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Appendix L: Chart found on page 114-121 of original guideline Nursing Care of Dyspena: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) has been replaced with the chart below.
Short acting β2 agonists:
• Promotes bronchodilation through stimula- • tremor tion of 2-adrenergic receptors thereby relax- • tachycardia Absorption: 20% inhaled, well absorbed (PO)
• Ratio-Salbutamol® MDI (HFA) 100 μg Distribution: 30% inhaled, crosses blood brain
Onset of action: a few minutes
Metabolism: liver extensively, tissues
Peaks: 15-20 minutes
Excretion: mostly urine, feces, breast milk
Duration: 2-4 hours, fenoterol up to 8 hours
Half-Life: 4-6 hrs
Absorption: partially absorbed (PO), minimal
(inhalation)
Distribution: crosses placenta
Metabolism: liver, gut wall
Excretion: bile, feces, urine, breast milk
Half-Life: unknown
Absorption: inhalation, minimal; incomplete PO
Distribution: unknown
Metabolism: liver, 90%
Excretion: breast milk, kidney 12%
Half-Life: 7 hours
• Oxeze® Turbuhaler® PD 6 μg and 12 μg Absorption: rapid, lung deposition 21-37%
Distribution: plasma protein binding
approximately 50%
Metabolism: liver, extensive
Excretion: 10% unchanged in urine
Half-Life: approximately 8-10 hours
Anticholinergic:
An anticholinergic drug that has been shown • dry mouth Absorption: minimal
• Atrovent® Wet Nebulization 125 μg/ml Distribution: does not cross blood-brain barrier
Onset of action: 5 – 15 minutes
Metabolism: liver, minimal
Peaks: 1 – 2 hours
Excretion: urine feces
Duration: 4 – 5 hours
Half-Life: 3-5 hrs
• An anticholinergic drug that inhibits M3- • dry mouth receptors at the smooth muscle leading to • constipation Absorption: highly bioavailable in the lung,
• 18 μg tiotropium light green capsule Onset of action: 30 minutes
Distribution: does not cross blood-brain barrier
Peaks: 1 – 4 hours
Metabolism: liver, minimal
Administer at the same time each day.
Duration: 24 hours
Excretion: urine feces
Capsules sensitive to light and moisture. Half Life: 5 – 7 days
Half-Life: 5-7 days
Methylxanthine:
• May have some anti-inflammatory effect concentration or the patient’s inability Absorption: well absorbed (PO), slowly
• Patients may benefit even when serum Distribution: crosses placenta, widely
Metabolism: liver
Excretion: kidneys, breast milk
Half-Life: 3-13 hrs, increased in liver disease,
Inhaled/ Oral Steroids:
• Prevents and suppresses activation and Rinsing, gargling and expectorating after Absorption: 20%
• Alti-beclomethasone® MDI (CFC) 50 g • Reduces airway swelling, mucus production, • hoarse voice Distribution: 10-25% in airways (no spacer)
Metabolism: minimal
• Increases responsiveness of smooth muscle Excretion: less than 10% in urine/feces
Half-Life: 15 hrs
• Pulmicort® Nebuamp® Wet Nebulization Absorption: 39%
Distribution: 10-25% in airways (no spacer)
• Pulmicort® Turbuhaler® PD100 μg, 200 Metabolism: liver
Excretion: 60% urine, smaller amounts in feces
Half-Life: 2-3 hrs
Same as other inhaled corticosteroids.
glucocorticoid prodrug that is hydrolyzed propellant and ethanol as a solution aerosol.
to the pharmacologically active metabolite Absorption: > 50% (active metabolite)
des-ciclesonide following administration.
