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PAT 20A/B Chapter Notes - Chapter N/A: Benzodiazepine, Nonsteroidal Anti-Inflammatory Drug, Theophylline

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Audrey Kenmir

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(2)PAT20 Fall Week 11 Drug Classifications (Asthma)
1. Bronchodilators
a) Anticholinergics *Respiratory Agent* (Anti- bronchial acetylcholine)
Anticholinergic drugs: ipratropium (Atrovent), tiotropium (Spiriva), aclidinium
(Tudorza Pressair)
Action: bronchodilation due to local site-specific anticholinergic antagonism of
muscarinic receptors in bronchial smooth muscle.
Use: maintenance of reversible symptoms associated with COPD, treats rhinorrhea
associated with common cold and allergic and non-allergic perennial rhinitis.
Pharmacokinetics (Ipratropium):
Onset- INHALED: 1-3 mins, INTRANASAL: 15 mins
Peak- INHALED: 1-2 hrs, INTRANASAL: unknown
Duration- INHALED: 4-6 hrs, INTRANASAL: 6-12 hrs
Side/Adverse Effects:
CNS: nervousness, dizziness, headache
CV: palpitations, tachycardia
EENT: glaucoma
GI: nausea, dry mouth, constipation
GU: urinary retention
RESP: paradoxical bronchospasm, cough, increase in symptoms, bronchitis and
OTHERS: blurred vision (aerosol), chest and back pain (solution)
Hypersensitivity to drug, atropine, soya lecithin, soybean, peanuts.
-No significant reactions reported, especially with other bronchodilators and
Dosages (Ipratropium):
Aerosol = 18 mcg/spray; Inhalation solution = 0.02 %; Nasal spray = 0.03 % (21
mcg/spray), 0.06 % (42 mcg/spray)
Nursing Management Proprieties:
Assess: history of hypersensitivity, respiratory function, patency of nasal passage.
Dietary management: increase fluid (8-10 glasses/days).
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b) Beta 2-Adrenergic Agonists *Respiratory Agent* (Anti- bronchial beta2-
Beta 2-adrenergic agonist drugs: salmeterol (Serevent Discus), epinephrine (Epipen),
terbutaline (Brethaire)
Action: agonist activity at beta 2-adrenergic receptors in bronchial smooth muscle
produces bronchodilation.
Use: treats/manages obstructive respiratory disease as sole agent or in combination
with other bronchodilators/anti-asthmatic drugs.
Pharmacokinetics (Salmeterol):
Onset- INHALED: 10-25 mins
Peak- INHALED: 3-4 hrs
Duration- INHALED: 12 hrs
Side/Adverse Effects:
CNS: dizziness, drowsiness, headache, insomnia, nervousness
CV: angina, arrhythmias, associated with palpitations, hypo/hypertension
GI: nausea, vomiting, diarrhea, dry mouth, gastric distress
RESP: asthma, bronchitis, cough, nasopharyngitis, UTI
OTHER: back/joint pain, muscle cramps, pyrexia
-Concurrent use of NSAIDs, including aspirin and other ulcerogenic drugs,
increased risk of gastric irritation.
-Calcium, aluminum, magnesium, and iron products decrease absorption.
-Transient decrease in serum phosphate and calcium levels.
-Coffee, milk, orange juice, mineral water and other foods increase absorption.
Dosages (Salmeterol):
Powder for oral inhalation = 50 mcg/blister, in combination with fluticasone
Nursing Management Proprieties:
Assess: history of catecholamine hypersensitivity, adequate renal function, lung
sounds, diabetes.
Dietary management: avoid caffeine, maintain fluid intake.
Lab test evaluation: ABGs, FBS (patients with diabetes).
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