Chapter 21: Drug Therapy for Asthma and Other Respiratory Problems

A nurse is discharging a patient with a new prescription for an aerosol inhaler without a spacer. What are accurate teaching tips for this patient? (select all that apply) "Before inhaling, breathe out a small puff of air." "Open your mouth and place the mouthpiece 1 to 2 inches away." "After the medication is inhaled, hold your breath for 30 seconds." "Wait 1 minute between puffs of the medication." "Clean the plastic case and cap of the inhaler with warm running water."

"Open your mouth and place the mouthpiece 1 to 2 inches away." "Wait 1 minute between puffs of the medication." "Clean the plastic case and cap of the inhaler with warm running water." After tilting your head back slightly and breathing out fully and not a small puff of air, open your mouth and place the mouthpiece 1 to 2 inches away. Hold your breath for at least 10 and not 30 seconds to allow the medication to reach deep into the lungs; then breathe out slowly. Next, wait at least 1 minute between puffs. Then, replace the cap on the inhaler and clean the plastic case and cap of the inhaler by thoroughly rinsing in warm, running tap water. It should be noted to avoid spraying in the direction of the eyes.

A patient asks how prescribed corticosteroids help with her breathing. What is your best response? "They are fast-acting bronchodilators that relax the muscles in your airway." "They prevent the bronchial muscles from getting tight." "They thin excess secretions in your lungs." "They reduce inflammation that narrows the airways."

"They reduce inflammation that narrows the airways." Corticosteroid drugs are similar to natural cortisol that prevent or limit inflammation by slowing or stopping inflammatory mediator production. Corticosteroids are not fast-acting bronchodilators and do not relax muscles in the airway. They also do not prevent the bronchial muscles from getting tight. Mucolytics and not corticosteroids thin increased secretions in the airways.

*Inhalation Drug Therapy* - 3 types - 3 obvious advantages

*3 types:* - Metered-dose inhalers (MDIs) - Dry-powder inhalers (DPIs) - Nebulizers *3 obvious advantages:* - Therapeutic effects are enhanced - Systemic effects are minimized - Relief of acute attacks is rapid

BAM: SLM:

*BAM* Beta2 agonist Anticholinergics Methylxanthines *SLM* Steroids Leukotriene inhibitors Mast cell stabilizer

*Administering Bronchodilators* - Before - After - Patient teaching - Life span considerations

*Before:* - Auscultate lungs - Baseline vital signs - Always use a pump for IV methylxanthines *After:* - Breathing status, drug levels - Wait at least 5 min between different drugs *Patient teaching:* - Correct administration technique for inhalers - Always carry rescue inhaler - Take prevention drugs even with absence of symptoms *Life span considerations:* - Older patients - more sensitive to cardiac and nervous system side effects

*Administering Anti-Inflammatory Drugs* - Before - After - Patient teaching

*Before:* - Check patient's mouth for infection or thrush - Teach patient correct technique for using inhaler and spacer - Give bronchodilator first and wait at least 5 minutes before giving the anti-inflammatory *After:* - Help patient rinse mouth with water or mouthwash *Patient teaching:* - Remind patients to use anti-inflammatory inhalers at least 5 minutes after using an inhaled bronchodilator - Teach patients to take the drug as prescribed even when symptoms aren't present - With COPD: Take drug daily - Rinsing the mouth after using the drug can reduce the bad taste and mouth dryness - Checks gums, mouth, throat daily for redness or white patches

Bronchodilator Examples:

*Beta2-adrenergic agonists* - SABAs: albuterol (Proventil HFA) - LABAs: salmeterol (Serevent) *Cholinergic Antagonists* - ipratropium (Atrovent) *Xanthines* - aminophylline, theophylline

*Anti-Inflammatory Drugs* - Classes: - What they do: - Intended responses: - Side effects:

*Classes:* - Corticosteroids, mast cell stabilizers, leukotriene inhibitors *What they do:* - Decrease inflammation *Intended responses:* - Reduced swelling of mucus membranes and reduced secretions - Airway lumens open and wheezing decreases, PERF remains in range *Side effects:* - Cough, bad taste, mouth dryness, increased risk of infection

*Bronchodilators* - Examples: - What they do: - Rescue drugs routes: - Prevention drugs routes: - Intended responses: - Side effects: - Adverse effects:

