Respiratory Drugs w/ NCLEX style Qs

sympathetic nervous system review

"fight or flight"- epinepherine/adrenaline urinary/bowel retention vasodilation bronchodilation increased HR /resp rate

parasympathetic nervous system review

"rest and digest"- acetylcholine vasoconstriction slows HR/respirations return of GI motility increased secretions

Anticholinergics MOA

*blocks* parasympathetic receptors inhibiting action of acetylcholine resulting in bronchodilation and decreased secretions

first gen antihistamine therapeutic uses

-Seasonal allergic rhinitis -Perennial allergic rhinitis -perennial non-allergic rhinitis -n/v -motion sickness -insomnia -adjunct in treatment w/ anaphylactic reaction

first gen anti-histamine drugs (sedating)

-diphenhydramine (benadryl) -dimenhydrinate (Dramamine) -promethazine (phenergen) -hydroxyzine (vistaril) -chlorpheniramine -brompheniramine

Glucocorticoids- MOA

-inhibit inflammatory response by preventing release of leukotrienes, prostaglandins, and histamine; -reduce inflammation and edema of airways by inhibiting leukocytes and eosinophils

sympathomimetics nursing implications

-intranasal- don't use longer than 3-5 days -monitor for agitation, anxiety, insomnia and notify HCP -teach about abuse & safeguarding of drug -tachycardia/hypertension concern in pts with heart disease or hypertension

When taking cromolyn for EIB- when should the medication be taken?

10-15 mins prior to the activity but no more than an hour prior

When taking leukotriene modifiers for EIB- when should the medication be taken?

2 hours prior to the activity and not for another 24 hours

A nurse is reinforcing teaching with a client about diphenhydramine- what should the nurse instruct the client to monitor for? select all that apply A- dry mouth B- nonproductive cough C- skin rash D- drowsiness E- urinary hesitation

A- dry mouth D- drowsiness E- urinary hesitation

A nurse is reinforcing teaching with a client who has a new Rx for belomethasone by inhaler. which of the following instructions should the nurse include? A- rinse your mouth after each use B- limit fluid intake while taking C-Increase your intake of vit B12 D- You can take the med as needed

A- rinse your mouth after each use used to reduce risk of oral fungal infections

mucolytic drugs

Acetylcysteine (Mucomyst) administered via nebulizer or instilled directly into trach tube tylenol antidote- orally or IV

Beta2-Adrenergic Agonists Uses

Acute Bronchospasm EIB

A nurse is reinforcing instruction to a client who has a new Rx for albuterol and beclomethasone inhalers for the control of asthma. which instruction should the nurse give in the teaching? A- take albuterol at the same time each day B- admin albuterol inhaler prior to beclomethasone inhaler C- use beclomethasone if having an acute episode D- avoid shaking beclomethasone prior to use

B- admin albuterol inhaler prior to beclomethasone bc beta2's promote bronchodilation and enhances absorption of glucocorticoid

A nurse is teaching a client about fluticasone. Which statement by the client indicates understanding of the info? A- I should use the spray every 4 hours while awake B- it can take as long as 3 weeks before the med takes a max effect C- this med can also be used to treat motion sickness D- I can use this med when my nasal passages are blocked

B- client can see some benefits within within a few hours but max benefits can take up to 3 weeks

A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should monitor the client for which of the following as an adverse effect? A- sedation B- nasal congestion C- productive cough D- constipation

B- nasal congestion when used for over 5 days rebound nasal congestion can occur when taking nasal sympathomimetic meds

A nurse is reinforcing instructions to a client who has a new Rx for albuterol PO. which of the following instructions should the nurse include? A- you can take this med to abort an acute asthma attack B- tremors are an adverse effect of this med C- prolonged use of this med can cause hyperglycemia D- this med can slow skeletal growth rate

B- tremors can occur due to excessive stimulation of beta2 receptors of skeletal muscles inhaled albuterol is used to abort an acute asthma attack,not oral albuterol

If clients are using both beta2 adrenergic and glucocorticoids- which medication should they use first and why?

