs, GI tract, bile.
- M: Metabolized in liver.
- E: Excreted in urine (40%) and feces (40%). Not removed by hemodialysis. Half-life: 8.4 hours; metabolite,
28 hours (increased in elderly, hepatic impairment).

Drug-Drug and Drug-Food Interactions:

- Clarithromycin, erythromycin, fluconazole, ketoconazole may increase concentration.

- Any food: Increased drug absorption

Indications:

- Relief of nasal, non-nasal symptoms of seasonal allergic rhinitis (hay fever).

- Treatment of itching due to hives (urticaria).

Contraindications:

- Hypersensitivity to drug

Side Effects:

- Central Venous System: Headache, fatigue, drowsiness

- Gastrointestinal: Dry mouth and throat

Adverse Reaction:
 - Central Nervous System: Headache,nervousness,insomnia
- EENT: Conjunctivitis,earache,epistaxis,pharyngitis
- Gastrointestinal: Abdominal pain;dry mouth;diarrhea,stomatitis (in children)
- Skin: Rash,photosensitivity,angioedema
- Other: Tooth disorder (in children), fever,flulike symptoms,viral infections

Nursing Responsibilities:

- A: Assess lung sounds for wheezing, skin for urticaria, other allergy symptoms.
- D: Risk for infection (Indications)
- P: Patient will have a resolution of signs and symptoms of the infection.
- I:
 For upper respiratory allergies, increase fluids to decrease viscosity of secretions, offset thirst, replenish
loss of fluids from increased diaphoresis. Monitor symptoms for therapeutic response.
- E:
 Delayed progression of AIDS and decreased opportunistic infections in patients with HIV.
 Decrease in viral load and improvement in CD4 cell counts.

B. Nasal and systemic Decongestants

Brand Name: Neozep Forte

Generic Name: Phenylephrine hydrochloride+ Chlorpheniramine maleate+Paracetamol

Classification: Nasal and systemic decongestants/Antihistamine/Analgesic

Recommended Dosage, Route, and Frequency:

- Adults and children 12 years and older: 1 tablet or 15mL q6h

- Children 7 to 12 years old: 10mL q6h
- Children 2 – 6 years old: 5mL q6h
- Or as prescribed by the doctor.

Drug Action: ADME, Onset, Peak, Duration:

- A: Minimal absorption after intranasal, ophthalmic administration.

- M: Metabolized in liver, GI tract.
- E: Primarily excreted in urine. Half-life: 2.5 hours.

Drug-Drug and Drug-Food Interactions:

- MAOIs (e.g., phenelzine, selegiline) may increase vasopressor effects.

- Tricyclic antidepressants (e.g., amitriptyline, doxepin) may increase cardiovascular effects.

Indications:

- For the relief of clogged nose, runny nose, postnasal drip, itchy and watery eyes, sneezing, headache,
body aches, and fever associated with the common cold, allergic rhinitis, sinusitis flu, and other minor
respiratory tract infections.

Contraindications:
 - Hypersensitivity to phenylephrine. Injection: Severe hypertension, ventricular tachycardia. Oral: Use
within 14 days of MAOI therapy.
- Severe hypertension
- Ventricular tachycardia
- Angle-closure glaucoma
- During intraocular surgery when corneal epithelial barrier has been disturbed
- Elderly patients with severe arteriosclerotic or cerebrovascular disease
- Some low-birth-weight infants

Side Effects:

- Respiratory: Rebound nasal congestion due to overuse, esp. when used longer than 3 days.

Adverse Reaction:

- Central Nervous System: Headache, weakness, anxiety, restlessness, tremor, light-headedness,

dizziness,drowsiness,insomnia,hallucinations,nervousness,restlessness, giddiness, prolonged psychosis,
orofacial dystonia
- Cardiovascular: Hypertension, palpitations, tachycardia, bradycardia, arrhythmias
- EENT: With ophthalmic solution— transient pigment floaters in aqueous humor;rebound miosis; rebound
hyperemia (with prolonged use);light sensitivity;photophobia;blurred vision;allergic conjunctivitis; eye
burning, stinging, and irritation; transient epithelial keratitis; decreased IOP;with nasal solution—rebound
congestion, burning, stinging, sneezing,dryness,local irritation
- Gastrointestinal: Nausea, vomiting, gastric irritation, anorexia
- Genitourinary: urinary retention (in males with prostatitis)
- Hematologic: Leukopenia, agranulocytosis, thrombocytopenia
- Musculoskeletal: Brow ache (with ophthalmic solution)
- Respiratory: Asthmatic episodes
- Skin: Sweating, rash, urticaria,contact dermatitis,necrosis and sloughing (with extravasation at I.V.site)

Nursing Responsibilities:

- A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma,
recent use of MAOI therapy.
- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
 Monitor B/P, heart rate.
 For severe hypotension or shock states, monitor central venous pressure noninvasive hemodynamic
monitoring systems.
- E: Improved breathing pattern.

C. Intranasal Glucocorticoids

Brand Name:

Generic Name: Beclomethasone

Classification: Intranasal Glucocorticoids

Recommended Dosage, Route, and Frequency:

 - The usual starting dose is:
 Adults: Beclomethasone 50 microgram Neo-haler: The most you should take in 24 hours is 16 puffs.
Beclomethasone 100 microgram Neo-haler: The most you should take in 24 hours is 8 puffs.
Beclomethasone 250 microgram Neo-haler: The most you should take in 24 hours is 4 puffs.
 Children: Beclomethasone 50 microgram Neo-haler: The most you should take in 24 hours is 8 puffs.
Beclomethasone 100 microgram Neo-haler: The most you should take in 24 hours is 4 puffs.

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly absorbed from pulmonary, nasal, GI tissue.

- M: Metabolized in liver.
- D: Protein binding: 87%.
- E: Excreted in feces (60%), urine (12%). Half-life: 2–4.5 hours.

Drug-Drug and Drug-Food Interactions:

- None significant.

Indications:

- Maintenance and prophylactic treatment of asthma in patients 5 years and older.

- Relief of seasonal/perennial rhinitis
- Prevention of nasal polyp recurrence after surgical removal
- Treatment of non-allergic rhinitis.
- Treatment of seasonal and perennial allergic rhinitis in patients 4 years and older.

Contraindications:

- Hypersensitivity to drug
- Status asthmaticus

Side Effects:

- Respiratory: Throat irritation, dry mouth, hoarseness, cough.