*Examples:* - Beta2-adrenergic agonists - Cholinergic antagonists - Methylxanthines *What they do:* - Relax smooth muscle, open airways *Rescue drugs routes:* - Inhaler, subcutaneous, IV *Prevention drugs:* - Nebulizer, oral *Intended responses:* - Pulmonary smooth muscles relax, airways widen - Wheezing decreases or disappears - PERF increases *Side effects:* - Rapid heart rate, increased BP, feeling of nervousness, dry mouth, difficulty sleeping *Adverse effects:* - Allergy, angina, heart attack, dysrhythmias, seizures

*Common Anti-inflammatory Drugs for Asthma and COPD* - 3 classes

*Inhaled Corticosteroids* - beclomethasone (QVAR) - budesonide (Pulmicort) - fluticasone (Flovent) *Mast Cell Stabilizers* - cromolyn sodium (Intal Inhaler) *Leukotriene Inhibitors* - montelukast sodium (Singulair)

What do Mucolytics do?

- Break connections that hold protein and mucus molecules - Reduce thickness of mucus - Oral or nebulizer forms - Few side effects: Very unpleasant odor, nausea and vomiting

What to do after giving Bronchodilators:

- Check the patient's breathing status after giving short-acting inhaler drugs to determine whether the drugs are effective. - Breathing improvement as measured by a slower respiratory rate, decreased or absent wheezes, and pulse oximetry values of 95% or higher usually occurs within 5 minutes of inhalation of short-acting bronchodilators. - Compare the patient's heart rate and blood pressure within 15 minutes after giving the drug to determine whether any systemic effects are present. - Ask about any chest pain. - Report severe tachycardia, a rapid rise in blood pressure, or chest pain immediately to the prescriber. - If a patient is to receive two or more drugs by inhaler for breathing problems, give the bronchodilator first and wait at least 5 minutes before giving the next drug. - This action allows time for the bronchodilator to widen the airways so the next drug can be inhaled more deeply into the respiratory tract and be more effective.

What are the 3 main pharmacologic classes of Drug Therapy for Asthma and Other Respiratory Problems?

1. Bronchodilators - Beta2 agonists (albuterol) 2. Anti-inflammatory agents - corticosteroids (beclomethasone or fluticasone) 3. Mucolytics - Guiafenesin - Mucomyst

List 5 systemic effects of bronchodilators.

1. Rapid heart rate 2. Increased blood pressure 3. Feeling of nervousness 4. Tremors 5. Difficulty sleeping

What are common side effects associated with inhaled anti-inflammatory drugs? (Select all that apply.) A. Bad taste B. Mouth dryness C. Seizures D. Leukopenia E. Oral infection

A. Bad taste B. Mouth dryness E. Oral infection

Which drug classes are used as therapy for pulmonary artery hypertension (PAH)? Select all that apply. A. Endothelin-receptor antagonists B. Inhaled corticosteroids C. Mucolytics D. Phosphodiesterase inhibitors E. Long-acting beta agonists F. Prostacyclin agents G. Short-acting beta agonists H. Vitamin K antagonists

A. Endothelin-receptor antagonists D. Phosphodiesterase inhibitors F. Prostacyclin agents H. Vitamin K antagonists

Before administering an inhaled corticosteroid, it is important to take which action? A. Teach the patient how to use the inhaler or spacer. B. Teach the patient to expect nervousness after using. C. Prime a new canister of nedocromil (Tilade) once before use. D. Administer inhaled corticosteroid agents before bronchodilators.

A. Teach the patient how to use the inhaler or spacer.

A patient has been given instructions on use of a dry-powder inhaler. Which patient action indicates the need for further instructions? A. The patient exhales deeply into the inhaler after the treatment. B. The patient stores the device in a dry place, at room temperature. C. The patient states she knows not to shake the inhaler prior to use. D. The patient removes the inhaler from her mouth as soon as she has inhaled.

