Nursing Pharmacology

Drugs acting on the Respiratory System

1ST GENERATION ANTI-HISTAMINES (H1 RECEPTOR ANTAGONIST)
ACTIONS:

Competes with histamine for H1-receptor sites on effector cells. Prevents, but doesn't reverse,
histamine-mediated responses. Highly lipophilic and therefore readily cross the blood-brain
barrier, contributing to adverse central nervous system effects including sedation, drowsiness,
and decreased cognitive processing At high doses, drug also has local anesthetic effects.

INDICATIONS:

Rhinitis, Allergy Symptoms

CONTRAINDICATIONS:

Hypersensitivity, history of experiencing adverse reactions to phenothiazines, breastfeeding

women, children younger than 2, and acutely ill or dehydrated children

ADVERSE REACTIONS:

CNS: drowsiness, sedation, confusion, sleepiness, dizziness, disorientation, extrapyramidal

symptoms
CV: hypotension, hypertension
EENT: dry mouth, blurred vision
GI: nausea, vomiting
GU: urine retention
Hematologic: leukopenia, agranulocytosis, thrombocytopenia
Metabolic: hyperglycemia
Respiratory: respiratory depression, apnea
Skin: photosensitivity, rash

NURSING CONSIDERATIONS:

Monitor patient for neuroleptic malignancy syndrome, altered mental status, autonomic
instability, muscle rigidity, and hyperpyrexia.
Tell patient to take oral form with food or milk to avoid GI irritation
Warn patient to avoid alcohol and hazardous activities that require alertness until CNS
effects of drug are known
Auscultate breath sounds before and after administration
Monitor vital signs
Have the patient void before each dose
Encourage oral fluids
Monitor vision changes

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Inform patient that sugarless gum, hard candy, or ice chips may relieve dry mouth
Warn patient about possible photosensitivity reactions. Advise use of sunblock.

SAMPLE MEDICATIONS:

promethazine (Phenergan)

chlorpheniramine

diphenhydramine

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hydroxyzine

2ND GENERATION ANTI-HISTAMINES (H1 RECEPTOR ANTAGONIST)

ACTIONS:

A long-acting, nonsedating antihistamine that selectively inhibits peripheral H1 receptors.

INDICATIONS:

Seasonal allergic rhinitis, Perennial allergic rhinitis, chronic urticaria

CONTRAINDICATIONS:

Hypersensitive to drug or to hydroxyzine, breastfeeding women

ADVERSE REACTIONS:

CNS: somnolence, fatigue, dizziness, headache

EENT: pharyngitis
GI: dry mouth, nausea, vomiting, abdominal distress

NURSING CONSIDERATIONS:

Therapeutic effects vary from person to person

Administer drug on an empty stomach
Auscultate breath sounds before and after administering
Monitor vital signs
Monitor vision changes
Observe for signs of renal toxicity (decreased urine output)
Encourage oral fluids
Have the patient void before each dose

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Warn patient to avoid alcohol and hazardous activities that require alertness until CNS effects of
drug are known.
Inform patient that sugarless gum, hard candy, or ice chips may relieve dry mouth

SAMPLE MEDICATIONS:

cetirizine hydrochloride ( Zyrtec)

loratadine

levocetirizine

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ORAL DECONGESTANTS
ACTIONS:

Stimulates alpha adrenergic receptors causing arterioles in the nasal passages to constrict

INDICATIONS:

Nasal congestion
Relieve the pain and congestion of otitis media

CONTRAINDICATIONS:

Lesion or erosion, glaucoma, HPN, DM, thyroid disease, CAD or prostate problems

ADVERSE REACTIONS:

Rebound congestion (rhinitis medicamentosa)

Hypertension, insomnia, anxiety, urinary retention. Local decongestant: local stinging and
burning
Sympathomimetic effects

NURSING CONSIDERATIONS:

Limit use to 3-5 days, Do not take other OTC cold or allergy preparations,
Follow manufacturers directions for use (Nasal spray, Nasal aerosol)
Monitor pulse blood pressure and cardiac response to the drug

SAMPLE MEDICATIONS:

pseudoephedrine (Sudafed)

pseudoephedrine (PediaCare)

