Podcast
Questions and Answers
A patient is prescribed medication for chronic bronchitis. Considering the classifications discussed, which initial medication category would directly target the constricted airways to provide immediate relief?
A patient is prescribed medication for chronic bronchitis. Considering the classifications discussed, which initial medication category would directly target the constricted airways to provide immediate relief?
- Bronchodilators (correct)
- Anti-inflammatory agents
- Leukotriene modifiers
- Mast cell stabilizers
Beta2-adrenergic agonists are frequently used in respiratory therapy. What is their primary mechanism of action in treating airflow disorders?
Beta2-adrenergic agonists are frequently used in respiratory therapy. What is their primary mechanism of action in treating airflow disorders?
- Stimulating alpha receptors to decrease inflammation
- Blocking muscarinic receptors to reduce mucus secretion
- Inhibiting leukotriene production to prevent airway edema
- Stimulating beta2 receptors to induce bronchodilation (correct)
Inhalation is a preferred route for administering many respiratory medications. What is the MOST significant advantage of delivering bronchodilators via inhalation compared to oral administration?
Inhalation is a preferred route for administering many respiratory medications. What is the MOST significant advantage of delivering bronchodilators via inhalation compared to oral administration?
- Reduced risk of systemic absorption (correct)
- Higher chance of medication interactions
- Increased medication metabolism by the liver
- Slower onset of therapeutic effect
A patient with asthma needs to use a dry powder inhaler (DPI). What is a crucial instruction to ensure effective medication delivery with this type of inhaler?
A patient with asthma needs to use a dry powder inhaler (DPI). What is a crucial instruction to ensure effective medication delivery with this type of inhaler?
Which of the following medication classifications primarily targets the inflammatory component of asthma rather than providing immediate bronchodilation?
Which of the following medication classifications primarily targets the inflammatory component of asthma rather than providing immediate bronchodilation?
A combination inhaler contains both a beta2-adrenergic agonist and a glucocorticoid. What is the rationale for combining these two different drug classes in a single inhaler for patients with asthma or COPD?
A combination inhaler contains both a beta2-adrenergic agonist and a glucocorticoid. What is the rationale for combining these two different drug classes in a single inhaler for patients with asthma or COPD?
Methylxanthines, like theophylline, are mentioned as a medication subgroup for airflow disorders. Considering their mechanism and side effect profile, when are methylxanthines typically considered in current respiratory pharmacotherapy?
Methylxanthines, like theophylline, are mentioned as a medication subgroup for airflow disorders. Considering their mechanism and side effect profile, when are methylxanthines typically considered in current respiratory pharmacotherapy?
A nebulizer is prescribed for a patient to administer a bronchodilator medication at home. What is a key advantage of using a nebulizer compared to a metered-dose inhaler (MDI) or dry powder inhaler (DPI), especially for certain patient populations?
A nebulizer is prescribed for a patient to administer a bronchodilator medication at home. What is a key advantage of using a nebulizer compared to a metered-dose inhaler (MDI) or dry powder inhaler (DPI), especially for certain patient populations?
A client with a history of glaucoma is prescribed ipratropium via inhaler. What action should the nurse prioritize based on this client history?
A client with a history of glaucoma is prescribed ipratropium via inhaler. What action should the nurse prioritize based on this client history?
Theophylline, a methylxanthine, is prescribed in an extended-release form. Which client characteristic would raise concern regarding the suitability of this medication formulation?
Theophylline, a methylxanthine, is prescribed in an extended-release form. Which client characteristic would raise concern regarding the suitability of this medication formulation?
A client taking theophylline reports restlessness and insomnia. What is the nurse's priority action?
A client taking theophylline reports restlessness and insomnia. What is the nurse's priority action?
A client is prescribed theophylline. Which instruction regarding caffeine intake is most important for the nurse to provide?
A client is prescribed theophylline. Which instruction regarding caffeine intake is most important for the nurse to provide?
A client is receiving intravenous aminophylline for severe asthma exacerbation. Which assessment finding requires immediate intervention?
A client is receiving intravenous aminophylline for severe asthma exacerbation. Which assessment finding requires immediate intervention?
A client is prescribed both inhaled ipratropium and a beta2-adrenergic agonist inhaler. What is the therapeutic rationale for using these medications concurrently?
A client is prescribed both inhaled ipratropium and a beta2-adrenergic agonist inhaler. What is the therapeutic rationale for using these medications concurrently?
A client taking theophylline is newly prescribed cimetidine for GERD. What potential drug interaction should the nurse monitor for?
A client taking theophylline is newly prescribed cimetidine for GERD. What potential drug interaction should the nurse monitor for?
A client is being discharged on theophylline. Which statement indicates a need for further teaching regarding medication management?
A client is being discharged on theophylline. Which statement indicates a need for further teaching regarding medication management?
What is the primary mechanism of action of methylxanthines like theophylline in treating respiratory conditions?
What is the primary mechanism of action of methylxanthines like theophylline in treating respiratory conditions?
A client with a theophylline level of 25 mcg/mL is exhibiting signs of toxicity. Which intervention is the priority?
A client with a theophylline level of 25 mcg/mL is exhibiting signs of toxicity. Which intervention is the priority?
Which client instruction is crucial when administering chewable theophylline tablets?
Which client instruction is crucial when administering chewable theophylline tablets?
A client is prescribed theophylline and reports using phenytoin for seizure control. What potential interaction should the nurse anticipate?
A client is prescribed theophylline and reports using phenytoin for seizure control. What potential interaction should the nurse anticipate?
For which respiratory condition is methylxanthine therapy, such as theophylline, no longer routinely recommended in evidence-based practice guidelines?
For which respiratory condition is methylxanthine therapy, such as theophylline, no longer routinely recommended in evidence-based practice guidelines?
When administering intravenous aminophylline, what is a critical safety measure the nurse must implement?
When administering intravenous aminophylline, what is a critical safety measure the nurse must implement?
Which factor significantly influences the initial theophylline dosage prescribed for a client?
Which factor significantly influences the initial theophylline dosage prescribed for a client?
Why is it important to advise clients using beta2-adrenergic agonists to avoid caffeine?
Why is it important to advise clients using beta2-adrenergic agonists to avoid caffeine?
A client with a history of which condition should be most closely monitored while taking albuterol?
A client with a history of which condition should be most closely monitored while taking albuterol?
Why might a client with diabetes mellitus need increased dosages of hypoglycemic medications when prescribed a beta2-adrenergic agonist?
Why might a client with diabetes mellitus need increased dosages of hypoglycemic medications when prescribed a beta2-adrenergic agonist?
A client taking a beta2-adrenergic agonist and a monoamine oxidase inhibitor (MAOI) concurrently should be monitored most closely for which adverse effects?
A client taking a beta2-adrenergic agonist and a monoamine oxidase inhibitor (MAOI) concurrently should be monitored most closely for which adverse effects?
A client with EIB is prescribed a medication to prevent symptoms. What is the minimum amount of time before exercising that the medication should be administered?
A client with EIB is prescribed a medication to prevent symptoms. What is the minimum amount of time before exercising that the medication should be administered?
Which instruction is most important to include when teaching a client about managing their asthma with albuterol?
Which instruction is most important to include when teaching a client about managing their asthma with albuterol?
What is the primary mechanism of action of inhaled anticholinergics (muscarinic antagonists) in treating COPD?
What is the primary mechanism of action of inhaled anticholinergics (muscarinic antagonists) in treating COPD?
A client is prescribed zileuton for asthma. Which instruction regarding potential adverse effects is MOST important to emphasize?
A client is prescribed zileuton for asthma. Which instruction regarding potential adverse effects is MOST important to emphasize?
A client taking montelukast reports increased anxiety and insomnia. What is the MOST appropriate nursing action?
A client taking montelukast reports increased anxiety and insomnia. What is the MOST appropriate nursing action?
A client who is prescribed ipratropium reports experiencing dry mouth. Which intervention should the nurse recommend?
A client who is prescribed ipratropium reports experiencing dry mouth. Which intervention should the nurse recommend?
Why are leukotriene modifiers generally avoided for acute asthma exacerbations?
Why are leukotriene modifiers generally avoided for acute asthma exacerbations?
Why should a nurse inquire about glaucoma when a client is prescribed an inhaled anticholinergic?
Why should a nurse inquire about glaucoma when a client is prescribed an inhaled anticholinergic?
A client taking warfarin begins taking zileuton. What potential interaction should the nurse monitor for?
A client taking warfarin begins taking zileuton. What potential interaction should the nurse monitor for?
A client is prescribed both an inhaled anticholinergic and another type of inhalant medication. What is the minimum recommended time interval between administering the two medications?
A client is prescribed both an inhaled anticholinergic and another type of inhalant medication. What is the minimum recommended time interval between administering the two medications?
A client is prescribed a combination inhaler containing both a LABA and a LAMA. What condition is this MOST likely intended to treat?
A client is prescribed a combination inhaler containing both a LABA and a LAMA. What condition is this MOST likely intended to treat?
A nurse is providing instructions to a client who is starting on inhaled ipratropium. Which of the following should be included in the teaching?
A nurse is providing instructions to a client who is starting on inhaled ipratropium. Which of the following should be included in the teaching?
Ipratropium is contraindicated, or requires cautious use, in clients with which of the following conditions?
Ipratropium is contraindicated, or requires cautious use, in clients with which of the following conditions?
A client with COPD is prescribed albuterol/ipratropium. What is its primary mechanism of action?
A client with COPD is prescribed albuterol/ipratropium. What is its primary mechanism of action?
Why is it important for clients taking beta2-adrenergic agonists to maintain a log of the frequency and intensity of asthma exacerbations?
Why is it important for clients taking beta2-adrenergic agonists to maintain a log of the frequency and intensity of asthma exacerbations?
Why is combining inhaled medications into a single inhaler considered beneficial for respiratory conditions?
Why is combining inhaled medications into a single inhaler considered beneficial for respiratory conditions?
A client with severe asthma is prescribed a triple therapy inhaler containing an inhaled glucocorticoid, a LABA, and a LAMA. What is the MAIN goal of using this combination?
A client with severe asthma is prescribed a triple therapy inhaler containing an inhaled glucocorticoid, a LABA, and a LAMA. What is the MAIN goal of using this combination?
What is the expected pharmacologic action of beta2-adrenergic agonists?
What is the expected pharmacologic action of beta2-adrenergic agonists?
A client taking fluticasone/salmeterol for COPD reports experiencing a hoarse voice. What instruction is MOST appropriate?
A client taking fluticasone/salmeterol for COPD reports experiencing a hoarse voice. What instruction is MOST appropriate?
What adverse effect of inhaled anticolinergics requires monitoring of urinary elimination patterns, especially in older adults?
What adverse effect of inhaled anticolinergics requires monitoring of urinary elimination patterns, especially in older adults?
Which of the following medications would reduce the effectiveness of beta2-adrenergic agonists?
Which of the following medications would reduce the effectiveness of beta2-adrenergic agonists?
A client with COPD is prescribed vilanterol/umeclidinium. What is the expected outcome of this medication?
A client with COPD is prescribed vilanterol/umeclidinium. What is the expected outcome of this medication?
A client is to start taking budesonide/albuterol. For what purpose is this combination of medications used?
A client is to start taking budesonide/albuterol. For what purpose is this combination of medications used?
A client with liver dysfunction is prescribed a leukotriene modifier for asthma. Which medication would be MOST appropriate?
A client with liver dysfunction is prescribed a leukotriene modifier for asthma. Which medication would be MOST appropriate?
A client taking theophylline begins taking zileuton. What potential interaction should the nurse monitor for?
A client taking theophylline begins taking zileuton. What potential interaction should the nurse monitor for?