Adverse Reaction:

- CNS: Headache
- EENT: Cataracts,nasal irritation or congestion,epistaxis,perforated nasal septum,nasopharyngeal or
oropharyngeal fungal infections,hoarseness, throat irritation
- GI: Esophageal candidiasis
- Metabolic: Adrenal suppression
- Respiratory: Cough,wheezing, bronchospasm
- Skin: Urticaria,angioedema
- Other: Anosmia,Churg-Strauss syndrome,hypersensitivity reactions

Nursing Responsibilities:

- A: Establish baseline history for asthma, rhinitis. Question for hypersensitivity to corticosteroids.
- D:
 Ineffective airway clearance (Indications)
 Risk for infection (Side Effects)
- P: The patient will show improvement in symptoms of asthma.
- I:
  Monitor respiratory status.
 Auscultate lung sounds.
 Observe for signs of oral candidiasis.
 In patients receiving bronchodilators by inhalation concomitantly with inhaled steroid therapy, advise use
of bronchodilator several minutes before corticosteroid aerosol (enhances penetration of steroid into
bronchial tree).
- E:
 Management of the symptoms of chronic asthma.
 Improvement in symptoms of asthma.

D. Antitussives
 Opioid

Brand Name:

Generic Name: Codeine

Classification: Opioid antitussive

Recommended Dosage, Route, and Frequency:

- The usual starting dose for adults and children aged 12 years or above for relief of mild to moderate pain
is 30mg to 60mg every six hours, as needed.
- The usual adult starting dose for diarrhea is 30mg, three or four times daily.
- This drug should not be taken by children below the age of 12 years due to the risk of severe breathing
problems.
- This medicine should not be taken for more than 3 days. If the pain does not improve after 3 days, talk to
your doctor for advice.

Drug Action: ADME, Onset, Peak, Duration:

- A: Well absorbed following PO administration.

- D: Protein binding: 7%–25%.
- M: Metabolized in liver.
- E: Excreted in urine. Half-life: 2.5–3.5 hrs.

Drug-Drug and Drug-Food Interactions:

- Alcohol, other CNS depressants (e.g., lorazepam, morphine, zolpidem) may increase CNS, respiratory
depression, hypotension.
- Anticholinergics may increase risk of urinary retention, severe constipation.
- MAOIs (e.g., phenelzine, selegiline) may produce a severe, sometimes fatal reaction (reduce dosage to 1/4
usual dose).

Indications:

- To relieve pain, suppress coughs and treat diarrhoea

Contraindications:

- Hypersensitivity to codeine
 - Respiratory depression in absence of resuscitative equipment, acute or severe bronchial asthma or
hypercarbia, paralytic ileus. Postoperative pain management in children following
tonsillectomy/adenoidectomy.

Side Effects:

- CNS: Drowsiness
- GI: Diarrhea
- Skin: Increased sweating

Adverse Reaction:

- CNS: Headache, cerebral artery occlusion, cerebrovascular accident

- CV: Hypertension, hypotension, bradycardia, angina,superficial thrombophlebitis , thrombophlebitis, deep
vein thrombosis, coagulation disorder, disseminated intravascular coagulation (DIC),increased fibrinolysis,
purpura
- GI: Nausea, vomiting
- GU: Renal dysfunction
- Hematologic: Purpura, hemorrhage, hemarthrosis, disseminated intravascular coagulation,coagulation
disorders,decreased fibrinogen plasma, thrombosis
- Musculoskeletal: Arthrosis, arthralgia
- Respiratory: Pneumonia, pulmonary embolism
- Skin: Pruritus, rash, urticarial
- Other: Fever, edema, pain, redness or reaction at injection site,hypersensitivity reaction

Nursing Responsibilities:

- A:
 Assess BP, pulse, and respirations before and periodically during administration.
 Pain: Assess type, location, and intensity of pain before and 1 hr (peak) after administration.
- D:
 Acute pain (Indications)
 Disturbed sensory perception
- P: Patient will verbalized decreased severity of pain.
- I:
 Monitor daily pattern of bowel activity, stool consistency.
 Increase fluid intake, environmental humidity to improve viscosity of lung secretions. Initiate deep
breathing, coughing exercises.
 Assess for clinical improvement; record onset of relief of pain, cough.
- E:
 Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status.
 Suppression of cough.
 Control of diarrhea.

 Nonopioid

Brand Name: Sinecod Forte

Generic Name: Butamirate Citrate

Classification: Nonopioid Antitussive

Recommended Dosage, Route, and Frequency:

- Syrup recommended dose is:

 Children 3 - 6 years: 5 ml 3 times daily
 Children 6 - 12 years: 10 ml 3 times daily
 Adolescents over 12 years: 15 ml 3 times daily
 Adults: 15 ml 4 times daily
- Tablet:
 Adolescents over 12 years: 1 -2 tablets daily
 Adults: 2 – 3 tablets daily q8-12h. To be swallowed whole.

Drug Action: ADME, Onset, Peak, Duration:

- A: Well and rapidly absorbed and it is hydrolyzed into phenyl-2-butyric acid and diethylamino
ethoxyethanol.
- D: Protein-binding: 89.3 – 91.6%.
- M: Hydrolysis of butamirate into phenyl-2-butyric acid and diethylamino ethoxyethanol,
- E: Excreted in urine over the 96-hour sampling period.

Drug-Drug and Drug-Food Interactions:

- Simultaneous administration of expectorants should be avoided because it may lead to the stagnation of
mucus in the respiratory tract, which increases risk of bronchospasm.

Indications:

- Symptomatic treatment

Contraindications:

- Hypersensitivity to butamirate citrate or to any of the ingredients.

Side Effects:

- Gastrointestinal: Nausea

Adverse Reaction:

- Central Venous System: Somnolence

- Gastrointestinal: Diarrhea
- Skin: Urticaria

Nursing Responsibilities:

 Assess BP, pulse, and respirations before and periodically during administration.
 Pain: Assess type, location, and intensity of pain before and 1 hr (peak) after administration.
- D:
 Acute pain (Indications)
- P: Patient will verbalized decreased severity of pain.
- I:
 Monitor daily pattern of bowel activity, stool consistency.
 Increase fluid intake, environmental humidity to improve viscosity of lung secretions. Initiate deep
breathing, coughing exercises.
  Assess for clinical improvement; record onset of relief of pain, cough.
- E:
 Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status.
 Suppression of cough.
 Control of diarrhea.

E. Expectorants

Brand Name:

Generic Name: Guaifenesin+Paracetamol+Phenylephrine Hydrochloride

Classification: Expectorants/Analgesic

Recommended Dosage, Route, and Frequency:

- Adults, the elderly and children 12 years and over: 2 tablets every 4 hours, as required. Do not take more
than 8 tablets (4 doses) in any 24 hour period.
- Do not give to children under 12 years. Do not take more medicine than the label tells you to. If you do
not get better, talk to your doctor.

Drug Action: ADME, Onset, Peak, Duration:

- A: Minimal absorption after intranasal, ophthalmic administration.

- M: Metabolized in liver.
- E: Primarily excreted in urine.

