Ventolin (Salbutamol), 2 puffs, PO, TID, to be given at 0600, 1400 and, 2200.
Atrovent (Ipratropium Bromide), 2 puffs, PO, TID, to be given at 0600, 1400 and, 2200.
Flovent (Fluticasone), 2 puffs, PO, BID, to be given at 1000 and 2200.
It is 2200 and your client should receive all three puffers. In what order would you administer these meds?
Inhaled b2-agonist may be used before the inhaled glucocorticoid to provide bronchodilation before administration
of the anti-inflammatory drug. The bronchodilator inhaled drug is generally taken several minutes before the
glucocorticoid or corticosteroid aerosol.
Reference
Lilley, L. L., Harrington, S., Snyder, J. S., Canadian, Swart, B. and Savoca, D. (2010) Pharmacology for Canadian
health care practice. 2nd edn. Toronto: Elsevier Canada.
(2) Exhale and close lips firmly around mouthpiece. Administer during second half of inhalation, and hold breath for
as long as possible to ensure deep instillation of medication.
(3) Use of spacer. Consult health care professional to determine method desired prior to instruction. Allow 1 2 min
between inhalations. Rinse mouth with
water or mouthwash after each use to minimize dry mouth and hoarseness. Wash inhalation assembly at least daily
in warm running water.
For use of dry powder inhalers, turn head away from inhaler and exhale (do not blow into inhaler). Do not shake.
Close mouth tightly around the mouthpiece of the inhaler and inhale rapidly.Steps for Using Your Inhaler*
Removethecapandholdinhalerupright.
Shaketheinhaler.
Tiltyourheadbackslightlyandbreatheoutslowly.
Positiontheinhalerinoneofthefollowingways(AorBisoptimal,butCisacceptableforthosewho
have difficulty with A or B. C is required for breath-activated inhalers):
Pressdownontheinhalertoreleasemedicationasyoustarttobreatheinslowly.
Breatheinslowly(3to5sec).
Holdyourbreathfor10sectoallowthemedicinetoreachdeeplyintoyourlungs.
Repeatpuffasdirected.Waiting1minutebetweenpuffsmaypermitsecondpufftopenetrateyour lungs better.
Spacers/holdingchambersareusefulforallpatients.Theyareparticularlyrecommendedforyoung children and older
adults and for use with inhaled corticosteroids. Avoid common inhaler mis- takes. Follow these inhaler tips:
Breathe out before pressing your inhaler.
Inhale slowly.
Breathe in through your mouth, not your nose.
Pressdownonyourinhaleratthestartofinhalation(orwithinthefirstsecondofinhalation).
Keep inhaling as you press down on inhaler.
Press your inhaler only once while you are inhaling (one breath for each puff).
Makesureyoubreatheinevenlyanddeeply.
If you are using a short-acting bronchodilator inhaler and a corticosteroid inhaler, use the bronchodilator first,
and allow 5 min to elapse before using the corticosteroid.Other inhalers have become available in addition to the
one illustrated here. Different types of inhalers may require different techniques.
Deglin, J. H., Vallerand, A. H. and Sanoski, C. A. (2010) Daviss drug guide for nurses. 12th edn. Philadelphia: F. A.
Davis Company.