PHARM Pharmacology Made Easy 5.0 - The Respiratory System
222 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

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?

  • 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?

  • 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?

  • 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?

<p>Exhale fully and then inhale rapidly and deeply (A)</p> Signup and view all the answers

Which of the following medication classifications primarily targets the inflammatory component of asthma rather than providing immediate bronchodilation?

<p>Glucocorticoids (D)</p> Signup and view all the answers

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?

<p>To provide both immediate bronchodilation and long-term anti-inflammatory effects (A)</p> Signup and view all the answers

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?

<p>As a later-line option when other therapies are insufficient (A)</p> Signup and view all the answers

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?

<p>Nebulizers require less coordination and effort from the patient during inhalation (A)</p> Signup and view all the answers

A client with a history of glaucoma is prescribed ipratropium via inhaler. What action should the nurse prioritize based on this client history?

<p>Contact the primary care provider to discuss the client's glaucoma history. (B)</p> Signup and view all the answers

Theophylline, a methylxanthine, is prescribed in an extended-release form. Which client characteristic would raise concern regarding the suitability of this medication formulation?

<p>Client is a current cigarette smoker. (C)</p> Signup and view all the answers

A client taking theophylline reports restlessness and insomnia. What is the nurse's priority action?

<p>Request an immediate theophylline blood level to be drawn. (A)</p> Signup and view all the answers

A client is prescribed theophylline. Which instruction regarding caffeine intake is most important for the nurse to provide?

<p>Reduce or eliminate caffeine intake while taking theophylline. (D)</p> Signup and view all the answers

A client is receiving intravenous aminophylline for severe asthma exacerbation. Which assessment finding requires immediate intervention?

<p>Occasional muscle twitching and palpitations. (C)</p> Signup and view all the answers

A client is prescribed both inhaled ipratropium and a beta2-adrenergic agonist inhaler. What is the therapeutic rationale for using these medications concurrently?

<p>To achieve synergistic bronchodilation effects. (B)</p> Signup and view all the answers

A client taking theophylline is newly prescribed cimetidine for GERD. What potential drug interaction should the nurse monitor for?

<p>Increased risk of theophylline toxicity. (B)</p> Signup and view all the answers

A client is being discharged on theophylline. Which statement indicates a need for further teaching regarding medication management?

<p>“If I miss a dose, I will double the next dose to catch up.” (C)</p> Signup and view all the answers

What is the primary mechanism of action of methylxanthines like theophylline in treating respiratory conditions?

<p>Blocking phosphodiesterase, leading to smooth muscle relaxation. (B)</p> Signup and view all the answers

A client with a theophylline level of 25 mcg/mL is exhibiting signs of toxicity. Which intervention is the priority?

<p>Preparing to administer activated charcoal to reduce further absorption. (B)</p> Signup and view all the answers

Which client instruction is crucial when administering chewable theophylline tablets?

<p>Chew the tablets thoroughly before swallowing. (D)</p> Signup and view all the answers

A client is prescribed theophylline and reports using phenytoin for seizure control. What potential interaction should the nurse anticipate?

<p>Decreased theophylline blood levels. (B)</p> Signup and view all the answers

For which respiratory condition is methylxanthine therapy, such as theophylline, no longer routinely recommended in evidence-based practice guidelines?

<p>Chronic obstructive pulmonary disease (COPD). (A)</p> Signup and view all the answers

When administering intravenous aminophylline, what is a critical safety measure the nurse must implement?

<p>Infuse the medication slowly at the prescribed rate per minute. (C)</p> Signup and view all the answers

Which factor significantly influences the initial theophylline dosage prescribed for a client?

<p>Client's age, weight, and metabolic factors. (A)</p> Signup and view all the answers

Why is it important to advise clients using beta2-adrenergic agonists to avoid caffeine?

<p>Caffeine can worsen cardiovascular side effects like increased heart rate and palpitations. (A)</p> Signup and view all the answers

A client with a history of which condition should be most closely monitored while taking albuterol?

<p>Cardiovascular disease (D)</p> Signup and view all the answers

Why might a client with diabetes mellitus need increased dosages of hypoglycemic medications when prescribed a beta2-adrenergic agonist?

<p>Beta2-adrenergic agonists can cause hyperglycemia, counteracting the effects of hypoglycemic medications. (B)</p> Signup and view all the answers

A client taking a beta2-adrenergic agonist and a monoamine oxidase inhibitor (MAOI) concurrently should be monitored most closely for which adverse effects?

<p>Hypertension, tachycardia, and angina. (B)</p> Signup and view all the answers

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?

<p>2 hours (A)</p> Signup and view all the answers

Which instruction is most important to include when teaching a client about managing their asthma with albuterol?

<p>Use the inhaler at the first sign of asthma symptoms. (C)</p> Signup and view all the answers

What is the primary mechanism of action of inhaled anticholinergics (muscarinic antagonists) in treating COPD?

<p>Blocking acetylcholine receptors to prevent bronchoconstriction and reduce secretions. (C)</p> Signup and view all the answers

A client is prescribed zileuton for asthma. Which instruction regarding potential adverse effects is MOST important to emphasize?

<p>Report abdominal pain, tenderness, or nausea immediately. (B)</p> Signup and view all the answers

A client taking montelukast reports increased anxiety and insomnia. What is the MOST appropriate nursing action?

<p>Educate the client to be aware of any behavioral changes and report to the provider. (C)</p> Signup and view all the answers

A client who is prescribed ipratropium reports experiencing dry mouth. Which intervention should the nurse recommend?

<p>Providing the client with sugar-free hard candy to suck on. (D)</p> Signup and view all the answers

Why are leukotriene modifiers generally avoided for acute asthma exacerbations?

<p>They take too long to take effect. (C)</p> Signup and view all the answers

Why should a nurse inquire about glaucoma when a client is prescribed an inhaled anticholinergic?

<p>Anticholinergics can increase intraocular pressure, potentially worsening narrow-angle glaucoma. (C)</p> Signup and view all the answers

A client taking warfarin begins taking zileuton. What potential interaction should the nurse monitor for?

<p>Increased anticoagulant effects of warfarin, increasing the risk of bleeding. (A)</p> Signup and view all the answers

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?

<p>5 minutes (C)</p> Signup and view all the answers

A client is prescribed a combination inhaler containing both a LABA and a LAMA. What condition is this MOST likely intended to treat?

<p>Maintenance treatment of COPD (B)</p> Signup and view all the answers

A nurse is providing instructions to a client who is starting on inhaled ipratropium. Which of the following should be included in the teaching?

