Nurs330 Pharmacology ch.40 Drugs for Asthma and Other Pulmonary Disorders

The nurse teaches a patient about self-administration of multiple inhaled medications. Which statement should indicate to the nurse that teaching has been effective?

"I will use the bronchodilator inhaler before using the corticosteroid inhaler." -The bronchodilator inhaler should be used before the corticosteroid inhaler. The corticosteroid inhaler should be used 5 to 10 minutes after the bronchodilator inhaler to ensure the medication reaches deep into the bronchial tree. The patient should clean the inhalers at least weekly. Inhalers, like all medications, have guidelines about frequency of use. The patient should be instructed to notify the healthcare provider if symptoms persist despite using the inhalers as directed.

A patient is prescribed ipratropium (Atrovent) for chronic obstructive pulmonary disease (COPD). Which teaching should the nurse provide?

"Increase your fiber intake." -Because an anticholinergic medication, such as ipratropium, can cause constipation, the patient should be instructed to increase fiber and fluid intake. The patient may experience a bitter taste after taking the medication, and although it is problematic for some patients, it does not indicate an allergic reaction. The patient should notify the healthcare provider if difficulty urinating occurs, because this is an adverse effect of anticholinergic medications (especially if the patient has an enlarged prostate); however, this does not indicate renal failure.

The nurse compares oral albuterol (VoSpire ER) with inhaled albuterol (Proventil HFA, Ventolin HFA). Which statement should the nurse make about this comparison?

"Inhaled albuterol work in about 15 minutes." -Compared with oral albuterol, inhaled albuterol works in about 15 minutes. Oral albuterol has a longer onset of action and should not be used for acute asthma attacks. Inhaled albuterol is a pregnancy category C drug.

The nurse is asked why a peak expiratory flowmeter is important in asthma management. Which information should the nurse provide in response?

"It helps evaluate medication effectiveness." -Peak expiratory flowmeter results help to evaluate medication effectiveness. COPD is a chronic disease that is not curable. Peak expiratory flowmeter results do not determine whether the patient is a candidate for a lung transplant, nor do they determine the amount of mucus production.

A patient with exercise-induced bronchospasm is prescribed a leukotriene modifier. Which teaching should the nurse provide?

"Take the medication 2 or more hours before you exercise." -Montelukast (Singulair) is the only leukotriene modifier approved to prevent exercise-induced bronchospasm. The medication is effective if taken 2 or more hours before exercise. The medication will not terminate an acute asthma attack. There are no identified interactions with herbal preparations. If an acute asthma attack occurs, a short-acting beta2-agonist, such as albuterol (Proventil HFA, Ventolin HFA), should be used.

albuterol 사용제한 및 사용방법

4~6시간 마다 1~2컵 사용 albuterol사용을 오랫동안 한 사람은 효과가 떨어진다. 환자는 ipratropium을 사용권고받았다. During drug administration, keep lips sealed around mouthpiece. Keeping the lips sealed around the mouthpiece helps prevent the drug from escaping out of the mouth and irritating the eyes. Breathe deeply and slowly through your mouth. Breathing deeply and slowly allows maximum delivery of the drug to the lungs. Rinse your mouth after the treatment is complete. Ipratropium can leave a bitter taste in the mouth. Having the patient rinse his mouth out after the treatment can prevent this unpleasant side effect.

which one should we take the first

5mins waiting after puping inhaler(albuterolo) and broncho open and the second on ipro and steroid last and rinse mouth (AIS)

asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. -obstruction of the airways by bronchial hyperresponsiveness, production of excess mucous or bronchospasm. assessment : triggers(cold air, dust, mold, pollen) s/s : SOB, tachypnea and tachycardia wheezing, diaphoresis, accessory muscles, pulmonary function test : decreased (include : peak expiratory flow rate(PEFR), Forced vital capacity(FVC), Forced expiratory volume in one sec(FEV1), decreased FEV1/FVC ratio. Medications : corticosteroids, ipratropium, albuterol inhalers, nebulizer treatments Implementation : severely effected w/ oxygen, pursed lip breathing and monitoring pulse oximetry Education: how to carry their inhalers, rinse their mouth after, avoid trigger

A patient is prescribed cromolyn for chronic obstructive pulmonary disease (COPD). Which should the nurse expect to see documented in the medical record?

Allergy to corticosteroids Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Cromolyn is not effective for acute attacks. Diagnoses of intermittent asthma and end-stage COPD alone do not indicate a need for cromolyn. Cromolyn reduces inflammation and is not prescribed as an antitussive.

A patient with asthma asks how to avoid acute asthma attacks. Which response should the nurse make?

Avoid exposure to dust, pollen, and mold."

The nurse reviews the physiology of ventilation. Which structure should the nurse identify that impacts the rate of ventilation?

Brainstem (ventilation rate dermine) -The rate at which ventilation occurs is determined by brainstem neurons. The bronchiolar smooth muscle, diaphragm, and airway play a role in the patient's respiratory status, but do not determine how many times ventilation occurs per minute.

