Antihistamines, Decongestants, Antitussives, Expectorants & Respiratory Drugs

B. dextromethorphan (Robitussin-DM) oral solution (non-opioid, do not want to depress the CNS more with an opioid)

A 94-year-old patient has a severe dry cough. He has coughed so hard that the muscles in his chest are hurting. He is unsteady on his feet and slightly confused. Which drug would be the best choice for this patient's cough? A. benzonatate (Tessalon Perles) capsules B. dextromethorphan (Robitussin-DM) oral solution C. codeine cough syrup D. guaifenesin (Mucinex)

D. Longer duration of action salmeterol is a stronger form of albuterol that is commonly used

A nurse is providing education to a patient taking two different medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? A. Shorter onset of action B. Better side effect profile C. Quicker peak action D. Longer duration of action

A. loratadine (claritin) Loratadine is a second generation antihistamine that causes less adverse effects such as drowsiness

A patient asks the nurse about the newer antihistamines. He wants one that doesn't cause drowsiness. Which of these is appropriate? A. loratadine (claritin) B. diphenhydramine (bendadryl) C. dimenhydrinate (drammamine) D. meclizine (antivert)

B. sustained use of nasal decongestants over several days may result in rebound congestion.

A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that A. oxymetazoline is not an effective nasal decongestant. B. sustained use of nasal decongestants over several days may result in rebound congestion. C. oxymetazoline should be administered in an hourly regimen for severe congestion. D. the patient is probably displaying an idiosyncratic reaction to oxymetazoline.

B. sinus tachyardia It increases the respiratory drive having an increasing effect on the heart CNS would increase, the patient would experince anorexia, and the urinary output would increase not have retention

A patient has been receiving aminophylline (xanthine derivative) infusion for 24 hours. The nurse will assess for which adverse effect when assessing the patient during the infusion? A. CNS depression B. sinus tachyardia C. increased appetite D. temporary urinary retention

D. This drug often causes a "hangover"effect Hangover/sedation is an expected effect with this antihistamine. Therefore the main cause would just be taking the drug itself not that she was getting too much sleep, taking too much, or the reason that it is not meant to help people sleep

A patient has been self-medicating with diphenydramine (Bendadryl) to help her sleep. She calls the nurse to ask "why do I feel so tired during the day after I take this pill?" Which statement by the nurse is correct? A. You are probably getting too much sleep B. You are taking too much of the drug C. This drug is not really meant to help people sleep D. This drug often causes a "hangover"effect

B. BPH D. narrow-angle glaucoma E. asthma They worsen the symptoms of BPH causing urinary retention with the anticholinergic effects, the can constrict the BV's of the eye causing pupil dilation and increase in intraocular pressure, and the drying of secretions in the upper and lower respiratory tracks for asthma

A patient is asking about taking an antihistamine for springtime allergies. The nurse assesses for contraindications to antihistamine therapy. Which of these conditions if present, would be contraindicated? select all that apply.... A. type 2 DM B. BPH C. hyperthyroidism D. narrow-angle glaucoma E. asthma

A. epinephrine Epi will turn on all the receptors and cause massive opening of things Montelukast is used for chronic asthma not acute exacerbations

A patient is experiencing status asthmacticus. The nurse will prepare to administer which drug first? A. epinephrine B. methylprednisolone (soul-medrol) C. cromolyn (Intal) D. montelukast (singulair)

A. Antihistamines - they will work to block the allergens or histamines, and the allergy testing will be altered because the responses to different stimuli may be inhibited due to the blocking of inflammation and allergic response

A patient is making an appointment for allergy testing. The nurse instructs the patient not take what class of medications at least 4 days before allergy testing? A. Antihistamines B. Decongestants C. Bronchodilators D. Antitussives

