Medication Safety Precautions for Tiotropium Handihaler Use

Health Teaching: Medication Safety Precautions for Tiotropium Handihaler Use

Tiotropium inhibits the respiratory smooth muscle spasms, prevents collapse of airways, and thereby, promote airway patency, thus allowing more air exchange. Tiotropium also helps with inhibiting the mucus secretions from the glands in the respiratory tract. Tiotropium can be used in individuals with history of asthma and COPD, to help relax the bronchial smooth muscle, reduce the mucus secretions, and promote the ease of breathing. In this post, we discuss medication safety precautions for Tiotropium handilaer usage. Nurses can use this teaching as an example of patient and caregiver education to add to skilled nursing documentation or educate patient and caregiver. Medication safety precautions to be observed while using Tiotropium handilaer include:

1. Tiotropium use can result in dry mouth, reduced acid secretion in the stomach, indigestion, decreased bowel activity, bloating, and constipation. Sucking on a sugar free hard candy can help with symptomatic relief of dry mouth. Proper hydration measures and compliance with daily fluid intake recommendations can help with relief from constipation. If you experience any further bothersome constipation, report it to your physician for a recommendation on laxative/stool softener use. Observing compliance with fiber intake recommendations in the diet can also help with preventing episodes of constipation with the medication. Report any bothersome complaint of indigestion to your physician for further recommendation.
2. Tiotropium use should normally help with relaxation of the airways and improve the ease of breathing. But, use of tiotropium occasionally can paradoxically result in narrowing of airways, exacerbation of dyspnea and shortness of breath, and increased effort of breathing. This side-effect of tiotropium intake can lead to complications in individuals with history of asthma, COPD, and other breathing disorders. Promptly report to your physician regarding any incidents of exacerbation of shortness of breath and difficulty breathing, following tiotropium use, so that, a change in plan of care could be considered.
3. Tiotropium use can result in elevated heart rate and consequent high blood pressure. Individuals with history of hypertension can be at increased risk for grossly elevated heart rate and high blood pressure with tiotropium. Closely follow for signs and symptoms of elevated blood pressure, such as, headache, fatigue, nosebleeds, episodes of confusion, diminishing vision, chest pain, palpitations, and pounding in the chest and neck. Report any such findings to your physician immediately, so that, an alternative plan of care could be considered. Observe compliance with antihypertensive medications prescribed, if any. Observe compliance with recording and log maintenance of everyday blood pressure numbers, which can help for an easy follow-up and reporting of numbers consistently out of the normal parameters.
4. Tiotropium use can result in relaxation of smooth muscle of bladder and contraction of urinary sphincter, which leads to increased urinary retention and increased difficulty passing urine. Retention of urine in the bladder can increase the chances for urinary tract infection, especially in senior citizens and individuals with history of multiple UTIs. Individuals can present with fever, chills, rigors, burning sensation of the urethra, pain during act of urination, and foul smell of urine. Report to your physician regarding any of these symptoms for any change in plan of care to be considered.
5. Tiotropium is minimally metabolized in the liver and a significant portion of the drug administered is excreted unchanged in urine. Individuals with compromised renal function cannot excrete the medication normally, which allows the medication to stay in blood circulation for longer time, resulting in toxicity and consequent side-effects. So, tiotropium must be used with caution in individuals with compromised renal function, with possible dose adjustments, periodical monitoring for renal functions, and close watch for development of any dangerous side-effects and toxicity symptoms with the medication. Observe compliance with periodical labs ordered for renal function evaluation, while taking tiotropium.
6. Tiotropium use can also result in increase in the intraocular pressure, leading to worsening of glaucoma in individuals with history. Individuals can present with eye pain, headache, deteriorating and blurred vision with haloes around light due to poorly controlled glaucoma. Report any vision changes following tiotropium intake to your physician immediately, so that, an alternative plan of care could be considered. Observe compliance with eye drops prescribed for glaucoma, if any.
7. If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose, to avoid overdose and toxicity with the medication. Notify your doctor and other health care personnel regarding your dose noncompliance.
8. From the point of placing the capsule in the device, closing the mouthpiece over the central chamber, pressing the green button once fully to puncture the capsule in the center chamber and releasing it, do not breathe into the exposed mouthpiece, as this can result in blowing away the medication powder from breathing into the lungs and medication wastage.
9. Gargle and rinse the mouth with water after every dose of tiotropium inhalation. Spit out this water after rinsing and do not swallow. This helps prevent any unpleasant taste, dryness of the mouth, and any discomfort of throat irritation.
10. Tiotropium use can result in dry eyes with reduced tear production, irritation and redness of eyes, and blurred vision. Use of artificial tears can help relieve symptoms of dry eye.
11. Closing the mouth tightly around the mouthpiece, breathe in slow and deep for a complete breath, for a count of 5 seconds, which will help delivery of the powdered medication into the lungs. Withdraw the mouthpiece and handihaler from your mouth and hold your breath for a count of 5 seconds, giving time for the medication to be deposited into the airways, for it to act.
12. Maintain strict compliance with inhalation of the medication as ordered, with regards to dosage and frequency, to derive the benefit of the medication. Compliance with the use of tiotropium inhalations as ordered, at regularly spaced intervals, is very important to prevent any exacerbation of asthma and COPD attacks.
13. Tiotropium capsules, containing the medication as a dry-powder, are to be used only for inhalation, using a Handihaler and not to be swallowed orally. Use only one capsule at a time in the handihaler device.
14. Notify your doctor of any unresolving shortness of breath, any exacerbation of asthma and COPD episodes, so that, your dosage on the medication could be revised.
15. Your physician could change the dose of inhalation medication, based on the response you show. So, maintain compliance with follow-up physician appointments and be accommodative to the plan of dose changes, until you show an optimum response.
16. Make sure the mouthpiece is clean before having it in the mouth. Once every week, clean the handihaler with soap and water and dry it thoroughly with a clean towel. Let it air dry for an additional 10 minutes, before you can start using it again.
17. Do not change the dose on this medication without consulting your doctor. Do not overdose on the use of tiotropium inhalations, as it can significantly increase the chances of side effects and toxicity.
18. Take the inhalation dose at the same time, every day, for the duration prescribed, to avoid forgetting the medication dose.
19. Breathe out slowly through the nose or mouth and do one more inhalation having the mouthpiece in, to make sure that you are breathing in all of the powdered medication and no medication is getting wasted.
20. Replace the cap on the mouthpiece of handihaler, once you completed intake of your prescribed dose.
21. Holding the handihaler upright and away, with the mouthpiece upwards, perform a normal quiet breathing in and then, breathe out normally.
22. Sit up straight or stand up. Bring the handihaler closer to your mouth and place the mouthpiece in between the teeth, with the chin up a little. This position of the chin will help better deposition of the medication into the airways. Make sure the tongue is not obstructing the mouthpiece, by having the mouthpiece over the tongue and not under.