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pseudoephedrine (Mucinex D)

TOPICAL NASAL STEROID DECONGESTANTS

ACTIONS:

Produce a direct local effect that blocks many of the complex reaction responsible for the
inflammation response

INDICATIONS:

Seasonal allergic rhinitis

Relive inflammation after the removal of the nasal polyps

CONTRAINDICATIONS:

Acute infection

ADVERSE REACTIONS:

Local burning
Irritation stinging
Dryness of the mucosa
Headache

NURSING CONSIDERATIONS:

Teach the patient how to administer these drug properly

Clear nasal passages before using the drug
Benefits may take 2 to 3 weeks to appear

SAMPLE MEDICATIONS:

beclomethasone (Vancenase)

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flunisolide (Nasalide)

oxymetazoline (Afrin)

EXPECTORANTS
ACTION:

Facilitate the excretion of fluid in the respiratory tract allowing expectoration during a cough
Helps loosen congestion in your chest and throat, making it easier to cough out through your
mouth
Guaifenesin increases the volume and reduce the viscosity of tenacious sputum and is used as
an expectorant for productive cough

INDICATIONS:

Relief of dry, unproductive cough

Facilitation of secretion removal
Relieve the symptoms of cough and mucus in the chest due to colds, flu, or hay fever
Help clear mucus or phlegm from the chest when you have congestion from a cold or flu. It
works by thinning the mucus or phlegm in the lungs.

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CONTRAINDICATIONS:

Cough accompanied by excessive secretions

Cough with a fever, rash, or persistent headache
Pregnancy, lactation.
Porphyria.
Should not use this medicine if you are allergic to guaifenesin.
Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child under 4
years of age. Using these medicines in very young children might cause serious or possibly lifethreatening side effects.
Do not use Mucinex if you are allergic to guaifenesin or any other ingredient found in Mucinex
Sustained-Release tablets

ADVERSE REACTIONS:

GI symptoms (gastric upset, nausea, vomiting, anorexia epigastric pain)

Headache, dizziness or both
Mild rash
Metallic taste
Drowsiness

NURSING CONSIDERATIONS & SAMPLE MEDICATIONS:

guaifenesin (Robitussin)

o
o
o
o
o

Have the client call the physician if cough persist more than 7 days after the treatment is
initiated
Assess for type and frequency of cough
Encourage oral fluid
Avoid cigarette smoke
Advise the use of small, frequent meals
Advise the patient to avoid drinking or performing dangerous

guaifenesin (Mucinex)
o
o
o
o

Have the client call the physician if cough persist more than 7
after the treatment is initiated
Assess for type and frequency of cough
Encourage oral fluid
Avoid cigarette smoke

days

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o
o
o
o

o
o
o
o
o
o
o
o

o
o

Advise the use of small, frequent meals

Advise the patient to avoid drinking or performing dangerous
Do not use Mucinex if you are allergic to guaifenesin or any other ingredient found in
Mucinex Sustained-Release tablets
Ask health care provider if Mucinex may interact with other medicines that you take.
Check with your health care provider before you start, stop, or change the dose of any
medicine.
Some medical conditions may interact with Mucinex: if you are pregnant, planning to
become pregnant, or are breast-feeding
if you are taking any prescription or non-prescription medicine, herbal preparation, or
dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a chronic cough that occurs with smoking, asthma, chronic bronchitis, or
emphysema, or if your cough occurs with large amounts of mucus
Take Mucinex by mouth with or without food.
Drinking extra fluids while you are taking Mucinex is recommended. Check with your
doctor for instructions.
Swallow Mucinex Sustained-Release tablets whole. Do not break, crush, or chew a
Mucinex tablet before swallowing.
If you miss a dose of Mucinex and you are taking it regularly, take it as soon as possible.
If it is almost time for your next dose, skip the missed dose. Go back to your regular
dosing schedule. Do not take 2 doses at once.
If cough persists for more than 1 week or is accompanied by a fever, contact your health
care provider. A persistent cough could be a sign of a serious condition.
Monitor adverse effects

guaifenesin (Diabetic Tussin EX)

o
o
o
o
o
o
o

Have the client call the physician if cough persist more than 7 days after the treatment is
initiated
Assess for type and frequency of cough
Encourage oral fluid
Avoid cigarette smoke
Advise the use of small, frequent meals
Advise the patient to avoid drinking or performing dangerous
Monitor adverse effects