B. Five minutes One minute is in between two puffs of the same medication

A patient is prescribed two different types of inhaled medications for treatment of chronic obstructive pulmonary disease (COPD). After administering the first medication, how long should the nurse wait to administer the second medication? A. One minute B. Five minutes C. Ten minutes D. Fifteen minutes

D. heart palpitations - decongestates constrict the BV's, can lead to vascular/systemic constriction causing heart palpitations

A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptoms, which may indicate an adverse effect of this drug? A. increased cough B. dry mouth C. slower heart rate D. heart palpitations

A. allergy to soy lecithin B. allergy to peanuts

A patient is to receive a new prescription for an ipratropium (atrovent) inhaler. The nurse will assess for which potential contraindications? select all that apply... A. allergy to soy lecithin B. allergy to peanuts C. allergy to iodine products D. hypertension E. seizure disorders

A. a beta agonist (albuterol) leukotriene receptor agonist is used for long term asthma corticosteroid is not the first step in the treatment of an acute episode anticholinergic is not used for SOB

A patient who has a history of asthma is experiencing acute episode of SOB and needs to take medication for immediate relief. The nurse will choose which medication that is appropriate for this situation? A. a beta agonist (albuterol) B. an leukotriene receptor antagonist (montelukast) C. a corticosteroid (fluticasone) D. anticholinergic (ipratropium)

A. corticosteroid

A patient who has asthma may be prescribed which type of inhaled drug for its antiinflammatory effects? A. corticosteroid B. anticholinergic C. xanthine derivative D. beta adrenergic

D. guaifenesin (Mucinex) - decreases the viscosity of secretions, allowing the secretions to be secreted easier

A patient with a tracheostomy developed pneumonia. It is very difficult for the patient to cough up the thick, dry secretions he has developed. The nurse identifies which drug as being most effective in helping this patient? A. benzonatate (Tessalon Perles) capsules B. dextromethorphan (Robitussin-DM) oral solution C. codeine cough syrup D. guaifenesin (Mucinex)

B. The nurse should ask the patient to come to the office for an evaluation of his respiratory status.

A patient with chronic bronchitis calls the office for a refill of his albuterol inhaler. He just had the prescription filled 2 weeks ago, but he says it is empty. When asked, he tells the nurse, "I use it whenever I need it, but now when I use it I feel so sick. I've been needing to use it more often." What is the most appropriate action by the nurse? A. The nurse should confirm the pharmacy location for the needed refill. B. The nurse should ask the patient to come to the office for an evaluation of his respiratory status. C. The nurse should tell the patient not to use this drug too often. D. The nurse should consult the prescriber for a different inhaler prescription.

A. expected adverse effect of this medication -still has cradiac effects and works to open up things by turing on receptors

After a nebulizer treatment with the beta agonist, albuterol, the patient complains of feeling a little shaky with slight hand tremors. The patient's heart rate is 98 BPM increased from the pretreatment rate of 88BPM. The nurse knows that this reaction is an? A. expected adverse effect of this medication B. allergic reaction to this medication C. indication that he has received an overdose of the medication D. idiosyncratic reaction to this medication

B. rinse out the mouth with water the mouth has to be rinsed to prevent the build up of bacteria/medication in the mouth that could cause thrush A bronchodialator should be used before the corticosteroid to open up the airway more for the sterioid, the dose should not be repeated rather the use of LABA should be used

After the patient takes a dose of an inhaled corticosteroid, such as fluticasone (flovent), what is the most important action the patient needs to do next? A. hold the breath for 60 seconds B. rinse out the mouth with water C. follow the corticosteroid with a bronchodilator inhaler, if ordered D. repeat the dose in 15 minutes if the patient feels short of breath

C. Cellulose

Before administering an antileukotriene medication, the nurse would assess the patient for allergies to which substance? (Select all that apply.) A. Lactose B. Povidone C. Cellulose D. Chlorhexedine

A. Tachycardia This can be an adverse effect if the beta-agonist works on other receptors that are found in the heart

Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? A. Tachycardia B. Nonproductive cough C. Hypoglycemia D. Sedation