A client taking phenytoin begins taking montelukast. What potential interaction should the nurse monitor for?
A client taking phenytoin begins taking montelukast. What potential interaction should the nurse monitor for?
A client is prescribed both furosemide and a glucocorticoid. Monitoring for which electrolyte imbalance is most critical due to the interaction of these medications?
A client is prescribed both furosemide and a glucocorticoid. Monitoring for which electrolyte imbalance is most critical due to the interaction of these medications?
The concurrent use of glucocorticoids and NSAIDs requires careful monitoring due to an increased risk of which adverse effect?
The concurrent use of glucocorticoids and NSAIDs requires careful monitoring due to an increased risk of which adverse effect?
A client with diabetes is started on glucocorticoid therapy. What adjustment in their diabetes management plan might be anticipated due to the interaction between glucocorticoids and hypoglycemic agents?
A client with diabetes is started on glucocorticoid therapy. What adjustment in their diabetes management plan might be anticipated due to the interaction between glucocorticoids and hypoglycemic agents?
Mast cell stabilizers like cromolyn are prescribed for asthma management due to their ability to primarily target which aspect of asthma pathology?
Mast cell stabilizers like cromolyn are prescribed for asthma management due to their ability to primarily target which aspect of asthma pathology?
A client is prescribed cromolyn for long-term management of allergy-related asthma. What is the primary mechanism by which cromolyn reduces inflammation in the airways?
A client is prescribed cromolyn for long-term management of allergy-related asthma. What is the primary mechanism by which cromolyn reduces inflammation in the airways?
For optimal prevention of exercise-induced bronchospasm (EIB) with inhaled cromolyn, when should a client administer the medication relative to their workout?
For optimal prevention of exercise-induced bronchospasm (EIB) with inhaled cromolyn, when should a client administer the medication relative to their workout?
A client newly prescribed inhaled cromolyn for asthma asks if it will provide immediate relief during an acute asthma attack. What is the most appropriate response?
A client newly prescribed inhaled cromolyn for asthma asks if it will provide immediate relief during an acute asthma attack. What is the most appropriate response?
A client with a known allergy to cromolyn is prescribed a medication for asthma. Which medication class would be contraindicated due to the client's allergy?
A client with a known allergy to cromolyn is prescribed a medication for asthma. Which medication class would be contraindicated due to the client's allergy?
A client using inhaled cromolyn reports experiencing a sudden rash, swelling of the mouth, and wheezing after inhalation. What is the priority nursing instruction?
A client using inhaled cromolyn reports experiencing a sudden rash, swelling of the mouth, and wheezing after inhalation. What is the priority nursing instruction?
Leukotriene modifiers are prescribed for asthma to achieve which therapeutic outcome?
Leukotriene modifiers are prescribed for asthma to achieve which therapeutic outcome?
Montelukast is classified as a leukotriene receptor antagonist. How does this mechanism of action reduce asthma symptoms?
Montelukast is classified as a leukotriene receptor antagonist. How does this mechanism of action reduce asthma symptoms?
Which leukotriene modifier necessitates routine monitoring of liver function tests due to its potential for causing liver damage?
Which leukotriene modifier necessitates routine monitoring of liver function tests due to its potential for causing liver damage?
Montelukast is prescribed to be administered once daily. What is the recommended timing for administration to optimize its therapeutic effect?
Montelukast is prescribed to be administered once daily. What is the recommended timing for administration to optimize its therapeutic effect?
All leukotriene modifiers carry a slight risk of neuropsychiatric adverse effects. Which of the following manifestations would necessitate immediate reporting to the healthcare provider?
All leukotriene modifiers carry a slight risk of neuropsychiatric adverse effects. Which of the following manifestations would necessitate immediate reporting to the healthcare provider?
A patient with asthma is prescribed budesonide/albuterol. What is the primary mechanism of action of this combination medication?
A patient with asthma is prescribed budesonide/albuterol. What is the primary mechanism of action of this combination medication?
Fluticasone/salmeterol is prescribed for a patient with COPD. What is the main therapeutic goal of this medication?
Fluticasone/salmeterol is prescribed for a patient with COPD. What is the main therapeutic goal of this medication?
A patient is prescribed fluticasone/vilanterol/umeclidinium. Which of the following mechanisms of action are provided by this combination medication?
A patient is prescribed fluticasone/vilanterol/umeclidinium. Which of the following mechanisms of action are provided by this combination medication?
A patient taking a beta2-adrenergic agonist reports experiencing heart palpitations and tremors. What is the underlying reason for these adverse effects?
A patient taking a beta2-adrenergic agonist reports experiencing heart palpitations and tremors. What is the underlying reason for these adverse effects?
Which adverse effect should the nurse monitor for in a patient taking an inhaled combination medication that contains an anticholinergic?
Which adverse effect should the nurse monitor for in a patient taking an inhaled combination medication that contains an anticholinergic?
A patient using an inhaled corticosteroid develops oral candidiasis. What intervention should the nurse anticipate?
A patient using an inhaled corticosteroid develops oral candidiasis. What intervention should the nurse anticipate?
A patient is prescribed albuterol/ipratropium via MDI. What is the recommended maximum daily dosage due to the stimulating effects of the medication?
A patient is prescribed albuterol/ipratropium via MDI. What is the recommended maximum daily dosage due to the stimulating effects of the medication?
A patient is prescribed vilanterol/umeclidinium. For which condition is this medication appropriate?
A patient is prescribed vilanterol/umeclidinium. For which condition is this medication appropriate?
A patient with asthma is prescribed budesonide/albuterol. How should the patient administer the medication?
A patient with asthma is prescribed budesonide/albuterol. How should the patient administer the medication?
A patient is prescribed fluticasone/salmeterol. What is the typical administration schedule for this medication?
A patient is prescribed fluticasone/salmeterol. What is the typical administration schedule for this medication?
A patient with COPD is prescribed fluticasone/vilanterol/umeclidium. When should the patient use this medication?
A patient with COPD is prescribed fluticasone/vilanterol/umeclidium. When should the patient use this medication?
What key information should the nurse include when teaching a patient about using inhaled combination medications?
What key information should the nurse include when teaching a patient about using inhaled combination medications?
Why is it important to teach clients taking inhaled medications to keep a log of the frequency and intensity of exacerbations?
Why is it important to teach clients taking inhaled medications to keep a log of the frequency and intensity of exacerbations?
How is the effectiveness of inhaled combination medications best evaluated in a patient with COPD or asthma?
How is the effectiveness of inhaled combination medications best evaluated in a patient with COPD or asthma?
A patient using a metered-dose inhaler (MDI) with a glucocorticoid reports a persistent sore throat. What intervention could minimize this side effect?
A patient using a metered-dose inhaler (MDI) with a glucocorticoid reports a persistent sore throat. What intervention could minimize this side effect?
A patient with asthma is prescribed albuterol via a metered-dose inhaler (MDI). What key instruction should the nurse provide to ensure effective medication delivery?
A patient with asthma is prescribed albuterol via a metered-dose inhaler (MDI). What key instruction should the nurse provide to ensure effective medication delivery?
A client with COPD is prescribed a dry powder inhaler (DPI). Which instruction is most important to ensure proper medication delivery with this device?
A client with COPD is prescribed a dry powder inhaler (DPI). Which instruction is most important to ensure proper medication delivery with this device?
A patient is prescribed both a beta2-adrenergic agonist and an inhaled glucocorticoid. What is the rationale for administering the beta2-adrenergic agonist before the inhaled glucocorticoid?
A patient is prescribed both a beta2-adrenergic agonist and an inhaled glucocorticoid. What is the rationale for administering the beta2-adrenergic agonist before the inhaled glucocorticoid?
A patient with asthma reports needing to use their albuterol inhaler more frequently than usual. What is the most appropriate nursing intervention based on this information?
A patient with asthma reports needing to use their albuterol inhaler more frequently than usual. What is the most appropriate nursing intervention based on this information?
A patient with a history of cardiac disease is prescribed a beta2-adrenergic agonist. Which potential adverse effect is most important for the nurse to monitor in this patient?
A patient with a history of cardiac disease is prescribed a beta2-adrenergic agonist. Which potential adverse effect is most important for the nurse to monitor in this patient?
What is the primary mechanism of action of beta2-adrenergic agonists in the treatment of respiratory disorders?
What is the primary mechanism of action of beta2-adrenergic agonists in the treatment of respiratory disorders?
When educating a patient on the use of a soft mist inhaler, what key point should the nurse emphasize regarding its use compared to a metered-dose inhaler (MDI)?
When educating a patient on the use of a soft mist inhaler, what key point should the nurse emphasize regarding its use compared to a metered-dose inhaler (MDI)?
A patient is prescribed albuterol prior to exercise. What is the rationale for this intervention??
A patient is prescribed albuterol prior to exercise. What is the rationale for this intervention??
Which statement accurately differentiates between short-acting beta2-adrenergic agonists (SABAs) and long-acting beta2-adrenergic agonists (LABAs)?
Which statement accurately differentiates between short-acting beta2-adrenergic agonists (SABAs) and long-acting beta2-adrenergic agonists (LABAs)?
A patient receives a new prescription for a nebulizer treatment at home. What education should the nurse provide regarding the use of this device?
A patient receives a new prescription for a nebulizer treatment at home. What education should the nurse provide regarding the use of this device?
A patient with asthma is using a metered-dose inhaler (MDI) without a spacer. What potential issue may arise from not using a spacer with an MDI?
A patient with asthma is using a metered-dose inhaler (MDI) without a spacer. What potential issue may arise from not using a spacer with an MDI?
Which beta2-adrenergic agonist has the shortest duration of action?
Which beta2-adrenergic agonist has the shortest duration of action?
A patient using a beta2-adrenergic agonist reports experiencing tremors. What intervention should the nurse implement?
A patient using a beta2-adrenergic agonist reports experiencing tremors. What intervention should the nurse implement?
What benefit do soft mist inhalers provide compared to other inhaler devices??
What benefit do soft mist inhalers provide compared to other inhaler devices??
What is a potential consequence of using a short-acting beta2-adrenergic agonist (SABA) more than twice a week?
What is a potential consequence of using a short-acting beta2-adrenergic agonist (SABA) more than twice a week?
Why is it important to instruct patients taking oral glucocorticoids to avoid NSAIDs and use acetaminophen instead for mild pain?
Why is it important to instruct patients taking oral glucocorticoids to avoid NSAIDs and use acetaminophen instead for mild pain?
A patient on long-term oral glucocorticoids is scheduled for surgery. Why might supplemental doses of glucocorticoids be necessary?
A patient on long-term oral glucocorticoids is scheduled for surgery. Why might supplemental doses of glucocorticoids be necessary?
What is the primary reason for tapering the dose of oral glucocorticoids gradually rather than stopping them abruptly?
What is the primary reason for tapering the dose of oral glucocorticoids gradually rather than stopping them abruptly?
A patient using an inhaled beta2-adrenergic agonist and an inhaled glucocorticoid concurrently should be instructed to:
A patient using an inhaled beta2-adrenergic agonist and an inhaled glucocorticoid concurrently should be instructed to:
A patient reports experiencing a sore throat, fatigue, and white patches in their mouth while taking an inhaled glucocorticoid. What action should the nurse take first?
A patient reports experiencing a sore throat, fatigue, and white patches in their mouth while taking an inhaled glucocorticoid. What action should the nurse take first?
A client on long-term glucocorticoid therapy should be educated about potential adverse effects. Which of the following should the nurse include?
A client on long-term glucocorticoid therapy should be educated about potential adverse effects. Which of the following should the nurse include?
Why is alternate-day dosing sometimes prescribed for clients on long-term oral glucocorticoid therapy?
Why is alternate-day dosing sometimes prescribed for clients on long-term oral glucocorticoid therapy?
