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Classification Example/
Prototype
Indications Side Effects Nursing
Considerations
Antiasthma Montelukast
Theophylline
Asthma Prevention of exercise-induced bronchoconstriction Bronchospasm CNS: headache, asthenia, dizziness, fatigue, fever, somnolence, weakness. EENT: conjunctivitis, otitis media, nasal congestion, nosebleed, laryngitis, sinusitis, pharyngitis, rhinitis, tonsillitis, dental pain. GI: abdominal pain, dyspepsia, gastroenteritis, nausea, diarrhea. GU: pyuria. Hematologic: systemic eosinophilia. Respiratory: URI, cough, wheezing, pneumonia, bronchitis. Skin: rash, dermatitis, urticaria, eczema. Other: flulike symptoms, trauma, varicella, viral infection CNS: restlessness, dizziness, insomnia, headache, irritability, muscle twitching, fine tremors. CV: palpitations, sinus tachycardia, arrhythmias, extrasystoles, flushing, marked hypotension. GI: nausea, vomiting, diarrhea, epigastric pain. GU: transient diuresis. Metabolic: increased urinary catecholamines. Respiratory: tachypnea Assess patient’s underlying condition; monitor patient for effectiveness. Alert: Don’t abruptly substitute drug for inhaled or oral corticosteroids. Dose of inhaled corticosteroids may be reduced gradually. Alert: Drug isn’t indicated for use in patients with acute asthmatic attacks, status asthmaticus, or as monotherapy for management of exercise-induced bronchospasm. Continue appropriate rescue drug for acute worsening. Boxed Warning: Monitor patients for neuropsychiatric symptoms. Discontinue drug immediately if neuropsychiatric symptoms occur
Anticholinergic
s
Tiotropium
Bromide
To reduce COPD exacerbations; maintenance treatment of bronchospasm in COPD, including chronic bronchitis and emphyse ma Long-term maintenance treatment of asthma (Spiriva Respimat) CNS: depression, paresthesia, headache, dizziness, fever, ins omnia. CV: angina pectoris, chest pain, edema, palpitations, HTN. EENT: cataract, epistaxis, dry mouth, sinusitis, laryngitis, dysphonia, pharyngitis, rhinitis, oropharyngeal candidiasis. GI: abdominal pain, constipation, dyspepsia, GERD, stomatitis, vomiting, diarrhea. GU: UTI. Metabolic: hypercholesterolemia, hyperglycemia. Musculoskeletal: arthritis, leg pain, myalgia, skeletal pain. Respiratory: URI, cough, bronchitis. Skin: rash, pruritus. Other: allergic reaction, candidiasis, flulike syndrome, Alert: Use drug for maintenance treatment of COPD or asthma, not for acute bronchospasm. Watch for evidence of hypersensitivity (especially angioedema) and paradoxical bronchospasm Discontinue drug immediately. Monitor patient for anticholinergic effects (dry mouth, constipation, tachycardia, blurred vision, new or worsening glaucoma
infections. , dysuria, urine retention). Look alike-sound alike: Don’t confuse Spiriva with Inspra.