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o
o
o
o
o

Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child
under 4 years of age. Using these medicines in very young children might cause serious
or possibly life-threatening side effects.
Should not use this medicine if you are allergic to guaifenesin.
Instruct to take of exactly as directed on the label, or as prescribed by your doctor. Do
not use it in larger amounts or for longer than recommended.
Do not use this medication without telling your doctor if you are breast-feeding a baby.
Tell your doctor if you are pregnant or plan to become pregnant while using this
medication. Take guaifenesin with food if it upsets your stomach.
Measure the liquid form of guaifenesin with a special dose-measuring spoon or cup, not
a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist
for one.
Do not crush, chew, break, or open a controlled-release, delayed-release, or extendedrelease tablet or capsule. Swallow it whole. Breaking or opening the pill may cause too
much of the drug to be released at one time.
Store at room temperature away from moisture, heat, and direct sunlight.

guafenesin (Liquibid)

o
o
o
o
o
o
o
o

o
o
o
o
o

Have the client call the physician if cough persist more than 7 days after the treatment is
initiated
Assess for type and frequency of cough
Encourage oral fluid
Avoid cigarette smoke
Advise the use of small, frequent meals
Advise the patient to avoid drinking or performing dangerous
Monitor adverse effects
Do not give this medication to a child younger than 4 years old. Always ask a doctor
before giving a cough or cold medicine to a child. Death can occur from the misuse of
cough and cold medicines in very young children.
Should not use this medicine if you are allergic to guaifenesin.
Instruct to take of exactly as directed on the label, or as prescribed by your doctor. Do
not use it in larger amounts or for longer than recommended.
Do not use this medication without telling your doctor if you are breast-feeding a baby.
Tell your doctor if you are pregnant or plan to become pregnant while using this
medication. Take guaifenesin with food if it upsets your stomach.
Measure the liquid form of guaifenesin with a special dose-measuring spoon or cup, not
a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist
for one.

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Do not crush, chew, break, or open a controlled-release, delayed-release, or extendedrelease tablet or capsule. Swallow it whole. Breaking or opening the pill may cause too
much of the drug to be released at one time.
Store at room temperature away from moisture, heat, and direct sunlight.

SYMPATHOMIMETIC BRONCHODILATOR
ACTIONS:

Mimic the effects of the sympathetic nervous system

INDICATIONS:

Bronchospasms in acute and chronic asthma and bronchitis

Preventing exercise induced bronchospasm

CONTRAINDICATIONS:

Cardiac disease and arrhythmias

Hyperthyroidism
Pregnancy and lactation

ADVERSE REACTIONS:

GI upset
Cardiac arrhythmias and HPN, tachycardia, and palpitations
Sweating, pallor
Anxiety, nervousness, tremors

NURSING CONSIDERATIONS:

RR below 12 cpm and above 24 are considered abnormal

Auscultate the lung fields
Use minimal amount needed for the shortest period of time necessary
For exercise-induced asthma, use it 30 to 60 minutes before exercising
Nebulization: take small, deep breaths and hold breath for 10 seconds before slowly exhaling
Provide small frequent meals and nutritional consultation for GI effects

SAMPLE MEDICATIONS:

Salbutamol Merck

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salmeterol (Serevent Accuhaler)

formaterol (Easyhaler)

ANTI-TUSSIVES:
ACTIONS:

Depress the cough center located in the medulla; increase the proportion of serious bronchial
secretion.
Bromhexine enhances mucus transport by reducing mucus viscosity and by activating the
ciliated epithelium (mucociliary clearance).

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INDICATIONS:

Relief of non-productive cough; cough suppressant

FOR BROMHEXINE: Secretolytic therapy in acute and chronic bronchopulmonary diseases
associated with abnormal mucus secretion and impaired mucus transport.