Drug-Drug and Drug-Food Interactions:

- Barbiturates (for epilepsy or to help you sleep), such as phenobarbitones

- Tricyclic antidepressants such as imipramine, amitriptyline
- Medicines to treat heart or circulatory problems, or to lower blood pressure, (e.g. digoxin, guanethidine,
reserpine, methyldopa)
- Aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs)

Indications:

- Reduce fever
- Help loosen phlegm
- Nose decongestant

Contraindications:

- Hypersensitivity to drug
- Alcohol intolerance (with some products)

Side Effects:

- GI: Nausea, vomiting

Adverse Reaction:

- CNS: Headache, dizziness

- GI: Nausea, vomiting, diarrhea, stomach pain
- Skin: Rash, urticaria
Nursing Responsibilities:

- A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma,
recent use of MAOI therapy.
- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
 Monitor B/P, heart rate.
 For severe hypotension or shock states, monitor central venous pressure noninvasive hemodynamic
monitoring systems.
- E: Improved breathing pattern.

F. Antitussive/expectorant

Brand Name: Mucinex

Generic Name: Guaifenesin + Dextromethorphan hydrobromide

Classification: Antitussive/expectorant

Recommended Dosage, Route, and Frequency:

- adults and children 12 years and older: 1 tablet every 12 hours; not more than 2 tablets in 24 hours

Drug Action: ADME, Onset, Peak, Duration:

- A: Absorbed from the gastrointestinal tract.

- M: Metabolized in liver.
- E: Excreted in urine.

Drug-Drug and Drug-Food Interactions:

Indications:

- Helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of
bothersome mucus and make coughs more productive
- Temporarily relieves:
 Cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants
 The intensity of coughing
 The impulse to cough to help you get to sleep

Contraindications:

- For children under 12 years of age

- If you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression,
psychiatric or emotional conditions, or Parkinson's disease), or for 2 weeks after stopping the MAOI drug.
If you do not know if your prescription drug contains an MAOI, ask a doctor or pharmacist before taking
this product.

Side Effects:

- CNS: Headache

Adverse Reaction:
 - CNS: Persistent headache
- Hypersensitivity: Rash, fever

Nursing Responsibilities:

- A: Assess lung sounds, frequency and type of cough, and character of bronchial secretions periodically
during therapy. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.
- D: Ineffective airway clearance
- P: The patient will be able to expectorate the mucus from cough.
- I: Assess cough quality and productivity. Reevaluate treatment if cough persists and is accompanied by
fever or headache.
- E: Easier mobilization and expectoration of mucus from cough associated with upper respiratory infection.

2. DRUGS FOR LOWER RESPIRATORY DISORDERS

A. Sympathomimetics
 Alpha and Beta2 Adrenergic Agonists

Brand Name: Solmux Broncho

Generic Name: Salbutamol sulfate + Carbocisteine

Classification: Beta2 Adrenergic Agonists-Mucolytic

Recommended Dosage, Route, and Frequency:

- Adults and children over 12 years: 1 capsule q6-8h or 5 mL q6-8h

- Children 6 – 12 years: 2.5 mL q6-8h

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly absorbed from the gastrointestinal tract. Onset of action within 30 minutes, peak plasma
concentrations occur about 2 – 3 hours and persists for 6 hours.
- M: Metabolized in the liver.
- E: Excreted in the urine and feces. Half-life: 4 – 6 hours.
-

Drug-Drug and Drug-Food Interactions:

- Sympathomimetics bronchodilators or Epinephrine increase risk of deleterious cardiovascular effects

- Monoamine oxidase inhibitors or tricyclic antidepressants may increase risk of cardiac arrhythmia,
tachycardia and increased or decreased blood pressure.

Indications:

- For the symptomatic treatment of productive cough associated with acute and chronic obstructive
airways disease, such as acute and chronic bronchitis, bronchial asthma and bronchiectasis

Contraindications:

- Hypersensitivity to any ingredient in the product

- Active peptic ulcer

Side Effects:
 - Central Nervous System: Headache, sleeplessness
- Gastrointestinal: Nausea
- Skin: Rash, urticarial, angioedema

Adverse Reaction:

- Central Venous System: Nervousness, dizziness, weakness, restlessness, irritability, insomnia

- Gastrointestinal: Dyspepsia, unusual taste
- Cardiovascular: Tachycardia, palpitation, arrhythmias, extrasystoles, chest discomforts
- Hypersensitivity: Anaphylaxis

Nursing Responsibilities:

- A: Assess lung sounds, frequency and type of cough, and character of bronchial secretions periodically
during therapy. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.
- D: Ineffective airway clearance
- P: The patient will be able to expectorate the mucus from cough.
- I: Assess cough quality and productivity. Reevaluate treatment if cough persists and is accompanied by
fever or headache.
- E: Easier mobilization and expectoration of mucus from cough associated with upper respiratory infection

 Beta – Adrenergics

Brand Name: Serevent

Generic Name: Salmeterol

Classification: Beta2 adrenergc agonists

Recommended Dosage, Route, and Frequency:

- Adults and adolescents aged 12 years and older with Asthma:

 The usual starting dose is 2 puffs twice a day.
 For people with more severe asthma, your doctor may increase your dose to 4 puffs twice a day.
- Children with Asthma:
 In children aged 4 to 12 the usual dose is 2 puffs twice a day.
 Serevent is not recommended for use in children below 4 years of age.
- Adults with Chronic Obstructive Pulmonary Disease (COPD) including bronchitis and emphysema:
 The usual starting dose is 2 puffs twice a day.
 Not applicable for children and adolescents.

Drug Action: ADME, Onset, Peak, Duration:

- A: Minimal systemic absorption follows inhalation. Peak: 24 hrs.

- D: Action is primarily local.
- M & E: Unknown. Half-life: 3–4 hr.
Drug-Drug and Drug-Food Interactions:

- Beta blockers (e.g., carvedilol, metoprolol) may reduce effect; may produce bronchospasm.
- CYP3A4 inhibitors (e.g., ketoconazole, protease inhibitors) may increase concentration, risk of
prolongation.
 - MAOIs (e.g., phenelzine, selegiline), tricyclic antidepressants (e.g., amitriptyline, doxepin) may increase
concentration/effects (wait 14 days after stopping MAOIs, tricyclic antidepressants before starting
salmeterol).

Indications:

- Prevent breathing problem

- Helps to stop breathlessness and wheezing coming on

Contraindications:

- Hypersensitivity to salmeterol.
- Treatment of status asthmaticus, acute episodes of asthma or COPD.
- Use as monotherapy in treatment of asthma without concomitant long-term asthma control medication
(e.g., inhaled corticosteroids).

