Respiratory Disorders - Pharmacology
Prior to the administration of a second dose of aminophylline to the client admitted to the hospital for acute bronchitis, what priority assessment will the registered nurse (RN) implement? A. assess the client's sleep pattern B. assess the client's appetite C. assess the client's heart rate D. assess the client's blood pressure
C. assess the client's heart rate Methylxanthines are a class of drugs that have clinical use because of their bronchodilatory and stimulatory effects. Drugs in this class include theophylline and aminophylline. This drug class is used to treat asthma, emphysema, bronchitis, and other respiratory problems, but are not recognized as rescue drugs. Tachycardia and dysrhythmias are common side-effects of theophylline. This drug should be taken in the morning and caffeine is prohibited while taking this drug. The heart rate should be assessed and tachycardia reported to the healthcare provider before administering the next dose of this drug. If a cardiac stress test is ordered, this drug is stopped prior to the test. Beta blockers are not administered to an individual prescribed theophylline because of the effect each drug has on the heart.
Recognizing the risk of toxicity for the client prescribed theophylline, which order by the healthcare provider will the registered nurse (RN) seek clarification? Select all that apply. A. capoten B. calciferol C. cimetidine D. clonidine E. ciprofloxacin
C. cimetidine E. ciprofloxacin Theophylline has a narrow therapeutic range of 10 to 20 mcg/mL, of which any value greater than 20 mcg/mL is considered toxic. Frequent blood testing is indicated to monitor for toxicity. Early indicators of toxicity include the occurrence of anorexia, nausea/vomiting, insomnia, and/or restlessness. A critical sign of toxicity is the occurrence of tonic clonic seizures. Drugs that increase the occurrence of toxicity with theophylline include cimetidine and ciprofloxacin. These drugs are not administered to the individual prescribed theophylline.
What drug therapy is used to treat medical care associated PNA in the ICU?
β-lactam PLUS either azithromycin OR fluoroquinolone
What are the three classes of bronchodilator drugs currently used in asthma therapy?
1. Beta2-adrenergic agonists (short & long acting) 2. Methylxanthines 3. Anticholinergics
The registered nurse (RN) provides which education point to the client prescribed albuterol for the treatment of an asthma attack? Select all that apply. A. "This drug is indicated as the first drug for treatment of an asthma attack." B. "It is important to wash the mouthpiece of the device at least twice monthly." C. "This drug works best by preventing the occurrence of an asthma attack." D. "Take 2 to 4 puffs every 20 minutes for 3 treatments during an asthma attack." E. "If this drug is not beneficial in stopping the attack, seek medical attention immediately."
A. "This drug is indicated as the first drug for treatment of an asthma attack." D. "Take 2 to 4 puffs every 20 minutes for 3 treatments during an asthma attack." E. "If this drug is not beneficial in stopping the attack, seek medical attention immediately." Beta-2 adrenergic agonists are a class of drugs that work to dilate the bronchioles increasing the airflow through the lungs. Drugs within this category include albuterol and levalbuterol. Both albuterol and levalbuterol are the fastest acting bronchodilators and serve as the first line of treatment for an acute asthma attack. The correct technique for administration of the inhaler is to shake the device well, breathe out completely, then inhale the drug in, holding the breath after before exhaling. The mouthpiece of the device is cleaned 1 to 2 times weekly using warm water. When an attack occurs, administer 2 to 4 puffs every 20 minutes for 3 treatments. If the treatment is not effective, it is important to notify the healthcare provider immediately.
The nurse teaches that which medication can be used for preventative asthma treatment? A. Montelukast B. Albuterol C. Levalbuterol D. Prednisone
A. Montelukast Leukotriene inhibitors reduce inflammation and mucus of the lungs. They can be used to treat both allergies and asthma. Irritants such as weather changes, dust, pollen, pet dander are potential triggers for those with seasonal allergies and asthma. Irritants trigger leukotriene that increase both inflammation and mucus in the respiratory system. Leukotriene inhibitors can block that response and reduce both inflammation and mucus. Leukotriene inhibitors should be prescribed for daily administration and not on an "as needed" basis since they do take 1-2 weeks to see a therapeutic effect.
What special medication considerations are there for a community acquired MRSA PNA infection?
ADD vancomycin or linezolid (Zyvox) to medication treatment.
Name two short acting β-adrenergic agonist (SABA) medications used to treat asthma.
Albuterol (neb, MDI, oral - oral not for acute use; only long-acting) Lebalbuterol (neb, MDI)
Name two methylxanthine medications used to treat asthma.
Aminophylline (IV) Theophylline (oral)
The nurse is caring for a patient receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the patient would the nurse note as an expected side effect of this combination medication? A. "I feel as though my heart is racing." B. "I feel more bloated than usual." C. "My eyes have been watering lately." D. "I haven't had a bowel movement in 4 days."