A patient with a history of peptic ulcer disease is prescribed oral glucocorticoids for rheumatoid arthritis. What precaution is most important?
A patient with a history of peptic ulcer disease is prescribed oral glucocorticoids for rheumatoid arthritis. What precaution is most important?
A patient taking intranasal glucocorticoids reports frequent nosebleeds. What should the nurse recommend?
A patient taking intranasal glucocorticoids reports frequent nosebleeds. What should the nurse recommend?
A client on long-term glucocorticoids reports increased thirst and frequent urination. What should the nurse do first?
A client on long-term glucocorticoids reports increased thirst and frequent urination. What should the nurse do first?
A patient with completely blocked nasal passages is prescribed an intranasal glucocorticoid. What should the nurse administer first?
A patient with completely blocked nasal passages is prescribed an intranasal glucocorticoid. What should the nurse administer first?
After starting intranasal glucocorticoid therapy, how long should a patient expect it to take before experiencing the full therapeutic effects?
After starting intranasal glucocorticoid therapy, how long should a patient expect it to take before experiencing the full therapeutic effects?
A client on long-term glucocorticoid therapy is at risk of developing osteoporosis. Which interventions should the nurse include in the patient's teaching?
A client on long-term glucocorticoid therapy is at risk of developing osteoporosis. Which interventions should the nurse include in the patient's teaching?
A client with which condition should avoid oral glucocorticoids due to an increased risk of complications?
A client with which condition should avoid oral glucocorticoids due to an increased risk of complications?
A patient taking inhaled glucocorticoids is instructed to use a spacer. What is the primary reason for this recommendation?
A patient taking inhaled glucocorticoids is instructed to use a spacer. What is the primary reason for this recommendation?
A patient is prescribed oral prednisone for long-term management of rheumatoid arthritis. Which potential adverse effect should the nurse prioritize monitoring for during routine assessments?
A patient is prescribed oral prednisone for long-term management of rheumatoid arthritis. Which potential adverse effect should the nurse prioritize monitoring for during routine assessments?
A patient with asthma is prescribed inhaled beclomethasone. To enhance medication delivery and minimize the risk of oral candidiasis, what should the nurse instruct the patient to consistently use with the metered-dose inhaler (MDI)?
A patient with asthma is prescribed inhaled beclomethasone. To enhance medication delivery and minimize the risk of oral candidiasis, what should the nurse instruct the patient to consistently use with the metered-dose inhaler (MDI)?
For a patient with chronic obstructive pulmonary disease (COPD), why are inhaled glucocorticoids generally favored over oral glucocorticoids for long-term maintenance therapy?
For a patient with chronic obstructive pulmonary disease (COPD), why are inhaled glucocorticoids generally favored over oral glucocorticoids for long-term maintenance therapy?
A patient using nasal fluticasone for allergic rhinitis reports experiencing frequent nosebleeds and nasal dryness. Which of the following self-care measures should the nurse recommend to alleviate these side effects?
A patient using nasal fluticasone for allergic rhinitis reports experiencing frequent nosebleeds and nasal dryness. Which of the following self-care measures should the nurse recommend to alleviate these side effects?
A patient with type 2 diabetes mellitus is started on oral prednisone for an asthma exacerbation. What specific monitoring is most critical for this patient during the course of glucocorticoid therapy?
A patient with type 2 diabetes mellitus is started on oral prednisone for an asthma exacerbation. What specific monitoring is most critical for this patient during the course of glucocorticoid therapy?
A patient on long-term oral prednisone therapy reports persistent fatigue and a mild sore throat without fever. What should the nurse consider as a potential cause for these non-specific symptoms?
A patient on long-term oral prednisone therapy reports persistent fatigue and a mild sore throat without fever. What should the nurse consider as a potential cause for these non-specific symptoms?
What is the primary pharmacological action of glucocorticoids in managing inflammatory conditions like asthma?
What is the primary pharmacological action of glucocorticoids in managing inflammatory conditions like asthma?
A patient taking both a beta2-adrenergic agonist and a thiazide diuretic should be monitored closely for which electrolyte imbalance?
A patient taking both a beta2-adrenergic agonist and a thiazide diuretic should be monitored closely for which electrolyte imbalance?
A patient with seasonal allergies is not responding to traditional antihistamines. Considering the inflammatory cascade, which medication would MOST directly address the underlying cause of their persistent symptoms?
A patient with seasonal allergies is not responding to traditional antihistamines. Considering the inflammatory cascade, which medication would MOST directly address the underlying cause of their persistent symptoms?
To minimize the risk of peptic ulcer disease in a patient who is prescribed long-term oral prednisone, which intervention is most appropriate?
To minimize the risk of peptic ulcer disease in a patient who is prescribed long-term oral prednisone, which intervention is most appropriate?
Concurrent use of inhaled glucocorticoids and NSAIDs increases the risk for what adverse effect?
Concurrent use of inhaled glucocorticoids and NSAIDs increases the risk for what adverse effect?
A patient is prescribed inhaled budesonide for daily management of persistent asthma. What is the crucial instruction regarding the administration schedule of this medication?
A patient is prescribed inhaled budesonide for daily management of persistent asthma. What is the crucial instruction regarding the administration schedule of this medication?
A patient reports a persistent, non-productive cough that interferes with their sleep. While an antitussive is prescribed, what additional intervention would best address the potential underlying cause of the cough, assuming thickened mucus is a contributing factor?
A patient reports a persistent, non-productive cough that interferes with their sleep. While an antitussive is prescribed, what additional intervention would best address the potential underlying cause of the cough, assuming thickened mucus is a contributing factor?
What potential interaction should be monitored in a patient taking both anticholinergics and an inhaled combination medication that also contains an anticholinergic?
What potential interaction should be monitored in a patient taking both anticholinergics and an inhaled combination medication that also contains an anticholinergic?
A patient on oral prednisone for several weeks begins to exhibit symptoms of edema, muscle weakness, and reports feeling generally unwell. Which electrolyte imbalance is most likely contributing to these manifestations?
A patient on oral prednisone for several weeks begins to exhibit symptoms of edema, muscle weakness, and reports feeling generally unwell. Which electrolyte imbalance is most likely contributing to these manifestations?
First-generation antihistamines are contraindicated or used with extreme caution in patients with which condition?
First-generation antihistamines are contraindicated or used with extreme caution in patients with which condition?
A patient with a history of hypertension is experiencing severe nasal congestion due to a cold. Considering their medical history, which medication class would be LEAST appropriate for initial treatment of their congestion?
A patient with a history of hypertension is experiencing severe nasal congestion due to a cold. Considering their medical history, which medication class would be LEAST appropriate for initial treatment of their congestion?
An older male patient is prescribed diphenhydramine for seasonal allergies. What specific adverse effect should the nurse monitor for, given the patient's demographic?
An older male patient is prescribed diphenhydramine for seasonal allergies. What specific adverse effect should the nurse monitor for, given the patient's demographic?
A patient is prescribed both a sedating antihistamine for nighttime use and a nonsedating antihistamine for daytime use. What is the PRIMARY rationale for this medication regimen?
A patient is prescribed both a sedating antihistamine for nighttime use and a nonsedating antihistamine for daytime use. What is the PRIMARY rationale for this medication regimen?
For a patient undergoing long-term oral glucocorticoid therapy, which laboratory assessment is most important to monitor to detect potential adrenal insufficiency?
For a patient undergoing long-term oral glucocorticoid therapy, which laboratory assessment is most important to monitor to detect potential adrenal insufficiency?
Which of the following adverse effects is more commonly associated with inhaled glucocorticoids compared to oral glucocorticoids?
Which of the following adverse effects is more commonly associated with inhaled glucocorticoids compared to oral glucocorticoids?
A patient with a persistent cough is prescribed guaifenesin, an expectorant. What teaching point should the nurse emphasize to optimize the medication's effectiveness?
A patient with a persistent cough is prescribed guaifenesin, an expectorant. What teaching point should the nurse emphasize to optimize the medication's effectiveness?
A patient reports persistent dry mouth after starting diphenhydramine. What intervention should the nurse recommend?
A patient reports persistent dry mouth after starting diphenhydramine. What intervention should the nurse recommend?
Why is it generally advised to avoid or use non-steroidal anti-inflammatory drugs (NSAIDs) cautiously in patients taking glucocorticoids?
Why is it generally advised to avoid or use non-steroidal anti-inflammatory drugs (NSAIDs) cautiously in patients taking glucocorticoids?
Why are sedating antihistamines administered cautiously to clients taking CNS depressants?
Why are sedating antihistamines administered cautiously to clients taking CNS depressants?
Which glucocorticoid is most commonly administered orally for short-term management of acute asthma exacerbations?
Which glucocorticoid is most commonly administered orally for short-term management of acute asthma exacerbations?
A patient taking a sedating antihistamine reports experiencing dizziness. What safety precaution should the nurse emphasize?
A patient taking a sedating antihistamine reports experiencing dizziness. What safety precaution should the nurse emphasize?
A patient experiencing an acute asthma attack is prescribed an inhaled glucocorticoid. What is the most important education point for the nurse to emphasize regarding this medication in the context of acute symptom relief?
A patient experiencing an acute asthma attack is prescribed an inhaled glucocorticoid. What is the most important education point for the nurse to emphasize regarding this medication in the context of acute symptom relief?
A patient comes to the clinic reporting drowsiness, dry mouth, and constipation after starting diphenhydramine for allergies. Which of these side effects is related to diphenhydramine's anticholinergic properties?
A patient comes to the clinic reporting drowsiness, dry mouth, and constipation after starting diphenhydramine for allergies. Which of these side effects is related to diphenhydramine's anticholinergic properties?
A patient with a known history of benign prostatic hyperplasia (BPH) is prescribed diphenhydramine for allergic rhinitis. What is the MOST important instruction to give this patient?
A patient with a known history of benign prostatic hyperplasia (BPH) is prescribed diphenhydramine for allergic rhinitis. What is the MOST important instruction to give this patient?
A client taking a combination medication that includes an inhaled corticosteroid may require increased dosages of antidiabetic medications due to what effect of the corticosteroid?
A client taking a combination medication that includes an inhaled corticosteroid may require increased dosages of antidiabetic medications due to what effect of the corticosteroid?
A patient who is prescribed a sedating antihistamine for motion sickness should be instructed to take the medication at what time relative to the activity?
A patient who is prescribed a sedating antihistamine for motion sickness should be instructed to take the medication at what time relative to the activity?
A patient on MAOIs is prescribed a beta2-adrenergic agonist. What potential adverse effects should the nurse monitor for?
A patient on MAOIs is prescribed a beta2-adrenergic agonist. What potential adverse effects should the nurse monitor for?
A patient prescribed inhaled glucocorticoids is also taking immunosuppressants. What is the primary concern regarding this combination of medications?
A patient prescribed inhaled glucocorticoids is also taking immunosuppressants. What is the primary concern regarding this combination of medications?
A patient is taking a sedating antihistamine and reports abdominal discomfort. What instruction should the nurse provide?
A patient is taking a sedating antihistamine and reports abdominal discomfort. What instruction should the nurse provide?
A client using a combination inhaler containing a beta2-adrenergic agonist reports experiencing significant hand tremors that interfere with daily activities. What is the MOST appropriate initial action?
A client using a combination inhaler containing a beta2-adrenergic agonist reports experiencing significant hand tremors that interfere with daily activities. What is the MOST appropriate initial action?
What specific instruction should a nurse provide to a client who has been prescribed a combination inhaler containing an anticholinergic agent?
What specific instruction should a nurse provide to a client who has been prescribed a combination inhaler containing an anticholinergic agent?
A client is prescribed a combination inhaler containing a glucocorticosteroid. Why is it important to rinse the mouth and gargle after each use?