CONTRAINDICATIONS:

Hypersensitivity
Use in Children: Bisolvon should not be used in children

Patients at risk of developing resp failure

During an acute attack

Patients receiving MAOI or for 2 wk after discontinuing them
Persistent or chronic cough
Narrow-angle glaucoma
Prostatic hypertrophy
Stenosing peptic ulcer & pyloroduodenal obstructions predisposing to increased risk of GI
obstruction
Bladder-neck obstruction
Porphyria
Patients receiving antidepressant therapy
Lactation
Premature infants & neonates

ADVERSE EFFECTS:

Drying effect on the mucous membranes: nausea, constipation & dry mouth; euphoria, light
headedness & vomiting
CNS effects: sedation & drowsiness, respiratory depression

NURSING CONSIDERATIONS & SAMPLE MEDICATIONS:

bromhexine HCL (Bisolvon)

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o
o
o
o
o
o
o
o

Ensure that the drug is not taken any longer than recommended
Coughs that persist or accompanied by high fever, rash or excessive secretions should
see a doctor
Assess the type of cough the patient has
Antitussives are administered orally
Encourage oral fluids
Avoid irritants such as cigarette smoke, dust or fumes to decrease irritation of the throat
Take frequent sips of water, suck on sugarless candy or chew gum
Monitor adverse effects

dextromethorphan HBr (Robitussin)

o
o
o
o
o
o
o
o
o

Ensure that the drug is not taken any longer than recommended
Coughs that persist or accompanied by high fever, rash or excessive secretions should
see a doctor
Assess the type of cough the patient has
Antitussives are administered orally
Encourage oral fluids
Avoid irritants such as cigarette smoke, dust or fumes to decrease irritation of the throat
Take frequent sips of water, suck on sugarless candy or chew gum
May be taken with or without meals
Monitor adverse effects

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diphenhydramine HCl (Benadryl)

o
o
o
o
o
o
o
o
o
o
o

o
o
o
o

Ensure that the drug is not taken any longer than recommended
Coughs that persist or accompanied by high fever, rash or excessive secretions should
see a doctor
Assess the type of cough the patient has
Antitussives are administered orally
Encourage oral fluids
Avoid irritants such as cigarette smoke, dust or fumes to decrease irritation of the throat
Take frequent sips of water, suck on sugarless candy or chew gum
May be taken with or without meals
Monitor cardiovascular status especially with pre-existing cardiovascular disease.
Monitor for adverse effects especially in children and the older adult.
Supervise ambulation and use side-rails as necessary. Drowsiness is most prominent
during the first few days of therapy and often disappears with continued therapy. Older
adults are especially likely to manifest dizziness, sedation, and hypotension.
Do not use alcohol and other CNS depressants because of the possible additive CNS
depressant effects with concurrent use.
Do not drive or engage in other potentially hazardous activities until the response to drug
is known.
Increase fluid intake, if not contraindicated; drug has an atropine-like drying effect
(thickens bronchial secretions) that may make expectoration difficult.
Do not breast feed while taking this drug.

MUCOLYTICS
ACTIONS:

Normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of
acetaminophen.
Affects the mucoproteins in the respiratory secretions by splitting apart disulfide bonds

INDICATIONS:

Overdosage of acetaminophen

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Emphysema, atelectasis
Acute bronchopulmonary disease
Cystic Fibrosis

CONTRAINDICATIONS:

Acute cases of bronchospasm

Peptic ulcer
Esophageal varices

ADVERSE REACTIONS:

G.I upset
Stomatitis
Nausea and Vomiting
Fever
Rash
Rhinorrhea
Bronchospasm

NURSING CONSIDERATIONS:

Assess Respiratory Status (Lung Sounds)

Note changes in the amount of and consistency of sputum
Administer drug once patients is overdose with acetaminophen 24hrs prior

SAMPLE MEDICATIONS:

acetylcysteine (Bronkyl)

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acetylcysteine (Fluimucil)

acetylcysteine (Mucomyst)

ANTICHOLINERGIC BRONCHODILATOR
ACTION:

Also called as Muscarinic Receptor Antagonist, blocks or antagonizes the nerve reflexes that
cause the airways to constrict, to allow the air passages to remain open. Muscarinic receptor
antagonists bind to muscarinic receptors and inhibit acetylcholine mediated bronchospasm

INDICATION:
Bronchitis
Emphysema
Chronic Obstructive Pulmonary Disease
CONTRAINDICATION & CAUTION:
Glaucoma
Urinary bladder obstruction
Prostatic Hypertrophy
ADVERSE EFFECTS:
Dizziness
Headache
Fatigue
Nervousness
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Dry mouth
Sore throat
Palpitations
Urinary retention

NURSING CONSIDERATIONS:

Ensure adequate hydration

Encourage the patient to void before each dose of medication
Caution the patient not to exceed 12 inhalations in 24 hours
Provide small frequent meals and sugarless lozenges

SAMPLE MEDICATIONS:
1)

ipratropium bromide (Atrovent HFA)

Inhalation aerosol form
2-4 times daily puffs 3-4
Intranasal ipratropium is used for treating allergic or non-allergic rhinitis and rhinitis due to
the common cold
Orally inhaled ipratropium is used for preventing bronchospasms resulting from chronic obstructive
pulmonary disease or COPD.
It should not be used for the initial treatment of acute bronchospasm where a rapid response is
needed. Orally inhaled ipratropium is used off-label for treating asthma

2) oxitropium bromide (Oxivent) or flutropium bromide (Fluibron)

2 puffs 2-3 times daily

Given by MDI and PDI

3) tiotropium (Tiova)
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DPI inhale contents of 1 capsule daily

XANTHINE BRONCHODILATOR
ACTION:
Increase levels of energy producing cAMP (Cyclic Adenosine Monophosphate), this is done

competitively inhibiting Phosphodiesterase (PDE) the enzyme that breaks down cAMP. Result:
Decreased cAMP levels gives direct relaxation of the smooth muscles of the bronchi and the
blood vessels
Work by directly affecting the mobilization of calcium within the cell by stimulating 2
prostaglandins
Inhibit the release of slow reacting substance anaphylaxis

INDICATION:

Relief and prevention of bronchial asthma and reversible bronchospasm associated with chronic
bronchitis and emphysema
Adjunct therapy for the relief of pulmonary edema and paroxysmal nocturnal edema in left-side
heart failure
Respirations in Cheyne-Stokes respiration

CONTRAINDICATIONS:

GI Problems
Coronary Disease
Respiratory dysfunction
Renal or Hepatic disease
Alcoholism
Hyperthyroidism

ADVERSE REACTIONS:

Nausea

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Vomiting
Restlessness
Nervousness
Tachycardia
Tremors
Headache
Palpitations
Increased Respirations

NURSING CONSIDERATIONS:

Avoid xanthine-rich foods (char-broiled), coffee, cola, chocolate

Administer oral drug with food
Monitor patients response to drug

SAMPLE MEDICATIONS:
1) aminophylline
Aminophylline is usually administered as an injection at your doctor's office, hospital, or clinic. If
you are using aminophylline at home, carefully follow the injection procedures taught to you by

your health care provider.

Keep this product, as well as syringes and needles, out of the reach of children and away from
pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your
doctor or pharmacist to explain local regulations for proper disposal.

2) theophylline (Theo-dur)

Theophylline comes as a tablet, capsule, solution, and syrup to take by mouth. It usually is taken
every 6, 8, 12, or 24 hours. Follow the directions on your prescription label carefully, and ask your
doctor or pharmacist to explain any part you do not understand. Take theophylline exactly as
directed. Do not take more or less of it or take it more often than prescribed by your doctor.

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Take this medication with a full glass of water on an empty

stomach, at least 1 hour before or 2 hours after a meal. Do
not chew or crush the extended-release (long-acting)
tablets; swallow them whole. Extended-release capsules
(e.g., Theo-Dur Sprinkles) may be swallowed whole or
opened and the contents mixed with soft food and
swallowed without chewing.