C. reduces inflammation in the airway LTRA block the leukotrines that cause inflammation. The use of xanthine dertivatives increase the respiratory drive, expectorants such as guaifenesin loosen the secretionsm, albuterol stimulates immediate bronchodilators

During a teaching session for a patient who will be receiving a new prescription for the LTRA montelukast (singulair), the nurse will tell the patient that the drug has which therapeutic effects A. improves respiratory drive B. loosens and removes thickened secretions C. reduces inflammation in the airway D. stimulates immediate bronchodilators

D. improvement should be seen within a week of use Patients should never have a double dose, the gargling after the use of an inhaler is for corticosteriods, LRA should not be taken with a bronchospasm --> a bronchodialtor should be the used first for a bronchospasm (SABA- albuterol)

For patients taking a leukotriene receptor antagonist, the nurse should include which information in the patient teaching? A. if a dose is missed, the patient may take a double dose to maintain blood levels B. the patient should gargle or rinse the mouth after using the inhaler C. the medication should be taken at the first sign of bronchospasm D. improvement should be seen within a week of use

B. less sedative effect. -Loratadine (Claritin) is a 2nd generation drug with less powerful adverse effects

Loratadine (Claritin) has an advantage over traditional antihistamines such as diphenhydramine (Benadryl) in that loratadine has A. less risk of cardiac arrhythmias. B. less sedative effect. C. increased bronchodilating effects. D. less gastrointestinal upset.

C. Allergens Stablization of the mast cells, that have histamine within them, is key to not let the histamine release causing an allergic reaction and inflammation

Mast cell stabilizers are most effective in treating bronchoconstriction associated with which condition? A. Emphysema B. Exposure to cold C. Allergens D. Infection

B. albuterol (Proventil)

One of the attendees expresses concern regarding her granddaughter's asthma. The attendee tells the nurse that she is afraid that she will not know which of her granddaughter's medications to give first in case of an asthma attack. Which medication should the nurse inform the attendee to administer first for an acute asthma attack? A. ipratropium (Atrovent) B. albuterol (Proventil) C. budesonide (Pulmicort Turbuhaler) D. montelukast (Singulair)

A. Step 1

One of the attendees tells the nurse that he has asthma and is being treated with a short-acting inhaled beta2 agonist. The nurse identifies this treatment as which step of the stepwise therapy for the treatment of asthma? A. Step 1 B. Step 2 C. Step 3 D. Step 4

C. Increase fluid intake to decrease viscosity of secretions. Ex: guaifenesin (ex use: patient with a tracheostomy & pneumonia also)

Patient teaching regarding expectorants should instruct the patient to perform which action? A. Restrict fluids to decrease mucus production. B. Take the medication once a day only, usually at bedtime. C. Increase fluid intake to decrease viscosity of secretions. D. Increase fiber and fluid intake to prevent constipation.

C. "This medication works by preventing the inflammation that causes your asthma attack."

Patient teaching regarding the use of antileukotriene drugs such as zafirlukast (Accolate) would include which statement? A. "Take the medication as soon as you begin wheezing." B. "It will take about 3 weeks before you notice a therapeutic effect." C. "This medication works by preventing the inflammation that causes your asthma attack." D. "Increase fiber and fluid in your diet to prevent the common side effect of constipation."

C. Urinary retention (anticholingeric effects)

Prior to administering an antihistamine to a patient, it is most important for the nurse to assess the patient for a history of which condition? A. Chronic urticaria B. Motion sickness C. Urinary retention D. Insomnia

B. the medications only treat the symptoms.

The common cold is treated with empiric therapy, which means: A. the medications cure the cold. B. the medications only treat the symptoms. c. herbal medications are useful to eliminate symptoms. D. it is prevented with careful use of medications.