The nurse is reviewing the relationship between the respiratory and nervous systems. Which action should indicate the nervous system's control of ventilation?

Changing the diameter of the airways -The nervous system, specifically the sympathetic and parasympathetic systems, controls ventilation by changing the diameter of the very small and abundant bronchioles. The nervous system does not play a role in decreasing gas exchange in the alveoli, increasing the amount of mucus production, or increasing intrathoracic pressure.

Asthma 약물사용순서 첫번째, albuterol (puff), nebulizer) 두번째, ipratropium( 세번째,corticosteroids 네번째, alternatively methylprednisolone (Solu-Medrol) via IV injection.

Corticosteroids can be used to treat asthma exacerbations.

A patient with chronic obstructive pulmonary disease (COPD) is allergic to corticosteroid medications. Which medication should the nurse expect to be prescribed?

Cromolyn -Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Like corticosteroids, cromolyn is not effective for acute attacks. Flunisolide, budesonide (Pulmicort), and mometasone (Asmanex) are all corticosteroids.

A patient experiencing an asthma attack is given a dose of albuterol. Which outcome should the nurse assess to determine effectiveness?

Decreased adventitious breath sounds -Albuterol is a bronchodilator that relieves asthma symptoms, such as wheezing. Decreased adventitious breath sounds indicate an improvement in asthma symptoms. ecreased adventitious breath sounds - A fast heart rate and low potassium level are adverse effects of the medication.

A patient is prescribed an inhaled corticosteroid for long-term management of persistent asthma. Which therapeutic effect should the nurse expect?

Decreased airway edema Inhaled corticosteroids have an anti-inflammatory effect and decrease mucous production and edema in bronchial airways. An inhaled corticosteroid does not promote bronchodilation, prevent respiratory infections, or act as an expectorant.

A patient with chronic obstructive pulmonary disease (COPD) reports that an anticholinergic medication was changed to aid adherence with treatment. Which medication change should the nurse expect?

From ipratropium (Atrovent) to tiotropium (Spiriva) Tiotropium is taken once per day, whereas ipratropium is taken four or more times per day. The less frequent dosing decreases the chance of the patient missing a dose. Ipratropium and tiotropium are anticholinergics. Beclomethasone and budesonide are corticosteroids.

The nurse instructs a patient about multiple inhaled medications for asthma. For which patient statement should the nurse provide additional teaching?

I should dry the inhaler and spacer with a hair dryer." -The patient should be instructed to permit the spacer and inhaler to air dry. Feeling nervous is a potential, yet not serious, adverse effect of inhaled medications. Caffeine should be avoided to help prevent nervousness, tremors, or palpitations. The patient should rinse the mouth after using inhalers, especially corticosteroids, to prevent fungal infections, localized reactions, and systemic absorption.

A patient is prescribed multiple inhaled medications for asthma. Which patient statement should indicate to the nurse that teaching has been effective?

I will rinse my mouth after using the medications." -The patient should be instructed to rinse the mouth after using inhaled medications to help prevent systemic absorption or localized reactions. A short-acting inhaler should be used for acute asthma symptoms. If available, a spacer should always be used because even when inhalers are used properly, most of the aerosolized medication never reaches the lungs. The patient should be instructed to use a quick-acting inhaler as soon as possible after symptoms appear.

A patient reports increasing dietary fiber because of a prescribed medication for chronic obstructive pulmonary disease (COPD). Which medication should the nurse expect was prescribed for this patient?

Ipratropium (Atrovent) -Ipratropium, an anticholinergic medication, can cause constipation. The patient should increase fiber and fluid intake. The patient would not have to increase fiber intake for theophylline, fluticasone (Flovent), or cromolyn.

When was the last time you took a dose of albuterol? (Albuterol)

Knowing when Mr. Walsh last took a dose of albuterol is important to know because it prevents unintentional overdosing of medication. It also helps the medical team understand the severity of the patient's condition based on if he is responding or not responding to medication taken recently.

A patient is diagnosed with emphysema. Which should the nurse recall about the pathophysiology of this health problem?

Loss of bronchiolar elasticity Emphysema, a chronic pulmonary condition, is characterized by a loss of bronchiolar elasticity and destruction of alveolar wall structures. Partial collapse of the airways occurs on exhalation. Emphysema results in decreased perfusion and gas exchange at the alveolus. Excess mucus production in the lower respiratory tract is a characteristic of chronic bronchitis.

A patient experiences persistent asthma that has not been well controlled. Which type of bronchodilator should the nurse expect to be prescribed?

Methylxanthine -A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. Methylxanthines are used cautiously because of their narrow therapeutic index and interactions with multiple medications.

A patient is diagnosed with chronic obstructive pulmonary disease (COPD). Which should the nurse recall about this disease process when planning care?