Side Effects:

- CNS: Headache
- Respiratory: cough, throat dryness/irritation, pharyngitis.
- GI: nausea, heartburn, GI distress, diarrhea
- CV: tachycardia, palpitations

Adverse Reaction:

- CNS: headache, nervousness.

- CV: palpitations, tachycardia.
- GI: abdominal pain, diarrhea, nausea.
- Musculoskeletal: muscle cramps/soreness.
- Neuro: trembling.
- Respiratory: ASTHMA-RELATED DEATH, paradoxical bronchospasm, cough.

Nursing Responsibilities:

- A: Question history of cardiac disease, hepatic impairment, seizure disorder. Screen for concomitant
medications known to prolong QT interval. Assess lung sounds, vital signs.
- D: Ineffective airway clearance
- P: Patient will have an establish breathing pattern
- I: Monitor rate, depth, rhythm, type of respiration; quality/rate of pulse, B/P. Assess lungs for wheezing,
rales, rhonchi. Periodically evaluate serum potassium levels.
- E:
 Prevention of bronchospasm or reduction of frequency of acute asthma attacks in patients with
chronic asthma.
 Prevention of exercise-induced asthma.

B. Anticholinergics

Brand Name:

Generic Name: Ipratropium bromide

Classification: Anticholinergic

Recommended Dosage, Route, and Frequency:

- Adults, elderly and children over 12 years:

 250 – 500mcg 3 – 4 times a day
- Children 6-12 years:
 250mcg as prescribed by the doctor
- Children up to 5 years:
 125-250mcg at least q6h

Drug Action: ADME, Onset, Peak, Duration:

- A: Not readily absorbed into systemic circulation either from the surface of the lung or from the GI tract as
confirmed by blood levels and renal excretion studies. Much of an inhaled dose is swallowed.
- D: Not applicable.
- M & E: Metabolism is hepatic; elimination half-life is about 2 hours. Most of an administered dose is
excreted unchanged in feces. Absorbed drug is excreted in urine and bile.

Drug-Drug and Drug-Food Interactions:

- Antimuscarinics, including ophthalmic preparations: May produce additive effects. Avoid use together.
- Fluorocarbon propellant-containing oral inhalants, such as adrenocorticoids, cromolyn, glucocorticoids,
and sympathomimetics: May increase risk of fluorocarbon toxicity if too-closely timed administration of
ipratropium and other oral inhalants containing fluorocarbon propellant. A 5-minute interval between
administration of such agents is recommended.

Indications:

- Inhaln: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis
and emphysema.
- Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the
common cold (0.06% solution).

Contraindications:

- Contraindicated in patients hypersensitive to drug or atropine or its derivatives and in those with a history
of hypersensitivity to soya lecithin or related food products, such as soybeans and peanuts.

Side Effects:

- Respiratory: upper respiratory tract infection, bronchitis

Adverse Reaction:

- CNS: dizziness, headache, nervousness, pain.

- CV: palpitations, chest pain.
- EENT: cough, blurred vision, rhinitis, pharyngitis, sinusitis.
- GI: nausea, GI distress, dry mouth.
- Musculoskeletal: back pain.
- Respiratory: upper respiratory tract infection, bronchitis, cough, dyspnea, bronchospasm, increased
sputum.
- Skin: rash.
- Other: flulike symptoms.
Nursing Responsibilities:

- A: Auscultate lung sounds. Question history of glaucoma, urinary retention, myasthenia gravis.
- D:
 Ineffective airway clearance (Indication)
 Activity intolerance (Indications)
- P: The patient will have an improved breath sounds.
- I:
 Monitor rate, depth, rhythm, type of respiration; quality, rate of pulse.
 Assess lung sounds for rhonchi, wheezing, rales. Monitor ABGs. Observe for retractions (clavicular, sternal,
intercostal), hand tremor.
 Evaluate for clinical improvement (quieter, slower respirations, relaxed facial expression, cessation of
retractions).
 Monitor for improvement of rhinorrhea
- E:
 Decreased dyspnea.
 Improved breath sounds.
 Decrease in rhinorrhea from perennial rhinitis or the common cold.

C. Methylxanthine derivatives

Brand Name: Aminophylline Injection

Generic Name: Theophylline Ethylene Diamine

Classification: Methylxanthine derivatives

Recommended Dosage, Route, and Frequency:

- Adults and the elderly: Your doctor will give you 250- 500 mg ( 5 mg per kilogram of bodyweight ) given
over a 20 minute period by slow intravenous injection, followed by 500 micrograms per kilogram of
bodyweight every hour by intravenous infusion.
- Children (6 months to 16 years): 5 mg per kilogram of bodyweight given over a 20 minute period by slow
intravenous infusion followed by a further intravenous infusion of 1mg per kilogram of bodyweight per
hour if they are between the ages of 6 months and 9 years, or 800 micrograms per kilogram of
bodyweight per hour if they are between the ages of 10 and 16 years.

Drug Action: ADME, Onset, Peak, Duration:

- A: Most dosage forms are absorbed well; absorption of the suppository, however, is unreliable and slow.
Rate and onset of action also depend on the dosage form selected. Food may alter the rate, but not the
extent of absorption, of oral doses.
- D: Distributed in all tissues and extracellular fluids except fatty tissue.
- M&E: Converted to theophylline, then metabolized to inactive compounds. Excreted in urine as
theophylline (10%).

Drug-Drug and Drug-Food Interactions:

- Alkali-sensitive drugs: Reduce aminophylline activity. Don’t add these drugs to I.V. fluids containing
aminophylline.
 - Allopurinol (high dose), cimetidine, corticosteroids, erythromycin, interferon, mexiletine, oral
contraceptives, propranolol, quinolones, troleandomycin: May increase serum aminophylline level by
decreasing hepatic clearance. Use together cautiously.
- Aminoglutethimide, carbamazepine, phenobarbital, phenytoin, rifampin: Decrease aminophylline effects.
Use together cautiously.
- Lithium: Increases lithium excretion. Monitor lithium levels.

Indications:

- Aminophylline Injection is used to treat wheezing and difficulty breathing (reversible airways obstruction)
and to treat an asthma attack that is not able to be helped by standard asthma medication (e.g. inhalers)

Contraindications:

- are allergic (hypersensitive) to Theophylline or Ethylene Diamine, or to any of the other ingredients
- suffer from a blood disorder known as acute porphyria
- have been given ephedrine.