B. drink extra fluid, unless contraindicated, to aid in expectoration of sputum Expectorants should have fluid intake, they do not have sedation or CNS effects to which someone would have to avoid driving, and the secretions should be thinner not thicker

The nurse is administering an expectorant and will provide which teaching? A. avoid fluids for 30-45 min after the dose B. drink extra fluid, unless contraindicated, to aid in expectoration of sputum C. avoid driving or operating heavy machinery while taking this med D. expect secretions to become thicker

A. Antihistamines B. Nasal decongestants C. Antitussives D. Expectorants Example: chronic bronchitis (inflammation and mucus) -antihistamines work to decrease the amount of inflammation, nasal decongestants work to constrict the BV's to expel mucus, antitussives work as a cough suppressant/anticholinergic effect to dry up the extra secretions, and expectorants to thin the secretions -antibiotics are not usually used unless there is bacteria involved

The nurse is discussing management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.) A. Antihistamines B. Nasal decongestants C. Antitussives D. Expectorants E. Antibiotics

C. fexofenadine (Allegra) D. loratadine (Claritin) E. cetirizine (Zyrtec)

The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? (Select all that apply.) A. ranitidine (Zantac) B. nizatidine (Axid) C. fexofenadine (Allegra) D. loratadine (Claritin) E. cetirizine (Zyrtec)

A. Drowsiness and dizziness Antitussive medications include: -Dextromethorphan: dizziness, drowsiness, N/V -Opioids: resp depression, sedation

The nurse is discussing use of antitussive medications with a patient. What common side effect does the nurse include in the patient teaching? A. Drowsiness and dizziness B. Diarrhea and abdominal cramping C. Tremors and anxiety D. Bradycardia and increased lacrimation

B. dizziness C. "hangover" effect D. drowsiness F. dry mouth - antihistamines like Diphenhydramine (Benadryl) & Loratadine (Claritin) can cause anticholinergic effects and sedation effects

The nurse is giving an antihistamine and will observe the patient for which side effects? Select all that apply.... A. hypertension B. dizziness C. "hangover" effect D. drowsiness E. tachycardia F. dry mouth

A. Coronary artery disease Bronchodilators are contradindications of heart diseases

The nurse is providing care to a patient prescribed a nonselective adrenergic agonist bronchodilator. Which medical diagnosis on this patient's chart would alert the nurse to question this order? A. Coronary artery disease B. Chronic obstructive pulmonary disease (COPD) C. Hyperkalemia D. Premature labor

C. intranasal steroids - the use of the other three medications may cause rebound congestion in an individual

The nurse is providing education to a patient with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications would the nurse anticipate the provider would recommend for the patient to use on a long-term basis? A. Anititussives B. Antihistamines C. Intranasal steroids D. Expectorants

A. antihistamines are best tolerated when taken with meals B. the patient can chew gum if he or she experiences dry mouth C. drowsiness is a frequent side effect of antihistamines E.the patient should avoid drinking alcoholic beverages while on these drugs

The nurse is providing patient teaching about antihistamine use. Will include which information? select all that apply...... A. antihistamines are best tolerated when taken with meals B. the patient can chew gum if he or she experiences dry mouth C. drowsiness is a frequent side effect of antihistamines D. OTC meds are usually safte to use with antihistamines E.the patient should avoid drinking alcoholic beverages while on these drugs

A. "If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately." It is an adverse effect however, you should never abruptly stop taking a medication

The nurse is providing teaching to a group of individuals with chronic obstructive pulmonary disease (COPD) at a community center. Which statement by one of the attendees indicates that further teaching is needed? A. "If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately." B. "I will inform my prescriber of any weight gain of 2 pounds or more in 24 hours or 5 pounds or more in 1 week." C. "I use omalizumab (Xolair) to control my asthma but not for an acute asthma attack." D. "When taking theophylline (Theo-Dur), I will advise my prescriber if I experience epigastric pain."