A. "I feel as though my heart is racing." Albuterol/ipratropium is a combination agent. One if a beta-2 adrenergic agonist & the other is an anticholinergic med. In combination they produce an overall bronchodilation effect. Common side and adverse effects include headache, dizziness, dry mouth, tremors, nervousness, and tachycardia.
A patient diagnosed with COPD is prescribed morphine sulfate continuous release. Which statement is the scientific rationale for prescribing this medication? A. Morphine will depress the respiratory drive B. Morphine dilates the bronchi & improves breathing C. Morphine is not addicting, so it can be given routinely D. Morphine causes bronchoconstriction & decreased sputum
B. Morphine dilates the bronchi & improves breathing Morphine continuous release (MS Contin), a narcotic analgesic, is a mild bronchodilator. The continuous-release formulation provides a sustained effect for the patient.
Name an anticholinergic agent medication used to treat asthma.
Ipratropium
What drug therapy is used to treat medical care associated PNA on a medsurg unit?
fluoroquinolone OR β-lactam plus macrolide
A nurse is providing teaching to a parent of a child who has asthma & a new prescription for cromolyn sodium MDI. Which of the following statement by the parent indicates the need for further teaching? A. "I will give my child a dose as soon as wheezing starts." B. "My child should rinse out his mouth after using the inhaler." C. "My child should exhale completely before placing the inhaler in his mouth." D. "If my child has difficulty breathing in the dose, a spacer can be used."
A. "I will give my child a dose as soon as wheezing starts." Cromolyn is a mast cell inhibitor that has a slow onset & is given for prophylactic treatment of asthma. Is it not a rescue medication.
The nurse is caring for a patient prescribed a glucocorticoid inhaler. Which of the following interventions are indicated for the patient's care? A. Advise the patient to gargle after each administration. B. Instruct the patient to use the inhaler PRN. C. Encourage the patient to avoid attaching a spacer to the inhaler. D. Teach the patient to check their forced expiratory volume daily. E. Tell the patient to keep the medication in the refrigerator.
A. Advise the patient to gargle after each administration. D. Teach the patient to check their forced expiratory volume daily. Gargling after each admin will help decrease development of oropharyngeal yeast infections. Forced expiratory volume is the most helpful lung function test & can be measured by a home spirometer. Glucocorticoids are intended for preventative therapy, not for aborting an ongoing asthma attack, and they should not be taken on a PRN basis. The med is stored at room temp. A spacer should be used because a spacer increases drug delivery to the lungs & decreases drug deposition on the oropharyngeal mucosa.
A nurse is caring for a patient who has asthma & a prescription for zileuton. Which of the following lab values should the nurse monitor while the patient is taking this med? A. Alanine aminotransferase (ALT) B. WBC count C. Potassium D. Chloride
A. Alanine aminotransferase (ALT) ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. This lab value should be monitored closely.
A patient begins therapy with theophylline. The nurse plans to teach the patient to limit the intake of which items while taking this med? A. Coffee, cola, and chocolate. B. Oysters, lobster, and shrimp. C. Melons, oranges, and pineapple. D. Cottage cheese, cream cheese, and dairy creamers.
A. Coffee, cola, and chocolate. Theophylline is a methylxanthine bronchodilator. The nurse teaches the patient to limit the intake of xanthine-containing foods while taking this med. These foods include coffee, cola, and chocolate.
A nurse is caring for a patient who has asthma & advanced RA & deformity of the hands. The nurse should anticipate that the patient will receive which of the following medication-deliver devices for the treatment of asthma? A. Dry-powder inhaler (DPI) B. Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer
A. Dry-powder inhaler (DPI) DPIs don't require hand-breath coordination & are easier to use for patients who have deformities of the hands. DPIs are used to deliver meds in a dry, micronized powder directly to the lungs. MDIs with spacer devices require hand-breath coordination in order to ensure max deposition of medication. Respimat inhalers deliver meds as a fine mist. Although these devices don't require as much hand-breath coordination as MDIs, they still require the patient to activate the device using a twisting motion, which can be more difficult for a patient who has deformity of the hands. Nebulizers are small machines that convert liquid meds into a fine mist for inhalation. The meds used with nebulizers often require twisting of small ampules to open.
A charge nurse is teaching a newly licensed nurse about a patient who has severe allergy-related asthma & a new prescription for omalizumab. Which of the following pieces of information should the charge nurse include to describe the medication's mechanism of action? A. It reduces the number of IgE molecules on mast cells. B. It stabilizes the cellular membrane of mast cells. C. It decreases the synthesis & release of inflammatory mediators. D. It relaxes the smooth muscles by blocking adenosine receptors.
