Lower Respiratory Drugs

An adolescent client is prescribed a leukotriene receptor antagonist as a part of a medication regime to manage his/her asthma. Which statement made by the client requires additional education on this classification of medications?

"I need to take the medication when I start to have problems breathing." These drugs are not indicated for the treatment of acute asthmatic attacks because they do not provide any immediate effects on the airways. Patients need to be cautioned that they should not rely on these drugs for relief from an acute asthmatic attack. The remaining statements are all accurate information regarding this classification of medications.

Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching?

"I should see some results in about 3 to 4 days." Inhaled steroids, such as triamcinolone, can take from 2 to 3 weeks to reach effective levels, so the client should be encouraged to take them to reach and then maintain the effective levels. The drug is not effective for acute attacks. It can cause hoarseness and sore throat. The client should rinse his mouth after using the inhaler to decrease the risk of systemic absorption and decrease gastrointestinal upset and nausea.

A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client's concern?

"Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." Salmeterol is a long-acting beta2-adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short-acting drug. This information makes all the other options incorrect.

The nurse is providing care for a newborn who has received an instillation of surfactin. What assessment data indicates the infant is experiencing adequate oxygen perfusion? Select all that apply.

- skin is pink over the entire body - skin is warm to touch

In children, high doses of nebulized albuterol have been associated with what conditions?

- tachycardia - hypokalemia - hyperglycemia In children, high doses of nebulized albuterol have been associated with tachycardia, hypokalemia, and hyperglycemia. Lowered or elevated blood pressure is not a usual issue with high doses of nebulized albuterol in children.

A patient who is prescribed ipratropium administers the drug at 9:15 AM. The patient should begin to notice the drug beginning to act at which time?

9:30 Inhaled ipratropium has an onset of action of 15 minutes, so the patient should begin to feel the effects of the drug at 9:30 AM.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem?

Adrenal insufficiency Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.

After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)?

Albuterol

example of bronchodilator

Albuterol

A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the health care provider to give the client?

Albuterol A selective, short-acting, inhaled beta2-adrenergic agonist (e.g., albuterol) is the initial rescue drug of choice for acute bronchospasm; subcutaneous epinephrine may also be considered.

Info about zarfirlukast

DO NOT PROVIDE IMMEDIATE EFFECTS ON AIRWAY- don't rely on for acute asthmatic attacks blocks receptors for the leukotrienes bound to the amino acid cysteine blocks signs and symptoms of asthma, such as neutrophil and eosinophil migration, leukocyte adhesion which contribute to edema, mucus secretion contraindicated with other drugs that use p450 system increased toxicity can occur

The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy?

Ipratropium A client who is taking ipratropium should not take tiotropium because both drugs are anticholinergics. Theophylline and corticosteroids like budesonide and fluticasone are not necessarily contraindicated.

Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA?

Leukotriene receptor antagonists Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.

Which medication is used to treat acute airflow obstruction?

Metaproterenol Metaproterenol is a short-acting beta-2 agonist used as a quick-relief medication. Beclomethasone is an inhaled corticosteroid used as a long-term control medication. Montelukast is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Azelastine is a second-generation antihistamine.

An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?

Mix the drug with saline. Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.

The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions?

Rinse mouth with water after each use.

A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation?

Salmeterol is contraindicated based on his wife's condition. The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.

Example of Xanthine Derivitives

Theophylline

A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which common adverse effects of the drug?

Throat irritation The most common adverse effects of inhaled albuterol include throat irritation, palpitations, sinus tachycardia, anxiety tremor, and increased blood pressure. Serious adverse effects such as bronchospasm, urticaria, and angioedema rarely occur. Headache, dyspepsia, and muscle cramps are frequent adverse effects of oral albuterol only.

After teaching a group of students about drugs as bronchodilators, the instructor determines that the teaching has been successful when the students identify which group of drugs as once being first-line agents?

Xanthines

example of leukotriene receptor antagonist

Zarfirlukast

example of mucolytic

acetylcysteine

With theophylline, the home care nurse needs to assess the client and the environment for certain products that can cause what to occur? (Select all that apply.)

affect metabolism of theophylline, decrease therapeutic effects, increase adverse effects

The nurse teaching a client about theophylline will include the identification of which possible symptoms of toxicity?

agitation and dysrhythmias Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other dysrhythmias, and tonic-clonic convulsions. Ventricular dysrhythmias or convulsions may be the first sign of toxicity. Chest pain, shortness of breath, polyuria, polyphagia, and decreased level of consciousness do not accompany theophylline overdose.