A client is prescribed a combination inhaler containing a glucocorticosteroid. Why is it important to rinse the mouth and gargle after each use?
A client with a new prescription for a combination inhaler asks about using a spacer. What is the primary benefit of using a spacer with a metered-dose inhaler (MDI)?
A client with a new prescription for a combination inhaler asks about using a spacer. What is the primary benefit of using a spacer with a metered-dose inhaler (MDI)?
A client with a history of hypertension starts using a combination inhaler. Which of the following adverse effects should the client be specifically instructed to report to their provider immediately?
A client with a history of hypertension starts using a combination inhaler. Which of the following adverse effects should the client be specifically instructed to report to their provider immediately?
A client is prescribed albuterol/ipratropium with a known history of glaucoma. What specific precaution should the healthcare provider consider?
A client is prescribed albuterol/ipratropium with a known history of glaucoma. What specific precaution should the healthcare provider consider?
Which pre-existing condition would be of MOST concern prior to administering a LABA/LAMA combination inhaler?
Which pre-existing condition would be of MOST concern prior to administering a LABA/LAMA combination inhaler?
A client with a history of a seizure disorder is prescribed budesonide/albuterol. Which potential effect of this combination warrants careful monitoring?
A client with a history of a seizure disorder is prescribed budesonide/albuterol. Which potential effect of this combination warrants careful monitoring?
Why is fluticasone/salmeterol contraindicated in clients experiencing status asthmaticus or acute bronchospasm?
Why is fluticasone/salmeterol contraindicated in clients experiencing status asthmaticus or acute bronchospasm?
A client taking fluticasone/salmeterol is also being treated with a monoamine oxidase inhibitor (MAOI). What is the primary concern regarding this drug interaction?
A client taking fluticasone/salmeterol is also being treated with a monoamine oxidase inhibitor (MAOI). What is the primary concern regarding this drug interaction?
A client with a history of benign prostatic hyperplasia (BPH) is prescribed an inhaled glucocorticoid/LABA/LAMA combination. What specific adverse effect should the nurse monitor for?
A client with a history of benign prostatic hyperplasia (BPH) is prescribed an inhaled glucocorticoid/LABA/LAMA combination. What specific adverse effect should the nurse monitor for?
A client who is using an inhaled combination medication containing a beta2-adrenergic agonist is also prescribed a nonselective beta-blocker for hypertension. What is the PRIMARY concern regarding this combination?
A client who is using an inhaled combination medication containing a beta2-adrenergic agonist is also prescribed a nonselective beta-blocker for hypertension. What is the PRIMARY concern regarding this combination?
A client is prescribed a combination inhaler containing both a beta2-adrenergic agonist and an anticholinergic. Which co-existing condition would require the MOST cautious use of this inhaler?
A client is prescribed a combination inhaler containing both a beta2-adrenergic agonist and an anticholinergic. Which co-existing condition would require the MOST cautious use of this inhaler?
A client using a combination inhaler that includes an inhaled corticosteroid reports experiencing hoarseness. What intervention is MOST appropriate to suggest?
A client using a combination inhaler that includes an inhaled corticosteroid reports experiencing hoarseness. What intervention is MOST appropriate to suggest?
A client with a known hypersensitivity to atropine is prescribed a respiratory medication. Which of the following medications would be MOST concerning?
A client with a known hypersensitivity to atropine is prescribed a respiratory medication. Which of the following medications would be MOST concerning?
Why are second-generation antihistamines preferred over first-generation antihistamines for managing allergic rhinitis?
Why are second-generation antihistamines preferred over first-generation antihistamines for managing allergic rhinitis?
A client with a history of hypertension is prescribed phenylephrine for nasal congestion. What potential adverse effect should the nurse monitor for?
A client with a history of hypertension is prescribed phenylephrine for nasal congestion. What potential adverse effect should the nurse monitor for?
A patient taking cetirizine reports experiencing a dry mouth. What is the MOST appropriate recommendation?
A patient taking cetirizine reports experiencing a dry mouth. What is the MOST appropriate recommendation?
A patient with a history of hypertension is prescribed an oral sympathomimetic for nasal congestion. Which of the following instructions is MOST important to provide?
A patient with a history of hypertension is prescribed an oral sympathomimetic for nasal congestion. Which of the following instructions is MOST important to provide?
Why is it important to avoid alcohol and other CNS depressants while taking sedating antihistamines?
Why is it important to avoid alcohol and other CNS depressants while taking sedating antihistamines?
A patient reports experiencing rebound congestion after using an over-the-counter nasal decongestant for 10 days. What intervention is MOST appropriate?
A patient reports experiencing rebound congestion after using an over-the-counter nasal decongestant for 10 days. What intervention is MOST appropriate?
Which of the following pre-existing conditions would be a contraindication for the use of a sympathomimetic medication?
Which of the following pre-existing conditions would be a contraindication for the use of a sympathomimetic medication?
A patient with allergic rhinitis is prescribed loratadine. What instruction should the nurse emphasize regarding the timing and administration of this medication?
A patient with allergic rhinitis is prescribed loratadine. What instruction should the nurse emphasize regarding the timing and administration of this medication?
A patient taking an MAOI antidepressant is prescribed pseudoephedrine for nasal congestion. What risk should the healthcare provider consider?
A patient taking an MAOI antidepressant is prescribed pseudoephedrine for nasal congestion. What risk should the healthcare provider consider?
Why are pseudoephedrine and ephedrine use restricted or require special monitoring?
Why are pseudoephedrine and ephedrine use restricted or require special monitoring?
Which of the following conditions would be a contraindication for using sedating antihistamines?
Which of the following conditions would be a contraindication for using sedating antihistamines?
Which of the following assessment findings would indicate a potential overdosage of an oral sympathomimetic medication?
Which of the following assessment findings would indicate a potential overdosage of an oral sympathomimetic medication?
A client reports difficulty sleeping after starting an oral decongestant. What is the MOST appropriate nursing intervention?
A client reports difficulty sleeping after starting an oral decongestant. What is the MOST appropriate nursing intervention?
A client with seasonal allergies is prescribed cetirizine. Which of the following assessment findings would warrant caution when administering this medication?
A client with seasonal allergies is prescribed cetirizine. Which of the following assessment findings would warrant caution when administering this medication?
What is the primary reason for cautioning clients against the prolonged use (longer than 3-5 days) of topical nasal decongestants?
What is the primary reason for cautioning clients against the prolonged use (longer than 3-5 days) of topical nasal decongestants?
How do sympathomimetic medications, such as phenylephrine, alleviate nasal congestion?
How do sympathomimetic medications, such as phenylephrine, alleviate nasal congestion?
What is a critical instruction to provide to individuals taking nonsedating antihistamines regarding activities that require mental alertness?
What is a critical instruction to provide to individuals taking nonsedating antihistamines regarding activities that require mental alertness?
Why are sympathomimetics like pseudoephedrine and ephedrine significantly limited in use?
Why are sympathomimetics like pseudoephedrine and ephedrine significantly limited in use?
How does theophylline interact with nonsedating antihistamines?
How does theophylline interact with nonsedating antihistamines?
A client with a history of coronary artery disease is prescribed a sympathomimetic for nasal congestion. Which monitoring parameter is MOST critical?
A client with a history of coronary artery disease is prescribed a sympathomimetic for nasal congestion. Which monitoring parameter is MOST critical?
A patient is prescribed benzonatate for a cough. How does this medication work?
A patient is prescribed benzonatate for a cough. How does this medication work?
Why are sympathomimetic medications like phenylephrine ineffective for treating allergic rhinitis-related sneezing and itching?
Why are sympathomimetic medications like phenylephrine ineffective for treating allergic rhinitis-related sneezing and itching?
A patient is prescribed an antitussive containing codeine. What common side effect should the patient be educated about?
A patient is prescribed an antitussive containing codeine. What common side effect should the patient be educated about?
Before administering a nonsedating antihistamine to an older adult, what specific consideration regarding their health history is MOST important?
Before administering a nonsedating antihistamine to an older adult, what specific consideration regarding their health history is MOST important?
A patient is prescribed dextromethorphan for a persistent cough related to a cold. Which of the following statements is MOST accurate regarding dextromethorphan?
A patient is prescribed dextromethorphan for a persistent cough related to a cold. Which of the following statements is MOST accurate regarding dextromethorphan?
A client who is breastfeeding asks if it safe to take loratadine for seasonal allergies. What is the MOST appropriate response?
A client who is breastfeeding asks if it safe to take loratadine for seasonal allergies. What is the MOST appropriate response?
When should a client who is prescribed a nonsedating antihistamine be assessed during ambulation to determine their degree of drowsiness and fatigue?
When should a client who is prescribed a nonsedating antihistamine be assessed during ambulation to determine their degree of drowsiness and fatigue?
A client taking a sympathomimetic reports feeling agitated and anxious. What is the underlying cause of these symptoms?
A client taking a sympathomimetic reports feeling agitated and anxious. What is the underlying cause of these symptoms?
A patient is prescribed both a beta2-adrenergic agonist and pseudoephedrine. What potential interaction should the healthcare provider be aware of?
A patient is prescribed both a beta2-adrenergic agonist and pseudoephedrine. What potential interaction should the healthcare provider be aware of?
Which instruction should a nurse provide to a client who is prescribed phenylephrine nasal spray to minimize the risk of rebound congestion?
Which instruction should a nurse provide to a client who is prescribed phenylephrine nasal spray to minimize the risk of rebound congestion?
Why is it important to instruct clients not to chew sustained-release guaifenesin tablets?
Why is it important to instruct clients not to chew sustained-release guaifenesin tablets?
A client taking guaifenesin reports dizziness. What should the nurse advise?
A client taking guaifenesin reports dizziness. What should the nurse advise?
A client with diabetes is prescribed guaifenesin. What precaution is most relevant?
A client with diabetes is prescribed guaifenesin. What precaution is most relevant?
What is the primary mechanism of action of acetylcysteine as a mucolytic agent?
What is the primary mechanism of action of acetylcysteine as a mucolytic agent?
A client receiving acetylcysteine develops bronchospasm. What is the priority intervention?
A client receiving acetylcysteine develops bronchospasm. What is the priority intervention?
What is the most important reason for ensuring that equipment used to administer acetylcysteine does not contain metal or rubber parts?
What is the most important reason for ensuring that equipment used to administer acetylcysteine does not contain metal or rubber parts?
A client with a tracheostomy is ordered to receive acetylcysteine. What is a critical nursing action before administering the medication?
A client with a tracheostomy is ordered to receive acetylcysteine. What is a critical nursing action before administering the medication?
A client is prescribed acetylcysteine, and reports nausea associated with a rotten-egg smell. What intervention should the nurse implement?
A client is prescribed acetylcysteine, and reports nausea associated with a rotten-egg smell. What intervention should the nurse implement?
Why is it important to instruct clients on the proper cleaning of nebulizer equipment used for respiratory treatments?
Why is it important to instruct clients on the proper cleaning of nebulizer equipment used for respiratory treatments?
Use caution when administering mucolytics to clients with?
Use caution when administering mucolytics to clients with?
A client with a history of peptic ulcer disease is prescribed acetylcysteine for excessive mucus production. What is the most important consideration regarding route of administration?
A client with a history of peptic ulcer disease is prescribed acetylcysteine for excessive mucus production. What is the most important consideration regarding route of administration?
A client is receiving acetylcysteine and activated charcoal concurrently. What potential interaction should the nurse monitor for?
A client is receiving acetylcysteine and activated charcoal concurrently. What potential interaction should the nurse monitor for?
Beta2-adrenergic agonists work to relieve bronchospasm by:
Beta2-adrenergic agonists work to relieve bronchospasm by:
How do anticholinergics relieve bronchospasm?