B. an expectorant - and expectorant to liquify the secretions to be able to expell the secretions with a productive cough

The nurse is reviewing a patient's medication orders for PRN medications that can be given to a patient who has bronchitis with a productive cough. Which drug will the nurse choose? A. an antitussive B. an expectorant C. an antihistamine D. a decongestant

B. increased heart rate D. nausea E. nervousness F. tremors Bronchodialators include adrenergic agonists, anticholinergic and xanthine derivatives causing the Beta and Alpha receptors to be turned on causing symptoms of increasing the HR, nausea, tremors (beta 1), and nervousness Blurred vision is an adverse effect of antihistamines (anticholinergic effects), would not be decreased heart rate it would be increased

The nurse is teaching a group of patient about the use of bronchodilators. It is important to remind them that using bronchodilators too frequently may cause which adverse effect? select all that apply.. A. blurred vision B. increased heart rate C. decreased heart rate D. nausea E. nervousness F. tremors

A. I will rinse my mouth with water after each dose C. This medication is taken twice a day, every 12 hour E. I will call my doctor if I notice white patches inside my mouth Advair is a corticosteroid so the mouth should be rinsed, white patches could indicate thrush This should not be taken as a rescue inhaler

The nurse is teaching a patient about the inhaler Advair. Which statements by the patient indicate a correct understanding of this medication? Select all that apply.... A. I will rinse my mouth with water after each dose B. I need to use this inhaler whenever I feel SOB but not less than 4 hours between doses C. This medication is taken twice a day, every 12 hours D. I can take this inhaler if I get short of breath while exercising E. I will call my doctor if I notice white patches inside my mouth

C. a patient who has had recent abdominal surgery - will suppress the cough relex, in which is good for abdominal surgery because we do not want to increase the abdominal pressure

The nurse knows that an antitussive cough medication would be the best choice for which patient? A. a patient with a productive cough B. a patient with chronic paranasal sinusitis C. a patient who has had recent abdominal surgery D. a patient who has influenza

B. Therapeutic The range is 10-20

The nurse receives lab values for a patient with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? A. Subtherapeutic B. Therapeutic C. Toxic D. Life-threatening

C. Atrial fibrillation -pseudoepherdrine is a decongestant, that can cause constriction of BV's systemically such as in the heart

The nurse would question an order for pseudoephedrine in a patient with a history of which condition? A. Pneumonia B. Osteoporosis C. Atrial fibrillation D. Peptic ulcer disease

1st- C. albuterol 2nd- B. ipratropium 3rd- A. beclamethasone

The physician orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Beclovent) inhalers for your patient. Put the drugs in the correct order in which they will be administered, using the choices A through C listed below. A. beclomethasone (Beclovent) B. ipratropium bromide (Atrovent) C. albuterol (Proventil)

D. They decrease inflammation.

What is the role of corticosteroids in the treatment of acute respiratory disorders? A. They stimulate the immune system. B. They directly dilate the bronchi. C. They increase gas exchange in the alveoli. D. They decrease inflammation.

D. "This inhaler is not to be used alone to treat an acute asthma attack." should be taken with a short acting--> albuterol

What statement by the patient, who is using the anticholinergic inhaler ipratropium bromide (Atrovent), indicates to the nurse that teaching has been successful? A. "I will increase my intake of caffeine." B. "I may gain weight as a result of taking this medication." C. "Nausea and vomiting are common adverse effects of this medication, so I will always take it with meals." D. "This inhaler is not to be used alone to treat an acute asthma attack."