Beta2 bc the beta2 will open the airways and allow more absorption of the glucocorticoid to be more effective

first gen antihistamine MOA

Bind to H1 Histamine Receptors effectively blocking the release of histamine, therefore limits vasodilation, bronchoconstriction, & limits capillary permeability (reduce edema). Mild cholinergic blocker.

antitussive adverse effects- opioids

CNS depression: sedation, drowsiness, dizziness, lightheadedness , respiratory depression n/v constipation potential for abuse

sympathomimetic adverse effects

CNS stimulation: agitation, anxiety, insomnia tachycardia/heart palpitations abuse- ephedrine, pseudoephedrine rebound nasal congestion

A nurse is teaching a client who has a Rx for long term use of oral prednisone for chronic asthma. The nurse should instruct client to monitor for which adverse effect? A- constipation B- nervousness C- bradycardia D- weight gain

D- weight gain and fluid retention are adverse effects of oral prednisone due to effect of sodium and water retention diarrhea is an adverse effect of prednisone- not constipation

Methylxanthines MOA (structurally similar to caffeine)

Smooth muscle relaxation/bronchodilation via inhibition of phosphodiesterase

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? a) "I use my corticosteroid inhaler each time I feel short of breath." b) "I see my doctor if I have an upper respiratory infection and always get a flu shot." c) "I use my bronchodilator inhaler before walking so I don't become short of breath." d) "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."

a) "I use my corticosteroid inhaler each time I feel short of breath." Rationale: Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? a) Coffee b) Orange juice c) Mineral water d) Cranberry juice

a) Coffee Rationale: Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects. Orange juice, mineral water, and cranberry juice are fluids that are allowed.

A client has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? a) Coffee, cola, and chocolate b) Oysters, lobster, and shrimp c) Melons, oranges, and pineapple d) Cottage cheese, cream cheese, and dairy creamers

a) Coffee, cola, and chocolate Rationale: Theophylline (Theo-24) is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

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.

leukotriene modifiers- therapeutic uses

adjunct in treatment of allergic rhinitis, asthma, EIB

glucocorticoid nursing implications-inhaled

admin on routine basis- not PRN use beta2 agonist first if ordered rinse mouth and gargle (yeast) USE A SPACER!!!

Beta2 Adrenergic drugs (lower respiratory)

albuterol (short acting) levalbuterol (short acting) formoterol (long acting) salmertol (long acting) terbutaline (long acting)

second gen therapeutic uses

allergic rhinitis idiopathic urticaria

second gen MOA

antagonize histamine effect at H1 receptor sites without binding to or inactivating histamine; minimal anticholinergic effect

Mast cell stabilizers- nursing implications

asthma prophylaxis- 20mg QID EIB 10-15 mins prior (no more than an hour) to activity seasonal allergy- prior to exposure

A nurse is teaching a client about the effects of diphenhydramine (Benadryl), an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication? a) Take it on an empty stomach. b) Avoid activities requiring mental alertness. c) Use alcohol for additional effect in reducing cough. d) Avoid chewing sugarless gum or using oral rinses mouth.

b) Avoid activities requiring mental alertness. Rationale: Diphenhydramine (Benadryl) has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system (CNS) depressants, operating a car, or engaging in other activities requiring mental acuity during use. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a) Beclomethasone first and then the salmeterol b) Salmeterol first and then the beclomethasone c) Alternating a single puff of each, beginning with the salmeterol d) Alternating a single puff of each, beginning with the beclomethasone

b) Salmeterol first and then the beclomethasone Salmeterol (Serevent Diskus) is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse should monitor the client receiving the first dose of albuterol (Proventil HFA) for which side effect of this medication? a) Drowsiness b) Tachycardia c) Hyperkalemia d) Hyperglycemia

b) Tachycardia Rationale: Albuterol is a bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. The items in the other options are not side effects of this medication.

glucocorticoid drugs

beclamethasone( QVAR)- inhaled budesonide-inhaled prednisone-oral fluticasone: (flonase)- intranasal (flovent)-inhaled

Mucolytics MOA

break disulfide linkages of proteins in mucus decreasing viscosity so it can be coughed out more easily

mucolytics- adverse effects

bronchospasm- caution in asthma pts GI distress- rotten egg smell/swallowing of secretions ATI: dizziness, drowsiness, hypotension, tachycardia, hepatotoxicity, aspiration risk due to increased secretions

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

c) Calming the client's persistent cough Rationale: Benzonatate is a locally acting antitussive that decreases the intensity and frequency of cough without eliminating the cough reflex. The other options are not intended effects of this medication.

Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? a) Osteoarthritis b) Hypothyroidism c) Diabetes mellitus d) Polycystic disease

c) Diabetes mellitus Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

A client taking albuterol (ProAir HFA) by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? a) Get more exercise each day. b) Use a dehumidifier in the home. c) Drink increased amounts of fluids every day. d) Take an extra dose of albuterol before bedtime.

c) Drink increased amounts of fluids every day .Rationale: A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions. This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake. Additional exercise will not effectively clear bronchial secretions. A dehumidifier will dry secretions, making the situation worse. The client should not take additional medication.

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 tests 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.

The health care provider (HCP) prescribes cromolyn (Intal) for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? a) Promote bronchodilation. b) Decrease the risk of infection. c) Suppress an allergic response. d) Eliminate the need for a rescue inhaler.

c) Suppress an allergic response. Rationale: Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast-cell stabilizer, antiasthmatic, and antiallergic. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It is not a bronchodilator. It does not decrease the risk of infection. It does not eliminate the need for the rescue inhaler.

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.

c) Take the tablet with a full glass of water Rationale: Guaifenesin (Mucinex) is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions.

second gen drugs

cetirizine (Zyrtec) loratadine (Claritin) fexofenadine (Allegra)

antitussive drugs

codeine- opioid dextromethorphan (Delsym) benzonatate (Tessalon)

Anticholinergics- Nursing implications

contraindicated in narrow angle glaucoma pts sip on water/hard candy monitor urinary retention rinse mouth after use due to bad taste

Mast Cell Stabilizer drugs

cromolyn

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 client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? a) "Inhaled glucocorticoids cure the condition." b) "Inhaled glucocorticoids treat this condition more effectively." c) "Inhaled glucocorticoids decrease the symptoms more quickly." d) "Inhaled glucocorticoids are preferred because of decreased adverse effects."

d) "Inhaled glucocorticoids are preferred because of decreased adverse effects." Rationale: Triamcinolone is an adrenocorticosteroid. Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. COPD is a progressive condition and cannot be cured. Options 2 and 3 are incorrect.

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."

d) "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. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.

A client with an exacerbation of chronic obstructive pulmonary disease has been on oral glucocorticoids and is currently being weaned to triamcinolone (Azmacort) by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a) Chills, fever, and generalized rash b) Vomiting, diarrhea, and increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue

d) Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

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) Bronchospasm Rationale: 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.

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.

d) 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 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

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.

anticholinergics therapeutic uses

decrease bronchoconstriction decrease secretions (used in COPD pts) *NOT A RESCUE INHALER*

first gen adverse effects

drowsiness dizziness anticholinergic effects: dry mouth, constipation, urinary hesitancy

Anticholinergics- adverse effects

dry mouth/pharyngeal irritation systemic absorption: increased intraocular pressure, headache, dizziness, blurred vision, epistaxis, bronchospasm, hypotension urinary retention

glucocorticoid adverse effects- nasal

dry mucous membranes epistaxis sore throat headache

second gen nursing implications

fall risk at higher doses (10mg+) anticholinergic interventions as needed

first gen nursing implications

fall risk, anticholinergic interventions, 3 F's, give with food for GI upset, don't crush EC, don't use with alcohol or other CNS depressants, take at bedtime due to sedative effect take 30 mins prior to activity for motion sickness monitor for urinary retention- esp elderly men

antitussive- nursing implications

fall risk- monitor while ambulating give with food for GI upset prevent constipation with 3 F's short term- use as low of a dose as possible use only as needed- potential for abuse

methylxanthine- adverse effects

few AE at therapeutic levels (5-15mcg) elevated levels: CNS stimulation, restlessness, insomnia, n/v/d; toxic levels: seizures/dysrhythmias

Expectorant- adverse effects

few AE's dizziness, drowsiness, headache n/d allergic reaction ATI: caution in pts with asthma due to bronchospasm serotonin syndrome can occur in pts taking MAOI's

antitussive adverse effects- non opioid

few adverse effects mild nausea, dizziness, sedation some potential for abuse

what 2 drugs make Advair?

fluticasone and salmeterol

Expectorant drugs

guaifenesin

what 2 drugs make Duoneb?

ipatroprium bromide and albuterol

Anticholinergic drugs (lower respiratory)

ipratroprium (atrovent) tiotropium (spiriva)

COPD

is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. usually includes 2 of the following: asthma, emphysema, chronic bronchitis

second gen adverse effects

less effects than first gen drugs drowsiness, fatigue mild anticholinergic effects

leukotriene modifiers- MOA

leukotriene antagonists-(montelukast&zafirulkast) decreases # of leukotrienes-(zileuton)