Side Effects:

- CNS: headaches, muscle twitching

- GI: diarrhea, epigastric pain
- Metabolic: hyperglycemia, increased urinary catecholamines
- Skin: urticaria

Adverse Reaction:

- CNS: irritability, dizziness, nervousness, restlessness, headache, insomnia, stammering speech, abnormal
behavior, mutism, unresponsiveness alternating with hyperactivity, seizures
- CV: palpitations, sinus tachycardia, extrasystoles, marked hypotension, arrhythmias, circulatory failure
- GI: nausea, vomiting, diarrhea, epigastric pain, hematemesis, gastroesophageal reflux, anorexia
- GU: urine retention (in men with enlarged prostate), diuresis, increased excretion of renal tubular cells
and red blood cells, proteinuria
- Metabolic: hyperglycemia
- Musculoskeletal: muscle twitching
- Respiratory: tachypnea, respiratory arrest
- Skin: flushing

Nursing Responsibilities:

- A:
 Check vital signs and fluid intake and output.
 Check that patient hasn’t had recent theophylline therapy before giving loading dose.
- D:
 Ineffective airway clearance (Indication)
 Activity intolerance (Indications)
- P: The patient will have an improved breath sounds.
- I:
 Monitor patient’s response to drug and assess pulmonary function test results.
 GI symptoms may be relieved by taking oral drug with full glass of water at meals, although food in
stomach delays absorption. Enteric-coated tablets may also delay absorption. There’s no evidence that
antacids reduce GI adverse reactions.
 E: Improved breath sounds.
 D. Leukotriene modifiers
 RECEPTOR ANTAGONISTS

Brand Name: Zykast

Generic Name: Montelukast Sodium + Levocetirizine HCl

Classification: Leukotriene Receptor Antagonist/Antihistamine

Recommended Dosage, Route, and Frequency:

- Adults: 1 tablet containing Montelukast 10mg pplus Levocetirizine 5 mg once daily, or as prescribed by the
doctor.
- Children and adolescent: (15 years old and above) 1 tablet containing Montelukast 10mg pplus
Levocetirizine 5 mg once daily, or as prescribed by the doctor.

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly absorbed from GI tract. Peak plasma concentration is achieved 3 hours after administration of a
10mg dose in adults in the fasted state.
- D: Protein binding: 99%.
- M: Extensively metabolized in liver.
- E: Excreted almost exclusively in feces. Half-life: 2.7–5.5 hours (slightly longer in elderly).

Drug-Drug and Drug-Food Interactions:

- CYP450 inducers (such as phenobarbital,rifampin): Decreased montelukast effects

Indications:

- Relief of symptoms associated with seasonal and perennial allergic rhinitis.

Contraindications:

- Hypersensitivity to montelukast plus levocetirizine

- Pregnancy and lactation
- Patients with severe renal impairment

Side Effects:

- Central Nervous System: Headache, dizziness

- Respiratory: Cough, pharyngitis, sinusitis
- Gastrointestinal: Abdominal pain, dyspepsia, diarrhea, laryngitis
- EENT: Dental pain, otitis media

Adverse Reaction:

- Central Nervous System: Fatigue,headache,dizziness, asthenia,agitation,aggressive behavior or

hostility,anxiousness,depression, disorientation,dream abnormalities,
hallucinations,insomnia,irritability,restlessness,somnambulism,tremor, suicidal thinking and behavior
(including suicide)
- EENT: nasal congestion,otitis and sinusitis (in children)
- Gastrointestinal: Infectious gastroenteritis
- Skin: rash

Nursing Responsibilities:
 - A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma.
- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
 Stay alert for excessive CNS depression.
 Closely monitor renal function tests in patients with renal impairment.
- E: Improved breathing pattern

 SYNTHESIS INHIBITORS

Brand Name: Zyflo

Generic Name: Zileuton

Classification: Synthesis Inhibitors

Recommended Dosage, Route, and Frequency:

- The recommended dosage of ZYFLO for the symptomatic treatment of patient s with asthma is one 600-
mg tablet four times a day for a total daily dose of 2400 mg. For ease of administration, ZYFLO may be
taken with meals and at bedtime.

Drug Action: ADME, Onset, Peak, Duration:

- A: Zileuton is rapidly absorbed upon oral administration with a mean time to peak plasma concentration
(Tmax) of 1.7 hours and a mean peak level (Cmax) of 4.98 μg/mL. The absolute bioavailability of ZYFLO is
unknown.
- D: The apparent volume of distribution (V/F) of zileuton is approximately 1.2 L/kg. Zileuton is 93% bound
to plasma proteins, primarily to albumin, with minor binding to αl-acid glycoprotein.
- M & E: Elimination of zileuton is predominantly via metabolism with a mean terminal half-life of 2.5
hours.

Drug-Drug and Drug-Food Interactions:

- Co-administration of ZYFLO and theophylline results in, on average, an approximate doubling of serum
theophylline concentrations.
- Co-administration of ZYFLO and warfarin results in a clinically significant increase in prothrombin time
(PT).
- Co-administration of ZYFLO and propranolol results in doubling of propranolol AUC and consequent
increased beta-blocker activity.

Indications:

- ZYFLO is indicated for the prophylaxis and chronic treatment of asthma in adults and children 12 years of
age and older.

Contraindications:

- Active liver disease or transaminase elevations greater than or equal to three times the upper limit of
normal
- Hypersensitivity to zileuton or any of its inactive ingredients

Side Effects:
 - CNS: headache
- Skin: rash

Adverse Reaction:

- CNS: SUICIDAL THOUGHTS, headache, agitation, aggression, anxiety, depression, dizziness, dream
abnormalities, hallucinations, insomnia, irritability, malaise, nervousness, restlessness, somnolence,
tremor, weakness.
- EENT: conjunctivitis.
- CV: chest pain.
- GI: abdominal pain, constipation, dyspepsia, flatulence, increased liver enzymes, nausea, vomiting.
- GU: urinary tract infection, vaginitis.
- MS: arthralgia, myalgia, neck pain. Neuro: hypertonia.

Nursing Responsibilities:

- A: Obtain baseline symptomology, vital signs. Question history of hypertension, cardiac disease, asthma.
- D: Ineffective breathing pattern
- P: Patient will have an enhanced patency in breathing.
- I:
 Closely monitor renal function tests in patients with renal impairment.
- E: Improved breathing pattern

E. Glucocorticoids
 Intranasal sprays

Brand Name:

Generic Name: Beclomethasone

Classification: Intranasal Glucocorticoids

Recommended Dosage, Route, and Frequency:

- The usual starting dose is:

 Adults: Beclomethasone 50 microgram Neo-haler: The most you should take in 24 hours is 16 puffs.
Beclomethasone 100 microgram Neo-haler: The most you should take in 24 hours is 8 puffs.
Beclomethasone 250 microgram Neo-haler: The most you should take in 24 hours is 4 puffs.
 Children: Beclomethasone 50 microgram Neo-haler: The most you should take in 24 hours is 8 puffs.
Beclomethasone 100 microgram Neo-haler: The most you should take in 24 hours is 4 puffs.

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly absorbed from pulmonary, nasal, GI tissue.

