Respiratory Medications & NCLEX Pharmacology — Bronchodilators, Steroids, TB Drugs, Vaccines, and Nursing Priorities | Chapter 48: Saunders NCLEX-PN Review

Respiratory Medications & NCLEX Pharmacology — Bronchodilators, Steroids, TB Drugs, Vaccines, and Nursing Priorities | Chapter 48: Saunders NCLEX-PN Review

Chapter 48 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri provides a complete overview of respiratory pharmacology, covering inhalation devices, medication classes, safety considerations, and NCLEX-style clinical applications. It ensures mastery of drug mechanisms, side effects, and patient teaching for safe and effective respiratory care.

Watch the lecture above for a full breakdown, then review the detailed summary below to reinforce pharmacology knowledge for respiratory nursing and NCLEX success.

Saunders NCLEX-PN Examination Review book cover

Inhalation Devices & Administration

  • Metered-Dose Inhalers (MDI), Dry Powder Inhalers (DPI), Nebulizers: Correct sequence, device cleaning, spacer use, rinsing mouth post-use
  • Order of administration when using multiple inhalers: Bronchodilator → Wait 5 minutes → Corticosteroid

Bronchodilators

  • β2-adrenergic agonists: Albuterol (short-acting), Salmeterol (long-acting) — rescue vs. maintenance, tremor, tachycardia
  • Methylxanthines: Theophylline — therapeutic range 10–20 mcg/mL, toxicity signs (tachycardia, seizures), avoid caffeine
  • Anticholinergics: Ipratropium — contraindicated with peanut allergy, dry mouth relief strategies

Anti-inflammatory Medications

  • Glucocorticoids: Inhaled (fluticasone) and oral (prednisone) — oral candidiasis prevention, adrenal suppression risk, tapering
  • Leukotriene Modifiers: Montelukast — taken in the evening, monitor liver function
  • Mast Cell Stabilizers: Cromolyn sodium — asthma prevention, not for acute attacks
  • Monoclonal Antibodies: Omalizumab — IgE binding, subcutaneous injection precautions, anaphylaxis monitoring

Upper Respiratory Medications

  • Antihistamines: Diphenhydramine (sedation, anticholinergic effects), Loratadine (non-sedating)
  • Nasal Decongestants: Oxymetazoline, Pseudoephedrine — rebound congestion with prolonged use, hypertension caution

Cough & Mucus Management

  • Expectorants: Guaifenesin — increase fluid intake
  • Mucolytics: Acetylcysteine — nebulized, strong odor, protects liver in acetaminophen toxicity
  • Antitussives: Dextromethorphan (non-opioid), Codeine (opioid) — CNS depression risk
  • Opioid Antagonists: Naloxone — reverses respiratory depression, repeat dosing possible

Tuberculosis Medications

  • First-line: Isoniazid (peripheral neuropathy, give vitamin B6), Rifampin (red-orange body fluids, contraception interference), Ethambutol (optic neuritis), Pyrazinamide (hepatotoxicity)
  • Second-line: Streptomycin (ototoxicity, nephrotoxicity), Cycloserine, Capreomycin — monitor kidney and hearing function

Vaccines & Antivirals

  • Influenza Vaccine: Inactivated vs. live attenuated, contraindications, annual administration
  • Antivirals: Oseltamivir, Zanamivir — start within 48 hours of symptom onset
  • Pneumococcal Conjugate Vaccine: High-risk populations, booster protocols

NCLEX Nursing Priorities

  • Correct inhaler sequencing and device teaching
  • Monitor therapeutic levels and toxicity signs for theophylline
  • Identify and teach about drug-specific side effects
  • Promote adherence to multi-drug TB regimens
  • Implement infection control with contagious respiratory diseases

Conclusion

This chapter builds a solid pharmacologic foundation for respiratory care, preparing NCLEX-PN candidates to manage both acute and chronic respiratory conditions with safe medication administration and evidence-based interventions.

Subscribe to Last Minute Lecture for more NCLEX-focused lectures and study resources.

View the full Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) playlist here: Complete NCLEX-PN Review Playlist

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