A. It reduces the number of IgE molecules on mast cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm. Stabilizing the cellular membrane of mast cells is the MOA of mast cell stabilizers. Decreasing the synthesis & release of inflammatory mediators is the MAO of glucocorticoids. Relaxing smooth muscle by blocking adenosine receptors is the MOA of methylxanthines.
A nurse is caring for a patient with asthma who has been taking an inhaled glucocorticoid & LABA combination dry-powdered inhaler for maintenance therapy. The nurse should identify that which of the following is a disadvantage of this med? A. Restricted dosage flexibility B. Complicated delivery device C. Serious systemic effects D. Limited efficacy over time
A. Restricted dosage flexibility A disadvantage of an inhaled glucocorticoid & a LABA being combined is that the dosages of these meds are fixed, so the dosages cannot be adjusted. This combo med DPI is an easy-to-use device that allows the patient to self-admin medication after receiving basic instruction about its use. This combo med DPI is delivered locally to the lungs. Systemic effects are mild & generally don't occur.
A nurse is caring for a patient who has asthma & requires long-term treatment. The nurse should identify that which of the following meds used for long-term treatment places the patient at an increased risk of asthma-related death? A. Salmeterol B. Fluticasone C. Budesonide D. Theophylline
A. Salmeterol Salmeterol is a LABA. When this med is used alone for the long-term treatment of asthma, this class of med increases the patient's risk of asthma-related death. To decrease this risk, the patient should be prescribed both a LABA along with an ICS.
While providing care for a client with a history of asthma and prescribed albuterol, the registered nurse (RN) is aware that which drug classification is contraindicated for this client? Select all that apply. A. beta blockers B. calcium channel blocker C. angiotensin-converting enzyme inhibitor D. nonsteroidal anti-inflammatory drug E. antihistamines
A. beta blockers D. nonsteroidal anti-inflammatory drug Beta-2 adrenergic agonists are a class of drugs that work to dilate the bronchioles increasing the airflow through the lungs. Drugs within this category include albuterol and levalbuterol. Side-effects of albuterol and levalbuterol include: tachycardia, palpitations, tremors, and insomnia. Other side-effects include nausea, vomiting, and headache. While taking a beta-2 adrenergic agonist beta blockers and nonsteroidal anti-inflammatory drugs (NSAIDS) are contraindicated. These drugs in combination have the potential to worsen asthma and result in bronchospasms. Test Taking Tip: Remember that beta blockers and nonsteroidal anti-inflammatory drugs cannot be given with albuterol. Remember Bad Beta Blockers with alButerol. Remember NO to NSAIDs with albuterol.
Recognizing that the client prescribed theophylline for the treatment of bronchitis is at risk for toxicity, which clinical manifestation will alert the registered nurse (RN) to this occurrence? Select all that apply. A. loss of appetite B. drowsiness C. restlessness D. onset of seizures E. insomnia
A. loss of appetite C. restlessness D. onset of seizures E. insomnia Theophylline has a narrow therapeutic range of 10 to 20 mcg/mL, of which any value greater than 20 mcg/mL is considered toxic. Frequent blood testing is indicated to monitor for toxicity. Early indicators of toxicity include the occurrence of anorexia, nausea/vomiting, insomnia, and/or restlessness. A critical sign of toxicity is the occurrence of tonic clonic seizures. Drugs that increase the occurrence of toxicity with theophylline include cimetidine and ciprofloxacin. These drugs are not administered to the individual prescribed theophylline. Test taking tip: When thinking about clinical manifestations of toxicity with theophylline, ask yourself what will present if the level is too high. Remember that the higher the range, the higher the stimulation. This will help you remember seizures, insomnia, restlessness, and anorexia.
While using a fluticasone inhaler with spacer for treatment of asthma, which intervention will the registered nurse (RN) educate the client to implement to assist in preventing an oral yeast infection from occurring? Select all that apply. A. rinse mouth after each inhalation/spacer administration B. clean the spacer with warm water each day of use. C. brush teeth using baking soda and water twice daily. D. avoid swallowing the water used to rinse the mouth after drug administration. E. scrub the tongue with a firm bristle toothbrush twice daily.
A. rinse mouth after each inhalation/spacer administration. B. clean the spacer with warm water each day of use. D. avoid swallowing the water used to rinse the mouth after drug administration. Corticosteroids are a group of drugs that help reduce inflammation specifically in the respiratory system. Specific drugs in this drug class include: fluticasone, beclomethasone, and methylprednisolone. The drugs are administered using inhalation therapy as part of the treatment plan for asthma. Because of the risk of the individual developing oral thrush (Candida albicans) it is beneficial for the individual to use a spacer to administer this inhalation drug. The inhaler device mouthpiece is attached to the spacer. This will allow delivery of the drug without residual drug collecting in the oral cavity. It is important that the individual implement interventions for oral care to decrease the risk of developing oral thrush. These interventions include: rinse mouth with water after each inhalation administration. This water should not be swallowed, but instead deposited in the sink after rinsing the mouth. It is also beneficial to clean the spacer with warm water daily to prevent the potential growth of yeast.