<p>Rinse your mouth with water after each use to minimize any unpleasant aftertaste. (B)</p> Signup and view all the answers

Ipratropium is contraindicated, or requires cautious use, in clients with which of the following conditions?

<p>Prostatic hyperplasia (A)</p> Signup and view all the answers

A client with COPD is prescribed albuterol/ipratropium. What is its primary mechanism of action?

<p>Dilating the bronchial smooth muscles by stimulating beta2-adrenergic and inhibiting muscarinic receptors (A)</p> Signup and view all the answers

Why is it important for clients taking beta2-adrenergic agonists to maintain a log of the frequency and intensity of asthma exacerbations?

<p>To identify potential triggers and patterns associated with asthma attacks. (A)</p> Signup and view all the answers

Why is combining inhaled medications into a single inhaler considered beneficial for respiratory conditions?

<p>It is more convenient for the client than taking medications separately. (D)</p> Signup and view all the answers

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?

<p>To reduce inflammation and prevent bronchoconstriction for long-term control of asthma (C)</p> Signup and view all the answers

What is the expected pharmacologic action of beta2-adrenergic agonists?

<p>Bronchodilation through the sympathetic nervous system. (D)</p> Signup and view all the answers

A client taking fluticasone/salmeterol for COPD reports experiencing a hoarse voice. What instruction is MOST appropriate?

<p>Rinse the mouth with water after each use. (D)</p> Signup and view all the answers

What adverse effect of inhaled anticolinergics requires monitoring of urinary elimination patterns, especially in older adults?

<p>Urinary retention (D)</p> Signup and view all the answers

Which of the following medications would reduce the effectiveness of beta2-adrenergic agonists?

<p>Beta-adrenergic blockers (C)</p> Signup and view all the answers

A client with COPD is prescribed vilanterol/umeclidinium. What is the expected outcome of this medication?

<p>Prevention of exacerbations or worsening of COPD (C)</p> Signup and view all the answers

A client is to start taking budesonide/albuterol. For what purpose is this combination of medications used?

<p>To prevent constriction and reduce exacerbations of asthma (D)</p> Signup and view all the answers

A client with liver dysfunction is prescribed a leukotriene modifier for asthma. Which medication would be MOST appropriate?

<p>Montelukast (A)</p> Signup and view all the answers

A client taking theophylline begins taking zileuton. What potential interaction should the nurse monitor for?

<p>Increase in theophylline levels. (C)</p> Signup and view all the answers

A client taking phenytoin begins taking montelukast. What potential interaction should the nurse monitor for?

<p>Decreased levels of montelukast. (B)</p> Signup and view all the answers

A client is prescribed both furosemide and a glucocorticoid. Monitoring for which electrolyte imbalance is most critical due to the interaction of these medications?

<p>Hypokalemia (A)</p> Signup and view all the answers

The concurrent use of glucocorticoids and NSAIDs requires careful monitoring due to an increased risk of which adverse effect?

<p>Gastrointestinal bleeding (C)</p> Signup and view all the answers

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?

<p>Decreased effectiveness of insulin, potentially requiring a higher dose. (D)</p> Signup and view all the answers

Mast cell stabilizers like cromolyn are prescribed for asthma management due to their ability to primarily target which aspect of asthma pathology?

<p>Prophylactic reduction of bronchial inflammation (A)</p> Signup and view all the answers

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?

<p>Preventing release of histamine and leukotrienes (C)</p> Signup and view all the answers

For optimal prevention of exercise-induced bronchospasm (EIB) with inhaled cromolyn, when should a client administer the medication relative to their workout?

<p>10 to 15 minutes prior to exercise (D)</p> Signup and view all the answers

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?

<p>No, cromolyn is for preventing asthma exacerbations and is not effective for acute attacks. (D)</p> Signup and view all the answers

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?

<p>Mast Cell Stabilizers (B)</p> Signup and view all the answers

A client using inhaled cromolyn reports experiencing a sudden rash, swelling of the mouth, and wheezing after inhalation. What is the priority nursing instruction?

<p>Seek immediate medical care due to potential severe allergic reaction. (D)</p> Signup and view all the answers

Leukotriene modifiers are prescribed for asthma to achieve which therapeutic outcome?

<p>Reduction of bronchoconstriction and inflammation as adjunctive therapy (B)</p> Signup and view all the answers

Montelukast is classified as a leukotriene receptor antagonist. How does this mechanism of action reduce asthma symptoms?

<p>By blocking the action of leukotrienes at receptor sites. (D)</p> Signup and view all the answers

Which leukotriene modifier necessitates routine monitoring of liver function tests due to its potential for causing liver damage?

<p>Both Zileuton and Zafirlukast (C)</p> Signup and view all the answers

Montelukast is prescribed to be administered once daily. What is the recommended timing for administration to optimize its therapeutic effect?

<p>In the evening (D)</p> Signup and view all the answers

All leukotriene modifiers carry a slight risk of neuropsychiatric adverse effects. Which of the following manifestations would necessitate immediate reporting to the healthcare provider?

<p>Suicidal thoughts or behaviors (A)</p> Signup and view all the answers

A patient with asthma is prescribed budesonide/albuterol. What is the primary mechanism of action of this combination medication?

<p>Budesonide reduces airway inflammation, while albuterol stimulates beta2 receptors for bronchodilation. (B)</p> Signup and view all the answers

Fluticasone/salmeterol is prescribed for a patient with COPD. What is the main therapeutic goal of this medication?

<p>To prevent exacerbations and worsening of COPD symptoms. (A)</p> Signup and view all the answers

A patient is prescribed fluticasone/vilanterol/umeclidinium. Which of the following mechanisms of action are provided by this combination medication?

<p>Reduction of airway inflammation, stimulation of beta2 receptors, and inhibiting acetylcholine at muscarinic receptors. (C)</p> Signup and view all the answers

A patient taking a beta2-adrenergic agonist reports experiencing heart palpitations and tremors. What is the underlying reason for these adverse effects?

<p>The medication is mimicking the action of the sympathetic nervous system. (D)</p> Signup and view all the answers

Which adverse effect should the nurse monitor for in a patient taking an inhaled combination medication that contains an anticholinergic?

<p>Urinary retention (C)</p> Signup and view all the answers

A patient using an inhaled corticosteroid develops oral candidiasis. What intervention should the nurse anticipate?

<p>Notifying the provider to prescribe antifungal therapy. (B)</p> Signup and view all the answers

A patient is prescribed albuterol/ipratropium via MDI. What is the recommended maximum daily dosage due to the stimulating effects of the medication?

