respiratory week 5 pharm nurs180

name of nasal spray glucocorticoids

mometasone fluticasone budesonide

Which medication below blocks the function of Leukotriene for the treatment of asthma? A. Salmeterol B. Theophylline C. Tiotropim D. Montelukast

montelukast zileutin zafirlukast

anticholinergic meds (Ipratropium/tiotropium/edrophonium) are contraindicated in

-those who are allergic to soy/peanuts -narrow angle glaucoma -caution in BPH

when do you take cromolyn, a mast cell stabilizer

15-20 minutes before exercise

what is albuterol and when is it usually used

Albuterol is a short-acting beta2-adrenergic agonist that is used to provide immediate relief for an acute asthma attack.

what is the therapeutic range for methylxanthines

5-15 toxic effects over 20

name of the mucolytics

Acetylcysteine (Mucomyst) hypertonic saline

You're assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient's lung fields and note expiratory wheezes. The patient's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack? A. Theophylline B. Tiotropium C. Albuterol D. Cromolyn

Albuterol During an asthma attack, the patient needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators, such as Albuterol, short-acting beta agonists. Another type of short-acting bronchodilator is an anticholinergic bronchodilator called Ipratropium (this is given if a patient can't tolerated short-acting beta agonists like Albuterol).

what are the short acting beta2 adrenergic agonists

Albuterol and levalbuterol

Select all the correct options that represent the pathophysiology of an asthma attack. A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation. B. The mucosa lining experiences severe inflammation. C. The goblet cells within the mucosa lining produce excessive amounts of mucous. D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis.

B. The mucosa lining experiences severe inflammation. C. The goblet cells within the mucosa lining produce excessive amounts of mucous. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop....hence acidosis. Remember CO2 is acidic.

A client has been given a prescription for benzonatate (Tessalon). Which observation should the nurse look for to evaluate the effectiveness of the medication? a) Increasing the client's comfort level b) Decreasing the client's anxiety level c) Calming the client's persistent cough d) Eliminating the client's nausea and vomiting

Benzonatate is a locally acting antitussive that decreases the intensity and frequency of cough without eliminating the cough reflex.

A nurse has administered a dose of salmeterol (Serevent Diskus) to a client. The client develops a generalized rash and urticaria, and the eyelids begin to swell. Which action should the nurse take? a) Apply a lanolin-based cream to the rash. b) Encourage the client to drink fluids quickly. c) Assess the client's vision with a Snellen chart. d) Call the health care provider (HCP) immediately

Call the health care provider (HCP) immediately.Rationale: Hypersensitivity reaction can occur in clients taking salmeterol. Signs include rash, urticaria, and swelling of the face, lips, or eyelids. The nurse should call the HCP immediately if any of these occur.

A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will? A. Immediately stop the nebulizer B. Re-adjust the nebulizer C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication. D. Reassure the patient this is a temporary side effect of this medication.

Cromolyn can temporarily cause the following side effects during administration: sneezing, burning in nose, itchy/watery eyes, bad taste in mouth. Reassure the patient that these are temporary side effects of this medication.

late signs of hypoxia

Cyanosis hypotension

cholinergic effects

DUMBBBELSS: Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Brochrhea, Emesis, Lacrimation, Sweating, Salivation

what is status asthmaticus

Life-threatening episode of airway obstruction(asthma) that is unresponsive to common treatment

adverse effects of methylxanthines

GI distress/dysrhythmias/tachycardia restlessness/seizures/insomnia

adverse effects of guaifenesin an expectorant

GI upset, Drowsiness, Rash

if someone is having severe bronchospasm/anaphylaxis what can be given

IM/IV epinephrine

Cromolyn sodium is prescribed for the client with allergic asthma. The nurse should plan care understanding that which is an action of this medication? a) Dilate the bronchi. b) Increase the number of eosinophils. c) Promote the migration of eosinophils into the inflammatory site. d) Inhibit the release of mediators from mast cells after exposure to an antigen.

Inhibit the release of mediators from mast cells after exposure to an antigen. Rationale: Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway hyperresponsiveness in some clients with asthma. It has no bronchodilating action.

A client is receiving theophylline intravenously. After several dosages, the client started to become restless and complains of palpitations. The nurse determines that the client is experiencing theophylline toxicity in which of the following? A.Theophylline level of 10mcg/ml. B.Theophylline level of 15mcg/ml. C.Theophylline level of 20mcg/ml. D.Theophylline level of 25mcg/ml.

theophylline level of 25 Theophylline toxicity is likely to occur when the serum level is higher than 20 mcg/ml. Early signs of toxicity include restlessness, nervousness, tachycardia, tremors and palpitations

when it comes to beta 2 adrenergics what is used for the control of chronic asthma

PO formoterol and salmeterol

due to the liver injury of these medications.... you get a liver function test (AST/ALT)

montelukast zileutin (leukotriene modifiers)

name of leukotriene modifiers

montelukast zileuton zafirlukast

what is infection of the mouth by candidacies treated with

nystatin swish and swallow then you done eat 15 minutes after

adverse effects of decongestants (adrenergic agonists)

rebound congestion agitation nervousness uneasiness

. A patient received a nebulizer of Albuterol. What is a side effect of this medication? A. Bradycardia B. Tachycardia C. Drowsiness D. Feeling cold

tachycardia

how do mucolytics work

thin out mucus, makes more watery so it can be coughed out

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? a) "Clear the nasal passages after use." b) "Take the medication only as needed." c) "The medication should start to work immediately." d) "The medication works locally and decreases inflammation."