The registered nurse (RN) is aware of what primary benefit of the prescription of a drug classified as a glucocorticosteroid? A. treats total body inflammation B. weakens the overall immune system C. relieves body irritation D. prevents the spread of infection
A. treats total body inflammation Glucocorticosteroids are a specific group of drugs that work to treat total body inflammation. Drugs that fall into the class of glucocorticosteroids include: prednisone, dexamethasone, and hydrocortisone. The presence of an active fungal infection is a contraindication for taking glucocorticosteroids. This drug, when administered orally, should not be discontinued abruptly, but should be tapered. Prednisone and dexamethasone can also suppress the immune system, requiring caution for infection exposures when the drug is taken long-term. Glucocorticosteroid helps treat the whole body inflammation, not just one location. Think glucose goes throughout the body as drugs from this class go throughout the body.
Which instruction will the registered nurse (RN) provide the client who is prescribed theophylline for the treatment of asthma? Select all that apply. A. "It is recommended to take this drug at the end of the day." B. "It is recommended to take this drug at the beginning of the day." C. "This drug needs to be taken every day as prescribed for your asthma." D. "This drug needs to be taken whenever you feel an asthma attack occurring." E. "It is beneficial to avoid all forms of caffeine while taking this drug."
B. "It is recommended to take this drug at the beginning of the day." C. "This drug needs to be taken every day as prescribed for your asthma." E. "It is beneficial to avoid all forms of caffeine while taking this drug." Methylxanthines are a class of drugs that have clinical use because of their bronchodilatory and stimulatory effects. Drugs in this class include theophylline and aminophylline. This drug class is used to treat asthma, emphysema, bronchitis, and other respiratory problems, but are not recognized as rescue drugs. Tachycardia and dysrhythmias are common side-effects of theophylline. This drug should be taken in the morning and caffeine is prohibited while taking this drug. The heart rate should be assessed and tachycardia reported to the healthcare provider before administering the next dose of this drug. If a cardiac stress test is ordered, this drug is stopped prior to the test. Beta blockers are not administered to an individual prescribed theophylline because of the increased risk of bronchospasms. Test Taking Tip: It is helpful to remember that this drug has an 'increasing' effect. This will help you think of no caffeine, early day, and every day.
The parent expresses frustration to the nurse that the montelukast just isn't working though she has been giving it to her child nightly for the past 3 nights. The nurse correctly educates the mother with which correct statement? A. "It may not be the correct medication for your child's asthma symptoms" B. "It takes 1-2 weeks to see a therapeutic response from the medication." C. "I will notify the provider, he may need a higher dosage of medication." D. "Stop giving the medication if it is not working for your child."
B. "It takes 1-2 weeks to see a therapeutic response from the medication." Leukotriene inhibitors are anti-inflammatory drugs. Leukotriene inhibitors such as montelukast are taken for reduction and prevention of asthma attacks. It works by blocking the inflammation that the irritant may cause. Leukotriene inhibitors are taken as long-term therapy. They should not be taken on a (as needed) prn basis nor should they be used as an asthma attack rescue drug. Rescue drugs, such as albuterol, are used for an acute asthma attack since it works by causing bronchodilation. Remember that montelukast is a preventative and takes 1-2 weeks for therapeutic effect
What statement made by the client prescribed salmeterol will the registered nurse (RN) identify as the need for further education? A. "I understand that this drug will help to improve my breathing while treating my asthma." B. "This is the drug that I will take first whenever I feel an asthma attack beginning." C. "It will be necessary to take this drug with other drugs prescribed to treat my asthma." D. "It will be necessary for me to take this drug as a long term treatment for my asthma."
B. "This is the drug that I will take first whenever I feel an asthma attack beginning." Beta-2 adrenergic agonists are a class of drugs that work to dilate the bronchioles increasing the airflow through the lungs. Drugs within this category include albuterol, levalbuterol, and salmeterol. Both albuterol and levalbuterol are the fastest acting bronchodilators and serve as the first line of treatment for an acute asthma attack. Salmeterol is a slow-acting beta-2 agonist and is not considered a rescue drug. Salmeterol is used with steroids as a long-term control of medium to severe asthma. Test Taking Tip: When reading through this question, focus on what you know about the drug salmeterol. Remember that this is the one beta-2 agonist that is NOT a rescue drug. This drug has a slower onset compared to albuterol.