<p>Six inhalations (C)</p> Signup and view all the answers

A patient is prescribed vilanterol/umeclidinium. For which condition is this medication appropriate?

<p>For daily maintenance to prevent bronchospasms (D)</p> Signup and view all the answers

A patient with asthma is prescribed budesonide/albuterol. How should the patient administer the medication?

<p>Two inhalations as needed, up to twelve inhalations in a 24-hr period. (A)</p> Signup and view all the answers

A patient is prescribed fluticasone/salmeterol. What is the typical administration schedule for this medication?

<p>One to two inhalations, twice a day. (D)</p> Signup and view all the answers

A patient with COPD is prescribed fluticasone/vilanterol/umeclidium. When should the patient use this medication?

<p>Once a day for maintenance treatment of COPD. (C)</p> Signup and view all the answers

What key information should the nurse include when teaching a patient about using inhaled combination medications?

<p>How to clean the inhaler device, recognize adverse effects, and avoid triggers of exacerbations. (C)</p> Signup and view all the answers

Why is it important to teach clients taking inhaled medications to keep a log of the frequency and intensity of exacerbations?

<p>To help them learn and understand what is causing their exacerbations. (D)</p> Signup and view all the answers

How is the effectiveness of inhaled combination medications best evaluated in a patient with COPD or asthma?

<p>By assessing changes in respiratory effort, lung sounds, and oxygen saturation. (A)</p> Signup and view all the answers

A patient using a metered-dose inhaler (MDI) with a glucocorticoid reports a persistent sore throat. What intervention could minimize this side effect?

<p>Attaching a spacer to the MDI inhaler (D)</p> Signup and view all the answers

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?

<p>Exhale completely, then inhale slowly while pressing the canister, holding your breath for 10 seconds. (B)</p> Signup and view all the answers

A client with COPD is prescribed a dry powder inhaler (DPI). Which instruction is most important to ensure proper medication delivery with this device?

<p>Inhale deeply and rapidly to draw the powder into the lungs. (D)</p> Signup and view all the answers

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?

<p>Beta2-adrenergic agonists promote bronchodilation, allowing better penetration of the glucocorticoid. (D)</p> Signup and view all the answers

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?

<p>Assess the patient's inhaler technique to ensure proper use. (C)</p> Signup and view all the answers

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?

<p>Angina (A)</p> Signup and view all the answers

What is the primary mechanism of action of beta2-adrenergic agonists in the treatment of respiratory disorders?

<p>Relaxing bronchial smooth muscle to cause bronchodilation. (D)</p> Signup and view all the answers

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)?

<p>Soft mist inhalers deliver medication as a fine mist that lasts longer in the air than MDIs. (C)</p> Signup and view all the answers

A patient is prescribed albuterol prior to exercise. What is the rationale for this intervention??

<p>To prevent exercise-induced bronchospasm. (A)</p> Signup and view all the answers

Which statement accurately differentiates between short-acting beta2-adrenergic agonists (SABAs) and long-acting beta2-adrenergic agonists (LABAs)?

<p>SABAs provide quick relief of bronchospasms, while LABAs are used for maintenance therapy. (B)</p> Signup and view all the answers

A patient receives a new prescription for a nebulizer treatment at home. What education should the nurse provide regarding the use of this device?

<p>The patient should inhale and exhale normally through the mouthpiece until the medication is gone. (B)</p> Signup and view all the answers

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?

<p>Decreased medication deposition in the lungs and increased deposition in the oropharynx. (D)</p> Signup and view all the answers

Which beta2-adrenergic agonist has the shortest duration of action?

<p>Albuterol (C)</p> Signup and view all the answers

A patient using a beta2-adrenergic agonist reports experiencing tremors. What intervention should the nurse implement?

<p>Reassure the patient that tremors are a common side effect and usually decrease with continued use. (A)</p> Signup and view all the answers

What benefit do soft mist inhalers provide compared to other inhaler devices??

<p>They release medication in a way that lasts longer in the air, meaning that the patient can inspire the same does of medication in a longer period of time. (D)</p> Signup and view all the answers

What is a potential consequence of using a short-acting beta2-adrenergic agonist (SABA) more than twice a week?

<p>Indication of poorly controlled asthma requiring further evaluation and adjustment of maintenance therapy. (A)</p> Signup and view all the answers

Why is it important to instruct patients taking oral glucocorticoids to avoid NSAIDs and use acetaminophen instead for mild pain?

<p>NSAIDs increase the risk of gastric ulcers when taken with glucocorticoids, while acetaminophen does not have this effect. (C)</p> Signup and view all the answers

A patient on long-term oral glucocorticoids is scheduled for surgery. Why might supplemental doses of glucocorticoids be necessary?

<p>The adrenal gland may not be functioning optimally, and unable to produce enough cortisol during stress. (C)</p> Signup and view all the answers

What is the primary reason for tapering the dose of oral glucocorticoids gradually rather than stopping them abruptly?

<p>Abrupt cessation can cause adrenal crisis if adrenal suppression has occurred. (B)</p> Signup and view all the answers

A patient using an inhaled beta2-adrenergic agonist and an inhaled glucocorticoid concurrently should be instructed to:

<p>Use the beta2-adrenergic agonist first to dilate the airways before administering the inhaled glucocorticoid. (C)</p> Signup and view all the answers

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?

<p>Assess for oral candidiasis and notify the primary care provider for possible antifungal treatment. (A)</p> Signup and view all the answers

A client on long-term glucocorticoid therapy should be educated about potential adverse effects. Which of the following should the nurse include?

<p>Increased risk of infection and delayed wound healing. (C)</p> Signup and view all the answers

Why is alternate-day dosing sometimes prescribed for clients on long-term oral glucocorticoid therapy?

<p>To decrease the incidence of adverse drug reactions and adrenal function suppression. (B)</p> Signup and view all the answers

A patient with a history of peptic ulcer disease is prescribed oral glucocorticoids for rheumatoid arthritis. What precaution is most important?

<p>Monitor the patient closely for signs of gastrointestinal bleeding. (C)</p> Signup and view all the answers

A patient taking intranasal glucocorticoids reports frequent nosebleeds. What should the nurse recommend?

<p>Apply petroleum jelly to the nasal passages and use a humidifier. (A)</p> Signup and view all the answers

A client on long-term glucocorticoids reports increased thirst and frequent urination. What should the nurse do first?

