NURS 1566 Clinical Form 3: Clinical Medications Worksheets(You will need to make additional copies of these forms)

Generic NameLevalbuterol

Trade NameXopenex

ClassificationTherapeutic: bronchodilatorsPharmacologic: adrenergics

Dose1.25 mg

RouteINH

Time/frequencyPrn Respiratory Therapy

Peak90 min 

Onset10-17 min 

Duration 5-6 hr 

Normal dosage range0.63 mg via nebulization three times daily (every 6-8 hr); may be increased to 1.25 mg three times daily (every 6-8 hr)

Why is your patient getting this medicationFor short term control of bronchospasm from pulmonary edema resulting from CHF

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)R-enantiomer of racemic albuterolBinds to beta-2 adrenergic receptors in airway smooth muscle leading to activation of adenylcyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP). Increases in cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased intracellular calcium relaxes bronchial smooth muscle. Indicated to treat bronchospasm due to reversible airway disease (short-term control agent).

Nursing Implications (what to focus on) Contraindications/warnings/interactions. Contraindicated in patients with known hypersensitivity, Use Cautiously in Cardiovascular disorders (including coronary insufficiency, hypertension, and arrhythmias); History of seizures; Hypokalemia; Hyperthyroidism; Diabetes mellitus; Unusual sensitivity to adrenergic amines. INTERACTIONS: Concurrent use or use within 2 weeks of tricyclic antidepressants or MAO inhibitors may ↑ risk of adverse cardiovascular reactions (use with extreme caution); Beta blockers block the beneficial pulmonary effects of adrenergic bronchodilators (choose cardioselective beta blockers if necessary and with caution); May ↑ risk of hypokalemia from potassium-losing diuretics; May ↓ serum digoxin levels; May ↑ risk of arrhythmias with hydrocarbon inhalation anesthetics or cocaine; Use with caffeine-containing herbs ( guarana, tea , coffee ) ↑ stimulant effect

Common side effectsCNS: anxiety, dizziness, headache, nervousness, Resp: increased cough, paradoxical bronchospasm, turbinate edema, CV: tachycardia, GI: dyspepsia, Endo: hyperglycemia, F and E: hypokalemia, Neuro: tremor,

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)none

Lab value alterations caused by medicineMay cause ↑ serum glucose and ↓ serum potassium

Be sure to teach the patient the following about this medication: : Instruct patient in the proper use of the nebulizer (see Appendix B ) and to take levalbuterol exactly as directed. Caution patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication; Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain; Advise patients to use levalbuterol first if using other inhalation medications, and allow 5 min to elapse before administering other inhalant medications unless otherwise directed; Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth; Instruct patient to notify health care professional if no response to the usual dose of levalbuterol

Nursing Process- Assessment(Pre-administration assessment)Assess lung sounds, pulse, and blood pressure before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects; Monitor pulmonary function tests before initiating therapy and periodically during course to determine effectiveness of medication;

AssessmentWhy would you hold or not give this med?Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify physician or other health care provider immediately. You would also hold this med if the pt was experiencing tachycardia.

EvaluationCheck after givingLung sounds, pulse, and blood pressure during peak of medication