- M: Metabolized in liver.
- D: Protein binding: 87%.
- E: Excreted in feces (60%), urine (12%). Half-life: 2–4.5 hours.

Drug-Drug and Drug-Food Interactions:

- None significant.

Indications:
 - Maintenance and prophylactic treatment of asthma in patients 5 years and older.
- Relief of seasonal/perennial rhinitis
- Prevention of nasal polyp recurrence after surgical removal
- Treatment of non-allergic rhinitis.
- Treatment of seasonal and perennial allergic rhinitis in patients 4 years and older.

Contraindications:

- Hypersensitivity to drug
- Status asthmaticus

Side Effects:

- Respiratory: Throat irritation, dry mouth, hoarseness, cough.

Adverse Reaction:

- CNS: Headache
- EENT: Cataracts,nasal irritation or congestion,epistaxis,perforated nasal septum,nasopharyngeal or
oropharyngeal fungal infections,hoarseness, throat irritation
- GI: Esophageal candidiasis
- Metabolic: Adrenal suppression
- Respiratory: Cough,wheezing, bronchospasm
- Skin: Urticaria,angioedema
- Other: Anosmia,Churg-Strauss syndrome,hypersensitivity reactions

Nursing Responsibilities:

- A: Establish baseline history for asthma, rhinitis. Question for hypersensitivity to corticosteroids.
- D:
 Ineffective airway clearance (Indications)
 Risk for infection (Side Effects)
- P: The patient will show improvement in symptoms of asthma.
- I:
 Monitor respiratory status.
 Auscultate lung sounds.
 Observe for signs of oral candidiasis.
 In patients receiving bronchodilators by inhalation concomitantly with inhaled steroid therapy, advise use
of bronchodilator several minutes before corticosteroid aerosol (enhances penetration of steroid into
bronchial tree).
- E:
 Management of the symptoms of chronic asthma.
 Improvement in symptoms of asthma.

 Aerosol inhalation

Brand Name:

Generic Name: Beclomethasone

Classification: Intranasal Glucocorticoids

Recommended Dosage, Route, and Frequency:

- The usual starting dose is:

 Adults: Beclomethasone 50 microgram Neo-haler: The most you should take in 24 hours is 16 puffs.
Beclomethasone 100 microgram Neo-haler: The most you should take in 24 hours is 8 puffs.
Beclomethasone 250 microgram Neo-haler: The most you should take in 24 hours is 4 puffs.
 Children: Beclomethasone 50 microgram Neo-haler: The most you should take in 24 hours is 8 puffs.
Beclomethasone 100 microgram Neo-haler: The most you should take in 24 hours is 4 puffs.

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly absorbed from pulmonary, nasal, GI tissue.

- M: Metabolized in liver.
- D: Protein binding: 87%.
- E: Excreted in feces (60%), urine (12%). Half-life: 2–4.5 hours.

Drug-Drug and Drug-Food Interactions:

- None significant.

Indications:

- Maintenance and prophylactic treatment of asthma in patients 5 years and older.

- Relief of seasonal/perennial rhinitis
- Prevention of nasal polyp recurrence after surgical removal
- Treatment of non-allergic rhinitis.
- Treatment of seasonal and perennial allergic rhinitis in patients 4 years and older.

Contraindications:

- Hypersensitivity to drug
- Status asthmaticus

Side Effects:

- Respiratory: Throat irritation, dry mouth, hoarseness, cough.

Adverse Reaction:

- CNS: Headache
- EENT: Cataracts,nasal irritation or congestion,epistaxis,perforated nasal septum,nasopharyngeal or
oropharyngeal fungal infections,hoarseness, throat irritation
- GI: Esophageal candidiasis
- Metabolic: Adrenal suppression
- Respiratory: Cough,wheezing, bronchospasm
- Skin: Urticaria,angioedema
- Other: Anosmia,Churg-Strauss syndrome,hypersensitivity reactions

Nursing Responsibilities:

- A: Establish baseline history for asthma, rhinitis. Question for hypersensitivity to corticosteroids.
- D:
 Ineffective airway clearance (Indications)
 Risk for infection (Side Effects)
- P: The patient will show improvement in symptoms of asthma.
 - I:
 Monitor respiratory status.
 Auscultate lung sounds.
 Observe for signs of oral candidiasis.
 In patients receiving bronchodilators by inhalation concomitantly with inhaled steroid therapy, advise use
of bronchodilator several minutes before corticosteroid aerosol (enhances penetration of steroid into
bronchial tree).
- E:
 Management of the symptoms of chronic asthma.
 Improvement in symptoms of asthma.

 Oral and intravenous

Brand Name: Prednisolone

Generic Name: Prednisone

Classification: Oral and intravenous Glucocorticoids

Recommended Dosage, Route, and Frequency:

- Severe inflammation and immunosuppression:

 Adults: Dosage individualized based on diagnosis, severity of condition, and response. Usual dosage is 5
to 60 mg PO daily as a single dose or in divided doses.
- Acute exacerbation of multiple sclerosis
 Adults:200 mg PO daily for 1 week, then 80 mg every other day for 1 month
- Adjunctive therapy for Pneumocystis jiroveci pneumonia in AIDS patients
 Adults: 40 mg PO BID for 5 days, then 40 mg once daily for 5 days,then 20 mg once daily for 11 days
- Or as prescribed by the doctor.

Drug Action: ADME, Onset, Peak, Duration:

- A: Well absorbed from GI tract.

- D: Protein binding: 70%–90%. Widely distributed.
- M: Metabolized in liver, converted to prednisolone.
- E: Primarily excreted in urine. Not removed by hemodialysis. Half-life: 2.5–3.5 hours.

Drug-Drug and Drug-Food Interactions:

- CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin) may decrease effects.

- Live virus vaccines may increase vaccine side effects, potentiate virus replication, decrease patient’s
antibody response to vaccine.
- May increase effect of warfarin.

