Bronchodilators: simple nursing

Anticholinergic drugs

"tropium" Ipratropium

During Asthma attack think AIM

A- Albuterol 1st I- Ipratropium 2nd M- Methyl-prednison-lone (brand:solu Medrol) 3rd (steroid last cause slow)

What is the ONLY rescue inhaler?

Albuterol

Teach pts to avoid _____________________ When taking theophylline

B-Blockers - lower HR and block effect of theophylline

A nurse is reviewing the medication history of a client who has asthma. Which of the following medication combinations should the nurse identify as non compatable? a. Albuterol and Montelukast b. Theophylline and zileuton c. Aminophylline And fluticasone d. Salmeterol and levalbuterol

B: CORRECT - zileuto, a leukotriene modifier, impairs metabolism of certain medications. If taken with theophylline can cause toxicity due to elevated theophylline.

Bronchodilator THINK

BAM

Bronchodilators memorization tip

BAM

Do you use Albuterol before or after steroid inhaler?

BEFORE

Mechanism of action for Albuterol?

Dilates lung and rapid heart rate

What do anticholinergics do?

Dry body out

Steroids inhalers are washed after ___________ use

Every

Think tropium, can't __________

Pee

Lower Respiratory Drugs

bronchodilators and anti-inflammatory

What do bronchodilators do?

dilate bronchi

Think ____________ for methylxanthines

"phylline" Theophylline Aminophylline

Bronchodilators BAM A is for ?

Anticholinergics

What is BAM

Beta 2 agonist (Albuterol) Anticholinergics (Ipratropium) THINK tropium cant pee Methylxanthines (Theophylline) THINK "phylline" caffeinated

2 drugs that increase toxicity risk when taking theophylline is

Cimetidine (H2 Blockers) Ciprofloxacin (ABX)

Dont give anticholinergics to pts that are ________

DRY - glaucoma - urinary retention & bph - bowel obstruction

Anti-Inflammatory memorization tip

SLM

What is SLM?

Steroids Leukotriene Inhibitor Mast Cell Stabilizers

What do anti-inflammatory drugs do?

reduce inflammation

AIM

1st - Albuterol 2nd - Ipratropium 3rd - Methylprednisolone

Why choose albuterol for asthma attack?

1st drug to use fastest acting bronchodilator

A nurse is caring for a client who has asthma and requires long-term treatment. The nurse should identify that which of the following medication used for long term treatment places the client as an increased risk for asthma related death? a. Salmeterol b. Fluticasone c. Budesonide d. Theophylline

A salmerterol is long acting beta2 agonist. When this med is used alone for long term treatment of asthma, this class of medication increases clients risk of asthma realted deaths. To decrease this risk, client should be prescribed both long action beta2 agonist along with inhaled cortisocosteroid

Which of the following prescriptions should nurse question a. Naproxen for an asthmatic pt b. Ipratropium for pt with glaucoma c. Losartan for pt with diabetes d. Theophylline for pt takin cimetidine e. Atenolol for pt with asthma

A - yes, avoid NSAIDS B - yes, never give to someone who cant see, pee, spit, or poo D - Yes, increases risk for toxicity (never cimetidine or ciprofloxacin E - yes, never give b blockers to asthmatic pt

A nurse is preparing a discharge teaching plan for a 6 year old client with asthma who has several prescription medications using metered dose inhaler (MDI's). Which of the following interventions should the nurse include in the plan? A. Add a spacer to each MDI B. Instruct the child to inhale more rapidly C. Ask the provider to change the child's medications from inhaled to oral formulations d. Administer oxygen by face mask along with the MDI

A: CORRECT MDI's are difficult to use correctly; even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for a lack of hand-lung coordination by increasing the amount of medication derived to the lungs B: NO - inhale medication slowly over 3-5 seconds C: NO - oral is not as effective D: NO

Which medication prescribed for asthma causes tachycardia and dysrhythmias? a. Phenobarbital b. Aminophylline c. Salmeterol d. Albuterol

A: NO, sedative B: YES, phylline get you feeling amped up C & D: dont cause dysrythmias

Bronchodilators: BAM B-Beta 2 Agonist drug example

Albuterol THINK BB "buterol" "Brutal Asthma attack"

What pt teaching should be included with new prescription of albuterol, ibuprofen, tiotropium, and beclomethasone? SATA a. Tinnitus is an expected side effect b. Tachycardia is expected after albuterol c. Report dark stools to the provider d. Drink fluids to prevent dry mouth and throat e. Ipratropium is used first during an attack

B - tachycardia is TTT of albuterol C - yes, ibuprofen can cause bleeding D - yes, get dry with tiotropium THINK PIUM - cant pee

Theophylline avoid what?