A. The patient exhales deeply into the inhaler after the treatment.

Which problem indicates that a patient may be excessively using his or her beclomethasone (QVAR) inhaler? A. The presence of thick white cheesy material on the tongue and roof of the mouth B. The onset of muscle cramps in the legs while at rest C. The need to get up to urinate 3 to 4 times every night D. The development of a dry, tickling cough

A. The presence of thick white cheesy material on the tongue and roof of the mouth

Which sign or symptom in a patient who is using a short-acting beta agonist (SABA) as a rescue drug indicates that he or she is using the inhaler very frequently? A. Tremors B. Urinary incontinence C. Oral candidiasis (thrush) D. Widely dilated pupils of the eye

A. Tremors

Mucomyst is the antidote for:

Acetaminophen

A patient with COPD is being given a mucolytic. What drug is typically administered using a nebulizer face mask? Guaifenesin (Mucinex) Acetylcysteine (Mucomyst) Albuterol (Proventil) Salmeterol (Serevent)

Acetylcysteine (Mucomyst) Mucomyst is commonly given for patients with (COPD) and works by breaking the connections that hold the protein and mucus molecules, resulting in thinner, less sticky mucus that is easier to cough up and spit out. Mucomyst is most commonly delivered with a nebulizer face mask and is also available as an oral drug. Typically 1 to 10 mL of a 20% solution is placed in a medication nebulizer and the patient uses a mask to breathe in the mist containing the drug every 6 hours. The drug has few side effects but does have a very unpleasant odor. Some patients experience nausea and even vomiting from the smell. Guaifenesin (Mucinex) is a systemic mucolytic drug that is taken orally and is not given by nebulizer. Albuterol can be used as a rescue drug using a nebulizer face mask, but it is a short-acting beta2 agonist, not a mucolytic drug. Salmeterol is not a mucolytic drug and is not administered using a nebulizer.

____________ or a ___________________ can occur if excessive amounts of bronchodilator drugs reach the blood.

Angina; heart attack

*Drug Therapy for Asthma and COPD* - What drugs do for asthma - What drugs do for COPD

Asthma - Rescue drugs stop attacks - Prevention drugs prevent attacks - Total therapy = rescue + prevention drugs COPD - Cannot be reversed - Drug therapy same as asthma with higher/more frequent doses Bronchodilators, anti-inflammatories, mucolytics used for both

What important instruction should be given to a patient who is taking guaifenesin (Mucinex)? A. "This medication is given to treat acetaminophen overdose." B. "This medication will thin your mucus and make it easier to cough up." C. "This medication can cause an oral infection called thrush." D. "This medication is used with a nebulizer facemask."

B. "This medication will thin your mucus and make it easier to cough up."

Which symptoms or conditions are side effects of cholinergic antagonist drugs? Select all that apply. A. Anorexia B. Blurred vision C. Constipation D. Diarrhea E. Sleepiness F. Urinary retention G. Watery eyes

B. Blurred vision C. Constipation G. Watery eyes

Symptom severity in a patient with asthma or chronic bronchitis is assessed by using which method? A. FEV1 B. PEFR C. PEEP D. CPAP

B. PEFR

What is the most important point to teach a patient using a long-acting beta agonist (LABA)? A. Brush your teeth and rinse your mouth 3 times daily to prevent a bad taste. B. Take the drug daily as prescribed even when you have no symptoms. C. Use a reliable form of contraception while taking this drug. D. Keep the inhaler with you at all times.

B. Take the drug daily as prescribed even when you have no symptoms.

What is the goal of drug therapy for asthma and/or COPD? A. To cure asthma or COPD B. To improve airflow and reduce symptoms C. To thicken bronchiolar cartilage and increase alveolar size D. To decrease alveolar recoil and improve contraction of bronchiolar smooth muscle

B. To improve airflow and reduce symptoms

A child with asthma is having difficulty using a "rescue" aerosol inhaler effectively. What alteration in treatment should be discussed with the provider? A. Switching the route of administration to oral B. Using a nebulized form of the drug with a facemask C. Switching to a dry powder inhaler D. Changing to a long-acting inhaler

B. Using a nebulized form of the drug with a facemask

Which action by the nurse is most essential during intravenous administration of treprostinil (Orenitram) for a patient with pulmonary hypertension? A. Disconnect the intravenous line when assisting the patient to the bathroom. B. Utilize strict sterile technique when preparing and administering the drug. C. Connect intravenous antibiotic drugs to the same line to prevent needle pain. D. Monitor the patient's laboratory tests for signs of deteriorating kidney function.