3) theobromine
theobromine is used as a vasodilator, a diuretic, and heart stimulant. And similar to caffeine, it may be
useful in management of fatigue and orthostatic hypotension.
like caffeine and the bronchodilator theophylline, is used as a CNS stimulant, mild diuretic, and
respiratory stimulant (in neonates with apnea of prematurity).

LEUKOTRIENE RECEPTOR ANTAGONIST

ACTIONS:

Selectively and competitively block or antagonize receptors for the production of D4 and E4
Components of SRSA.

INDICATIONS:

For prophylaxis and chronic treatment of bronchial asthma

CONTRAINDICATIONS:
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Hepatic and Renal Impairment

ADVERSE REACTIONS:

Headache
Dizziness
Myalgia
Nausea, Vomiting
Diarrhea
Elevated liver enzyme concentrations

NURSING CONSIDERATIONS:

Administer drug on empty stomach

Instruct patient to avoid OTC drugs which contains Aspirin which might interfere with the
effectiveness of these drugs
These drugs are not to be used during an acute asthmatic attack or bronchospasms

SAMPLE MEDICATIONS:

montelukast (Singulair)

zafirukast (Accolate)

zileuton (Zyflo)

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INHALED STEROIDS
ACTIONS:

Increase airflow and facilitate respiration

Decreased swelling associated with inflammation
Promotion of beta adrenergic activity

INDICATIONS:

Asthma

CONTRAINDICATIONS:

Active infection of the Respiratory System

ADVERSE REACTIONS:

Sore throat, hoarseness, coughing, dry mouth, and pharyngeal and laryngeal fungal infections
Lesions

NURSING CONSIDERATIONS:

Do not administer the drug to treat an acute asthma attack or status asthmaticus
Taper systemic steroids carefully during the transfer to inhaled steroids
Have the patient use decongestant drops before using the inhaled steroid
Have the patient rinse the mouth after using the inhaler
Monitor for any sign of respiratory infection continued use of steroids during an acute infection

SAMPLE MEDICATIONS:

beclomethasone (Qvar)

budesonide

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fluticasone

LUNG SURFACTANTS
ACTIONS:

Lowers surface tension on alveolar surfaces during respiration, and stabilizes the alveoli against
collapse at resting pressures
Lowers minimum surface tension and restores pulmonary compliance and oxygenation in
premature infants

INDICATIONS:

Prevention and treatment of Respiratory Distress Syndrome in premature infants, especially

those weighing < 1250 g.

CONTRAINDICATIONS:

Allergy to the drug

Nosocomial infections
For PORACTANT ALPHA: Hypersensitivity to porcine products (poractant alpha is obtained
from minced porcine lungs)
CAUTION: (for poractant alpha) Infants born > 3 weeks after ruptured membranes,
intraventricular hemorrhage of grade III or IV, major congenital malformations, pretreatment of
hypothermia or acidosis due to increased risk of intracranial hemorrhage

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ADVERSE REACTIONS:

Transient bradycardia, hypotension

Oxygen desaturation, intratracheal tube blockage (with poractant alpha), and cyanosis, airway
obstruction, and reflux of surfactant into endotracheal tubes (with calfactant)
Increased probability of posttreatment nosocomial sepsis in surfactant-treated infants was
observed in controlled clinical trials but was not associated with increased mortality

NURSING CONSIDERATIONS:

Place refrigerated drug at room temperature for at least 20 minutes or warm in the hand for at
least 8 minutes. Do not use artificial warming methods
Give to premature infants weighing less than 1250 g, or who have a surfactant deficiency,
preferably within 15 minutes of birth
Give to infants requiring mechanical ventilation and with RDS within 8 hours of birth
Suction infant before administration of beractant
Vials of beractant are for single use only. Store unopened vials inside carton to protect from light
and refrigerate at 2C to 8C until ready to use
Store poractant alpha refrigerated at 2C to 8C and protect from light. Do not shake vials, and
do not return to refrigerator more than once
For calfactant: Swirl vial to disperse suspension, do not dilute and do not shake
Monitor heart rate, color, chest expansion, facial expressions, oximeter, and endotracheal tube
patency and position during administration. Most adverse effects occur during dosing
Rales and moist breath sounds may occur transiently following drug administration. These do
not necessarily indicate a need for suctioning
Stop administration of poractant alpha and take appropriate measures if any of the following
occur: transient episodes of bradycardia, decreased oxygen saturation, reflux of poractant alpha
into endotracheal tube, or airway obstruction. Dosing may resume after stabilization
Do not suction airway for 1 hour after poractant alpha instillation unless there is significant
airway obstruction