<p>Assess the client for hyperglycemia and report findings to the provider. (A)</p> Signup and view all the answers

A patient with completely blocked nasal passages is prescribed an intranasal glucocorticoid. What should the nurse administer first?

<p>A nasal decongestant to open the nasal passages. (C)</p> Signup and view all the answers

After starting intranasal glucocorticoid therapy, how long should a patient expect it to take before experiencing the full therapeutic effects?

<p>2 to 3 weeks. (C)</p> Signup and view all the answers

A client on long-term glucocorticoid therapy is at risk of developing osteoporosis. Which interventions should the nurse include in the patient's teaching?

<p>Increase intake of calcium and vitamin D, and perform weight-bearing exercises daily. (B)</p> Signup and view all the answers

A client with which condition should avoid oral glucocorticoids due to an increased risk of complications?

<p>Systemic fungal infection. (C)</p> Signup and view all the answers

A patient taking inhaled glucocorticoids is instructed to use a spacer. What is the primary reason for this recommendation?

<p>To decrease medication deposition in the mouth and oropharynx. (A)</p> Signup and view all the answers

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?

<p>Hyperglycemia (A)</p> Signup and view all the answers

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)?

<p>Spacer (B)</p> Signup and view all the answers

For a patient with chronic obstructive pulmonary disease (COPD), why are inhaled glucocorticoids generally favored over oral glucocorticoids for long-term maintenance therapy?

<p>Inhaled forms have a lower risk of systemic side effects. (A)</p> Signup and view all the answers

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?

<p>Using a humidifier and increasing fluid intake (C)</p> Signup and view all the answers

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?

<p>Monitoring blood glucose levels (B)</p> Signup and view all the answers

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?

<p>Early indicators of a suppressed immune response and potential infection (B)</p> Signup and view all the answers

What is the primary pharmacological action of glucocorticoids in managing inflammatory conditions like asthma?

<p>Suppressing the production and release of inflammatory mediators (D)</p> Signup and view all the answers

A patient taking both a beta2-adrenergic agonist and a thiazide diuretic should be monitored closely for which electrolyte imbalance?

<p>Hypokalemia (C)</p> Signup and view all the answers

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?

<p>A mast cell stabilizer. (D)</p> Signup and view all the answers

To minimize the risk of peptic ulcer disease in a patient who is prescribed long-term oral prednisone, which intervention is most appropriate?

<p>Recommending the patient take prednisone with food or meals (A)</p> Signup and view all the answers

Concurrent use of inhaled glucocorticoids and NSAIDs increases the risk for what adverse effect?

<p>Gastrointestinal bleeding (C)</p> Signup and view all the answers

A patient is prescribed inhaled budesonide for daily management of persistent asthma. What is the crucial instruction regarding the administration schedule of this medication?

<p>Take it on a regular, scheduled basis as prescribed (D)</p> Signup and view all the answers

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?

<p>Increased fluid intake and humidification. (A)</p> Signup and view all the answers

What potential interaction should be monitored in a patient taking both anticholinergics and an inhaled combination medication that also contains an anticholinergic?

<p>Additive anticholinergic effects (D)</p> Signup and view all the answers

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?

<p>Hypokalemia (D)</p> Signup and view all the answers

First-generation antihistamines are contraindicated or used with extreme caution in patients with which condition?

<p>Glaucoma (D)</p> Signup and view all the answers

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?

<p>A sympathomimetic. (C)</p> Signup and view all the answers

An older male patient is prescribed diphenhydramine for seasonal allergies. What specific adverse effect should the nurse monitor for, given the patient's demographic?

<p>Urinary retention (D)</p> Signup and view all the answers

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?

<p>To provide continuous antihistamine coverage while minimizing daytime drowsiness. (B)</p> Signup and view all the answers

For a patient undergoing long-term oral glucocorticoid therapy, which laboratory assessment is most important to monitor to detect potential adrenal insufficiency?

<p>Plasma cortisol levels (D)</p> Signup and view all the answers

Which of the following adverse effects is more commonly associated with inhaled glucocorticoids compared to oral glucocorticoids?

<p>Oral candidiasis (D)</p> Signup and view all the answers

A patient with a persistent cough is prescribed guaifenesin, an expectorant. What teaching point should the nurse emphasize to optimize the medication's effectiveness?

<p>Use a humidifier to add moisture to the air. (B)</p> Signup and view all the answers

A patient reports persistent dry mouth after starting diphenhydramine. What intervention should the nurse recommend?

<p>Chewing sugar-free gum or sucking on hard candy (D)</p> Signup and view all the answers

Why is it generally advised to avoid or use non-steroidal anti-inflammatory drugs (NSAIDs) cautiously in patients taking glucocorticoids?

<p>Increased risk of gastrointestinal bleeding (B)</p> Signup and view all the answers

Why are sedating antihistamines administered cautiously to clients taking CNS depressants?

<p>To avoid a synergistic effect, leading to increased CNS depression (D)</p> Signup and view all the answers

Which glucocorticoid is most commonly administered orally for short-term management of acute asthma exacerbations?

<p>Prednisone (C)</p> Signup and view all the answers

A patient taking a sedating antihistamine reports experiencing dizziness. What safety precaution should the nurse emphasize?

<p>Avoiding driving or operating heavy machinery (C)</p> Signup and view all the answers

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?

<p>It is intended for long-term control and not for immediate relief of acute symptoms. (A)</p> Signup and view all the answers

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?

<p>Dry mouth and constipation (D)</p> Signup and view all the answers

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?

<p>Monitor for urinary retention and notify the provider if it occurs (A)</p> Signup and view all the answers

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?

<p>Hyperglycemic effect (D)</p> Signup and view all the answers

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?

<p>At least 30 minutes before the activity (A)</p> Signup and view all the answers

A patient on MAOIs is prescribed a beta2-adrenergic agonist. What potential adverse effects should the nurse monitor for?

<p>Hypertension, tachycardia, and angina (C)</p> Signup and view all the answers

A patient prescribed inhaled glucocorticoids is also taking immunosuppressants. What is the primary concern regarding this combination of medications?

<p>Increased risk of infection (D)</p> Signup and view all the answers

A patient is taking a sedating antihistamine and reports abdominal discomfort. What instruction should the nurse provide?

<p>Take the medication with food (A)</p> Signup and view all the answers

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?

<p>Advise the client to eliminate caffeine from their diet and notify their healthcare provider. (D)</p> Signup and view all the answers

What specific instruction should a nurse provide to a client who has been prescribed a combination inhaler containing an anticholinergic agent?