Distribution: protein binding 99%, lung
• Des-ciclesonide has a high affinity for the glucocorticoid receptor and exhibits Metabolism: ciclesonide hydrolyzed to active
metabolite, des-ciclesonide via esterases in lungs,
further metabolism via hepatic CYP3A4 and 2D6
Excretion: feces (78%)
Half-Life: 6 hours
• Flovent® Diskus® PD 50 μg, 100 μg, Absorption: 30% aerosol, 13.5% powder
Absorption: 10-25% in airways (no spacer), 91%
• Flovent® MDI(HFA) 50 μg, 125 μg, and Metabolism: liver
Excretion: less than 5% in urine, 97-100% in feces
Half-Life: 14 hrs
Oral or IV route-short term (less than 2 weeks): Absorption: well absorbed
Distribution: widely distributed; crosses placenta
Metabolism: liver, extensively
Excretion: urine, breast milk
Half-Life: 3-4 hrs
• Medrol® 4 mg tablets and 16 mg tablets Oral route-long term (more than 2 weeks): Absorption: rapid
Skin care education re: dry, thin, bruising. Distribution: widely distributed
Metabolism: liver
Excretion: urine
Half-Life: 18 to 36 hrs, depending on the drug
• weight gain• cataracts• glaucoma• peptic ulcer• ecchymosis• avascular necrosis of the hip Long-Acting β2 agonists:
• Promotes bronchodilation through stimula- • Oxeze® Turbuhaler® PD 6 μg and 12 μg tion of 2-adrenergicreceptors thereby relax- Absorption: rapid, lung deposition 21-37%
Distribution: plasma protein binding
Metabolism: liver, extensive
Onset of action: 1-3 minutes
Excretion: 10% unchanged in urine
Duration: 12 hours
Half-Life: approximately 8-10 hours
Onset of action: 10-20 minutes
Absorption: minimal systemic
Duration: 12 hours
Distribution: local
Metabolism: liver first pass
Excretion: unknown
Half-Life: 5.5 hrs
Combination Drugs:
• the same as those listed for each medication Dry Mouth-Rinse mouth due to dryness.
ipratropium/ 3 mg salbutamol per 2.5 ml vial and inhaled steroids: budesonide and formoterol • Symbicort® Turbuhaler® PD 100/6 βg, fluticasone and salmeterol • Advair® Diskus® PD 100/50 μg, • Advair® MDI(HFA) 125/25 μg, 250/25 μg Macrolides/Anti-Infectives:
Binds to 50S ribosomal subunits of subunits Absorption: 50%
Be aware whether the antibiotic the patient is of susceptible bacteria and suppresses protein Distribution: widely distributed
prescribed is to be taken with or without food.
Metabolism: liver
Excretion: kidney’s unchanged (20%-30%)
Determine if the patient has a sensitivity or Half-Life: 4-6 hrs
allergy to the prescribed medication.
• Binds to 50S ribosomal subunits of subunits Absorption: rapid, (PO) up to 50%
• PO 500 mg on day 1 then 250mg qd on of susceptible bacteria and suppresses protein Distribution: widely distributed
synthesis, much greater spectrum of activity Metabolism: unknown, minimal metabolism
• IV 500 mg qd > 2 days then 250 mg qd to Excretion:unchanged (bile); kidney’s, minimal
Half-Life: 11-70 hrs
• Binds to 50S ribosomal subunits of subunits Absorption: well absorbed (PO),
• PO 250-500 mg q6h (base, estolate, state), of susceptible bacteria and suppresses protein minimally absorbed (topically, ophthalmic) Distribution: widely distributed; minimally
• IV inf 15-20 mg/kg/day (lactobionate) Metabolism: liver partially
Excretion: unchanged (bile); kidney’s,
minimal unchanged
Half-Life: 1-3hrs
• Interfers with cell wall replication of susceptible Absorption: well absorbed (90%)
• PO 750 mg-1.5g qd in divided doses q8h organisms by binding to the bacterial cell wall, Distribution: readily in body tissues, fluids,
the cell wall, rendered osmotically unstable, Metabolism: liver (30%)
Excretion: breast milk, kidney, unchanged (70%)
Half-Life: 1-1.3hrs
• Inhibits protein synthesis, phosphorylation in Absorption: well absorbed
• PO/IV 100 mg q12h on day 1 then 100mg/ microorganisms by binding to 30S ribosomal Distribution: widely distributed; crosses placenta
subunits, reversibly binding to 50S ribosomal Metabolism: some hepatic recycling
Excretion: bile, feces, kidney, unchanged (20%-40%)
Half-Life: 15-22 hours; increased in severe renal
• Interferes with conversion of intermediate Absorption: well absorbed (75%) (PO)