How do anticholinergics relieve bronchospasm?
Methylxanthines relax bronchial smooth muscle by:
Methylxanthines relax bronchial smooth muscle by:
A patient with a history of emphysema is prescribed an antitussive. Which potential risk should be MOST carefully monitored by the healthcare provider?
A patient with a history of emphysema is prescribed an antitussive. Which potential risk should be MOST carefully monitored by the healthcare provider?
A client is prescribed both an opioid analgesic for chronic pain and a non-opioid antitussive for a persistent cough. What potential drug interaction should the nurse monitor for?
A client is prescribed both an opioid analgesic for chronic pain and a non-opioid antitussive for a persistent cough. What potential drug interaction should the nurse monitor for?
A client taking an opioid antitussive reports feeling lightheaded upon standing. Which intervention should the nurse implement FIRST?
A client taking an opioid antitussive reports feeling lightheaded upon standing. Which intervention should the nurse implement FIRST?
A patient with a history of substance use disorder is prescribed an antitussive for a severe cough. Which approach is MOST appropriate for managing this patient's medication?
A patient with a history of substance use disorder is prescribed an antitussive for a severe cough. Which approach is MOST appropriate for managing this patient's medication?
A male client with prostatic hypertrophy is prescribed an opioid antitussive. What specific instruction should the nurse provide regarding a potential adverse effect?
A male client with prostatic hypertrophy is prescribed an opioid antitussive. What specific instruction should the nurse provide regarding a potential adverse effect?
Which of the following findings would necessitate the MOST immediate intervention in a client receiving an opioid antitussive?
Which of the following findings would necessitate the MOST immediate intervention in a client receiving an opioid antitussive?
An older adult client is prescribed an opioid antitussive for a persistent cough. What is the PRIMARY reason for using these medications cautiously in this population?
An older adult client is prescribed an opioid antitussive for a persistent cough. What is the PRIMARY reason for using these medications cautiously in this population?
A client is prescribed guaifenesin for a productive cough associated with bronchitis. What is the expected outcome of this medication?
A client is prescribed guaifenesin for a productive cough associated with bronchitis. What is the expected outcome of this medication?
A client taking guaifenesin reports experiencing nausea. Which of the following instructions would be MOST appropriate to provide?
A client taking guaifenesin reports experiencing nausea. Which of the following instructions would be MOST appropriate to provide?
A client has been prescribed guaifenesin. Which instruction regarding fluid intake is MOST important for the nurse to emphasize?
A client has been prescribed guaifenesin. Which instruction regarding fluid intake is MOST important for the nurse to emphasize?
A client is taking guaifenesin for a cough associated with a cold. When should the client contact their healthcare provider?
A client is taking guaifenesin for a cough associated with a cold. When should the client contact their healthcare provider?
A patient reports taking St. John's Wort concurrently with an opioid antitussive. What potential interaction should the nurse be MOST concerned about?
A patient reports taking St. John's Wort concurrently with an opioid antitussive. What potential interaction should the nurse be MOST concerned about?
Which of the following instructions is MOST important for a client who is prescribed an antitussive containing codeine?
Which of the following instructions is MOST important for a client who is prescribed an antitussive containing codeine?
A nurse is reviewing a patient's medication list and notices the patient is taking both an opioid antitussive and a selective serotonin reuptake inhibitor (SSRI). What is the PRIMARY concern with this combination?
A nurse is reviewing a patient's medication list and notices the patient is taking both an opioid antitussive and a selective serotonin reuptake inhibitor (SSRI). What is the PRIMARY concern with this combination?
A client is prescribed a combination cold medication containing guaifenesin. The nurse should emphasize which of the following points when educating the client?
A client is prescribed a combination cold medication containing guaifenesin. The nurse should emphasize which of the following points when educating the client?
Flashcards
Respiratory System Medications
Respiratory System Medications
Medications that treat disorders of the respiratory system, including lower and upper respiratory tract disorders.
Agonists (Beta2-Adrenergic)
Agonists (Beta2-Adrenergic)
Stimulate receptors, specifically beta2 cells of the sympathetic nervous system, leading to bronchodilation.
Bronchodilators
Bronchodilators
Medications like beta2-adrenergic agonists, anticholinergics, and methylxanthines, which help to widen the airways.
Anti-inflammatory Respiratory Medications
Anti-inflammatory Respiratory Medications
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Airflow Disorders
Airflow Disorders
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Inhalation Devices
Inhalation Devices
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Benefits of Inhalation
Benefits of Inhalation
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Inhalation Devices Use
Inhalation Devices Use
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MDI Inhaler
MDI Inhaler
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MDI Spacer
MDI Spacer
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DPI Inhaler
DPI Inhaler
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Soft Mist Inhaler
Soft Mist Inhaler
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Nebulizer
Nebulizer
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Beta2-Adrenergic Agonists
Beta2-Adrenergic Agonists
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Rescue Inhalers
Rescue Inhalers
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Long-Acting Beta2-Adrenergic Agonists (LABAs)
Long-Acting Beta2-Adrenergic Agonists (LABAs)
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Albuterol
Albuterol
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Pharmacologic Action of Beta2-Agonists
Pharmacologic Action of Beta2-Agonists
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Adverse Effects of Beta2-Agonists
Adverse Effects of Beta2-Agonists
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Paradoxical Bronchospasm
Paradoxical Bronchospasm
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Beta2-Agonist Administration
Beta2-Agonist Administration
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Inhaler Sequence
Inhaler Sequence
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Beta2-Adrenergic Agonists Duration
Beta2-Adrenergic Agonists Duration
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Beta2-Adrenergic Agonist Instructions
Beta2-Adrenergic Agonist Instructions
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Asthma Exacerbation Log
Asthma Exacerbation Log
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Beta2-Agonist Heart Symptoms
Beta2-Agonist Heart Symptoms
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Albuterol Contraindications
Albuterol Contraindications
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Beta2-Agonist Interactions (Beta-Blockers)
Beta2-Agonist Interactions (Beta-Blockers)
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Beta2-Agonist Interactions (MAOIs and Tricyclics)
Beta2-Agonist Interactions (MAOIs and Tricyclics)
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Beta2-Agonist Interactions (Hypoglycemics)
Beta2-Agonist Interactions (Hypoglycemics)
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Inhaled Anticholinergics
Inhaled Anticholinergics
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SAMA Prototype
SAMA Prototype
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Anticholinergic Action
Anticholinergic Action
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Anticholinergic Side Effects
Anticholinergic Side Effects
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Dry Mouth Relief
Dry Mouth Relief
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Anticholinergic Use
Anticholinergic Use
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Inhaled Anticholinergic Instructions
Inhaled Anticholinergic Instructions
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Ipratropium Precautions
Ipratropium Precautions
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Beta2-agonist + anticholinergic interaction
Beta2-agonist + anticholinergic interaction
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Methylxanthines action
Methylxanthines action
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Methylxanthine side effects (early)
Methylxanthine side effects (early)
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Methylxanthine toxicity signs
Methylxanthine toxicity signs
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Theophylline therapeutic level
Theophylline therapeutic level
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Methylxanthine monitoring
Methylxanthine monitoring
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Methylxanthine admin route
Methylxanthine admin route
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Methylxanthine + Caffeine
Methylxanthine + Caffeine
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Smoking + Methylxanthines
Smoking + Methylxanthines
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Drugs increasing methylxanthine risk
Drugs increasing methylxanthine risk
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What decreases methylxanthine level?
What decreases methylxanthine level?
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Cimetidine risk
Cimetidine risk
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Activated charcoal
Activated charcoal
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Methylxanthine Toxicity treatment
Methylxanthine Toxicity treatment
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Methylxanthine: Lab tests
Methylxanthine: Lab tests
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Glucocorticoids & Diuretics
Glucocorticoids & Diuretics
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NSAIDs & Glucocorticoids
NSAIDs & Glucocorticoids
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Glucocorticoids & Hypoglycemics
Glucocorticoids & Hypoglycemics
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Beclomethasone Side Effect
Beclomethasone Side Effect
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Mast Cell Stabilizers
Mast Cell Stabilizers
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Cromolyn Action
Cromolyn Action
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Cromolyn for EIB
Cromolyn for EIB
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Cromolyn Timing for EIB
Cromolyn Timing for EIB
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Cromolyn for Allergies
Cromolyn for Allergies
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Cromolyn for Acute Attacks
Cromolyn for Acute Attacks
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Cromolyn Onset
Cromolyn Onset
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Leukotriene Modifiers
Leukotriene Modifiers
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Leukotriene Modifier Prototypes
Leukotriene Modifier Prototypes
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Montelukast Dosing
Montelukast Dosing
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Liver Damage & Leukotrienes
Liver Damage & Leukotrienes
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Inhaled drug sequence
Inhaled drug sequence
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Oral glucocorticoid dosing
Oral glucocorticoid dosing
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Tapering glucocorticoids
Tapering glucocorticoids
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Nasal glucocorticoid use
Nasal glucocorticoid use
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Inhaled glucocorticoid tips
Inhaled glucocorticoid tips
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Alternate-day benefits
Alternate-day benefits
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Abrupt stop danger
Abrupt stop danger
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Preventing Osteoporosis
Preventing Osteoporosis
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Report these side effects
Report these side effects
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Gastric protection rules
Gastric protection rules
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Infection signs to watch
Infection signs to watch
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Nasal glucocorticoid relief
Nasal glucocorticoid relief
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Caution conditions
Caution conditions
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Adrenal insufficiency signs
Adrenal insufficiency signs
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Avoid these scenarios
Avoid these scenarios
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EIB medication timing
EIB medication timing
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Zileuton/zafirlukast warning signs
Zileuton/zafirlukast warning signs
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Neuropsychiatric effects of asthma drugs
Neuropsychiatric effects of asthma drugs
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Monitoring for Zileuton/Zafirlukast
Monitoring for Zileuton/Zafirlukast
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Zileuton/Zafirlukast contraindication
Zileuton/Zafirlukast contraindication
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When to avoid Leukotriene Modifiers
When to avoid Leukotriene Modifiers
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Drugs reducing montelukast levels
Drugs reducing montelukast levels
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Zileuton Interactions
Zileuton Interactions
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Serious adverse effect of Zileuton
Serious adverse effect of Zileuton
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Inhalant combination medications
Inhalant combination medications
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SABA/SAMA prototype
SABA/SAMA prototype
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LABA/LAMA prototype
LABA/LAMA prototype
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Inhaled Glucocorticoid/SABA prototype
Inhaled Glucocorticoid/SABA prototype
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Inhaled Glucocorticoid/LABA prototype
Inhaled Glucocorticoid/LABA prototype
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Inhaled Glucocorticoid/LABA/LAMA Prototype
Inhaled Glucocorticoid/LABA/LAMA Prototype
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Theophylline and Coffee
Theophylline and Coffee
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Glucocorticoids
Glucocorticoids
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Glucocorticoid Examples
Glucocorticoid Examples
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Glucocorticoid Action
Glucocorticoid Action
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Oral Candidiasis
Oral Candidiasis
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Adrenal Insufficiency
Adrenal Insufficiency
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Muscle/Bone Effects
Muscle/Bone Effects
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Hyperglycemia
Hyperglycemia
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Peptic Ulcer Disease
Peptic Ulcer Disease
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Increased risk of infection
Increased risk of infection
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Nasal Glucocorticoid Side Effects
Nasal Glucocorticoid Side Effects
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Inhaler Spacer
Inhaler Spacer
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Oral Glucocorticoid Interventions
Oral Glucocorticoid Interventions
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Infection Signs on Steroids
Infection Signs on Steroids
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Analgesic for Nasal Steroids
Analgesic for Nasal Steroids
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Sedating Antihistamines
Sedating Antihistamines
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Nonsedating Antihistamines
Nonsedating Antihistamines
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Mucolytics
Mucolytics
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Inhaled Glucocorticoid/SABA Action
Inhaled Glucocorticoid/SABA Action
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Inhaled Glucocorticoid/LABA Action
Inhaled Glucocorticoid/LABA Action
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Beta2-Adrenergic Agonist Side Effects
Beta2-Adrenergic Agonist Side Effects
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Anticholinergic Adverse Effects
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Study Notes
Respiratory System Medications Overview
- Medications treat respiratory system disorders affecting the lower and upper respiratory tracts.