B. Utilize strict sterile technique when preparing and administering the drug.

Which drugs are long-acting beta agonists? (Select all that apply.) A. budesonide (Pulmicort) B. formoterol (Foradil) C. ipratropium (Atrovent) D. levalbuterol (Xopenex) E. nedocromil (Tilade) F. salmeterol (Serevent) G. tiotropium (Spiriva)

B. formoterol (Foradil) F. salmeterol (Serevent)

Cholinergic Antagonists ipratropium (Atrovent) Side effects:

Blurred vision Urinary retention Constipation Very dry

Drug that relaxes the smooth muscle around airways, causing the center openings to enlarge:

Bronchodilator

Which important point should be included when teaching patients about the use of long-acting beta2-adrenergic agonists? A. "Use this medication whenever you have new symptoms of wheezing." B. "Take an extra dose of this medication if your symptoms worsen." C. "Take this medication even when symptoms are not present." D. "Omit your daily dose of this medication if you are wheezing."

C. "Take this medication even when symptoms are not present."

A patient is using an aerosol inhaler without a spacer. Two puffs are prescribed. How far apart should the puffs be administered? A. 10 seconds B. 30 seconds C. 60 seconds D. 120 seconds

C. 60 seconds

A patient has just taken a short-acting inhaler drug to treat asthma symptoms. Which best indicates the medication has been effective? A. An increase in the respiratory rate B. A pulse oximetry value of 85% C. An increase of 15% in the peak flow D. Wheezing within 2 hours of use

C. An increase of 15% in the peak flow

A patient who received a bronchodilator 20 minutes ago now has all of the following responses. For which one do you notify the prescriber immediately? A. Change in oxygen saturation from 89% to 95% B. Bad taste in the mouth C. Chest pain on exertion D. Dryness of the mouth and throat

C. Chest pain on exertion

When a patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid at the same time, why must he or she wait 5 minutes after using the bronchodilator before using the inhaled corticosteroid? A. When the two drugs are taken one right after the other, the effects of both are reduced. B. When the two drugs are taken one right after the other, the side effects are more severe. C. Giving the bronchodilator first allows the inhaled corticosteroid to be more effective. D. Giving the bronchodilator first reduces the risk for an allergic reaction to the inhaled corticosteroid.

C. Giving the bronchodilator first allows the inhaled corticosteroid to be more effective.

Which beta-adrenergic agonist is most effective as a rescue drug? A. Arformoterol (Brovana) B. Formoterol (Foradil) C. Levalbuterol (Xopenex) D. Salmeterol (Serevent)

C. Levalbuterol (Xopenex)

Which precaution should you teach a woman taking bosentan (Tracleer)? A. Use strict aseptic technique while handling this drug. B. Avoid drinking caffeine while on this drug. C. Use a reliable form of contraception D. Rinse your mouth 4 times daily

C. Use a reliable form of contraception

A patient just took a short-acting inhaler drug. What symptoms of an adverse effect should be reported immediately to the prescriber?

Chest pain, severe tachycardia, rapid rise in blood pressure

ipratropium (Atrovent) is a (class, category):

Cholinergic antagonist, Bronchodilator

tiotropium (Spiriva) is a (class, category):

Cholinergic antagonist, Bronchodilator

A nurse is performing an admission assessment on a patient admitted with a respiratory diagnosis. What respiratory disorder is actually a combination of two disorders? Asthma Chronic obstructive pulmonary disease (COPD) Emphysema Chronic bronchitis

Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is a respiratory disorder that is a combination of chronic bronchitis and emphysema. Other less common respiratory disorders that involve the lung tissue rather than the airways and result in impairment of gas exchange are pulmonary artery hypertension (PAH) and pulmonary fibrosis Asthma, emphysema, and chronic bronchitis are not a combination of two disorders.

The nurse is caring for a patient with a new diagnosis of asthma. The nurse tells the patient what factors can trigger an asthma attack? (select all that apply) Emphysema Cold dry air Aspirin Microorganism Rescue inhaler

Cold dry air Aspirin Microorganism Asthma attacks can be triggered by the presence of allergens; irritants such as cold air, dry air, or fine particles in the air; microorganisms; and aspirin. Emphysema does not cause an asthma attack. A rescue inhaler helps manage an asthma attack.