Indications:

- Severe inflammation and immunosuppression

- Acute exacerbation of multiple sclerosis
- Adjunctive therapy for Pneumocystis jiroveci pneumonia in AIDS patients

Contraindications:
 - Allergic to prednisolone or any of the other ingredients of this medicine
- Have any infection, unless you are receiving specific treatment for it.
- Suffering from a herpes infection of the eye
- Suffering from galactose or lactose intolerance or glucose-galactose malabsorption

Side Effects:

- CNS: Headache
- GI: Nausea, vomiting

Adverse Reaction:

- CNS: Nervousness, depression, euphoria, personality changes,

psychosis,vertigo,paresthesia,insomnia,restlessness,seizures,meningitis, increased intracranial pressure
- CV: Hypotension, hypertension, vasculitis, heart failure, thrombophlebitis, thromboembolism, fat
embolism, arrhythmias, shock
- EENT: Posterior subcapsular cataracts (especially in children),glaucoma, nasal irritation and congestion,
rebound congestion,sneezing,epistaxis,nasopharyngeal and oropharyngeal fungal infections,perforated
nasal septum,anosmia,dysphonia,hoarseness,throat irritation (all with longterm use)
- GI: Abdominal distention, rectal bleeding, esophageal candidiasis, dry mouth, esophageal ulcer,
pancreatitis, peptic ulcer
- GU: Amenorrhea,irregular menses
- Hematologic: Purpura
- Metabolic: sodium and fluid retention, hypokalemia, hypocalcemia, hyperglycemia, decreased
carbohydrate tolerance, diabetes mellitus, growth retardation (in children), cushingoid effects (with long-
term use), hypothalamicpituitary-adrenal suppression (with systemic use longer than 5 days),adrenal
suppression (with high-dose,longterm use)
- Musculoskeletal: Muscle weakness or atrophy, myalgia, myopathy, osteoporosis, aseptic joint necrosis,
spontaneous fractures (with long-term use), osteonecrosis, tendon rupture
- Respiratory: Cough, wheezing, bronchospasm
- Skin: Rash, pruritus, contact dermatitis, acne, striae, poor wound healing, hirsutism, thin fragile skin,
petechiae,

Nursing Responsibilities:

- A:
 Question medical history
 Obtain baselines for height, weight, B/P, serum glucose, electrolytes. Check results of initial tests
(tuberculosis [TB] skin test, X-rays, EKG).
- D:
 Risk for infection (Side Effects)
 Disturbed body image (Side Effects)
- P: Patient will have a resolution of signs and symptoms of the infection.
- I:
 Monitor B/P, serum electrolytes, glucose, results of bone mineral density test, height, weight in children.
Be alert to infection (sore throat, fever, vague symptoms)
 Assess oral cavity daily for signs of Candida infection.
 Monitor for symptoms of adrenal insufficiency, immunosuppression.
- E: Decrease in presenting symptoms with minimal systemic side effects.
  Combination drug

Brand Name:

Generic Name: Fluticasone propionate & Salmeterol

Classification: Combination drug

Recommended Dosage, Route, and Frequency:

- Long-term therapy for asthma. Adults and children older than age 12: 1 oral inhalation b.i.d., morning and
evening, at least 12 hours apart.
 Adults and children older than age 12 not currently taking an inhaled corticosteroid: 1 oral inhalation of
Advair Diskus 100/50 b.i.d.
 Adults and children older than age 12 currently taking beclomethasone dipropionate: If daily dose of
beclomethasone dipropionate is 420 mcg or less, start with 1 oral inhalation of Advair Diskus 100/50 b.i.d.
If beclomethasone dipropionate daily dose is 462 to 840 mcg, start with 1 oral inhalation of Advair Diskus
250/50 b.i.d.
 Adults and children older than age 12 currently taking budesonide: If daily dose of budesonide is 400 mcg
or less, start with 1 oral inhalation of Advair Diskus 100/50 b.i.d. If budesonide daily dose is 800 to 1,200
mcg, start with 1 oral inhalation of Advair Diskus 250/50 b.i.d. If budesonide daily dose is 1,600 mcg, start
with 1 oral inhalation of Advair Diskus 500/50 b.i.d.
 Adults and children older than age 12 currently taking flunisolide: If daily dose of flunisolide is 1,000 mcg
or less, start with 1 oral inhalation of Advair Diskus 100/50 b.i.d. If flunisolide daily dose is 1,250 to 2,000
mcg, start with 1 oral inhalation of Advair Diskus 250/50 b.i.d.
 Adults and children older than age 12 currently taking fluticasone propionate inhalation aerosol: If daily
dose of fluticasone propionate inhalation aerosol is 176 mcg or less, start with 1 oral inhalation of Advair
Diskus 100/50 b.i.d. If fluticasone propionate inhalation aerosol daily dose is 440 mcg, start with 1 oral
inhalation of Advair Diskus 250/50 b.i.d. If fluticasone propionate inhalation aerosol daily dose is 660 to
880 mcg, start with 1 oral inhalation of Advair Diskus 500/50 b.i.d.
 Adults and children older than age 12 currently taking fluticasone propionate inhalation powder: If
fluticasone propionate inhalation powder daily dose is 200 mcg or less, start with 1 oral inhalation of
Advair Diskus 100/50 b.i.d. If fluticasone propionate inhalation powder daily dose is 500 mcg, start with 1
oral inhalation of Advair Diskus 250/50 b.i.d. If fluticasone propionate inhalation powder daily dose is
1,000 mcg, start with 1 oral inhalation of Advair Diskus 500/50 b.i.d.
 Adults and children older than age 12 currently taking triamcinolone acetonide: If triamcinolone
acetonide daily dose is 1,000 mcg or less, start with 1 oral inhalation of Advair Diskus 100/50 b.i.d. If
triamcinolone acetonide daily dose is 1,100 to 1,600 mcg, start with 1 oral inhalation of Advair Diskus
250/50 b.i.d.
- For patients already using an inhaled corticosteroid, maximum oral inhalation of Advair Diskus is 500/50
b.i.d.

Drug Action: ADME, Onset, Peak, Duration:

- A: Most of the fluticasone propionate delivered to the lung is systemically absorbed. Salmeterol acts
locally in the lung; therefore, plasma levels don’t predict therapeutic effect. Because of the small
therapeutic dose, systemic levels of salmeterol are low and undetectable after inhalation of
recommended doses. Inhalation – Fluticasone’s Peak: 1-2hr. Salmeterol’s peak: 5 min.
 - D: Drug is 91% bound to plasma proteins, is weakly and reversibly bound to erythrocytes, and isn’t
significantly bound to human transcortin. Binding of salmeterol to human plasma proteins averages 96%.
- M & E: The total clearance of fluticasone propionate is high, with renal clearance accounting for less than
0.02% of the total. The only circulating metabolite is the 17 beta-carboxylic acid derivative, which is
formed via the cytochrome P-450 3A4 pathway. Salmeterol base is extensively metabolized by
hydroxylation, with subsequent elimination predominantly in the feces. No significant amount of
unchanged salmeterol base was detected in either urine or feces. Following I.V. dosing, fluticasone had a
terminal elimination half-life of about 7.8 hours. Less than 5% of a dose is excreted in urine as
metabolites, with the remainder excreted in feces as parent drug and metabolite. Salmeterol xinafoate is
about 25% to 60% eliminated in urine and feces, respectively, over a period of 7 days. Terminal
elimination half-life is about 5.5 hours.