- Understanding common lung disorders aids in medication administration.
- Therapeutic actions for respiratory system medications are important to learn.
Learning Objectives
- Describe respiratory system structures and functions.
- Identify common disorders affecting the upper and lower respiratory tracts.
- Identify medications and their actions for various respiratory disorders.
- Explain adverse reactions, contraindications, and interactions of respiratory disorder medications.
- Describe nurse instructions for clients on respiratory disorder medications.
- Apply the nursing process to respiratory disorder medication therapy.
Medication Therapy for Non-Infectious Lower Respiratory Airflow Disorders
- Airflow disorders include asthma and chronic obstructive pulmonary diseases (COPD).
- COPD includes chronic bronchitis and emphysema.
- Two main medication classifications are bronchodilators and anti-inflammatory.
- Bronchodilator and anti-inflammatory subgroups include:
- Beta2-adrenergic agonists
- Anticholinergics (muscarinic antagonists)
- Methylxanthines
- Glucocorticoids
- Mast cell stabilizers
- Leukotriene modifiers
- Agonists stimulate receptors.
- Beta2-adrenergic agonists stimulate beta2 cells of the sympathetic nervous system.
Administering Medications by Inhalation
- Most bronchodilators and anti-inflammatory medications can be administered by inhalation.
- Inhalation benefits:
- Directly reaches the site of action in the bronchioles
- Minimizes systemic effects
- Faster relief of bronchoconstriction
- Inhalation devices include:
- Metered-dose inhalers (MDIs)
- Dry powder inhalers (DPIs)
- Soft mist inhalers
- Nebulizers
- Each inhalation device has unique advantages and disadvantages
Metered-Dose Inhalers (MDIs)
- MDIs are multi-dose, portable handheld pressurized canisters:
- Delivers a measured dose of medication
- Usual dosing is 1-2 inhalations with 1 minute in between
- MDI usage requires hand-breath coordination.
- Exhale first, then inhale while pressing down on the canister.
- Hold breath for 10 seconds after inhalation.
- Spacers attach to MDIs:
- Temporarily hold medication
- Allow more inhalation time
- Reduce mouth and oropharynx contact
Dry Powder Inhalers (DPIs)
- DPIs are portable devices:
- Preloaded with pre-set medication doses in powder form
- Or require the client to place capsules of medication powder inside the device
- DPIs are breath-activated.
- Require a deep, forceful breath to pull medication into airways.
- Hold breath for 10 seconds after inhalation.
Soft Mist Inhalers
- Soft mist inhalers are multi-dose portable devices preloaded with liquid medication, and do not use propellants.
- Slowly releases medication as a fine mist, lasting longer than MDIs.
- Usage requires hand-breath coordination.
- Exhale first, then inhale while pressing down on the canister.
- Hold breath for 10 seconds after inhalation.
- Spacers should not be used with soft mist inhalers.
Nebulizers
- Nebulizers turn liquid medication into a mist.
- Client breathes medication through a mask or mouthpiece.
- Available in portable, handheld, and tabletop versions.
- Client inhales and exhales until medication is gone.
- Takes longer to use than other inhalation devices.
Beta2-Adrenergic Agonists
- Relieve bronchospasms
- Prevent exercise-induced bronchospasm (EIB).
- Selection depends on the intended effect.
- Fast relief (rescue inhalers)
- Long-term management
- Beta2-adrenergic agonists are short-acting (SABA) or long-acting (LABA).
Beta2-Adrenergic Agonists Prototypes
- Short Acting Beta2-Adrenergic Agonists (SABA):
- Albuterol (prototype)
- Levalbuterol
- Long Acting Beta2-Adrenergic Agonists (LABA):
- Formoterol
- Salmeterol
- Terbutaline
- Vilanterol
- Olodaterol
Expected Pharmacologic Actions of Beta2-Adrenergic Agonists
- Stimulate beta2-adrenergic receptors of the sympathetic nervous system to cause bronchodilation.
- Relieve bronchospasm of the bronchi and bronchioles.
- Minor role in increasing ciliary motility.
- Minor role in depressing histamine release in the lungs
- SABAs help keep airways open, lasting 4-6 hours.
- LABAs are used for stable COPD, lasting up to 12 hours.
Adverse Drug Reactions of Beta2-Adrenergic Agonists
- Tachycardia
- Heart palpitations
- Tremors
- Angina (in clients with compromised cardiac blood vessels)
- Paradoxical bronchospasm.
- Overuse of short-acting rescue inhalers can be dangerous (more than twice a week requires medical attention).
Interventions for Clients Taking Beta2-Adrenergic Agonists
- Monitor for tachycardia, heart palpitations, and chest pain.
- Report findings to the provider.
Administration Guidelines for Beta2-Adrenergic Agonists
- Can be given orally or by inhalation.
- Short-acting preparations for acute exacerbations.
- Long-acting preparations for long-term control.
- Give short-acting preparations 30 minutes before exercise.
- If also taking inhaled glucocorticoids:
- Inhale beta2-adrenergic agonists medication first.
- This allows airways to dilate for better glucocorticoid delivery.
- Follow dosage limits and schedules.
- Store MDIs at appropriate temperatures.
Client Instructions for Beta2-Adrenergic Agonists
- Avoid caffeine.
- Notify provider if tremors interfere with daily activities.
- Watch for manifestations and triggers of asthma exacerbations.
- Keep a log of exacerbation frequency and intensity.
- Notify provider of changes in exacerbation patterns.
- Notify provider of chest pain, heart palpitations, or increased pulse rate (especially with cardiovascular disease, hypertension, or digitalis-type medication).
Contraindications and Precautions for Beta2-Adrenergic Agonists
- Contraindicated for clients who are allergic to the medication.
- Use caution in clients with:
- Allergy to beta2-adrenergic agonists
- History of tachydysrhythmias
- Tachycardia due to digitalis toxicity.
- Diabetes mellitus
- Hyperthyroidism
- Cardiovascular disease
- Hypertension
- Angina pectoris
Interactions of Beta2-Adrenergic Agonists
- Beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists.
- MAOIs and tricyclic antidepressants increase the risk of hypertension, tachycardia, and angina.
- Hypoglycemic or antidiabetic medications may require increased dosing.
Anticholinergics
- Inhaled anticholinergics (muscarinic antagonists) provide relief of bronchoconstriction and reduce secretions in COPD.
- Medication selection depends on the intended effect: rescue or long-term management.
Prototypes for Anticholinergics
- Short Acting Muscarinic Antagonists (SAMA):
- Ipratropium (prototype)
- Long Acting Muscarinic Antagonists (LAMA):
- Umeclidinium
- Tiotropium
- Aclidinium
- Revefenacin
Expected Pharmacologic Action of Anticholinergics
- Beta2-adrenergic agonists work on the sympathetic system.
- Anticholinergics work on the parasympathetic system.
- The parasympathetic system causes bronchoconstriction through acetylcholine
- Inhaled anticholinergics inhibit acetylcholine at the muscarine receptor, resulting in bronchodilation.
- Anticholinergics are also called muscarinic antagonists.
Adverse Drug Reactions of Anticholinergics
- Local reactions include dry mouth and pharyngeal irritation.
- Increased intraocular pressure (narrow-angle glaucoma).
- Urinary retention.
- Tachycardia.
- Headache.
- Dizziness.
- Blurred vision.
- Epistaxis.
- Bronchospasms.
- Hypotension.
Interventions for Anticholinergics
- Provide water and hard candy for dry mouth.
- Offer glaucoma testing for clients without routine eye exams.
- Monitor urinary elimination patterns.
Administration Guideline for Anticholinergics
- Administer via inhaler or nebulizer, following manufacturer's instructions.
- Maintain prescribed time between puffs.
- Wait at least 5 minutes after giving the anticholinergic before administering other inhalants.
- Have water available for rinsing the mouth after administration.
Client Instructions for Anticholinergics
- Inhaled anticholinergics are not meant for acute asthma exacerbation
- Address possible side effects.
- Suck on hard candy and sip water frequently for dry mouth.
- Have regular eye examinations for glaucoma and report any changes in urinary elimination.
Contraindications and Precautions for Anticholinergics
- Use caution with clients who have:
- Glaucoma
- Prostatic hyperplasia
- Bladder neck obstruction
- Urinary retention and closely monitor such conditions
Interactions of Anticholinergics
- Beta2-adrenergic agonists enhance bronchodilation, so dosage adjustment may be needed.
Methylxanthines
- Used in the long-term management of chronic stable asthma.
- Evidence-based practice no longer recommends methylxanthines for treating COPD.
Methylxanthines Prototypes
- Theophylline (prototype)
- Theophylline can also be extended release, providing 24-hour coverage; assess blood levels periodically to ensure safety.
- Aminophylline (generic only) is preferred for intravenous administration.
Expected Pharmacologic Action of Methylxanthines
- Relax smooth muscles of bronchi by blocking phosphodiesterase.
Adverse Drug Reactions of Methylxanthines
- Restlessness and insomnia are the most common side effects.
- Nausea, vomiting, diarrhea, palpitations, and muscle twitching.
- Toxic levels can cause life-threatening seizures and dysrhythmias.
- Therapeutic level of theophylline is 10 to 20 mcg/mL.
- Toxicity occurs at levels greater than 20 mcg/mL.
Interventions for Clients Receiving Methylxanthines
- Closely monitor blood levels to maintain a therapeutic level.
- Notify the provider if medication levels begin to rise.
- Administer activated charcoal to decrease absorption.
- Monitor heart rate and rhythm.
- Antidysrhythmics may be necessary.
- Initiate anticonvulsant therapy per the provider and institute seizure precautions if a seizure occurs.
Administration
- Give methylxanthines orally.
- Base initial dose on client factors affecting metabolism and excretion.
- Give at prescribed intervals to maintain a therapeutic level.
- If a dose is missed, do not double the next dose.
- Chewable tablets should be chewed thoroughly; sustained-release or enteric-coated should not be crushed or chewed.
- Intravenous administration is set aside for emergencies and care must be taken to infuse the medication slowly at the prescribed dosage per minute.
Client Instructions
- Reduce or eliminate caffeine intake.
- Have periodic laboratory testing of medication levels.
- Provide clients with a list of adverse drug reactions.
- Stop taking the medication and notify their provider if they experience toxic effects.
Contraindications and Precautions
- Use cautiously in patients who smoke tobacco or marijuana.
- Clients taking medications for seizure disorders, tuberculosis, peptic ulcer disease, or certain bacterial infections need to be aware of medication-to-medication interactions and adjust dosages as needed.
Interactions
- Cimetidine and some fluoroquinolones increase the risk of toxicity.
- Nicotine, phenobarbital, and phenytoin increase metabolism of theophylline, causing a decrease in blood level.
Glucocorticoids
- Suppress the immune system and decrease inflammation
- Inhaled glucocorticoids are for long-term management of chronic asthma and COPD.
- Oral glucocorticoids are for short-term management of post-exacerbation manifestations.
- Can provide intravenously in emergent situations.