Which is the most important point to include in patient teaching for a female patient with pulmonary hypertension who will have bosentan (Tracleer) prescribed? A. "We can electronically transfer this prescription to your retail pharmacist." B. "A yellowish tinge to your skin is common while taking this medication." C. "If you have any difficulty swallowing the tablet, cut it in half." D. "Your pregnancy test must be negative before this drug can be given."

D. "Your pregnancy test must be negative before this drug can be given."

A patient is taking ipratropium (Atrovent), and reports having difficulty emptying his bladder. What should be the nurse's action? A. Report symptoms of kidney disease to the prescriber. B. Encourage the patient to drink more fluids. C. Ask the prescriber for an order for an indwelling catheter. D. Discuss the patient's symptoms with the prescriber.

D. Discuss the patient's symptoms with the prescriber.

A patient who has COPD asks what exactly guaifenesin (Mucinex) does to help him breathe better. What is your best answer? A. "It thins the lining of your lung air sacs making it easier for oxygen to enter your body." B. "It decreases inflammation and reduces your risk for lung infections." C. "It suppressed your cough reflex so that you can breathe better while sleeping." D. It thins your lung secretions making it easier for you to cough them out."

D. It thins your lung secretions making it easier for you to cough them out."

A nurse just administered a prescribed rescue bronchodilator to a patient experiencing an asthma attack. What signs indicate that the drug is effective? (select all that apply) Decreased respiratory rate Increased respiratory rate Increased heart rate Improved positive expiratory rate flow (PERF) by at least 15% Decreased or absent wheezes

Decreased respiratory rate Improved positive expiratory rate flow (PERF) by at least 15% Decreased or absent wheezes Breathing improvements noted after administration of a short-acting bronchodilator include a slower respiratory rate, and not faster; decreased or absent wheezes; PERF increase by at least 15%; and pulse oximetry values of 95% or higher within 5 minutes of inhalation. Compare the patient's heart rate and blood pressure within 15 minutes after giving the drug to determine whether any systemic effects are present and ask about any chest pain. The heart rate may increase slightly but it is necessary to report any severe tachycardia, a rapid rise in blood pressure, or chest pain immediately to the prescriber.

A nurse is caring for a patient with asthma who has been ordered to receive a bronchodilator and another inhalation drug. How should the nurse administer both drugs at the same time to this patient? Give both drugs together. Give the bronchodilator 5 minutes after the other drug. Give the bronchodilator 5 minutes before the other drug. Allow 30 minutes between giving the two drugs.

Give the bronchodilator 5 minutes before the other drug. If a patient is to receive two or more drugs by inhaler for breathing problems, give the bronchodilator first and wait at least 5 minutes before giving the next drug. This action allows time for the bronchodilator to widen the airways so the next drug can be inhaled more deeply into the respiratory tract and be more effective. Giving both drugs together does not allow for the best absorption of the drugs. Giving the bronchodilator 5 minutes after the other drug does not allow for the best absorption of the drugs. Allowing 30 minutes between the two drug doses is not necessary.

A patient is taking an inhaled anticholinergic agent. What side effect can occur if this agent reaches the bloodstream? Urinary incontinence Diarrhea Headache Seizure

Headache Cholinergic antagonists can cause some specific side effects if they reach the bloodstream. These effects include headache, urinary retention and not urinary incontinence, blurred vision, eye pain, and nausea. Diarrhea and seizures are not side effects of anticholinergic agents. Cholinergic antagonists, also known as anticholinergic drugs, block the parasympathetic nervous system. These drugs let a person's natural epinephrine and norepinephrine bind to smooth muscle receptors leading to bronchodilation. One way to remember the side effects of cholinergic antagonists is the rhyme "can't see, can't spit, can't pee, can't...poop."

beclomethasone (QVAR) is an (class, category):

Inhaled corticosteroid, Anti-inflammatory drug for asthma + COPD

budesonide (Pulmicort) is a (class, category):

Inhaled corticosteroid, Anti-inflammatory drug for asthma + COPD

fluticasone (Flovent) is a (class, category):

Inhaled corticosteroid, Anti-inflammatory drug for asthma + COPD

triamcinolone (Azmacort) is a (class, category):

Inhaled corticosteroid, Anti-inflammatory drug for asthma + COPD

The nurse is performing discharge teaching to a patient with a prescription for an aerosol inhaler with a spacer. What teaching tip for using an aerosol inhaler with a spacer is correct? Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. If you are prescribed to take two puffs, wait at least 5 minutes before taking the second puff. Breathe in quickly and shallow. If the spacer makes a whistling sound, you are breathing in too slowly. Three times a day clean the plastic mouthpiece and the cap of the inhaler by thoroughly rinsing them in warm, running tap water.

Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. After removing the caps from the spacer and the inhaler, insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. If two puffs are prescribed, wait at least 1 minute and not 5 minutes before taking the second puff. Breathe in slowly (not quickly) and deeply (not shallow). If the spacer makes a whistling sound, you are breathing in too fast (not slowly). At least once each day, and not three times a day, clean the plastic mouthpiece and the cap of the inhaler by thoroughly rinsing them in warm, running tap water.

A nurse has been ordered to administer a dry-powder inhaler to a patient. What should be done first before giving this drug? Moisten the capsule before inserting it in the inhaler. Place the inhaler in water for proper cleaning. Keep the inhaler in a dry place at room temperature. Shake the inhaler several times before using.

Keep the inhaler in a dry place at room temperature. The powder used in a dry-powder inhaler may already be loaded in the inhaler or may have to be placed in the inhaler each time it is used. The technique used with dry-powder inhalers differs from that of standard aerosol inhalers (metered dose inhalers [MDIs]) because the powder must remain dry to be active. Box 21-3 describes teaching tips for how to use a dry-powder inhaler. The capsule must be kept dry, not moistened. The inhaler should not be washed or placed in water. An inhaler for dry powder should not be shaken.

montelukast sodium (Singulair) is a (class, category):

Leukotriene inhibitor, Anti-inflammatory drug for asthma + COPD

zafirlukast (Accolate) is a (class, category):

Leukotriene inhibitor, Anti-inflammatory drug for asthma + COPD

formoterol (Foradil) is a (class, category):

Long-acting beta2 agonist, Bronchodilator

salmeterol (Serevent) is a (class, category):

Long-acting beta2 agonist, Bronchodilator

cromolyn sodium (Intal) is a (class, category):

Mast cell stabilizer, Anti-inflammatory drug for asthma + COPD

nedocromil sodium (Tilade) is a (class, category):

Mast cell stabilizer, Anti-inflammatory drug for asthma + COPD

aminophylline (Truphylline) is a (class, category):

Methylxanthine, Bronchodilator

theophylline (Theo-Dur) is a (class, category):

Methylxanthine, Bronchodilator

Drug that reduces the thickness of mucus:

Mucolytic

What is the antidote for acetaminophen?

Mucomyst

Why are mucolytics helpful in the management of chronic obstructive pulmonary disease (COPD)? Mucus becomes less sticky and is easier to cough up. Airways widen and air moves more freely through them. Mucus-secreting cells are inhibited and less mucus is produced. Less mucus is trapped in the alveoli, and they then have better recoil.

Mucus becomes less sticky and is easier to cough up. Mucolytics break the connections holding the protein and mucus molecules together. This results in thinner, less sticky mucus that is easier to cough up.

albuterol (Proventil) is a (class, category):

Short-acting beta2 agonist, Bronchodilator

terbutaline (Brethine) is a (class, category):

Short-acting beta2 agonist, Bronchodilator

A patient with asthma has a positive expiratory rate flow reading of 60% of the personal best. Which type of medication would you expect the patient to take at this point? Short-acting beta2-adrenergic agonist (SABA) Long-acting beta2-adrenergic agonist (LABA) Cholinergic antagonist Mucolytic

Short-acting beta2-adrenergic agonist (SABA) A PERF value below 60% shows a low airflow into and out of the airways, requiring a short-acting beta2-adrenergic agonist (SABA) rescue drug be used as soon as possible. Long-acting beta2-adrenergic agonists (LABAs) are prevention or controller drugs. Cholinergic antagonists are prevention or controller drugs. Mucolytics are prevention or controller drugs used primarily for chronic obstructive pulmonary disease.