A nurse is caring for a patient who has asthma & is prescribed a short-acting beta2-agonist. Which of the following should the nurse identify as the expected outcome of this medication? A. Reduces the frequency of attacks B. Reverses bronchospasm C. Prevents inflammation D. Decreases chronic manifestations
B. Reverses bronchospasm Short-acting beta2-agonists bind to beta2-adrenergic receptors in the lungs, resulting in relaxation of bronchial smooth muscles. Reducing the frequency of attacks of asthma, and decreasing chronic manifestations of asthma, is achieved through the use of long-term control agents such as inhaled corticosteroids & long-acting beta2-agonists. Preventing inflammation is achieved through the use of inhaled corticosteroids.
The nurse has a prescription to give a patient salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse would admin the med using which procedure? A. Beclomethasone first & then the salmeterol. B. Salmeterol first & then the beclomethasone. C. Alternating a single puff of each, beginning with the salmeterol. D. Alternating a single puff of each, beginning with the beclomethasone.
B. Salmeterol first & then the beclomethasone. Salmeterol is an adrenergic type of bronchodilator, and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
A nurse is teaching a patient with chronic asthma who has a new prescription for cromolyn. Which of the following instructions should the nurse include in the teaching? A. Use the inhaler just before exercise. B. The medication's therapeutic effects can take up to several weeks to develop. C. You will shake the medication container for 3 seconds. D. You will need to exhale slowly after you inhale.
B. The medication's therapeutic effects can take up to several weeks to develop. A SABA inhaler is used prior to exercise & reduces manifestations associated with exercise-induced asthma. However, this patient has chronic asthma. Cromolyn is delivered via a nebulizer, not a MDI. The mist is inhaled with each breath over a few minutes. The patient should inhale & exhale normally as the treatment is being delivered.
A nurse is reviewing the medication history of a patient who has asthma. Which of the following med combinations should the nurse identify as incompatible? A. Albuterol & montelukast B. Theophylline & zileuton C. Aminophylline & fluticasone D. Salmeterol & levalbuterol
B. Theophylline & zileuton Zileuton, a leukotriene modifier, impairs the metabolism of certain med. Concurrent use of zileuton with theophylline can cause toxicity due to elevated theophylline, which is a systemic methylxanthine used to relax the smooth muscles of the airway. Therefore, these meds are incompatible when used together. Albuterol is a SABA bronchodilator, and montelukast is a leukotriene modifier. These meds are often prescribed together to treat the immediate manifestations of asthma as well as to help prevent asthma attacks. Aminophylline is a systemic methylxanthine that helps decrease smooth muscle contraction, dilating the bronchioles. Fluticasone is an ICS that decreases airway inflammation. These meds can be administered concurrently without causing additional harm. Salmeterol is a LABA bronchodilator, and levalbuterol is a SABA bronchodilator. These meds are often prescribed together for both short- and long-term control of asthma manifestations.
The nurse is teaching the patient's family about montelukast. Which statement by the family requires further teaching? A. This medicine works by reducing inflammation of the lungs. B. This medicine should be taken at the onset of an asthma attack. C. This medicine works by blocking the inflammation process. D. This medicine is used for maintenance therapy to prevent asthma attacks.
B. This medicine should be taken at the onset of an asthma attack. Leukotriene inhibitors are anti-inflammatory drugs. Leukotriene inhibitors such as montelukast are taken for prevention of asthma attacks. It works by blocking the inflammation that the irritant may cause. Leukotriene inhibitors are taken as long-term therapy and should not be used as an asthma attack rescue drug.
A nurse is assessing a patient who takes oral theophylline for chronic bronchitis relief. The nurse should recognize that which of the following findings indicates toxicity to theophylline? A. Constipation B. Tremors C. Fatigue D. Bradycardia
B. Tremors Theophylline is a xanthine-derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures can occur if blood levels continue to rise.
While providing care for the client prescribed beclomethasone, which assessment finding will the registered nurse (RN) attribute to the current drug therapy? Select all that apply. A. increased drowsiness B. a slow healing wound C. blood glucose of 142 mg/dL D. inner mouth sores E. loss of appetite
B. a slow healing wound C. blood glucose of 142 mg/dL D. inner mouth sores Corticosteroids are a group of drugs that help reduce inflammation specifically in the respiratory system. Specific drugs in this drug class include: fluticasone, beclomethasone, and methylprednisolone. These drugs have a slow onset of action and are not the first line of treatment for an acute respiratory event. When used in the treatment/management of asthma, corticosteroids are used as a third line of treatment in combination with first albuterol and second ipratropium, both of which are bronchodilators. Specific side-effects that can occur with these drugs include: delayed wound healing, development of mouth sores, and increased blood glucose. For this question it helps to remember that steroids weaken the immune system. This will help you remember slow wound healing and mouth sores. Also, remember that blood glucose will increase.