Glucocorticoids Prototypes
- Beclomethasone dipropionate (inhalant)
- Prednisone (oral)
- Fluticasone (intranasal or inhaled)
- Budesonide (nasal or inhalation)
Expected Pharmacologic Action of Glucocorticoids
- Suppress inflammation by preventing the release of:
- Leukotrienes
- Prostaglandins
- Histamine
- Prevent the action of white blood cells, decreasing edema of the airways.
Adverse Drug Reactions
- Inhaled glucocorticoids can cause oral candidiasis, hoarseness, and difficulty speaking.
- Oral glucocorticoids cause adrenal function suppression.
- Muscle wasting and bone demineralization can cause osteoporosis.
- Hyperglycemia.
- Peptic ulcer disease.
- Increased susceptibility to infection.
- Fluid and electrolyte imbalances.
- Nasal glucocorticoids can cause dry mucous membranes, epistaxis, sore throat, and headaches.
Interventions Inhaled
- Attach a spacer to the MDI.
- Timely initiation of antifungal therapy decreases discomfort.
Interventions Oral
- Monitor plasma medication levels to determine the amount of adrenal function suppression.
- Providers should prescribe the lowest possible effective dose or alternate-day dosing.
- Implement gastric protective measures.
- Closely monitor blood glucose levels for hyperglycemia.
- Observe for manifestations of infection that may not include fever or inflammation
- Monitor closely for sodium retention or hypernatremia, and potassium loss or hypokalemia.
Interventions Nasal
- Provide comfort measures such as fluids, throat lozenges or hard candy, and humidified air.
- Administer a non-NSAID analgesic such as acetaminophen for headaches that may be caused by intranasal glucocorticoids.
Administration Inhaled
- Give inhaled glucocorticoids on a regular schedule rather than PRN.
- Give at the same time as an inhaled beta2-adrenergic agonist, have the client use the beta2 agonist first.
Administration Oral
- Give short-term oral glucocorticoid therapy in single or divided doses for 5 to 10 days
- Use alternate-day dosing for long-term use.
- Taper the dose slowly until the lowest possible oral dose that is effective has been reached.
- Supplemental doses will also be needed in times of stress.
Administration Nasal
- Give intranasal glucocorticoids using a nasal metered-dose spray device.
- Gradually taper the medication from the initial dose to the lowest effective dose over a period of time.
- Expect the full therapeutic effects to take 2 to 3 weeks to develop.
- Use a nasal decongestant first to open the nasal passages so the glucocorticoid can reach deep into the nasal structures.
Client Instructions Inhaled
- Encourage them to use a spacer during administration.
- Encourage clients to rinse their mouths and to gargle after using the inhaler.
Client Instructions Oral
- Make sure they understand the short- and long-term implications of taking these medications.
- Ensure the client understands that these medications can never be stopped abruptly and instruct clients to increase their intake of calcium and vitamin D.
- Instruct clients to report the incidence of polyphagia, polydipsia, or polyuria.
- Clients need to report weight gain, edema, or generalized weakness.
Client Instructions Nasal
- Instruct them to use a humidifier, increase their fluid intake, and suck on hard candy or lozenges.
- Tell clients to notify their provider if they develop a sore throat that does not respond to therapy or is accompanied by fatigue.
- A client can take over-the-counter non-NSAID analgesics such as acetaminophen for headaches.
Contraindications and Precautions
- Be cautious giving glucocorticoids to clients who have peptic ulcer disease, diabetes mellitus, hypertension, renal dysfunction, or are taking NSAIDs regularly.
- Be cautious when changing from systemic to inhaled corticosteroids.
- Monitor for adrenal insufficiency manifestations.
Interactions
- Do not give glucocorticoids with potassium-depleting diuretics.
- The use of NSAIDs with glucocorticoids increases the risk of gastrointestinal bleeding.
- The effects of insulin and oral hypoglycemics are also decreased.
Mast Cell Stabilizers
- Used to reduce bronchial inflammation prophylactically in mild to moderate asthma, to treat long-term allergy-related asthma, and to prevent EIB and allergic rhinitis.
Mast Cell Stabilizers Prototypes
- Cromolyn (prototype)
Expected Pharmacologic Action
- Prevent the: release of leukotrienes and histamine
- Prevent the stimulation of the inflammatory response by white blood cells.
- They do not have bronchodilation effects.
Adverse Drug Reactions
- Minimal adverse drug reactions; cough or bronchospasm may occur in fewer than 1 out of 10,000 clients.
Interventions
- Cromolyn is contraindicated in clients with a previous allergic response to the medication.
Administration
- Give mast cell stabilizers with a power-driven nebulizer; maintain clients on the lowest effective dosage.
- Administer 10 to 15 minutes prior to activity to prevent EIB.
- In case of seasonal allergies, take cromolyn prior to exposure.
Client Instructions
- Take is as prescribed for prevention of exacerbations of asthma.
- The medication will not be effective against an acute asthma attack.
- It may take up to several weeks to achieve therapeutic effects.
Contraindications and Precautions
- The use of mast cell stabilizers is contraindicated in clients who are allergic to cromolyn.
Interactions
- There are no known medication or food interactions with mast cell stabilizers.
Leukotriene Modifiers
- Oral medications prescribed as adjunctive therapy to decrease bronchoconstriction and inflammation when other anti-inflammatory medications are not able to produce the desired therapeutic effect.
- Used in the treatment of allergic rhinitis, asthma, and exercise-induced bronchospasm.
Leukotriene Modifiers Prototypes
- Montelukast (prototype)
- Zileuton
- Zafirlukast
Expected Pharmacologic Action
- Work to suppress the effect of leukotrienes.
- Zileuton, a leukotriene inhibitor, decreases the number of leukotrienes available to cause inflammation.
- Montelukast and zafirlukast, leukotriene antagonists, decrease inflammation by preventing the activation of leukotrienes.
Adverse Drug Reactions
- Zileuton, and less frequently, zafirlukast may cause liver damage.
- All the leukotriene modifiers carry the slight risk of adverse neuropsychiatric manifestations.
Interventions
- Because of the potential for liver damage, closely monitor the client's liver function tests.
- Mild analgesics may be necessary for headaches.
Administration
- Give montelukast once daily in the evening in oral or chewable tablets and oral granules.
- If you give the medication to prevent EIB, make sure it is at least 2 hours before exercising and tell the client not to take it again for 24 hours.
Client Instructions
- Instruct clients taking zileuton or zafirlukast to report abdominal pain or tenderness, nausea, or anorexia.
- For clients who report headaches after administration, encourage them to use over-the-counter analgesics as needed.
- Educate clients and family to be aware of any behavioral changes such as anxiety, agitation, insomnia, or irritability.
- Monitor clients for behavioral changes indicating suicidal ideation or depression.
Contraindications and Precautions
- Do not give zileuton and zafirlukast to clients who have liver dysfunction.
- Do not give leukotriene modifiers for acute asthma exacerbations.
- Use leukotriene modifiers with caution in clients who have severe asthma.
Interactions
- Clients taking phenobarbital, rifampin, or phenytoin may need higher doses of montelukast.
- Both zileuton and zafirlukast can increase levels of warfarin.
- Zileuton can also increase levels of theophylline and propranolol.
Respiratory Inhalant Combination Medications
- Inhaled medications containing fixed dosages of two or three medications used to control or prevent respiratory bronchoconstriction and inflammation manifestations.
- Combining inhaled medications in a single inhaler is more convenient than taking the medications separately.
- Medications are from one of the three categories listed below:
- Inhaled corticosteroids
- Beta2-adrenergic agonist
- Short and long Acting (SABA & LABA)
- Anticholinergics (also called muscarinic antagonists)
- Short and long Acting (SAMA & LAMA)
Respiratory Inhalant Combinations Prototypes
SABA/SAMA Combination
- Albuterol/Ipratropium (prototype)
- Used for the treatment of COPD.
LABA/LAMA combination
- Vilanterol/Umeclidinium
- Formoterol/Glycopyrrolate
- Formoterol/Aclidinium
- Olodaterol/Tiotropium
- Used for maintenance treatment of COPD.
Inhaled Glucocorticoid/SABA Combination
- Budesonide/Albuterol
- Used to prevent bronchoconstriction and reduce exacerbations of asthma.
Inhaled Glucocorticoid/LABA Combination
- Fluticasone/Salmeterol
- Fluticasone/Vilanterol
- Mometasone/Formoterol
- Budesonide/Formoterol
- Used for maintenance treatment of COPD.
Inhaled Glucocorticoid/LABA/LAMA Combination
- Fluticasone/Vilanterol/Umeclidium
- Budesonide/Formoterol/Glycopyrrolate
- Used for maintenance treatment of COPD and asthma.
Expected Pharmacologic Action
SABA/SAMA Combination
- Work together to prevent and treat bronchoconstriction by relaxing the bronchial smooth muscles through stimulating the beta2-adrenergic receptors (SABA effect from albuterol) and inhibiting acetylcholine at the muscarinic receptor (SAMA effect from ipratropium)
LABA/LAMA Combination
- Work together to prevent and treat bronchoconstriction by relaxing the bronchial smooth muscles through stimulating the beta2-adrenergic receptors (LABA effect from vilanterol) and inhibiting acetylcholine at the muscarinic receptor (LAMA effect from umeclidinium).
Inhaled Glucocorticoid/SABA Combination
- Work together by decreasing inflammation of the bronchioles (corticosteroid effect from budesonide) and by relaxing the bronchial smooth muscles through stimulating the beta2 receptors (SABA effect from albuterol).
Inhaled Glucocorticoid/LABA Combination
- Work together to treat inflammation in the airways (corticosteroid effect from fluticasone) and treat bronchoconstriction by relaxing the bronchial smooth muscles through stimulating the beta2 receptors (LABA effect from salmeterol).
Inhaled Glucocorticoid/LABA/LAMA Combination
- Work together to treat inflammation in the airways (corticosteroid effect from fluticasone), treat bronchoconstriction by relaxing the bronchial smooth muscles through stimulating the beta2-adrenergic receptors (LABA effect from vilanterol), and inhibiting acetylcholine at the muscarinic receptor (LAMA effect from umeclidinium).
Adverse Drug Reactions
- Beta2-adrengic agonists: tachycardia, heart palpitation, tremor, or chest pain.
- Anticholinergics: dry mouth, pharyngeal irritation, increased intraocular pressure, urinary retention, tachycardia, arrhythmias, chest pain, headaches, dizziness, epistaxis, bronchospasm, and hypotension.
- Inhaled corticosteroids: oral candidiasis and hoarse voice.
Interventions
- Monitor respiratory status for breathing effort, lung sounds, oxygen saturation, pulmonary function tests, and potential side effects.
- Monitor for tachycardia, heart palpitations, and any chest pain the client may experience with beta2-adrenergic agonists.
- Monitor anticholinergic clients for dry mucous membranes, schedule glaucoma tests, and monitor for urinary retention,
- Minimize side effects by attaching a spacer to the MDI inhaler when giving a glucocorticoid combination.
Administration - Combination of SABA/SAMA
- Supplied as a metered-dose inhaler or nebulizer solution.
- Give one inhalation of MDI or one nebulizer treatment, four times a day.
- Maximum dosage is six times a day due to the stimulating effects of the medications.
- Store in a dry place and avoid extremes in temperature and use for acute exacerbations.
Administration - Combination of LABA/LAMA
- Supplied as a metered-dose inhaler, soft mist inhaler, or dry powder inhaler and given one inhalation, once a day.
- Store in a dry place and avoid extremes in temperature, do not use this medication to treat acute bronchospasms.
Administration - Combination of Inhaled Glucocorticoid/SABA
- Supplied as a metered-dose inhaler, give two inhalations as needed, the maximum dosage is 12 inhalations in a 24-hour period.
