Beta 2 Adrenergic Agonists: Albuterol (Proventil, Ventolin), Formoterol (Foradil Aerolizer), Salmeterol (Serevent), Terbutalin (Brethine)
-Pregnancy Risk Category C.
-Contraindicated in clients who have tachydysrhythmia.
- Use cautiously in clients who have diabetes, hyperthyroidism, heart disease, hypertension and angina.
-Use of beta-adrenergic blockers (propranolol) can negate the effects of both medications.
-MAOIs and tricyclic antidepressants can increase the risk of tachycardia and angina.
Methylxanthines: Theophylline (Theolair, Theo-24)
-Pregnancy category C
-Use cautiously in clients who have heart disease, hypertension, liver and kidney dysfunction, and diabetes.
-Use cautiously in children and older adults.
-Caffeine increases CNS and cardiac adverse effects
-Phenobarbital and phenytoin decrease theophylline levels.
-Cimetidine (Tagamet), ciprofloxacin (Cipro) and other fluoroquinolone antibiotics increase theophylline levels.
Inhaled anyticholinergics: ipratropium (Atrovent), tiotrapium (Spiriva)
- Pregnancy risk category B
-Contraindicated in clients who have an allergy to peanuts because the medication preparations may contain soy lecithin.
-Use cautiously in clients who have narrow-angle glaucoma and benign prostatic hyperplasia (due to anticholinergic effects)
(If two inhaled medications are prescribed, instruct clients to wait at least 5 minutes between medications)
Glucocorticoids: Beclomethasone (QVAR), Prednisone
-Pregnancy Risk Category C
-Contraindicated in clients who have received a live virus vaccine and those with systemic fungal infections.
-Use cautiously in children and in clients who have diabetes, hypertension, peptic ulcer disease, and/or kidney dysfunction.
-Use cautiously in clients taking NSAIDs
Leukotriene modifiers: montelukast (Singulair), sileuton (Zyflo), zafirlukast (Accolate)
-Singulair and Accolate are Pregnancy Category B. Zyflow is C.
-Use cautiously in clients who have liver dysfunction.
-Zileuton and zafirlukast inhibit metabolism of warfarin and theophylline.
-Hepatotoxicity, as evidenced by an increase in AST
-Obtain baseline liver function, monitor liver function tests after 12 weeks and then every 6 months, advise clients to observe for indications of liver dysfunction (anorexia, vomiting, nausea, jaundice) and notify provider if symptoms occur, avoid alcohol, mediation may be discontinued if liver function tests are abnormal.
-Myopathy, as evidenced by muscle aches, pain and tenderness. May progress to myositis or rhabdomyolysis.
-Obtain baseline CK level. Monitor CK levels while on treatment periodically, advise clients to report muscle aches, pain and tenderness, medication may be discontinued if CK levels are elevated.
-Adverse effects: CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairment), Gingival hyperplasia, skin rash, teratogenic, cardiovascular effects, endocrine and other effects, interference with vitamin K-dependent clotting factors causing bleeding in newborns.
-Advise the client that phenytoin doses must be individualized. Dosing usually starts twice a day and can be switched to once-a-day dosing with an extended release form when maintenance dose has been established.
-Advise the client that phenytoin has a narrow therapeutic range, and strict adherence to the medication regimen is imperative to prevent toxicity or therapeutic failure.
-Sexual dysfunction (no orgasm, impotence, decreased libido)
-CNS stimulation (inability to sleep, agitation, anxiety) Notify provider, dose may need to be lowered) Take dose in the morning, avoid caffeinated beverages.
-Weight loss early in therapy, may be followed by weight gain with long-term treatment
-Serotonin syndrome may begin 2-72 hours after starting tx, may be lethal. (Mental confusion, difficulty concentrating, fever, agitation, anxiety, hallucinations, incoordination, hyperreflexia, diaphoresis, tremors)
-Withdrawal syndrome resulting in headache, nausea, visual disturbances, anxiety, dizziness, and tremors.
-Hyponatremia (more likely in older adults taking diuretics) - Obtain baseline serum sodium and monitor periodically.
-Sleepiness, faintness, lightheadedness