B. Neurologic status Due to the sedation effects such as dizziness and drowsiness

What system assessment will the nurse monitor in a patient due to a known common side effect of traditional antihistamines? A. Cardiac status B. Neurologic status C. Respiratory status D. Gastrointestinal status

C. tachycardia

When a patient is taking parenteral xanthine derivatives such as aminophylline, the nurse should monitor for which adverse effect? A. decreased respirations B. hypotension C. tachycardia D. hypoglycemia

A. glaucoma - can dialate the pupil too much causing sever intraocular pressure

When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? A. glaucoma B. fever C. peptic ulcer disease D. allergic rhinitis

C. stop cough reflex- non productive Antitussive medications should not be used with productive coughs because is can cause statis of mucus and bacterial growth Decongestants are used to relieve nasal congestion as well as thin the secretions

When giving an antitussive, the nurse remembers that they are used primarily for? A. relieve nasal congestion B. thin secretions C. stop cough reflex- non productive D. suppress productive and non productive coughs

C. hypertension - alpha adrenergics work in the heart to increase the stimulation

When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic stimulating effects that may result in which effect? A. fever B. bradycardia C. hypertension D. CNS depression

B. Do not use in patients younger than 2 years of age, unless prescribed. - there have been no clinical trials that have been done on children (due to ethical reasons) to know the efficacy or the safety of the use of OTC medications for allergies in children

When providing general education on use of over-the-counter medications for allergies, which is the highest priority for the nurse to include? A. Discontinue use 4 days before allergy testing. B. Do not use in patients younger than 2 years of age, unless prescribed. C. It may cause dry mouth. D. The medication treats the symptoms but is not a cure.

B. montelukast (singulair) Theophylline is a xanthine derivative Albuterol is a bronchodialator

Which drug acts by blocking leukotrines, thus reducing inflammation in the lungs? A. cromolyn (Intal) B. montelukast (singulair) C. theophylline (elixophyllin) D. albuterol (proventil)

B. decongestants (naphazoline) E. inhaled corticosteroids (beclomethasone)

Which drugs are considered first line drugs for the treatment of nasal congestion? select all that apply... A. antihistamine (diphenhydramine) B. decongestants (naphazoline) C. antitussives (dextromethorphan) D. expectorants (guaifenesin) E. inhaled corticosteroids (beclomethasone)

A. Liver enzymes

Which laboratory value would the nurse assess before administering zafirlukast (Accolate) antihistamine to a patient? A. Liver enzymes B. Cardiac enzymes C. Renal function tests D. Complete blood count

A. albuterol (Ventolin) SABA

Which medication will the nurse teach a patient with asthma to use when experiencing an acute asthma attack? A. albuterol (Ventolin) B. salmeterol (Serevent) C. theophylline (Theo-Dur) D. montelukast (Singulair)

C. St. John's wort

Which over-the-counter/herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? A. Caffeine B. Diphenhydramine C. St. John's wort D. Echinacea

B. "I will rinse my mouth with water after each use."

Which statement by a patient best demonstrates an understanding of the teaching on flunisolide (AeroBid)? A. "I will take two puffs to treat an acute asthma attack." B. "I will rinse my mouth with water after each use." C. "I will immediately stop taking my oral prednisone as soon as I start using the AeroBid." D. "I will not use my albuterol inhaler while I am taking AeroBid."

B. "This medication will help prevent the inflammatory response of my allergies." Beclomethasone is an inhaled corticosteroid and has anti-inflammatory effects

Which statement by the patient demonstrates understanding of action or use of beclomethasone diproprionate (Beconase)? A. "I will need to taper off the medication to prevent acute adrenal crisis." B. "This medication will help prevent the inflammatory response of my allergies." C. "I will need to monitor my blood sugar more closely because it may increase secondary to Beconase." D. "I only need to take this medication when my symptoms get bad."

C. "Wait 1 to 2 minutes before you take a second puff of the same drug." Should wait 5 minutes if taking a dose of a different drug

Which statement would be included when teaching a patient about the proper use of metered-dose inhalers? A. "After you inhale the medication once, repeat until you obtain relief." B. "Make sure that you puff out air repeatedly after you inhale the medication." C. "Wait 1 to 2 minutes before you take a second puff of the same drug." D. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."