• For respiratory infections PO 500 mg q12h DNA fragments into high-molecular-weight Distribution:widely distributed
Metabolism: liver (15%)
Excretion: kidneys (40-50%)
Half-Life: 3-4 hr; increased in renal disease
Fluoroquinolone/Antibacterial:
• Bacterialcidal, interferes with DNA replication, Absorption: unknown
repair, transcription and recombination in Distribution: crosses placenta
susceptible gramnegative and gram-positive Metabolism: liver
bacteria, preventing cell reproduction and Excretion: feces, urine
Half-Life: 12-13.5 hrs
Psychotropics:
• Acts by inhibiting the action of serotonin by Absorption: rapidly absorbed
• PO 5 mg tid; may increase by 5 mg/day q2-3 binding to serotonin and dopamine receptors Distribution: unknown
Metabolism: liver extensively
Excretion: feces
Half-Life: 2-3 hours
• hypertension• hypotension• dizziness• headache• tremors• nausea• diarrhea• constipation • Depresses cerebral cortex, hypothalamus, Absorption: variable PO, well absorbed IM
• PO 10-50 mg q1-4h initially then increase up Distribution: widely distributed; crosses placenta
Metabolism: liver, GI mucosa extensively
produced by dopamine at synapse, exhibits Excretion: kidneys
• In elderly, use lowest effective dose a strong alphaadrenergic, anticholinergic Half-Life: 30 hours
blocking action, mechanism for antipsychotic Opioid Analgesics:
• Depresses pain impulse transmission at the Absorption: variably absorbed (PO); well absorbed
Nebulized opioids are almost exclusively spinal cord level by interacting with opioid (IM, SC, rectally); completely absorbed IV used in palliative care in patients with • PO 10-30 mg q4h prn; ext rel q8-12h; rectal Distribution: widely distributed, crosses placenta
Metabolism: liver extensively
• IV 4-10 mg diluted in 4-5 ml water for Excretion: kidneys
Half-Life: 1.5- 2 hours
• bradycardia• hypotension• nausea• vomiting• constipation• urinary retention • Depresses pain impulse transmission at the Absorption: well absorbed (PO); completely
spinal cord level by interacting with opiod (e.g., egg allergy, thimersol sensitivity) • Analgesic PO 2 mg q3- 6h prn, may increase receptors, increases respiratory tract fluid by Distribution: unknown, crosses placenta
decreasing surface tension and adhesiveness, Metabolism: liver extensively
• SC/IM 1-2 mg q3-6h prn, may increase to which increases removal of mucus, analgesic, Excretion: kidneys
Half-Life: 2-3 hours
• IV 0.5-1mg q3h prn; rec 3 mg q4-8h prn Vaccination:
• Inhibits influenza virus neuraminidase with • pain and/or erythema at injection site Absorption: rapidly absorbed
possible alteration of virus particle aggregation • anaphylaxis Distribution: protein binding is low
Metabolism: converted to oseltamivir carboxylate
Excretion: eliminated by conversion
Half-Life: 1-3 hours
• pain and/or erythema at the injection site Allergy to any components of the drug.
• IM/SC immunizing dose is a single injection • Revaccination: One injection of 0.5ml • pain and/or erythema at the injection site • Administer a single 0.5ml dose of the vaccine SC or IM (preferably in the deltoid muscle or Antiviral:
• Selectively inhibits influenza virus neuroam- Absorption: inhalation 4% - 17%
inidase; by blocking the action of this enzyme, Distribution: protein binding, plasma<10%
5mg/blister (4 blisters per Rotadisk), packaged there is decreased viral release from infected Metabolism: liver
with Diskhaler inhalation device 2 inhalations cells, increased formation of viral aggregates, • bronchospasm-use cautiously with patients Excretion: feces and urine
(10mg) twice daily x 5 days. Begin within 2 days with asthma or COPD-Fast acting bronchodilator Half-Life: 2.5-5 hrs
• Inhibits influenza virus neuraminidase with Absorption: rapidly absorbed
• PO 75 mg x 5 days begin treatment within possible alteration of virus particle aggregation • fatigue Distribution: protein binding is low
Metabolism: converted to oseltamivir carboxylate
Excretion: eliminated by conversion
Half-Life: 1-3 hours

Source: http://rnao.ca/sites/rnao-ca/files/storage/related/6136_COPD_Supp_AppL_FA.pdf