By Justine Buick, MSN, RN
I spend a lot of time looking at the “most prescribed meds” and meds most likely to be asked about on the NCLEX. Here are my top 13 respiratory meds to know for 2017:
A note about side effects:
Because side effects are such a problem for students to remember, I want you to know the difference between mild/common side effects and a KILLER side effect. Your actions will be different depending on the situation. And if you can’t recognize the difference, you will be in trouble with NCLEX questions.
For a side effect that is mild or common, you will have to teach your patient how to deal with the side effect or provide comfort or safety measures. For a side effect that is KILLER, you will have to STOP the med and save their life!
Lots of meds have the same prefix or suffix. Therefore, I’ve bolded that part so you will be able to recognize the med name better.
- albuterol, levalbuterol: These are short-acting bronchodilator inhalers, which are to be given with an acute attack. Side effects that are mild/common are tremors and tachycardia.
- ipratropium, tiotropium: These are long-acting bronchodilator inhalers, which are used as a maintenance inhaler and not for acute attacks. A KILLER side effect is anaphylaxis. The mild/common side effects are anticholinergic side effects. To remember the anticholinergic side effects, remember the letters “BCDU”, along with the nursing considerations:
- B: blurred vision (safety/falls precautions)
- C: constipation (give stool softeners, increase fiber/fluids, encourage walking)
- D: dry mouth (give ice chips or non-sugar candy to suck on)
- U: urinary retention (record I&O, don’t give anticholinergics to patients that have urinary retention problems like BPH (benign prostrate hyperplasia)
You may want to remember the anticholinergic side effects with this saying:
“You can’t see
you can’t shit
you can’t pee
and your mouth is dry”
- beclomethasone, prednisolone: These are corticosteroids and they all end in -lone or -sone. There are way more than what I just wrote. One odd-ball is called budesonide. They are used to decrease inflammation. A mild or common side effect is that they all increase blood sugar. They can also cause cushing’s like symptoms of edema and increased risk of infection. There are several types of steroids: inhalers, nasal, pills, IV. Teach your patients to take the steroids as prescribed and taper them if needed.
USE THE BRONCHODILATOR FIRST, THEN THE STEROID!
(open the airways, then decrease the inflammation)
- diphenhydramine: This is an anti-allergy: This is given for all kinds of issues, but for respiratory it’s given for those allergies that cause a runny nose. It can even be given for anaphylaxis. You probably know it better as benedryl (but that’s the brand name so they won’t say that). The mild/common side effects are anticholinergic side effects. Remember those? Just look above at the cute saying 🙂
- hydroxyzine: This is an anti-histamine. This is given mostly for itching but it can be given for anxiety. Hence the common/mild side effect is drowsiness.
- cetirizine, levocetirizine, loratadine: These are also anti-histamines. But these meds are given for seasonal allergies such as itchy eyes and runny nose symptoms. Mild/common side effects are drowsiness and a dry mouth. (Do I need to point out that if a med causes drowsiness, then one of your nursing considerations would be to implement safety/falls precautions? If you didn’t know that, you know it now).
- varenicline: This is a smoking deterrent med. Unfortunately a KILLER side effect is depression and suicidal thoughts.
- oseltamivir: This med is to treat the flu. Do you see the “VIR” letters in the med name? Any med that has “VIR” is an anti-viral. A KILLER side effect is seizures.
- Tuberculosis meds. These meds are usually taken for 6-9 months.
isoniazid: A common side effect is peripheral neuropathy. Also check the liver function tests periodically since this med is toxic to the liver.
rifampin: A common side effect is red-orange secretions; be sure to teach your patient that, so they don’t freak out when their pee is orange. Check liver function tests and kidney function tests periodically since it’s toxic to both the kidneys and liver.
- montelukast: this med is a bronchodilator that’s for allerigies and is taken as a pill. This med contains aspartame, so don’t give to patients that have PKU.
- guaifenesin: this med is an expectorant that helps a patient cough up mucus. Once again this med also contains aspartame, so don’t give it to a patient that has PKU (so redundant, I know. But maybe it will help you to remember).
- benzonatate: this med is an anti-tussive that suppresses the cough. Give ONLY for dry coughs.
- theophylline, aminophylline: These are 2nd choice bronchodilators. They aren’t give all that much, but for whatever reason, there’s tons of NCLEX questions on them. Theophylline therapeutic level is 10-20. Avoid caffeine (it’s similar to theophylline so it can increase side effects). If the level becomes toxic the KILLER side effects are GI upset, irritability, tachycardia, and seizures.
What questions do you have about respiratory meds? Post in the comments section.