A nurse is providing teaching to a patient with with chronic bronchitis about administering acetylcysteine using a hand-held nebulizer (HHN). Which of the following patient statements indicates an understanding of the teaching? A. "I should discard an open vile of the med after 24 hr." B. "I should limit my fluid intake while taking this med." C. "I should try to cough productively just before I begin the treatment." D. "If the medication becomes discolored, I should throw it out & get a new supply."
C. "I should try to cough productively just before I begin the treatment." A productive cough prior to beginning the treatment will clear sputum from lung surfaces, allowing better absorption of the medication. An open vile of the med can be stored in the refrigerator for up to 96 hr. The patient should drink plenty of fluids, at least 2 to 3 L each day, to hep thin the secretions. After opening, the med mix might develop a light purple color, which is expected & doesn't alter the potency of the med.
A nurse is caring for a patient with COPD who has been taking tiotropium. Which of the following patient statement should indicate to the nurse that the patient is experiencing an adverse effect of this med? A. "My body aches all over." B. "I am urinating more during the day." C. "My mouth feels dry all the time." D. "I have trouble sleeping at night."
C. "My mouth feels dry all the time." Dry mouth is a common adverse effect of this med's anticholinergic effects. Tiotropium is a long-acting anticholinergic inhaled med used for maintenance therapy for patients with COPD. It can cause urinary retention. It doesn't cause generalized body aches or insomnia.
What specific education point will the registered nurse (RN) provide the client prescribed methylprednisolone for the treatment of asthma? A. "This drug needs to be the first drug used in the event of an asthma attack." B. "This drug is administered after albuterol and before ipratropium to treat asthma." C. "This drug will help to decrease the swelling that is occurring in your lungs because of asthma." D. "This drug works so well that you can omit albuterol and ipratropium from the asthma treatment plan."
C. "This drug will help to decrease the swelling that is occurring in your lungs because of asthma." Corticosteroids are a group of drugs that help reduce inflammation specifically in the respiratory system. Specific drugs in this drug class include: fluticasone, beclomethasone, and methylprednisolone. These drugs have a slow onset of action and are not the first line of treatment for an acute respiratory event. When used in the treatment/management of asthma, corticosteroids are used as a third line of treatment in combination with first albuterol and second ipratropium, both of which are bronchodilators. Specific side-effects that can occur with these drugs include: delayed wound healing, development of mouth sores, and increased blood glucose.
A client enters the emergency department because of being awakened in the night with a bronchospasm. The client is diagnosed with asthma and the nurse provides instructions on which medication to utilize for onset of bronchospasm? A. Montelukast. B. Fluticasone-salmeterol. C. Albuterol inhaler. D. Budesonide-formoterol.
C. Albuterol inhaler. Albuterol is a short-acting beta agonist that rapidly reverses the signs/symptoms of bronchospasm. Albuterol is also referred to as the rescue inhaler for clients experiencing symptoms of an acute asthma attack. Clients should be instructed to use their albuterol inhaler at the onset of acute bronchospasm.
A nurse is caring for a patient who has COPD & has been taking fluticasone via inhaler for many years. Which of the following findings should the nurse identify as an adverse effect of long-term use of this med? A. GFR: > 60 B. ALT: 82 units/L C. Anorexia & weakness D. Varicose veins in the lower extremities
C. Anorexia & weakness The nurse should identify adrenal insufficiency as an adverse effect of the long-term use of an inhaled corticosteroid such as fluticasone. Manifestations can include anorexia, weakness, nausea, hypotension, and hypoglycemia.
The nurse knows that the mother correctly understands the use and function of montelukast when she makes which statement? A. It should be used at the onset of an asthma attack. B. It is used as a preventative as needed for asthma attacks. C. It should be taken nightly for asthma attack prevention. D. It should be given when he has been around irritants.
C. It should be taken nightly for asthma attack prevention. Asthma is a chronic respiratory condition that causes an increase in mucus production, as well, as inflammation, and bronchoconstriction. Leukotriene inhibitors are anti-inflammatory drugs that can be used to reduce and prevent the symptoms of asthma.They work by blocking the inflammation that the irritant may cause as well as reducing mucus. Leukotriene inhibitors are taken as long-term therapy and take 1-2 weeks for a therapeutic response. They should not be taken only as needed since it does take time for the medication to reach a therapeutic response.
A nurse is preparing a discharge teaching plan for a patient who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the med if a rash occurs. B. Take the med on an empty stomach to enhance absorption. C. Schedule the med on alternate days to decrease adverse effects. D Treat shortness of breath with an extra dose of the med.
