1.

Generic name & Brand name

2. Classification
3. Drug action, drug-drug interaction, & diet interaction
4. Dosage & route
5. Common side effects most common to drugs
6. Side effects experienced by client
7. Contraindications
8. Rationales for each nursing diagnosis
9. Health teaching

EMERGENCY MEDICATIONS
1. Methylprednisolone (Solu-Medrol)
Generic name: Methylprednisolone
Brand name: Solu-Medrol
Classification: Glucocorticoid
Drug action: Used to decrease inflammation for management of acute exacerbation of COPD
Drug-drug interaction:
 Aspirin, indomethacin, other NSAIDs: may increase risk of GI distress and bleeding.
 Barbiturates, carbamazepine(anticonvulsants), phenytoin (anticonvulsants), rifampin
(antibacterial): may decrease corticosteroid effect. Increase corticosteroid dosage
 Ketoconazole (antifungal) and macrolide (antibiotics): May decrease methylprednisolone
clearance. Decreased dose may be required.
Diet interaction:
 Grapefruit juice: may increase blood levels. May alter effect of the drug.
 Alcohol: While alcohol may not directly interact with corticosteroids, it can potentially worsen the
underlying condition being treated.
 Caffeine: May irritate your stomach.
 Fatty & spicy foods: may cause stomach upset.
 Avoid salty foods: may feel swollen and bloated
 Avoid foods with high sugar: drug may cause hyperglycemia
Dosage & Route: Adult PO/IV 40-80 mg/day in 1-2 divided doses; PO or IV
Common side effects most common to drug:
 CNS: euphoria, insomnia, vertigo, headache, depression, mood changes, seizures, malaise
 CV: arrythmias, hypertension, bradycardia, tachycardia, syncope, MI, edema
 EENT: cataracts, glaucoma
 GI: peptic ulceration, GI irritation, increased appetite, pancreatitis, nausea, vomiting
 Metabolic: hypokalemia, hyperglycemia, sodium and water retention, hypocalcemia
 Musculoskeletal: muscle weakness, osteoporosis, aseptic necrosis
Contraindications:
 Contraindicated in patient’s hypertensive to drug, in those with systemic fungal infections, in
premature infants.
 Prolonged use may increase risk of infection
Nursing Dx Rationales:
 Risk for infection r/t immunosuppression: may increase infection (side effects)
 Disturbed body image r/t drug-induced adverse reactions: one of the side effects of this drug is
increase in appetite
  Imbalanced Nutrition: More Than Body Requirements r/t metabolic changes: increase appetite

2. Ipratropium + Albuterol (DuoNeb)

Generic name: Ipratropium & Albuterol
Brand name: DuoNeb
Classification: Bronchodilators
Drug action: used to help treat airway narrowing (bronchospasm) that happens with chronic
obstructive pulmonary disease (COPD)
Drug-drug interaction:
 Anticholinergic agents: Although ipratropium bromide is minimally absorbed into the systemic
circulation, there is some potential for an additive interaction with concomitantly used
anticholinergic medications. Caution is, therefore, advised in the coadministration of DuoNeb with
other drugs having anticholinergic properties.
 ß-adrenergic agents: Caution is advised in the co-administration of DuoNeb and other
sympathomimetic agents due to the increased risk of adverse cardiovascular effects.
 ß-receptor blocking agents: These agents and albuterol sulfate inhibit the effect of each other. β-
receptor blocking agents should be used with caution in patients with hyperreactive airways, and if
used, relatively selective β1 selective agents are recommended.
 Diuretics: The electrocardiogram (ECG) changes and/or hypokalemia that may result from the
administration of non-potassium sparing diuretics (such as loop or thiazide diuretics) can be
acutely worsened by β-agonists, especially when the recommended dose of the β-agonist is
exceeded. Although the clinical significance of these effects is not known, caution is advised in the
co-administration of β-agonist-containing drugs, such as DuoNeb, with non-potassium sparing
diuretics.
 Monoamine oxidase inhibitors or tricyclic antidepressants: DuoNeb should be administered with
extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic
antidepressants, or within 2 weeks of discontinuation of such agents because the action of
albuterol sulfate on the cardiovascular system may be potentiated.
Diet Interaction:
 Caffeine: May irritate your stomach
Dosage & Route: (0.5 mg- 3mg) 2 INH q4-6hrs PRN; Inhalation
Common side effects:
 Stevens-Johnson Syndrome – rare but serious disorder that affects the skin, mucous membrane,
genitals, and eyes. Caused by medications.
 Hepatotoxicity
 severe and fatal immune-mediated endocrinopathies - disease marked by dysfunction of the
endocrine glands.
 Enterocolitis - inflammation in the inner lining of small intestine & colon.
 hepatitis
 pancreatitis
 n/v/d
 urticaria
 cough
 dyspnea
 toxic epidermal necrolysis - life-threatening disorder characterized by blistering & peeling of the
skin. Caused by drug interactions: antibiotics/anticonvulsants
  paradoxical bronchospasm - refers to the constriction of the airways after treatment with a
sympathomimetic bronchodilator. Theoretically, bronchodilators, such as beta ‐agonist inhalers, act
to ease asthma symptoms by relaxing the muscles surrounding the walls of the bronchial tubes,
which relieve bronchial constriction.
 tremors
 anxiety
 insomnia

Contraindications:
 DuoNeb is contraindicated in patients with a history of hypersensitivity to any of its components,
or to atropine and its derivatives
Nursing Dx Rationales:
 Ineffective breathing pattern r/t respiratory condition: patient has a COPD; she also states she is
having difficulty of breathing.
 Impaired gas exchange r/t underlying condition: patient is DYSPNEA
Instruction on How to Use:
IF NEBULIZER:
1.Remove one vial from the foil pouch. Place remaining vials back into pouch for storage.
2.Twist the cap completely off the vial and squeeze the contents into the nebulizer reservoir.
3. Connect the nebulizer to the mouthpiece or face mask.
4. Connect the nebulizer to the compressor.
5. Sit in a comfortable, upright position; place the mouthpiece in your mouth or put on the face
mask; and turn on the compressor.
6. Breathe as calmly, deeply and evenly as possible through your mouth until no more mist is
formed in the nebulizer chamber (about 5-15 minutes). At this point, the treatment is finished.
7. Clean the nebulizer
IF INHALATION:
 You do not need to shake the inhaler before use.
 Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and
close your lips. Keep your eyes closed to prevent spraying any medicine into your eyes. Breathe
in slowly while pressing the dose-release button on the inhaler. Hold your breath for 10 seconds,
then breathe out slowly.
 Close the cap until you use your inhaler again.