Bronchodilators Albuterol ^ To prevent or treat
bronchospasm in patients with reversible obstructive airway disease To prevent exercise- induced bronchospasm Adjuvant therapy for acute treatment of moderate to severe hyperkalemia CNS: tremor, nervousness, headache, hyperactivity, insomnia, dizziness, weakness, CNS stimulation, malaise. CV: tachycardia, palpitations, HTN, chest pain, lymphadenopathy, edema. EENT: conjunctivitis, otitis media, dry and irritated nose and throat (with inhaled form), nasal congestion, epistaxis, hoarseness, pharyngitis, rhinitis. GI: nausea, vomiting, heartburn, anorexia, altered taste, increased appetite. GU: UTI. Metabolic: hypokalemia. Musculoskeletal: muscle cramps, back pain. Respiratory: bronchospasm, cough, wheezing, dyspnea, bronchitis, increased sputum. Other: hypersensitivity reactions, flulike syndrome, cold symptoms. Drug may decrease sensitivity of spirometry used for diagnosis of asthma. Syrup contains no alcohol or sugar and may be taken by children as young as age 2. In children, syrup may rarely cause erythema multiforme or SJS. Monitor patient for effectiveness. Using drug alone may not be adequate to control asthma in some patients. Long-term control medications may be needed. In patients with COVID-19 who require a bronchodilator for asthma or COPD symptoms, use of pressurized metered-dose inhalers as opposed to nebulized delivery is preferred. Nebulized delivery may increase transmission of particles (SARS-CoV2) into the environment and potentially decrease the life of expiratory circuit filter. Alert: Drug may cause paradoxical bronchospasm. Monitor patient closely ; discontinue drug immediately and use alternative therapy if paradoxical bronchospasm occurs. Bronchospasm with inhaled formulations frequently occurs with first use of new canister or vial. Alert: Patient may use tablets and aerosol together. Monitor these patients closely for signs and symptoms of toxicity. Look alike-sound alike: Don’t confuse albuterol with atenolol or Albutein.
Nasal
Corticosteroids
Mometasone ^ Maintenance therapy
for asthma; asthma in patients who take an oral corticosteroid Prophylaxis of seasonal allergic rhinitis Nasal polyps Dermatoses Allergic rhinitis; nasal congestion associated with seasonal allergic rhinitis CNS: headache, depression, fatigue, insomnia, pain, paresthesia. EENT: allergic rhinitis, pharyngitis, dry throat, dysphonia, earache, epistaxis, nasal irritation, sinus congestion, sinusitis, oral candidiasis. GI: abdominal pain, anorexia, dyspepsia, flatulence, gastroenteritis, nausea, vomiting, thrush. GU: dysmenorrhea, menstrual disorder, UTI. Metabolic: decreased glucocorticoid levels. Musculoskeletal: arthralgia, back pain, myalgia. Respiratory: URI, respiratory disorder. Skin: burning, pruritus, skin atrophy, furunculosis, folliculitis, skin depigmentation, candidiasis, bacterial infection. Other: flulike symptoms, infection, fever. Alert: Don’t use inhalation form for acute bronchospasm. Life-threatening paradoxical bronchospasm can occur after inhalation. Stop drug and use a fast-acting bronchodilator. Wean patients slowly from a systemic corticosteroid after they switch to mometasone. Monitor pulmonary function tests, beta-agonist use, and asthma symptoms. Alert: If patient is switching from an oral corticosteroid to an inhaled form, watch closely for evidence of adrenal insufficiency, such as fatigue, lethargy, weakness, nausea, vomiting, and hypotension. After an oral corticosteroid is withdrawn, HPA function may not recover for months. Patient experiencing trauma, stress, infection, or surgery during this HPA recovery period is particularly vulnerable to adrenal insufficiency or adrenal crisis. watch for cushingoid effects. Assess patient for bone loss during long-term use. Watch for evidence of localized mouth infections, vision changes, loss of glucose control, and immunosuppression. If patient has taken a corticosteroid during pregnancy, monitor neonate for hypoadrenalism. Monitor older adults for increased sensitivity to drug effects.
Antiviral Oseltamivir ^ To prevent^ influenza^ A
and B To treat influenza CNS: headache, pain. GI: nausea, vomiting, diarrhea (infants). Skin: diaper rash (infants). Drug must be given within 2 days of onset of symptoms. Initiate postexposure prophylaxis within 48 hours after close contact with an infected individual. Initiate seasonal prophylaxis during a community outbreak. Alert: Closely monitor patients with influenza for neuropsychiatric symptoms, such as hallucinations, delirium, and abnormal behavior. Risks and benefits of continuing drug should be evaluated. Look alike-sound alike: Don’t confuse Tamiflu with Tambocor or Thera-Flu.