C. Schedule the med on alternate days to decrease adverse effects. Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy. A rash is not an expected adverse effect of oral glucocorticoids like prednisone. A patient shouldn't stop taking prednisone or other glucocorticoids abruptly if taking the med for more than 10 days. The dosage should be decreased gradually to prevent withdrawal syndrome during long-term therapy. Glucocorticoids can lead to significant GI distress & lead to ulcer formation. This med should not be taken on an empty stomach. Oral glucocorticoids are not used as a rescue med. The patient may need a short-acting bronchodilator if acute distress occurs.
A nurse is caring for a patient who has severe asthma & allergic rhinitis. The patient is taking theophylline. Which of the following meds should the nurse identify as being incompatible with theophylline? A. Cromolyn B. Albuterol C. Zafirlukast D. Methylprednisolone
C. Zafirlukast Zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance. Concurrent use of zafirlukast with theophylline suppresses the metabolism of theophylline, which can lead to toxicity. Therefore, another medication should be used. Cromolyn is a mast cell stabilizer that decreases inflammation of the airways or nasal passageways. Albuterol sulfate is a beta2-agonist that is used to treat bronchospasm. Methylprednisolone is an oral glucocorticoid that can be used for the long-term treatment & management of asthma. This med decreases inflammation of the airways.
What technique will the registered nurse (RN) educate the client to implement when administering the beclomethasone inhalation therapy? A. place the beclomethasone inhaler under warm water as it works better warmed. B. place the beclomethasone inhaler in the refrigerator as it works better chilled. C. administer the inhalation therapy through a spacer attached to the inhaler mouthpiece. D. position the mouthpiece of the inhaler one inch away from the open mouth as the drug is dispersed out.
C. administer the inhalation therapy through a spacer attached to the inhaler mouthpiece. Corticosteroids are a group of drugs that help reduce inflammation specifically in the respiratory system. Specific drugs in this drug class include: fluticasone, beclomethasone, and methylprednisolone. The drugs are administered using inhalation therapy as part of the treatment plan for asthma. Because of the risk of the individual developing oral thrush (Candida albicans) it is beneficial for the individual to use a spacer to administer this inhalation drug. The inhaler device mouthpiece is attached to the spacer. This will allow delivery of the drug without residual drug collecting in the oral cavity.
After the administration of albuterol during an asthma attack, the registered nurse (RN) is aware of what clinical manifestations indicate that the drug has been effective? Select all that apply. A. presence of irregular heart rate B. increase in alertness to surroundings C. increase in the productive cough D. decrease in alertness to surroundings E. a decrease in anxiousness
C. increase in the productive cough E. a decrease in anxiousness Beta-2 adrenergic agonists are a class of drugs that work to dilate the bronchioles increasing the airflow through the lungs. Drugs within this category include albuterol and levalbuterol. Both albuterol and levalbuterol are the fastest acting bronchodilators and serve as the first line of treatment for an acute asthma attack. The individual is educated to administer 2 to 4 puffs every 20 minutes for 3 treatments if an asthma attack occurs. The effectiveness of the treatment is noted by an increase in productive coughing, decreased anxiety, and the occurrence of hand tremors. If the treatment is not effective, it is important to notify the healthcare provider immediately.
While providing care for the client hospitalized for acute bronchitis and prescribed aminophylline, which clinical manifestation will the registered nurse (RN) attribute to the initiation of this drug therapy? Select all that apply. A. bradycardia B. bradypnea C. tachycardia D. dysrhythmia E. dry mouth
C. tachycardia D. dysrhythmia Methylxanthines are a class of drugs that have clinical use because of their bronchodilatory and stimulatory effects. Drugs in this class include theophylline and aminophylline. This drug class is used to treat asthma, emphysema, bronchitis, and other respiratory problems, but are not recognized as rescue drugs. Tachycardia and dysrhythmias are common side-effects of theophylline. This drug should be taken in the morning and caffeine is prohibited while taking this drug. The heart rate should be assessed and tachycardia reported to the healthcare provider before administering the next dose of this drug. If a cardiac stress test is ordered, this drug is stopped prior to the test. Beta blockers are not administered to an individual prescribed theophylline because of the effect each drug has on the heart.
The nurse is discharging a patient diagnosed with COPD. Which discharge instructions should the nurse provide regarding the patient's prescription for prednisone? A. Take all prednisone as ordered until the prescription is empty. B. Take prednisone on an empty stomach with a full glass of water. C. Stop taking prednisone if noticeable weight gain occurs. D. Do not abruptly discontinue taking prednisone.
D. Do not abruptly discontinue taking prednisone. Prednisone is a glucocorticoid steroid. Prednisone is not abruptly discontinued because cortisol (a glucocorticoid) is necessary to sustain life, and the adrenal glands stop producing cortisol while the patient is taking it exogenously. The med must be tapered off to prevent a life-threatening complication.