Methylxanthines- therapeutic uses

long term mgmt of asthma- not widely used; no longer recommended to use in COPD

Mast Cell Stabilizer therapeutic uses

mild-moderate asthma- reduces inflammation prophylactically EIB seasonal allergic rhinitis (intranasal)

Sympathomimetics MOA

mimics sympathetic nervous system by activating alpha1 adrenergic receptors in the nose causing vasoconstriction of blood vessels and shrinking of nasal turbinates

Mast cell stabilizer- adverse effects

minimal, one of the safest drugs cough or bronchospasm fewer than 1 in 10,000

Methylxanthines- nursing implications

monitor blood levels, take at regular time to maintain blood levels, IV for emergencies; Teach: avoid/decrease caffeine, notify HCP of s/s increased levels

mucolytics- nursing implications

monitor breath sounds prior to and after admin to assess movement of secretions may require an admin of bronchodilator to open airways have suction equipment ready teach clients to cough out secretions- don't swallow

leukotriene modifiers- drugs

montelukast (singulair) zafirlukast (accolate) zileuton (Zyflo)

leukotriene modifiers- adverse effects

montelukast- few effects zafirlukast & zileuton- liver damage suicidal thoughts/depression

sympathomimetics therapeutic uses

nasal congestion *does not treat sneezing or itching of rhinitis*

glucocorticoid adverse effects- inhaled

oral yeast hoarseness difficulty speaking

sympathomimetic drugs

phenylephrine (neo-synephrine) pseudoephedrine (sudafed) ephedrine naphazoline

Mast Cell Stabilizers- MOA

prevent release of leukotrienes & histamine which mediate inflammation prevent action of leukocytes & eosinophils to reduce inflammation & edema of airways

Expectorants- MOA

reduce surface tension of secretions; thinning the mucus making it easier to cough out ATI: promotes increased cough production by increasing and thinning mucous secretions

Tips for relieving dry mouth

sip water or sugarless drinks, avoid alcohol, tobacco, and caffeine, chew sugar free gum/candy, avoid salty/spicy foods, use humidifier at night, consider using saliva substitutes

Beta2 Adrenergic drug MOA

stimulate beta2 receptors of sympathetic nervous system

antitussive therapeutic uses

suppress chronic, nonproductive cough

Antitussive MOA

suppress cough reflex in the brain

glucocorticoid adverse effects- oral

suppresses adrenal function hyperglycemia, peptic ulcer disease, immunosuppression, fluid/electrolyte imbalance long term use: muscle wasting, and demineralization (osteoporosis)

Beta2-Adrenergic adverse effects

tachycardia heart palpitations tremors angina (mostly in CAD) ATI: use caution in pts with DM, hyperthyroidism, heart disease, hypertension, angina

leukotriene modifiers- nursing implications

take in evening EIB- take 2 hours prior to activity, dont take again for 24 hours take baseline liver function tests/monitor periodically Teach- report abdominal tenderness, anorexia, and nausea to HCP

glucocorticoid nursing implications- oral

taper doses to resume adrenal function, monitor BS, take with food, watch for s/s infection besides fever & inflammation, labs for hyponatremia/hyperkalemia, monitor weight gain/edema; teach pt to increase weight bearing exercises when taking long term

expectorant- nursing implications

teach- change positions slowly, report s/s allergic reaction, watch for other meds containing guaifenesin take with full glass of water- to promote thinning of mucus

Beta2 nursing implications

teach: avoid caffeine, avoid triggers, keep a log of exacerbations, when to call HCP monitor for adverse effects

Methylxanthine drugs

theophylline aminophylline (IV)

Expectorants- therapeutic uses

thin mucus secretions associated with a cold, URI, or bronchitis

mucolytics- therapeutic uses

thin secretions in COPD, emphysema, bronchitis, pneumonia, and cystic fibrosis antidote for acetaminophen overdose

glucocorticoid nursing implications- nasal

use humidifier sips on water/hard candy

Glucocorticoids- therapeutic uses

used daily on a regular term basis for PREVENTION long term mgmt of asthma-inhaled acute post-exacerbation symptoms-oral emergency situations-IV promote lung maturity/decrease resp distress in fetuses at risk for pre-term birth

Using anticholinergics and other inhaled meds

wait 5 mins after using anticholinergic before using other inhaled medication

Asthma

•Episodic and/or chronic symptoms of airway obstruction •Bronchial hyperresponsiveness to triggers •Evidence of at least partial reversibility of the airway obstruction •Alternative diagnoses are excluded