<p>Suck on hard candy or sip water frequently throughout the day. (C)</p> Signup and view all the answers

A client is prescribed a combination inhaler containing a glucocorticosteroid. Why is it important to rinse the mouth and gargle after each use?

<p>To reduce the risk of developing oral candidiasis. (D)</p> Signup and view all the answers

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)?

<p>It reduces the amount of medication deposited in the mouth and oropharynx. (D)</p> Signup and view all the answers

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?

<p>Heart palpitations or chest pain (C)</p> Signup and view all the answers

A client is prescribed albuterol/ipratropium with a known history of glaucoma. What specific precaution should the healthcare provider consider?

<p>The ipratropium component can increase intraocular pressure. (D)</p> Signup and view all the answers

Which pre-existing condition would be of MOST concern prior to administering a LABA/LAMA combination inhaler?

<p>Severe lactose intolerance (B)</p> Signup and view all the answers

A client with a history of a seizure disorder is prescribed budesonide/albuterol. Which potential effect of this combination warrants careful monitoring?

<p>Central nervous system (CNS) stimulation (B)</p> Signup and view all the answers

Why is fluticasone/salmeterol contraindicated in clients experiencing status asthmaticus or acute bronchospasm?

<p>It is a long-acting medication and not suitable for acute relief. (D)</p> Signup and view all the answers

A client taking fluticasone/salmeterol is also being treated with a monoamine oxidase inhibitor (MAOI). What is the primary concern regarding this drug interaction?

<p>Potentiation of cardiovascular effects (B)</p> Signup and view all the answers

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?

<p>Difficulty initiating or maintaining a urine stream (A)</p> Signup and view all the answers

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?

<p>Reduced effectiveness of the beta2-adrenergic agonist. (A)</p> Signup and view all the answers

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?

<p>Narrow-angle glaucoma (A)</p> Signup and view all the answers

A client using a combination inhaler that includes an inhaled corticosteroid reports experiencing hoarseness. What intervention is MOST appropriate to suggest?

<p>Rest the voice and use a humidifier. (D)</p> Signup and view all the answers

A client with a known hypersensitivity to atropine is prescribed a respiratory medication. Which of the following medications would be MOST concerning?

<p>Ipratropium (A)</p> Signup and view all the answers

Why are second-generation antihistamines preferred over first-generation antihistamines for managing allergic rhinitis?

<p>They have a lower incidence of anticholinergic and sedative side effects. (A)</p> Signup and view all the answers

A client with a history of hypertension is prescribed phenylephrine for nasal congestion. What potential adverse effect should the nurse monitor for?

<p>Increased blood pressure (C)</p> Signup and view all the answers

A patient taking cetirizine reports experiencing a dry mouth. What is the MOST appropriate recommendation?

<p>Chew sugar-free gum or suck on hard candies to stimulate saliva production. (A)</p> Signup and view all the answers

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?

<p>Monitor blood pressure regularly and report significant increases. (B)</p> Signup and view all the answers

Why is it important to avoid alcohol and other CNS depressants while taking sedating antihistamines?

<p>To minimize the risk of additive CNS depression, which can be life-threatening. (D)</p> Signup and view all the answers

A patient reports experiencing rebound congestion after using an over-the-counter nasal decongestant for 10 days. What intervention is MOST appropriate?

<p>Recommend a nasal glucocorticoid and gradually taper the nasal decongestant. (C)</p> Signup and view all the answers

Which of the following pre-existing conditions would be a contraindication for the use of a sympathomimetic medication?

<p>Narrow-angle glaucoma (C)</p> Signup and view all the answers

A patient with allergic rhinitis is prescribed loratadine. What instruction should the nurse emphasize regarding the timing and administration of this medication?

<p>Take the medication once daily, preferably at a consistent time. (B)</p> Signup and view all the answers

A patient taking an MAOI antidepressant is prescribed pseudoephedrine for nasal congestion. What risk should the healthcare provider consider?

<p>Potentiation of sympathomimetic effects, leading to hypertensive crisis. (C)</p> Signup and view all the answers

Why are pseudoephedrine and ephedrine use restricted or require special monitoring?

<p>They have a potential for misuse and abuse due to their stimulant properties. (D)</p> Signup and view all the answers

Which of the following conditions would be a contraindication for using sedating antihistamines?

<p>Prostatic hypertrophy (D)</p> Signup and view all the answers

Which of the following assessment findings would indicate a potential overdosage of an oral sympathomimetic medication?

<p>Increased heart rate and palpitations. (C)</p> Signup and view all the answers

A client reports difficulty sleeping after starting an oral decongestant. What is the MOST appropriate nursing intervention?

<p>Monitor for agitation, anxiety, and insomnia, considering a mild hypnotic if needed. (B)</p> Signup and view all the answers

A client with seasonal allergies is prescribed cetirizine. Which of the following assessment findings would warrant caution when administering this medication?

<p>History of urinary retention (D)</p> Signup and view all the answers

What is the primary reason for cautioning clients against the prolonged use (longer than 3-5 days) of topical nasal decongestants?

<p>To avoid rebound congestion. (D)</p> Signup and view all the answers

How do sympathomimetic medications, such as phenylephrine, alleviate nasal congestion?

<p>By stimulating alpha1-adrenergic receptors, causing vasoconstriction and shrinking nasal turbinates. (C)</p> Signup and view all the answers

What is a critical instruction to provide to individuals taking nonsedating antihistamines regarding activities that require mental alertness?

<p>Avoid driving or operating machinery until they determine the medication's effect on their alertness. (C)</p> Signup and view all the answers

Why are sympathomimetics like pseudoephedrine and ephedrine significantly limited in use?

<p>Due to their potential for abuse. (B)</p> Signup and view all the answers

How does theophylline interact with nonsedating antihistamines?

<p>Theophylline reduces the clearance of antihistamines, potentially leading to toxicity. (B)</p> Signup and view all the answers

A client with a history of coronary artery disease is prescribed a sympathomimetic for nasal congestion. Which monitoring parameter is MOST critical?

<p>Monitoring for chest pain or changes in heart rhythm (C)</p> Signup and view all the answers

A patient is prescribed benzonatate for a cough. How does this medication work?

<p>By suppressing the cough reflex in the brain. (B)</p> Signup and view all the answers

Why are sympathomimetic medications like phenylephrine ineffective for treating allergic rhinitis-related sneezing and itching?