Which medication is a long-acting beta-2 adrenergic agonist & DPI that is used only for COPD? A. Roflumilast (Daliresp) B. Salmeterol (Serevent) C. Ipratropium (Atrovent HFA) D. Indacaterol (Arcapta Neohaler)
D. Indacaterol (Arcapta Neohaler) Roflumilast is an oral med used for COPD. Salmeterol is a DPI, but it is also used in asthma with inhaled corticosteroids. Ipratropium is used for COPD, but it's delivered via metered-dose inhaler or nebulizer.
The nurse teaches that which medication can be used to treat both allergies and asthma? A. Albuterol B. Prednisone C. Cetirizine D. Montelukast
D. Montelukast Leukotriene inhibitors reduce inflammation and mucus of the lungs. They can be used to treat both allergies and asthma. Irritants such as weather changes, dust, pollen, pet dander are potential triggers for those with seasonal allergies and asthma. Irritants trigger leukotriene that increase both inflammation and mucus in the respiratory system. Leukotriene inhibitors can block that response and reduce both inflammation and mucus. Thereby, making leukotriene inhibitors a preventative medication for asthma symptoms.
A nurse is providing teaching to a patient with asthma who has a new prescription for a short-acting beta2-agonist (SABA) bronchodilator. Which of the following pieces of information should the nurse share? A. The SABA will provide prolonged control of asthma attacks. B. SABAs are also available in oral form. C. The SABA will have to be taken with an inhaled glucocorticoid. D. Notify the provider if the SABA is needed more than 2x per week.
D. Notify the provider if the SABA is needed more than 2x per week. SABA bronchodilators are used as a PRN rescue med to stop an ongoing asthma attack. If the patient requires the SABA more than 2x/wk the provider should be notified because a prescription for a long-acting beta2-agonist (LABA) might be required. Using a SABA more than 2x/wk can lead to serious adverse effects. Prolonged control of asthma requires the use of LABA bronchodilator. LABAs are available in inhaled or oral form. All oral bronchodilators are long-acting. SABAs are only available as inhaled preparations. LABA bronchodilators should not be used as monotherapy. LABAs should be combined with inhaled glucocorticoid.
A nurse is caring for a patient who is experiencing an acute asthma exacerbation. Which of the following medications should the nurse identify as being contraindicated for this patient? A. Dextromethorphan B. Montelukast C. Ciprofloxacin D. Propranolol
D. Propranolol A patient who is experiencing an acute asthma exacerbation requires the use of a beta2-agonist to alleviate bronchospasm & relax the patient's airway. Therefore, propranolol is contraindicated. Propranolol is a beta-blocker that is used to treat cardiac conditions, including HTN. Blocking the beta receptors prevents the action of beta2-agonists such as albuterol. Dextromethorphan is an OTC couch suppressant. Montelukast is a leukotriene receptor blocker that is used as a prophylaxis for the maintenance of asthma. Ciprofloxacin is an antibiotic.
What drug therapy is used to treat community acquired PNA in a person with comorbidities?
Fluoroquinolone OR β-lactam, PLUS macrolide. Fluoroquinolone includes ciprofloxacin & levofloxacin. β-lactam includes high dose amoxicillin, ceftriaxone, or cefuroxime.
Name three inhaled corticosteroid medications used to treat asthma.
Fluticasone (MDI, DPI) Beclomethasone (MDI) Budesonide (DPI)
What are side effects of Rifampin for TB treatment?
GI upset Hepatotoxicity Flu-like symptoms Body fluids may turn orange-red
What are side effects of Streptomycin for TB treatment?
Hearing (ototoxic) Balance changes Renal toxicity (nephrotoxic - need renal function tests throughout therapy)
What are side effects of Pyrazinamide for TB treatment?
Hepatotoxicity Gout
What are side effects of Isoniazid for TB treatment?
Hepatotoxicity Peripheral neuropathy
Name 5 medications used to treat TB.
Isoniazid Rifampin Pyrazinamide Ethambutol Streptomycin
What drug therapy is used to treat community acquired PNA in a previously healthy person?
Macrolide OR tetracycline Macrolides include erythromycin, azithromycin, and clarithromycin. Doxycycline is a tetracycline.
Name two leukotriene modifier medications used to treat asthma.
Montelukast (oral) Zafirulkast (oral)
Name an IgE agonist medication used to treat asthma.
Omalizumab (subcut q 2-4 wk)
What are side effects of Ethambutol for TB treatment?
Optic neuritis (monthly eye exams are needed while on meds)
Name a long-acting β-adrenergic agonist (LABA) medication used to treat asthma.
Salmeterol (DPI)
