McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 5 5 Drugs acting on the lower respiratory tract

TABLE 55.1

DRUGS IN FOCUS Bronchodilators/antiasthmatics

Drug name

Dosage/route

Usual indications

Xanthines

Loading dose: Adult, paediatric (>6 months): 6 mg/kg over 20–30 minutes Maintenance: Adult 0.7 mg/kg for next 12 hours then 0.5 mg/kg thereafter Young adult smokers and paediatrics (9–16 years): 1 mg/kg for next 12 hours then 0.8 mg/kg Paediatric: 20 mg/kg IV followed by 5 mg/kg per day for neonatal apnoea Adult 200–300 mg q 12 hours Paediatric (2–12 years) 10 mg/kg q 12 hours

Relief of symptoms or prevention of bronchial asthma and reversal of bronchospasm associated with COPD

aminophylline (generic)

caffeine (Cafnea)

Short-term management of neonatal apnoea Relief of symptoms or prevention of bronchial asthma and reversal of bronchospasm associated with COPD Drug of choice for treatment of acute bronchospasm Maintenance treatment of asthma and prevention of bronchospasm in people ≥5 years of age with reversible obstructive airway disease; prevention of exercise-induced bronchospasm in people ≥12 years of age Special considerations: people taking the drug for asthma maintenance should not use additional doses of the drug for exercise-induced asthma Treatment of acute bronchospasm in adults and children, although adrenaline is the drug of choice

theophylline (Nuelin)

Sympathomimetics

Adult: 12.5–25 mg IM, SC or IV 3 mg/kg/day IV or SC in 4 to 6 divided doses

adrenaline (EpiPen)

eformoterol (Foradile, Oxis)

Adult: 1–2 caps inhaled b.d. Paediatric: (>5 years) 1 cap b.d.

ephedrine (generic)

Adult: 12.5–25 mg IM, SC or IV Paediatric: 3 mg/kg/day IV or SC in 4 to 6 divided doses Adult: 150 mcg once daily by inhalation Adult: 5 mg q 4–6 hours by inhalation Paediatric (4–12 years): 2.5 mg q 4–6 hours by inhalation Adult and paediatric >12 years: 1–2 puffs q 12 hours Paediatric (4–12 years): one inhalation b.d. at least 12 hours apart Adult and paediatric >12 years: 3–4.5 mg up to b.d Paediatric <12 years: 0.075 mg/kg/dose up to q 6 hours

indacaterol (Onbrez) salbutamol (Ventolin)

Long-term maintenance of COPD

Treatment and prophylaxis of bronchospasm and acute asthma attacks

salmeterol (Seretide, Serevent)

Prevention of exercise-induced asthma; prophylaxis of bronchospasm in selected people >4 years of age

terbutaline (Bricanyl)

Treatment and prophylaxis of bronchospasm

Anticholinergics

Adult: 250–500 mcg Nasal spray: two sprays per nostril t.d.s. to q.i.d Paediatric: 250 mcg

Maintenance and treatment of bronchospasm for adults with COPD; nasal spray for rhinorrhoea associated with seasonal and perennial rhinitis or the common cold Long-term, once-daily maintenance and treatment of bronchospasm associated with COPD in adults

ipratropium (Atrovent)

tiotropium (Spiriva)

18 mcg/day (one capsule) using the HandiHaler inhalation device