Administration - Combination of Inhaled Glucocorticoid/LABA
- Supplied as a metered-dose inhaler, soft mist inhaler, or dry powder inhaler, given 1 to 2 inhalations, twice a day.
- Store in a dry place and avoid extremes in temperature and do not use this medication to treat acute bronchospasms.
Administration - Combination of Inhaled Glucocorticoid/LABA/LAMA
- Supplied in a dry powder inhaler, give once a day for maintenance treatment of COPD and asthma.
- Do not use this medication to treat acute bronchospasms.
Client Instructions
- Teach how to correctly use and clean the inhaler device and about the medication's effects, administration, adverse effects, interactions, and when to contact their provider.
- Teach the client to watch for impending exacerbations, and to keep a log of the frequency and intensity.
- In beta2-adrenergic agonists combinations, tell the client to avoid caffeine and report tremors.
- In anticholinergics combination, instruct the client to suck on hard candy, sip water, have eye exams, and report urinary changes.
- In glucocorticoid combinations, encourage the client to rinse their mouths and to gargle and to use a spacer.
Contraindications and Precautions – Combination of SABA/SAMA
- Clients who have cardiovascular disorders, diabetes, hypokalemia, renal impairment, seizure disorders, glaucoma, and hyperthyroidism should proceed with caution.
- do not give to clients with atropine hypersensitivity or clients who have glaucoma, prostatic hyperplasia, or bladder neck obstruction because anticholinergics (ipratropium) can increase intraocular pressures and urinary retention.
Contraindications and Precautions – Combination of LABA/LAMA
- Contraindicated for clients who have severe lactose or milk protein hypersensitivities.
- Should be used cautiously in clients who have cardiovascular disorders, diabetes, hypokalemia, renal impairment, seizure disorders, glaucoma, hyperthyroidism, or are taking MAOIs.
- Should be used cautiously with clients with glaucoma, prostatic hyperplasia, or bladder neck obstructions because the anticholinergic (umeclidinium) can increase intraocular pressures and urinary retention.
Contraindications and Precautions – Combination of Inhaled Glucocorticoid/SABA
- Contraindicated for clients who have severe lactose or milk protein hypersensitivities.
- Should be used cautiously for clients who have cardiovascular disorders, diabetes, hyperthyroidism, seizure disorders, or hypokalemia.
- Inhaled corticosteroids (budesonide) should be used with caution for clients who are at risk for infections due to the immunosuppression effect.
Contraindications and Precautions – Combination of Inhaled Glucocorticoid/LABA
- Do not give fluticasone/salmeterol to clients who have status asthmaticus or acute bronchospasms, it is used to prevent bronchospasm from occurring.
- Contraindicated for clients who have severe lactose or milk protein hypersensitivities.
- Use with caution for clients who have cardiovascular disorders, or those at risk for osteoporosis, or being treated with MAOIs.
Contraindications and Precautions – Combination of Inhaled Glucocorticoid/LABA/LAMA
- Are the same as the above inhaled corticosteroid/LABA combination, however, with the addition of a LAMA, caution should be used with clients who a pre-existing bladder neck obstruction, history of urinary retention, or prostatic hypertrophy.
Interactions
- Beta2-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists.
- Monitor potassium levels and EKG changes and antidiabetic medications may require increased dosing.
- Monitor for gastrointestinal bleeding with concurrent use of inhaled glucocorticoid and NSAIDs.
- Clients who are taking anticholinergics and an inhaled combination medication with anticholinergics may experience additive effects, monitorfor anticholinergic adverse effects.
First-Generation (Sedating) Antihistamines
- Managment of mild allergic reactions such as seasonal allergic rhinitis, mild transfusion and Anaphylactic reactions, and treat motion sickness.
First-Generation (Sedating) Antihistamines Prototypes
- Diphenhydramine (prototype)
- Dimenhydrinate
Expected Pharmacologic Action
- Sedating antihistamines bind to H1 receptors, effectively blocking the release of histamine, and are mild cholinergic blockers.
Adverse Drug Reactions
- Drowsiness and dizziness, dry mouth, constipation, and urinary hesitancy.
Interventions
- Monitor clients when ambulating, and advise against operating machinery or driving.
- Recommend switching to a nonsedating antihistamine or recommend to suck hard candy.
- Recommend the client select high-fiber menu choices or obtain a prescription for a fiber supplement or laxative.
- Monitor clients for urinary retention and administer acetaminophen for fever.
- Administer activated charcoal for acute toxicity.
Administration
- Do not crush or chew the medication and do not take with alcohol or other CNS depressants.
- If given for motion sickness, administer it at least 30 minutes before the activity, and preferably 1 to 2 hours before the activity.
Client Instructions
- Instruct clients to take the medication at or just before bedtime and to suck on hard candy for dry mouth and to increase their fluid and fiber intake for constipation.
- Provide instructions about how to stop taking the medication and when to seek medical care.
Contraindications and Precautions
- Sedating antihistamines are contraindicated in newborns and children under the age of 2 and breastfeeding women.
- Contraindicated in clients who have narrow-angle glaucoma, prostatic hypertrophy, or acute exacerbation of asthma.
Interactions
- Sedating antihistamines interact with alcohol and other CNS depressants.
Second-Generation (Nonsedating) Antihistamines
- Treat allergic rhinitis and chronic idiopathic urticaria.
Second-Generation (Nonsedating) Antihistamines Prototypes
- Cetirizine
- Loratadine
- Fexofenadine
- Desloratadine
Expected Pharmacologic Action
- Antagonize histamine effects at H1 receptor sites, without binding to or inactivating histamine with minimal anticholinergic effects.
- Therapeutic effects are longer lasting than the first-generation antihistamines, so dosing is once daily.
Adverse Drug Reactions
- Drowsiness and fatigue, and mild anticholinergic effects.
Interventions
- Assess them during ambulation to determine their degree of drowsiness and fatigue.
- Ensure that they have water available and maintenance of fluid intake of 1,500 to 2,000 mL per day.
Administration
- Nonsedating antihistamines can be given with or without food but, do not give them with other over-the-counter antihistamines.
- Decrease the dose of nonsedating antihistamines in clients who have compromised liver or kidney function.
Client Instructions
- Tell clients to take nonsedating antihistamines once daily at a time convenient for them.
- Make sure clients take frequent sips of water and suck on hard candy for dry mouth and throat.
Contraindications and Precautions
- Do not give nonsedating antihistamines to infants under 6 months of age or breastfeeding women.
- Use them cautiously with clients who have impaired kidney or liver function.
Interactions
- Theophylline can reduce the clearance of nonsedating antihistamines from the body and lead to toxicity.
- Concurrent use with sedative/hypnotics, opioid analgesics, or alcohol can potentiate CNS depression.
Sympathomimetics
- Reduce the nasal congestion that occurs with allergic rhinitis, sinusitis, and the common cold.
Sympathomimetics Prototypes
- Phenylephrine (prototype)
- Pseudoephedrine
- Ephedrine
Expected Pharmacologic Action
- Mimic the actions of the sympathetic nervous system by activating the alpha1-adrenergic receptors in the nose vasoconstriction.
- Topical application of sympathomimetics provides relief from nasal congestion quickly, but prolonged use or overuse can result in rebound congestion.
Adverse Drug Reactions
- Oral administration can cause agitation, anxiety, and insomnia, systemic vasoconstriction leading to.
- Hypertension, arrhythmias, and heart palpitations, abuse potential, and the potential for abuse.
Interventions
- Administer these medications only when necessary, monitor clients for agitation, anxiety, and insomnia.
- Recommend a nasal glucocorticoid to minimize manifestations of rebound congestion, if applicable, and, inform them of the risk for abuse.
Administration
- Do not exceed the recommended dose and take the medication only when it is necessary.
- Do not use topical sympathomimetics for longer than 3 to 5 days to avoid rebound congestion.
Client Instructions
- Tell the client to notify the provider of excessive manifestations of CNS stimulation and report prolonged tachycardia or heart palpitations.
- Warn clients to avoid using nasal preparations for more than 3 to 5 days because of the risk of rebound congestion, which can often be worse than the original congestion.
Contraindications and Precautions
- Contraindicated for chronic rhinitis and clients with narrow-angle glaucoma, uncontrolled heart disease, hypertension, or dysrhythmia, and administer with caution in clients who have coronary artery disease or hypertension.
- Over-the-counter medications are required to provide a written warning on their label, and caution in older adults.
Interactions
- MAOI antidepressants potentiate the effects of sympathomimetics.
- Beta2-adrenergic agonists and other stimulants potentiate the hypertensive effects.
Antitussives
- Suppress chronic, nonproductive coughing and are well known by their common name, cough suppressants.
Antitussives Prototypes
- Codeine (opioid prototype medication)
- Dextromethorphan (nonopioid prototype medication)
- Benzonatate (nonopioid)
Expected Pharmacologic Action
- Both opioid and nonopioid antitussives work by suppressing the cough reflex in the brain.
Adverse Drug Reactions
- Side effects of CNS depressant medications that include dizziness and lightheadedness, as is gastrointestinal distress, constipation, and respiratory depression, and there is the potential for abuse.
Interventions
- Monitor clients as they change positions or ambulate.
- Administer the antitussive with either food or milk.
- Give an antitussive only when needed and encourage a diet high in fluids and fiber.
- Closely monitor the respiratory rate and give a reversal medication.
Administration
- Only use antitussives on a short-term basis and at the lowest effective dose possible.
Client Instructions
- Caution clients to change positions slowly and to sit or lie down if they experience lightheadedness.
- Tell clients to take the medication with food or milk and instruct them to lie down if feeling nauseated, to prevent vomiting, and to increase their daily intake of fluids and fiber.
- Triggers from the environment that precipitate coughing can help decrease the need for an antitussive.
Contraindications and Precautions
- Contraindicated in clients with known sensitivity and in cases where concurrent use of MAO inhibitors or selective serotonin reuptake inhibitors (SSRIs) is indicated.
- Caution when giving them to clients who have a reduced respiratory reserve.
- Exercise caution when using antitussives in clients who have a history of substance misuse or substance use disorder; use opioid antitussives with extreme caution in children and older adults.
- They are not recommended for chronic coughs and inform men with prostatic hypertrophy.
Interactions
- Alcohol and other CNS depressants will increase the CNS-depressant effects.
- Nonopioid antitussives increase the analgesic effects of opioids and fever and hypotension may occur if nonopioid antitussives are taken with MAOI antidepressants, and St. John's wort may increase sedation.
Expectorants
- Used to treat colds and other upper respiratory infections that produce mucus as a part of the disease process.
- They can also be given for bronchitis to facilitate removal of secretions.
Expectorants Prototypes
- Guaifenesin
Expected Pharmacologic Action
- Reduction in the surface tension of secretions, which thins thick mucus.
Adverse Drug Reactions
- Dizziness, drowsiness, headache, gastrointestinal distress, and an allergic reaction.
Interventions
- Clients should be instructed to seek medical care if they experience dizziness, allergic reaction, or gastrointestinal distress.
Administration
- Advise to increase fluid intake, to help the expectorant liquefy secretions.
- Notify the provider if cough worsens or a high fever develops but, do not chew sustained-release tablets or crush.
Client Instructions
- Avoid driving or engaging in
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Description
Learning Objectives:
- Describe the structures and functions of the respiratory system.
- Identify common disorders affecting the upper and lower respiratory tract.
- Identify medications and their expected actions used to treat a variety of disorders affecting the respiratory system.
- Explain the adverse reactions, contraindications, and interactions associated with medications used to treat a variety of respiratory disorders.
- Describe instructions the nurse should provide to clients receiving medications to treat a variety of respiratory disorders.
- Apply the nursing process related to medication therapy used to treat respiratory disorders.