Info on albuterol

beta agonist increases sympathetic nervous system affect, including bronchodilation FOR ACUTE/ EMERGENCY ISSUES contraindicated in conditions that would be worsened by sympathetic stimulation: cardiac disease, vascular disease BLACK BOX WARNING`

Which medication is contraindicated for the treatment of acute bronchospasm?

cromolyn Cromolyn stabilizes mast cells and is not used in acute bronchospasm. Aminophylline is used in limited cases but is administered for acute asthma attack. Albuterol and formoterol are used for acute asthma attack.

Example of mast cell stabilizer

cromolyn sodium

info on flunisolide

prevents bronchospasm inhibits the production of leukotrienes and prostaglandins though interference with arachidonic acid metabolism don't use if have active infection; can cause infection have to rinse mouth after

Info about cromolyn sodium

prophylactic agent in treating mild- moderate asthma works at surface of the mast cell to inhibit mast cell rupture; thus prevents reaction and causes of reaction can cause bronchospasm, throat irritation, cough

The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which statement by the client indicates the need for further education?

"I will use this medication when I am having an asthma attack." Cromolyn (Intal) is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders. Adverse reactions include drying of the throat and coughing or wheezing. It should not be used during an acute asthma attack because it may worsen the bronchospasm.

A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse?

Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following?

Increased serum theophylline When administering zileuton along with theophylline, the nurse should monitor for increased serum theophylline. Serum zileuton levels and pulse rate are not increased when zileuton is administered along with theophylline. Increased prothrombin time is seen when warfarin, and not theophylline, is given along with zileuton.

example of anticholinergic

Ipratropium

Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use?

It helps decrease systemic absorption. Spacers help decrease systemic absorption, because less flunisolide is swallowed. Spacers may also help alleviate dysphonia by filtering larger aerosol particles that ordinarily deposit in the oropharynx and extrathoracic airways (this precaution also reduces the risk for oropharyngeal candidiasis). The use of a spacer does not prevent intrapulmonary delivery of the drug; nor does it reduce the risk of tachycardia and sinusitis.

A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective?

Monitoring respirations for bilateral chest movement

A 5-year-old boy is brought to the ED with an asthma exacerbation, including wheezing (a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway). Those who have asthma chronically present with what signs, even when they may appear symptom free? (Select all that apply.)

airway inflammation, damaged airway mucosa Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free.

What is considered a possible trigger for an asthma attack? Select all that apply.

cigarette smoking, exercise, allergens, pollutants

The client's theophylline levels are increased when the lab results are added to the electronic health record. The nurse questions the client about his intake of which?

coffee

example of anti-inflammatory

flunisolide

A client, diagnosed with asthma, is prescribed a leukotriene receptor antagonist. The nurse will discuss the importance of which diagnostic lab tests to determine how effectively the medication is being metabolized and excreted?

kidney function, liver function

Info about xanthine derivates

normal levels: 5-15 onset: 15 mins peak: 2 hours inhibits phosphodiesterases- which prevents cAMP breakdown and increases inotropy, dronotropy, and chrontropy drug/ food interactions: caffeine, chocolate, nicotine has direct effect on smooth muscles of respiratory tract Adverse effects- GI upset, nausea, tachy, irritability

A history of an allergy to which would be a contraindication to the use of anticholinergics? (Select all that apply.)

peanuts, soy The use of ipratropium and tiotropium, anticholinergics, is contraindicated in the presence of known allergy to soy products or peanuts.

info about ipratopium

used for treatment and maintenance of bronchospasm antagonizes the action of acetylcholine by blocking muscarinic cholinergic receptors blocks the vagal effect, the relaxation of smooth muscle in the bronchi occurs, leading to bronchodilation

info on acetylcysteine

used to liquefy the thick, tenacious secretions splits disulfide bonds that are responsible for holding the mucous material together can cause bronchospasms teach how to use nebulizer