<p>They primarily target alpha1-adrenergic receptors to relieve nasal congestion, not histamine-mediated symptoms. (D)</p> Signup and view all the answers

A patient is prescribed an antitussive containing codeine. What common side effect should the patient be educated about?

<p>Drowsiness (C)</p> Signup and view all the answers

Before administering a nonsedating antihistamine to an older adult, what specific consideration regarding their health history is MOST important?

<p>History of impaired kidney or liver function. (B)</p> Signup and view all the answers

A patient is prescribed dextromethorphan for a persistent cough related to a cold. Which of the following statements is MOST accurate regarding dextromethorphan?

<p>It is a nonopioid antitussive and rarely causes drowsiness. (D)</p> Signup and view all the answers

A client who is breastfeeding asks if it safe to take loratadine for seasonal allergies. What is the MOST appropriate response?

<p>&quot;It is best to avoid loratadine while breastfeeding, as it can pass into breast milk and may affect the infant.&quot; (C)</p> Signup and view all the answers

When should a client who is prescribed a nonsedating antihistamine be assessed during ambulation to determine their degree of drowsiness and fatigue?

<p>When dosages are higher than typically recommended (B)</p> Signup and view all the answers

A client taking a sympathomimetic reports feeling agitated and anxious. What is the underlying cause of these symptoms?

<p>Stimulation of adrenergic receptors in the central nervous system. (D)</p> Signup and view all the answers

A patient is prescribed both a beta2-adrenergic agonist and pseudoephedrine. What potential interaction should the healthcare provider be aware of?

<p>Potentiation of hypertensive effects. (D)</p> Signup and view all the answers

Which instruction should a nurse provide to a client who is prescribed phenylephrine nasal spray to minimize the risk of rebound congestion?

<p>Limit the use of the medication to 3 to 5 days. (D)</p> Signup and view all the answers

Why is it important to instruct clients not to chew sustained-release guaifenesin tablets?

<p>Chewing the tablet can lead to a rapid release of the medication, potentially increasing adverse effects. (D)</p> Signup and view all the answers

A client taking guaifenesin reports dizziness. What should the nurse advise?

<p>Sit or lie down to prevent injury, and change positions slowly. (C)</p> Signup and view all the answers

A client with diabetes is prescribed guaifenesin. What precaution is most relevant?

<p>Monitor blood glucose levels closely due to the sugar content of some formulations. (B)</p> Signup and view all the answers

What is the primary mechanism of action of acetylcysteine as a mucolytic agent?

<p>Breaking disulfide linkages in mucus to decrease its viscosity. (A)</p> Signup and view all the answers

A client receiving acetylcysteine develops bronchospasm. What is the priority intervention?

<p>Discontinue the acetylcysteine and administer a bronchodilator. (D)</p> Signup and view all the answers

What is the most important reason for ensuring that equipment used to administer acetylcysteine does not contain metal or rubber parts?

<p>Acetylcysteine can damage these materials. (B)</p> Signup and view all the answers

A client with a tracheostomy is ordered to receive acetylcysteine. What is a critical nursing action before administering the medication?

<p>Clear the client’s airway through suctioning. (D)</p> Signup and view all the answers

A client is prescribed acetylcysteine, and reports nausea associated with a rotten-egg smell. What intervention should the nurse implement?

<p>Administer ordered antiemetic. (A)</p> Signup and view all the answers

Why is it important to instruct clients on the proper cleaning of nebulizer equipment used for respiratory treatments?

<p>To prevent microbial contamination and pulmonary infections. (B)</p> Signup and view all the answers

Use caution when administering mucolytics to clients with?

<p>History of Asthma. (C)</p> Signup and view all the answers

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?

<p>Avoid oral administration due to the risk of gastric bleeding. (B)</p> Signup and view all the answers

A client is receiving acetylcysteine and activated charcoal concurrently. What potential interaction should the nurse monitor for?

<p>Decreased effectiveness of activated charcoal. (A)</p> Signup and view all the answers

Beta2-adrenergic agonists work to relieve bronchospasm by:

<p>Stimulating beta2 receptors in the bronchioles. (B)</p> Signup and view all the answers

How do anticholinergics relieve bronchospasm?

<p>Inhibiting the parasympathetic system. (B)</p> Signup and view all the answers

Methylxanthines relax bronchial smooth muscle by:

<p>Blocking phosphodiesterase enzymes. (A)</p> Signup and view all the answers

A patient with a history of emphysema is prescribed an antitussive. Which potential risk should be MOST carefully monitored by the healthcare provider?

<p>Respiratory depression due to reduced respiratory reserve (A)</p> Signup and view all the answers

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?

<p>Potentiation of the analgesic effects of the opioid (B)</p> Signup and view all the answers

A client taking an opioid antitussive reports feeling lightheaded upon standing. Which intervention should the nurse implement FIRST?

<p>Instruct the client to change positions slowly and sit or lie down (C)</p> Signup and view all the answers

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?

<p>Avoid opioid-based antitussives and monitor closely for misuse (B)</p> Signup and view all the answers

A male client with prostatic hypertrophy is prescribed an opioid antitussive. What specific instruction should the nurse provide regarding a potential adverse effect?

<p>Monitor for and report any difficulty initiating urination (D)</p> Signup and view all the answers

Which of the following findings would necessitate the MOST immediate intervention in a client receiving an opioid antitussive?

<p>A respiratory rate of 10 breaths per minute (A)</p> Signup and view all the answers

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?

<p>Increased sensitivity to CNS depressant effects (A)</p> Signup and view all the answers

A client is prescribed guaifenesin for a productive cough associated with bronchitis. What is the expected outcome of this medication?

<p>Thinning of respiratory secretions for easier expectoration (D)</p> Signup and view all the answers

A client taking guaifenesin reports experiencing nausea. Which of the following instructions would be MOST appropriate to provide?

<p>Take the medication with food or a full glass of water (B)</p> Signup and view all the answers

A client has been prescribed guaifenesin. Which instruction regarding fluid intake is MOST important for the nurse to emphasize?

<p>Increase daily fluid intake to help liquefy secretions (C)</p> Signup and view all the answers

A client is taking guaifenesin for a cough associated with a cold. When should the client contact their healthcare provider?

<p>If a high fever develops or the cough worsens (B)</p> Signup and view all the answers

A patient reports taking St. John's Wort concurrently with an opioid antitussive. What potential interaction should the nurse be MOST concerned about?

<p>Increased CNS depression and sedation (B)</p> Signup and view all the answers

Which of the following instructions is MOST important for a client who is prescribed an antitussive containing codeine?