Drug-Drug and Drug-Food Interactions:

- Beta blockers: Blocked pulmonary effect of salmeterol may produce severe bronchospasm in patients
with asthma. Avoid use together. If needed, use a cardioselective beta blocker extremely cautiously.
- Ketoconazole, other inhibitors of cytochrome P-450: May increase fluticasone levels and adverse effects.
Use together cautiously.
- Loop diuretics, thiazide diuretics: ECG changes or hypokalemia may result from or be worsened by
potassium-wasting diuretics. Use together cautiously.
- MAO inhibitors, tricyclic antidepressants: May potentiate the action of salmeterol on the vascular system.
Avoid use within 2 weeks of these drugs.

Indications:

- Maintenance treatment of asthma as prophylactic therapy. May decrease the need for or eliminate use of
systemic corticosteroids in patients with asthma.

Contraindications:

- Contraindicated in patients hypersensitive to drug or its components. Also contraindicated as primary

treatment of status asthmaticus or other acute asthmatic episodes.

Side Effects:

- EENT: pharyngitis
- Respiratory: upper respiratory tract infection

Adverse Reaction:

- CNS: sleep disorders, tremors, hypnagogic effects, compressed nerve syndromes, headache.
- CV: palpitations, pain.
- EENT: pharyngitis, sinusitis, hoarseness or dysphonia, oral candidiasis, rhinorrhea, rhinitis, sneezing, nasal
irritation, blood in nasal mucosa, keratitis, conjunctivitis, eye redness, viral eye infections, congestion.
- GI: nausea, vomiting, abdominal pain and discomfort, diarrhea, gastroenteritis, oral discomfort and pain,
constipation, oral ulcerations, oral erythema and rashes, appendicitis, dental discomfort and pain, unusual
taste.
- Musculoskeletal: muscle pain, arthralgia, articular rheumatism, muscle stiffness, tightness, rigidity, bone
and cartilage disorders.
- Respiratory: upper respiratory tract infection, upper respiratory tract inflammation, lower viral respiratory
tract infections, bronchitis, cough, pneumonia.
- Skin: viral skin infections, urticaria, skin flakiness, disorders of sweat and sebum, sweating.
- Other: viral infections, chest symptoms, fluid retention, bacterial infections, allergies, allergic reactions.
Nursing Responsibilities:

- A: Establish baseline history for asthma, rhinitis. Question for hypersensitivity to corticosteroids.
- D:
 Ineffective airway clearance (Indications)
 Risk for infection (Side Effects)
- P: The patient will show improvement in symptoms of asthma.
- I:
 Monitor respiratory status.
 Auscultate lung sounds.
 Observe for signs of oral candidiasis.
 In patients receiving bronchodilators by inhalation concomitantly with inhaled steroid therapy, advise use
of bronchodilator several minutes before corticosteroid aerosol (enhances penetration of steroid into
bronchial tree).
- E:
 Management of the symptoms of chronic asthma.
 Improvement in symptoms of asthma.

F. Cromolyn and nedocromil

Brand Name: Tilade

Generic Name: Nedocromil sodium

Classification: Cromolyn and Nedocromil

Recommended Dosage, Route, and Frequency:

- The usual starting dose for adults and children over 6 years is 2 puffs four times a day
- Taking puffs at meal times and at bed time may help you to remember to take it
- Your doctor may tell you to take more or less puffs depending on how bad your asthma is. As your
asthma gets better, your doctor may suggest that you reduce your daily dose to 2 puffs twice a day. If this
happens, use your inhaler in the morning when you wake and again before you go to bed

Drug Action: ADME, Onset, Peak, Duration:

- A: Low
- D: Approximately 89% protein bound in human plasma over a concentration range of 0.5 to 50 µg/mL
- M & E: Nedocromil is not metabolized after IV administration and is excreted unchanged. Eliminated
primarily unchanged in urine (70%) and feces (30%). Half-life: 3.3 hours.

Drug-Drug and Drug-Food Interactions:

- In particular, tell your doctor if you are also using a steroid medicine: This can be either an inhaler (such as
beclometasone) or a tablet (such as prednisolone)
- If you are using a steroid as well as Tilade, your doctor may decide to reduce the amount of steroid taken
or gradually stop the steroid altogether

Indications:

- Tilade is used to treat asthma.

Contraindications:
 - You are allergic (hypersensitive) to nedocromil sodium or any of the other ingredients of Tilade

Side Effects:

- CNS: headache
- GI: indigestion, abdominal pain
- Respi: cough, wheezing

Adverse Reaction:

- Respi: severe wheezing, breathlessness

- Hypersensitivity: swallowing or breathing problems, swelling of your lips, face, throat or tongue

Nursing Responsibilities:

- A: Establish baseline history for asthma, rhinitis.

- D:
 Ineffective airway clearance (Indications)
- P:
- I: Monitor pulmonary function periodically.
- E: Improved airway clearance

G. Mucolytics

Brand Name: Ultreinac

Generic Name: Acetylcysteine

Classification: Mucolytics

Recommended Dosage, Route, and Frequency:

- Adults: 600mg daily or 200mg 2 – 3 times a day

- Children: 100mg 2-4 times a day according to age, or as prescribed by the doctor

Drug Action: ADME, Onset, Peak, Duration:

- A: Rapidly absorbed from the gastrointestinal tract. Peak plasma concentrations occur about 0.5 – 1 hour
after oral dose of 200-600mg.
- D: Protein-binding: 50%
- M: Metabolized in the liver.
- E: Excreted in the urine.

Drug-Drug and Drug-Food Interactions:

- There are no known significant interactions.

Indications:

- Mucolytic agent in adjunctive treatment of acute and chronic bronchopulmonary disease, pulmonary
complications of cystic fibrosis, atelectasis, or pulmonary complications related to surgery, post-traumatic
chest conditions, tracheostomy care, or use during anesthesia.

Contraindications:
 - Hypersensitivity to acetylcysteine

Side Effects:

- Gastrointestinal: Nausea, vomiting

- Respiratory: Increased bronchial secretions, throat irritation, bronchospasm, wheezing

Adverse Reaction:

- Central Nervous System: Dizziness,drowsiness,headache

- Cardiovascular: Hypotension,hypertension, tachycardia
- EENT: Severe rhinorrhea
- Gastrointestinal: Nausea,vomiting,stomatitis,constipation,anorexia
- Hepatic: Hepatotoxicity
- Respiratory: Hemoptysis,tracheal and bronchial irritation,increased secretions,wheezing,chest tightness,
bronchospasm
- Skin: Urticaria,rash,clamminess, angioedema
- Other: Tooth damage,chills,fever, hypersensitivity including anaphylaxis

Nursing Responsibilities:

- A: Assess blood pressure, pulse, respiration, lung sounds, and character of secretions before and
throughout therapy.
- D: Ineffective airway clearance
- P: Patient will have an increased ease of breathing.
- I: Administer around the clock to maintain therapeutic plasma levels.
- E: Decreased bronchospasm. Increased ease of breathing.