Most patients with COPD are lifelong tobacco users. -Most patients with COPD are lifelong smokers, accounting for 85-90% of all nonasthmatic COPD cases. Strict medication management can relieve symptoms, but they do not alter COPD progression. The patient is high risk for pulmonary infections because microbes thrive in mucus-rich environments. Mucolytics loosen thick bronchial secretions and are important for COPD management.

albuterol overdose side effect

Mr. Walsh has been taking 12-15 puffs of his albuterol inhaler each day recently, despite the maximum prescribed dose of 12 puffs per day. This may lead to some systemic side effects of albuterol, such as headache, sore throat, and palpitations.

A patient asks if arformoterol (Brovana) can be used to terminate an acute asthma attack. Which response should the nurse provide?

No, because it takes longer to achieve maximum effects." -Arformoterol is a long-acting inhaled beta2-agonist (LABA) that should not be used to terminate acute asthma attacks because it has a relatively slow onset of action and will not abort an acute bronchospasm; an inhaled short-acting beta2-agonist should be used instead. Arformoterol has a black box warning that states asthma-related death is a risk. Risk for rebound bronchoconstriction is not why the medication is not used to terminate an acute asthma attack. The medication is not the newest LABA on the market, nor is it necessarily the safest. The medication takes longer to start acting.

An older patient is prescribed long-term beclomethasone (Qvar). Which should the nurse consider before administering the medication?

Recent diagnosis of osteoporosis -When taken long term, oral and inhaled corticosteroids such as beclomethasone can affect bone physiology in adults and children. At-risk patients, including those with osteoporosis, should have periodic bone mineral density tests, and the healthcare provider may prescribe a bisphosphonate medication to prevent fractures. There are no known food or medications that interact significantly with beclomethasone. A recent completion of antibiotic therapy is not of concern, although an active infection is a contraindication for the medication's use.

Salmeterol and fluticasone

Salmeterol and fluticasone increase Mr. Walsh's risk of infection by suppressing his immune system. Individuals with an infection should take medications that contain corticosteroids cautiously.

A patient is newly diagnosed with intermittent asthma. Which type of inhaled medication should the nurse expect to be prescribed initially?

Short-acting beta2-adrenergic agonist (SABA) -Short-acting beta agonists (SABAs) have a rapid onset of action, usually several minutes. SABAs are the most frequently prescribed drugs for aborting or terminating an acute asthma attack. Their effects, however, last only 2 to 6 hours, so the use of SABAs is generally limited to as-needed (prn) management of acute episodes. Inhaled corticosteroids (ICS) are used for the long-term prevention of asthmatic attacks. Long-acting beta agonists (LABAs) have therapeutic effects that last up to 12 hours. These medications have a relatively slow onset of action and will not abort an acute bronchospasm. The leukotriene modifiers are second-line medications to reduce inflammation and ease bronchoconstriction and are used as alternative drugs in the management of asthma symptoms.

A patient taking montelukast (Singulair) is demonstrating symptoms of an overdose. Which treatment should the nurse anticipate?

Supportive treatment Since there is no specific treatment for overdose, treatment for suspected montelukast overdose is supportive. Isoproterenol and epinephrine are not indicated for montelukast overdose. Gastric lavage is indicated for theophylline overdose.

A patient with persistent asthma is prescribed a methylxanthine bronchodilator. Which should the nurse suspect as the reason for this medication to be prescribed?

The patient's asthma has been uncontrolled by other medications. -A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. There is not enough information to conclude that the patient experiences exercise-induced bronchospasms, has COPD, or has been nonadherent with other medications.

The nurse is teaching a patient about the pathogenesis of asthma. Which information should the nurse include about the action of the smooth muscles within the airway?

They are hyperresponsive to stimuli -The smooth muscles located in the airway are hyperresponsive to stimuli, which results in bronchospasm and inflammation in the patient with asthma. During an asthma attack, histamines and prostaglandins are released. Activation of beta2-adrenergic receptors would result in bronchodilation.

A patient is prescribed theophylline for asthma. Which should the nurse suspect as the reason this medication was prescribed?

Treatment with a beta agonist was unreasonsive. -Theophylline is currently used primarily for the long-term oral prophylaxis of asthma that is unresponsive to beta agonists or inhaled corticosteroids. It is not the preferred treatment for asthma. Asthma was not recently diagnosed because other medications have to have been attempted. It has a narrow margin of safety.

Corticosteroids

for long term treatment (for anti inflammatory action to treat, reversible airflow obstruction) this medications can be administered via nebulizer, or metered-dose inhalers, dry-powder inhalers.

Ipratropium (Anticholinergic Bronchodilator)

relief of acute bronchospasm, anticholinergics can combined w/

Albuterol How many puffs of albuterol do you take daily on average? Correct

repeated maximum dosing of albuterol can lead to drug tolerance due to beta-2 receptor down-regulation, which means that more medication must be administered to have a similar effect. Additionally, if the patient's asthma is becoming resistant to the albuterol, it indicates an increase in the severity of disease, which may require a change in medication.

albuterol

using for shoterm and longterm of asthma short term treatment include : short-acting b2 agonists are administered via inhaler for bronchodilation (albuterol or proventil) inhaler using: wait between pops . b/c it is powder