SAMPLE MEDICATIONS:

beractant (Survanta)

poractant alpha (Curosurf)

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calfactant (Infasurf)

MAST CELL STABILIZERS

ACTIONS:

Inhibits release of bronchoconstrictorshistamine and SRS-A (slow-reacting substance of

anaphylaxis) from sensitized pulmonary mast cells, thereby suppressing an allergic response.
Particularly effective for IgE-mediated or extrinsic asthma precipitated by exposure to specific
allergen, e.g., pollens, dust, and animal dander by inhibiting the release of bronchoconstrictor
substances.

INDICATIONS:

Prophylaxis for mild to moderate seasonal and perennial bronchial asthma and allergic rhinitis
Prevention of exercise-related bronchospasm
Prevention of acute bronchospasm induced by known pollutants or antigens
Orally for systemic mastocytosis

CONTRAINDICATIONS:

Use of aerosol (because of fluorocarbon propellants) in patients with coronary artery disease or
history of arrhythmias
Dyspnea, acute asthma, status asthmaticus
Pregnancy (category B), lactation
Safe use in children < 6 years old not determined
Use of capsule not recommended for children
CAUTION: Renal or hepatic dysfunction

Velez College, Inc. College of Nursing, BSN II 2nd Semester, Nursing Pharmacology, S.Y. 20152016 Prepared by: BSN II B
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ADVERSE REACTIONS:

Peripheral eosinophilia, RARE: angioedema, bronchospasm, anaphylaxis

Swelling of parotid glands, dry mouth, slightly bitter after-taste, nausea, vomiting, esophagitis
Headache, dizziness, peripheral neuritis
Erythema, urticarial, rash, contact dermatitis
Sneezing, nasal stinging and burning, dryness and irritation of throat and trachea, cough, nasal
congestion, itchy and puffy eyes, lacrimation, transient ocular burning, stinging

NURSING CONSIDERATIONS:

Withhold drug and notify physician if angioedema or bronchospasm occur

Advise patients to clear as much mucus as possible before inhalation treatments
Protect cromolyn from moisture and heat. Store in tightly closed, light-resistant containers at
15C to 30C unless otherwise directed
Reduce doses of nedocromil in stages, with each lower dose maintained for several weeks of
good control prior to further decreasing dose
Monitor for exacerbation of asthmatic symptoms, including breathlessness and cough that may
occur in patients receiving cromolyn during corticosteroid withdrawal
For patients with asthma, therapeutic effects may be noted within a few days but generally not
until 1 to 2 weeks of therapy
Minimize throat irritation, cough, and hoarseness by gargling with water, drinking a few swallows
of water, or by sucking on a lozenge after each treatment
Talk to a physician about what to do in the event of an acute asthmatic attack. Cromolyn is of no
value during an acute asthmatic attack.
Treatment with cromolyn 15 minutes before doing protracted exercises reportedly blunts the
effects of vigorous exercise as well as cold air
Assess for coughing and bronchospasms induced by nedocromil. These are indications for
discontinuation of the drug and should be promptly reported
Monitor patients for whom synthetic or inhaled steroid therapy has been reduced, as nedocromil
may not fully substitute for the decrease in dose of steroid
Do not use nedocromil to treat acute bronchospasms as it is not a bronchodilator
Continue therapy even during symptom-free periods

SAMPLE MEDICATIONS:

cromolyn sodium (Crolom)

Velez College, Inc. College of Nursing, BSN II 2nd Semester, Nursing Pharmacology, S.Y. 20152016 Prepared by: BSN II B
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cromolyn sodium (Intal)

nedocromil sodium (Tilade)

Velez College, Inc. College of Nursing, BSN II 2nd Semester, Nursing Pharmacology, S.Y. 20152016 Prepared by: BSN II B
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