<p>Avoid activities requiring mental alertness due to potential sedation. (A)</p> Signup and view all the answers

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?

<p>Contraindication due to increased risk of adverse effects. (B)</p> Signup and view all the answers

A client is prescribed a combination cold medication containing guaifenesin. The nurse should emphasize which of the following points when educating the client?

<p>Avoid taking additional medications that also contain guaifenesin (D)</p> Signup and view all the answers

Flashcards

Respiratory System Medications

Medications that treat disorders of the respiratory system, including lower and upper respiratory tract disorders.

Agonists (Beta2-Adrenergic)

Stimulate receptors, specifically beta2 cells of the sympathetic nervous system, leading to bronchodilation.

Bronchodilators

Medications like beta2-adrenergic agonists, anticholinergics, and methylxanthines, which help to widen the airways.

Anti-inflammatory Respiratory Medications

Medications like glucocorticoids, mast cell stabilizers, and leukotriene modifiers, which help reduce inflammation in the airways.

Signup and view all the flashcards

Airflow Disorders

Asthma, chronic bronchitis, and emphysema.

Signup and view all the flashcards

Inhalation Devices

Metered-dose inhalers (MDIs), dry powder inhalers (DPIs), soft mist inhalers, and nebulizers.

Signup and view all the flashcards

Benefits of Inhalation

Directly reach the bronchioles, minimize systemic effects, and provide faster relief of bronchoconstriction.

Signup and view all the flashcards

Inhalation Devices Use

Delivers Beta2-adrenergic agonists, anticholinergics, glucocorticoids, or combination of these medications directly to the lungs.

Signup and view all the flashcards

MDI Inhaler

A handheld pressurized canister that delivers a measured dose of medication.

Signup and view all the flashcards

MDI Spacer

Attaches to an MDI to hold medication, giving more time to inhale.

Signup and view all the flashcards

DPI Inhaler

A portable device with pre-set doses of powdered medication that requires a fast, deep breath.

Signup and view all the flashcards

Soft Mist Inhaler

A multi-dose device preloaded with liquid medication that doesn't use propellants, releasing a fine mist.

Signup and view all the flashcards

Nebulizer

A device that turns liquid medication into a mist, inhaled through a mask or mouthpiece.

Signup and view all the flashcards

Beta2-Adrenergic Agonists

Medications used to relieve bronchospasms and prevent exercise-induced bronchospasm (EIB).

Signup and view all the flashcards

Rescue Inhalers

Medications that provide fast relief from bronchospasms.

Signup and view all the flashcards

Long-Acting Beta2-Adrenergic Agonists (LABAs)

Medications used for long-term management of respiratory conditions.

Signup and view all the flashcards

Albuterol

Prototype short-acting beta2-adrenergic agonist (SABA) medication.

Signup and view all the flashcards

Pharmacologic Action of Beta2-Agonists

Stimulation of beta2-adrenergic receptors, causing bronchodilation.

Signup and view all the flashcards

Adverse Effects of Beta2-Agonists

Increased heart rate, palpitations, and tremors.

Signup and view all the flashcards

Paradoxical Bronchospasm

Monitor for increased bronchoconstriction after treatment.

Signup and view all the flashcards

Beta2-Agonist Administration

Administer short-acting for acute exacerbations, long-acting for long-term control.

Signup and view all the flashcards

Inhaler Sequence

Inhale beta2-adrenergic agonist before the glucocorticoid medication.

Signup and view all the flashcards

Beta2-Adrenergic Agonists Duration

Beta2-adrenergic agonists are either short acting or long acting.

Signup and view all the flashcards

Beta2-Adrenergic Agonist Instructions

Avoid caffeine and report tremors to your healthcare provider.

Signup and view all the flashcards

Asthma Exacerbation Log

Track frequency and intensity to identify triggers.

Signup and view all the flashcards

Beta2-Agonist Heart Symptoms

Report chest pain, palpitations, or increased HR to your provider.

Signup and view all the flashcards

Albuterol Contraindications

Allergy to albuterol or other beta2-adrenergic agonists.

Signup and view all the flashcards

Beta2-Agonist Interactions (Beta-Blockers)

Beta-adrenergic blockers reduce the effectiveness.

Signup and view all the flashcards

Beta2-Agonist Interactions (MAOIs and Tricyclics)

MAOIs and tricyclic antidepressants increase the risk of hypertension, tachycardia, and angina.

Signup and view all the flashcards

Beta2-Agonist Interactions (Hypoglycemics)

Increased dosing may be required.

Signup and view all the flashcards

Inhaled Anticholinergics

Provide relief of bronchoconstriction and reduce secretions in COPD.

Signup and view all the flashcards

SAMA Prototype

Ipratropium

Signup and view all the flashcards

Anticholinergic Action

Inhibits acetylcholine at muscarinic receptors, causing bronchodilation.

Signup and view all the flashcards

Anticholinergic Side Effects

Dry mouth and pharyngeal irritation.

Signup and view all the flashcards

Dry Mouth Relief

Sip water, suck on hard candy.

Signup and view all the flashcards

Anticholinergic Use

Not for acute asthma exacerbations.

Signup and view all the flashcards

Inhaled Anticholinergic Instructions

Suck on sugar-free hard candies and sip water frequently.

Signup and view all the flashcards

Ipratropium Precautions

Glaucoma, prostatic hyperplasia, bladder neck obstruction, or urinary retention.

Signup and view all the flashcards

Beta2-agonist + anticholinergic interaction

Beta2-adrenergic agonists may increase the bronchodilation effects of inhaled anticholinergics.

Signup and view all the flashcards

Methylxanthines action

Methylxanthines relax the smooth muscles of the bronchi by blocking phosphodiesterase.

Signup and view all the flashcards

Methylxanthine side effects (early)

Restlessness and insomnia are common side effects indicating blood levels of methylxanthines above therapeutic level.

Signup and view all the flashcards

Methylxanthine toxicity signs

Seizures and dysrhythmias may occur when blood level of methylxanthines reaches a toxic level.

Signup and view all the flashcards

Theophylline therapeutic level

The therapeutic level of theophylline is 10 to 20 mcg/mL.

Signup and view all the flashcards

Methylxanthine monitoring

Monitor blood levels to maintain therapeutic level.

Signup and view all the flashcards

Methylxanthine admin route

Administer orally.

Signup and view all the flashcards

Methylxanthine + Caffeine

Reduce or eliminate caffeine intake to avoid increased central nervous system stimulation.