The medication works locally and decreases inflammation."Rationale: Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness.

names of the methylxanthines

Theophylline Aminophylline Theobromine

when a decongestant and steroid is ordered which is taken first

a topical decongestant used first and then glucocorticoid

The nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? a) "I will take the medication on an empty stomach." b) "I won't drink alcohol while taking this medication." c) "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth. "d) "I won't do activities that require mental alertness while taking this medication."

a) "I will take the medication on an empty stomach."Rationale: Diphenhydramine (Benadryl) has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses or sugarless gum or hard candy to minimize dry mouth.

A client has a prescription to take guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? a) Take an extra dose if fever develops. b) Take the medication with meals only. c) Take the tablet with a full glass of water. d) Decrease the amount of daily fluid intake.

take with water

The health care provider (HCP) has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse should teach the client to monitor for which side effect of the medication? a) Constipation b) Painful coughing c) Increased urination d) Difficulty swallowing

a) Constipation Rationale: Codeine sulfate is an opioid analgesic and a frequent side effect is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

what is used to decrease the absorption of methylxanthines

activated charcoal

name of beta 2 adrenergic agonists meds

albuterol levalbuterol salmeterol terbutaline isoproterenol

early signs of hypoxia

anxiety confusion restlessness

why should patient report behavior changes while taking montelukast or zileutin

because it can cause depression ---> suicidal ideation

what are the names of the inhaled steroids

beclamethasone fluticasone budesonide

How do expectorants work?

break apart the mucus

A client is taking cetirizine (Zyrtec). The nurse should inform the client of which side effect of this medication? a) Diarrhea b) Excitability c) Drowsiness d) Excess salivation

c) Drowsiness Rationale: Cetirizine (Zyrtec) is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a) Platelet count b) Neutrophil count c) Liver function tests d) Complete blood count

c) Liver function testsRationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. because can cause liver damgae

Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming? A. Caffeine B. Dairy C. Wheat D. Shellfish

caffeine

Which of the following statements by a client taking montelukast (Singulair) should indicate the need for further teaching? a) "I will need to have my liver function checked. "b) "I can take the medication with food or without ."c) "I may be able to decrease the use of my metered-dose inhaler. "d) "I will take the medication when I first notice I am having trouble breathing."

d) "I will take the medication when I first notice I am having trouble breathing."Rationale: Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the side and adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? a) Insomnia b) Constipation c) Hypotension d) Bronchospasm

d) BronchospasmRationale: Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia. also leaves metal taste in mouth

A client is scheduled to receive acetylcysteine (Mucomyst) 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect to see as a result of the administration of this medication? a) Bronchodilation b) Decreased coughing c) Absence of wheezing d) Thinning of respiratory secretions

d) Thinning of respiratory secretions Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The other three options are the outcomes of respiratory medication therapy, but not of acetylcysteine.

how do decongestants work

decreasing blood flow to sinus, causes vasoconstriction/ reduces inflammation in the nasal membranes

adverse effects of montelukast and zileutin (leukotriene modifiers)

depression ---> suicidal ideation liver injury headache

name of non opioid anti tussive

dextromethorphan/benzonatate/diphenhydramine

name of decongestants

ephedrine phenylephrine pseudoephedrine oxymetazoline

when a beta agonist and steroid inhalant is ordered what is the order of usage?

first use the beta2 adrenergic which bronchodilates and then a steroid med

A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium (Combivent). Upon reviewing the medical history of the patient, the nurse questions the prescription if which of the following is noted? A. History of smoking. B.History of allergy to egg. C.History of allergy to peanut. D.History of a previous infection.

history of allergy to peanut The client with a peanut allergy should not take ipratropium because the product contains soy lecithin, which is in the same plant family as peanuts.

anticholinergics (Ipratropium/tiotropium/edrophonium) adverse effects

hoarseness dizziness blurred vision dry mouth

what does smoking while taking theophylline(a methylxanthine) do

increases the metabolism so the dosage will need to be increased

name of the inhaled anticholinergics

ipratropium tiotropium edrophonium

how to treat the dysrhythmias methylxanthines can possibly cause

lidocaine

avoid use of caffeine with

methylxanthines beta 2 adrenergic agonists

A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the following statements made by the client will need further instructions? "I can eat gum after I drink the medicine". "I can take the medicine on an empty stomach". C"I should avoid using alcohol". D I will avoid driving while using this medication

this med is an antihistamine so it should be taken with food or milk to minimize gastrointestinal upset.

what are antitussives used for

to stop non productive coughing

how to treat the seizures Theophylline/aminophylline/theobromine can possibly cause

with diazepam

do you take antihistamines with or without food

with food to avoid GI upset