B-blockers Caffeine Drugs starting with C Drugs starting with Z

A nurse is assessing a client who take 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: CORRECT THINK "phylline" feelin caffiene and amped up Theophylline is a bronchodilator Early manifestations of toxicity is CNS stimulation, often seen as tremors. Seizures can occur is blood levels continue to rise.

Monitoring client who has asthma, takes albuterol, and recently started taking propranolol to treat cardiovascular disorder. The clients reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change? a. Potentiative interaction b. Detrimental inhibitory interaction c. Increased adverse reaction d. Toxicity reducing inhibitory interaction

B: CORRECT a detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When these are taken together, propranolol can integer with Albuterol therapeutic effects.

A nurse is reviewing the medication history of a client who has mild intermittent asthma. The nurse should anticipate a prescription for which of the following inhalers for the client? a. Ipratropium b. Albuterol sulfate c. Tiotropium d. Budesonide

B: CORRECT A: ipratropium is form of atropine brescribed to treat bronchospasm related to COPD. No approved for athma C: Tiotropium is long acting inhaled anticholinergic that is prescribed for long term maintaince therapy for clients who have COPD> Not approved for asthma. D. Budesonide is inhaled corticosteroids prescribed to decrease inflammation in clients who have asthma.

A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline? a. Cromolyn b. Albuterol c. Zafirlukast d. Methylprednisolone

C: CORRECT zafirlukast is a lerkotrien receptor antagonist prescribed for asthma maintenance. Concurrent use of zafirlukast along with theophylline suppresses the metabolism of theophylline which can lead to toxicity.

Think phylline has you feeling ___________ and toxic with super __________ heart rate

Caffeinated and super FAST heart rate

Cleaning Meter Dose inhaler

Clean mouthpiece 1-2 times/week with warm water

A nurse is providing teaching to a client with asthma who has a new prescription for a short acting beta 2 against (SABA) bronchodilator. Which of the following pieces of information should the nurse share? a. The SABA will provide prolonged control of asthma attacks b. SABA's are also available in an 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 twice per week

D: CORRECT SABA bronchodilators are used as a PRN rescue mediation to stop an ongoing asthma attack. If the client requires more than twice per week, the provider should be notified because long acting beta 2 agonist might be requires.

Nurse is caring for a client who has a nonproductive cough. Which of the following types of medication should the nurse recommend? a. Expectorant b. Mucolytic c. Bronchodilator d. Antitussive

D: CORRECT - suppress cough reflex A. Expectorants help mobilize secretions B. Mucolytics help liquefy secretions C. Bronchodilators help open air passages

Avoid what when taking albuterol?

Don't take at bedtime (insomnia) Avoid beta blockers Avoid NSAIDS (ibuprofen)

M stands for what in BAM

Methylxanthines

Theophylline take at night or in morning?

Morning, get amped up

Longer acting bronchodilator that reduces ____________

Secretions

During asthma attack teach patient

Shake before you take it breathe all the way out and inhale, hold, then exhale Take 2-4 puffs every 20 min for 3 rounds if doesn't work after 3 doses notify HCP

Patient with severe asthma. What do you give? SATA A. Inhaled salmeterol B. Albuterol inhaler C. Nebulizer Ipratropium D. IV methamphetamines E. IV methylprednisolone

THINK AIM Albuterol Ipratropium Methylprenisolone B, C, E

side effects of ipratropium

THINK tropium - can't pee dry mouth, hoarseness - use gum and candy - drink fluids NO swallowing tiotropium capsule, always put in inhaler

Side effects for Albuterol?

TTT Tachycardia & palpitations Tremor Tossing and turning at night (insomnia)

THINK TTT for "phylline"

Toxic - theophylline > 20 is toxic need frequent blood draws Tonic Clonic Seizures - number one sign of sever toxicity (N&V) Tachycardia & Dysrhythmias