respiratory medication

1. ★ TB medications

  •  Use multidrug to prevent multi-drug resistant TB.
    1st month, 2nd month: INH, Rifadin, Myambutol, PZA 모두를  daily 복용
    3rd month, 4th month, 5th month, 6th month: INH, Rifadin을 일주일에 2번 복용
  • Not to skip doses and to take medication for the full length of the prescribed therapy. Not to take any other medication without consulting with the HCP. Avoid the importance of f/u HCP visits, vision testing, and laboratory tests. To avoid alcohol. The oral pill effect will decrease.

1-1. ① isoniazid (INH)

  • side/adverse effects: hepatotoxicity, neurotoxicity (peripheral neuritis, optic neuritis, vision changes), pyridoxine (vitamin B6) deficiency
  • 하루에 한번. Administer isoniazid 1 hour before or 2 hours after a meal (공복) because food may delay absorption. Administer isoniazid at least 1 hour before antacids, especially those antacids that contain aluminum. Use with caution in clients taking nicotinic acid (Niacin). To avoid tyramine-containing foods. 임산부 가능.

1-2. ② rifampin (Rifadin)

  • side/adverse effects: hepatotoxicity, red-orange-colored body secretions
  • To take medication on an empty stomach with 8oz of water 1 hour before or 2 hours after meals and to avoid taking antacids with the medication. The soft contact lens can become permanently discolored. 임산부 가능.

1-3. ③ ethambutol (Myambutol)

  • side/adverse effects: optic neuritis, dizziness, hepatotoxicity는 없음
  • Administer once every 24 hours and administer with food to decrease GI upset. Monitor for visual changes. If changes occur, withhold the medication. 13세 이상만 복용.

1-4. ④ pyrazinamide (PZA)

  • hepatotoxicity

2. ★ medication inhalation devices

  • onset time: 5 minutes
  • If two different inhaled medications are prescribed, instruct the client to wait 5 minutes following administration of the first before inhaling the second. If a second dose of the same medication is needed, instruct the client to wait for 1 to 2 minutes before taking the second dose.
  • If two different inhaled medications are prescribed and one of the medications contains a glucocorticoid, administer the bronchodilator first and the corticosteroid second. (기도확장 후 염증치료)
  • ① Shake. ② Push & Inhale 5 sec. ③ Hold 10 ∼15 sec. ④ Exhale 시 pursed lip. ⑤ 1 ∼2 min 후 2nd puff. ⑥ Gargle mouth after steroids d/t Candida.
  • Wash MDI device at least weekly.
  • Alupent를 MDI 후 loudly wheezing의 의미:  tolerance to the medication or paradoxical bronchospasm → notify to HCP

3. bronchodilators

  • methylxanthine (Theophylline)
  • Stimulate the CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis, and relax smooth muscle.
  • side/adverse effect: restlessness, nervousness, tremors, palpitations, tachycardia, headache, dizziness, A/N/V, mouth dryness, throat irritation, hyperglycemia, decrease in clotting time
  • Provide adequate hydration. Administer oral medication with or after meals to decrease GI irritation. Monitor for a therapeutic serum theophylline level of 10 to 20 mcg/ml. Administer the medication at regular intervals around the clock to maintain a sustained therapeutic level. Theophylline toxicity is likely to occur when the serum level is higher than 20mcg/ml. Intravenously administered theophylline preparations should be administered slowly and always via an infusion pump. To avoid caffeine-containing products such as coffee, tea, cola, and chocolate, and OTC medications. If eating charcoal-broiled food, it will increase the effectiveness of the medication. β blockers, cimetidine (Tagamet), and erythromycin increase the effects of theophylline. Barbiturates and carbamazepine (Tegretol) decrease the effects of theophylline.

4. expectorants

  • ex) guaifenesin (Mucinex)
  • Expectorants loosen bronchial secretions so that they can be eliminated with coughing. They are used for a dry unproductive cough and to stimulate bronchial secretions.
  • side/adverse effect: GI irritation, oropharyngeal irritation, rash
  • Take the medication with a full glass of water to loosen mucus. To maintain adequate fluid intake. To periodically take some deep breaths and cough.

5. leukotriene modifiers

  • ex) montelukast (Singulair), zafirlukast (Accolate)
  • Used in the prophylaxis and treatment of chronic bronchial asthma, not used for acute asthma episodes. (to prevent asthma attack)
  • Contraindicated in clients with hypersensitivity, women in pregnancy, and breastfeeding mothers.
  • side/adverse effect: N/V/D, hepatotoxicity, fever, myalgia, headache, dizziness
  • Increase fluid intake. Not to discontinue the medication and to take as prescribed, even during symptom-free periods. Singulair QD in the evening. Accolate in empty stomach, bid. If the medication is the type of granola, mix in a soft diet, take within 15 minutes.

6. ★ antihistamines

  • ex) cetirizine (Zyrtec), diphenhydramine (Benadryl)
  • These medications compete with histamine for receptor sites, thus preventing a histamine response. Decrease nasopharyngeal, gastrointestinal, and bronchial secretions by blocking the H1 receptor. (H1 blocker)
  • Should be used with caution in clients with COPD because of their drying effect.
  • side/adverse effect: drowsiness, dizziness, urinary retention, constipation, dry mouth, blurred vision, hearing disturbances, photosensitivity, hypotension
  • Administer with food or milk. Avoid SC injection, and administer by IM injection in a large muscle if the IM route is prescribed. To suck on hard candy or ice chips for dry mouth. It can cause CNS depression if taken with alcohol, opioids, hypnotics, or barbiturates. To avoid hazardous activities, alcohol, and other CNS depressants.