Albuterol is a short-acting beta2 agonist and should be used only as needed to stop an acute asthma exacerbation or 30 min prior to exercising to prevent exercise-induced bronchospasm. Salmeterol (Serevent) is an example of a drug that should be taken every 12 hours for long-term asthma management. Albuterol canisters should be kept away from heat and direct sunlight, but refrigerating them is not recommended. Inhaled glucocorticoids, such as beclomethasone (QVAR), may cause oral yeast infections. They are not an adverse effect of albuterol.
Caffeine may increase central nervous system stimulation, causing nervousness, insomnia, and tremors. It may also increase cardiac stimulation and cause tachycardia. Patients taking methylxanthines should be instructed to avoid caffeine intake. Alcohol use is not contraindicated for patients taking theophylline. Exercise is not contraindicated for patients who have asthma. Theophylline should not impair the patient’s ability to operate a motor vehicle.
Zileuton may cause liver damage and hepatitis. Patients should report any signs of hepatic toxicity, such as abdominal pain or jaundice. Dysphagia, or difficulty swallowing, is not likely to result from taking zileuton, although this drug can cause neck pain and rigidity. Zileuton is unlikely to cause blurred vision, although it can cause conjunctivitis. Bradycardia is unlikely to result from taking zileuton, although this drug can cause chest pain.
Ipratropium, an anticholinergic drug, is contraindicated for patients who are allergic to peanuts or soybeans because the medication preparation may contain peanut oil and soy lecithin. This drug should be used with caution in patients who have glaucoma due to the risk for increased intraocular pressure. Patients who have a seizure disorder or who take MAOIs or thyroid hormones can take ipratropium.
Beclomethasone, an inhaled glucocorticoid, may cause oropharyngeal candidiasis. Patients should gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat, and report any white patches inside the mouth or on the tongue. Leukotriene modifiers are more likely to cause liver injury and abdominal pain. Muscle twitching and palpitations may indicate methylxanthine toxicity.
Codeine is contraindicated for patients who have decreased respiratory reserve, such as with emphysema or asthma. Codeine is not contraindicated for patients who have cataracts, although it can exacerbate some types of glaucoma due to a possible increase in intraocular pressure. Codeine may cause constipation, hypotension, and reduced respirations. It should be used with caution in patients with hypothyroidism because the drug can worsen bradycardia. Codeine can help suppress a nonproductive cough.
Cromolyn may prevent exercise-induced asthma if used 15 min before exercising. Cromolyn is not effective at stopping bronchospasm. Cromolyn via nebulizer may be used up to four times per day to prevent bronchospasm. Using the inhaler at bedtime will not prevent exercise-induced asthma.
Dextromethorphan may cause euphoria and hallucinations at high doses. Patients taking it should be monitored for the potential for abuse. Dextromethorphan is unlikely to cause tachycardia, fluid retention, or blurred vision; however, it can cause dizziness, dyspepsia, and constipation.
Cetirizine, an oral antihistamine, may or may not cause drowsiness, so it is safest to avoid driving and activities that require mental alertness until the amount of drowsiness the patient experiences has been determined. Increasing fluids may help reduce dry mouth and constipation. Cetirizine may cause drowsiness and sedation. Taking cetirizine in the morning will not minimize its adverse effects. Taking antihistamines with food may help reduce gastric distress.
Add an intranasal glucocorticoid.
Taper the dose prior to discontinuation.
Restrict the drug’s use to one nostril at a time.
Phenylephrine, a topical sympathomimetic, should be used short-term to prevent rebound congestion. Limiting the drug’s use to 3 to 5 days, adding an intranasal glucocorticoid, tapering the dose prior to discontinuation, and restricting the drug’s use to one nostril at a time are all methods that can be used to avoid rebound congestion. Adding a beta2 adrenergic agonist will not have an effect on the nasal mucosa.