A nurse is teaching a patient whose peak expiratory rate flow (PERF) reading is 85% of the patient's personal best. What should the nurse teach the patient to do next with regard to his or her prescribed asthma medications? Skip the controller dose. Take controller medications as ordered. Use the rescue drug. Use the rescue drug and seek emergency help.

Take controller medications as ordered. A decrease in PERF of 15% to 20% below the expected value for a person may occur when the airways are narrowed. The patient needs to take the controller medications as ordered and not skip the controller dose. Long-acting beta-adrenergic agonists (LABAs) or controllers should be taken as prescribed even when symptoms of asthma are not present because these drugs are used to prevent an attack, not stop an attack that has already started. A short-acting adrenergic (SABA) inhaler or rescue drug does not need to be used if the patient's PERF is 85% of the personal best. When the PERF value drops below 50%, revealing a dangerously low airflow into and out of the airways, a rescue drug must be used and emergency measures sought. Some drugs reduce the attack severity or stop the attack (rescue or reliever drugs), and other drugs actually prevent the attack (controller drugs). Do not use long-acting adrenergic (LABAs) inhalers for immediate relief of symptoms during an asthma attack. Only a short-acting adrenergic (SABA) inhaler will be effective.

A PEFR value that has dropped below 50% indicates what is occurring?

The patient has dangerously low airflow into and out of the airways.

The nurse is providing discharge instructions to a patient prescribed an inhaled anti-inflammatory. What side effect is the patient at risk for when taking this drug? Thrush Dry eyes Shortness of breath Increased mouth secretions

Thrush This patient is at an increased risk for oral infection, specifically a candida fungal infection known as "thrush." Other side effects of inhaled anti-inflammatories include cough, bad taste (not sweet taste), mouth dryness (not increased mouth secretion), and teary of the eyes (not dry eyes). Shortness of breath is not a side effect of taking inhaled anti-inflammatory drugs, but is one of the reasons this drug may be given. Check for thrush by inspecting the patient's mouth and throat for the appearance of any white or cream-colored patches of a cheesy coating on the mucous membranes, roof of the mouth, and tongue.

Only rescue med for someone who is constricted and actively wheezing:

albuterol (Proventil HFA)

_________________ is short acting and will break an asthma attack.

albuterol (Proventil HFA)

A child who takes a _____________________________________ close to bedtime may have difficulty sleeping.

beta2 adrenergic agonist

If a patient is taking more than one type of inhaled drug, the ______________________ drug should be given at least 5 minutes before the other drug.

bronchodilator

A common method to measure airway function is ______________________________________________.

peak expiratory flow rate (PEFR)

Asthma medication that is used only during an acute episode is known as a ____________ drug.

rescue

A patient can use a ___________________________________________ when about to start an activity that is likely to induce an asthma attack.

rescue drug (or reliever drug)

The nurse must ensure that the patient using an oral inhaler knows the proper technique for using it, and for a ______________, if one is ordered.

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Drug Therapy for Asthma and Other Respiratory Problems *Key Points*

• Teach patients with asthma to take drugs exactly as prescribed, even when asthma symptoms have not been present for days. • Teach patients with asthma to carry a short-acting adrenergic rescue inhaler at all times. • When giving two or more inhalation drugs for asthma at the same time, administer the bronchodilator first and wait at least 5 minutes before giving the second and third drugs. • Teach patients using dry-powder inhalers not to wash the inhaler or exhale into it. • Remind the patient who is taking more than one inhaled drug for asthma to take the bronchodilator first and wait at least 5 minutes before taking any other inhaled drug. • Anti-inflammatory drugs are not used for rescue because they do not cause bronchodilation. • Inhaled corticosteroids reduce local immune responses and can lead to the development of oral thrush. • Mucolytic drugs only help reduce thick secretions and do not cause bronchodilation or reduced inflammation. • Drug therapy for pulmonary artery hypertension (PAH) should not be stopped, delayed, or interrupted. • To reduce the risk for bloodstream infection and sepsis, use strict aseptic technique when working with continuous parenteral prostacyclin drug therapy. • Never give any other drugs through the line in use for continuous prostacyclin therapy. • Endothelin-receptor antagonists can cause birth defects and are not to be used during pregnancy or lactation. • Do not split or crush endothelin-receptor antagonist tablets. • Prostacyclin agents can cause severe bleeding.