Signup and view all the flashcards

Smoking + Methylxanthines

Smoking tobacco or marijuana can affect metabolic rates of methylxanthines.

Signup and view all the flashcards

Drugs increasing methylxanthine risk

Cimetidine and some fluoroquinolones increase the risk of methylxanthine toxicity.

Signup and view all the flashcards

What decreases methylxanthine level?

Nicotine, phenobarbital, and phenytoin decrease blood level.

Signup and view all the flashcards

Cimetidine risk

Cimetidine for indigestion increases the risk for methylxanthine toxicity.

Signup and view all the flashcards

Activated charcoal

Activated charcoal can decrease absorption of methylxanthines in case of elevated levels.

Signup and view all the flashcards

Methylxanthine Toxicity treatment

Antidysrhythmics and anticonvulsants are necessary to restore heart rate, rhythm and for seizures.

Signup and view all the flashcards

Methylxanthine: Lab tests

Clients must have periodic laboratory testing to maintain a therapeutic level

Signup and view all the flashcards

Glucocorticoids & Diuretics

Avoid giving glucocorticoids with potassium-depleting diuretics like furosemide (Lasix) to prevent hypokalemia.

Signup and view all the flashcards

NSAIDs & Glucocorticoids

Combining NSAIDs with glucocorticoids increases the risk of gastrointestinal bleeding.

Signup and view all the flashcards

Glucocorticoids & Hypoglycemics

Glucocorticoid therapy can decrease the effects of insulin and oral hypoglycemics, potentially leading to hyperglycemia.

Signup and view all the flashcards

Beclomethasone Side Effect

A white coating in the mouth is a possible indication of oral candidiasis (thrush), an adverse effect of beclomethasone oral inhaler use.

Signup and view all the flashcards

Mast Cell Stabilizers

Mast cell stabilizers are anti-inflammatory inhalants used prophylactically to reduce bronchial inflammation in mild to moderate asthma.

Signup and view all the flashcards

Cromolyn Action

Cromolyn is a prototype mast cell stabilizer that prevents the release of leukotrienes and histamine.

Signup and view all the flashcards

Cromolyn for EIB

Cromolyn is used to prevent exercise-induced bronchospasm (EIB).

Signup and view all the flashcards

Cromolyn Timing for EIB

Administer cromolyn 10 to 15 minutes prior to exercise, but no sooner than 1 hour prior, to prevent EIB.

Signup and view all the flashcards

Cromolyn for Allergies

When used prophylactically for seasonal allergies, cromolyn should be taken prior to exposure to allergens.

Signup and view all the flashcards

Cromolyn for Acute Attacks

Cromolyn will not be effective against an acute asthma attack.

Signup and view all the flashcards

Cromolyn Onset

Take cromolyn as prescribed for prevention, and it may take several weeks to achieve therapeutic effects.

Signup and view all the flashcards

Leukotriene Modifiers

Leukotriene modifiers are oral medications used as adjunctive therapy to decrease bronchoconstriction and inflammation.

Signup and view all the flashcards

Leukotriene Modifier Prototypes

Montelukast is the prototype leukotriene modifier, while zileuton and zafirlukast have more adverse effects.

Signup and view all the flashcards

Montelukast Dosing

Montelukast is given once daily in the evening.

Signup and view all the flashcards

Liver Damage & Leukotrienes

Zileuton and zafirlukast, but not montelukast, may cause liver damage, requiring monitoring of liver function tests.

Signup and view all the flashcards

Inhaled drug sequence

Administer beta2-adrenergic agonist first to dilate airways before inhaled glucocorticoid use.

Signup and view all the flashcards

Oral glucocorticoid dosing

Short-term: single/divided doses (5-10 days). Long-term: alternate-day dosing.

Signup and view all the flashcards

Tapering glucocorticoids

Prevents adrenal crisis from adrenal suppression by slowly reducing the dose.

Signup and view all the flashcards

Nasal glucocorticoid use

Nasal metered-dose spray. Taper from initial to lowest effective dose.

Signup and view all the flashcards

Inhaled glucocorticoid tips

Spacer use minimizes medication in mouth/oropharynx; rinse mouth to prevent oral candidiasis.

Signup and view all the flashcards

Alternate-day benefits

Alternate-day dosing decreases side effects and adrenal suppression.

Signup and view all the flashcards

Abrupt stop danger

Gradually taper dose to prevent adrenal insufficiency.

Signup and view all the flashcards

Preventing Osteoporosis

Increase calcium/vitamin D intake and weight-bearing exercise.

Signup and view all the flashcards

Report these side effects

Polyphagia, polydipsia, polyuria, weight gain, edema, weakness.

Signup and view all the flashcards

Gastric protection rules

Avoid NSAIDs, take with food, report bloody vomit or black stools.

Signup and view all the flashcards

Infection signs to watch

Report sore throat, fatigue, tachycardia, drainage. Look for white patches.

Signup and view all the flashcards

Nasal glucocorticoid relief

Use humidifier, increase fluids, suck on hard candy.

Signup and view all the flashcards

Caution conditions

Peptic ulcer disease, diabetes, hypertension, renal dysfunction, NSAIDs.

Signup and view all the flashcards

Adrenal insufficiency signs

Nausea, weakness, fatigue, hypotension, hypoglycemia, abdominal pain, loss of appetite.

Signup and view all the flashcards

Avoid these scenarios

Systemic fungal infection and recent live virus immunization.

Signup and view all the flashcards

EIB medication timing

Give at least 2 hours before exercise; avoid redosing within 24 hours.

Signup and view all the flashcards

Zileuton/zafirlukast warning signs

Report immediately: abdominal pain/tenderness, nausea, or anorexia.

Signup and view all the flashcards

Neuropsychiatric effects of asthma drugs

Anxiety, agitation, insomnia, irritability are possible neuropsychiatric adverse effects.

Signup and view all the flashcards

Monitoring for Zileuton/Zafirlukast

Regular liver function tests are needed to detect liver damage early when taking these drugs.

Signup and view all the flashcards

Zileuton/Zafirlukast contraindication

Liver dysfunction.

Signup and view all the flashcards

When to avoid Leukotriene Modifiers

Not for acute exacerbations; other options have higher efficacy.

Signup and view all the flashcards

Drugs reducing montelukast levels

Phenobarbital, rifampin, or phenytoin.

Signup and view all the flashcards

Zileuton Interactions

Increases levels of Warfarin, Theophylline and Propranolol.

Signup and view all the flashcards

Serious adverse effect of Zileuton

Abdominal pain.

Signup and view all the flashcards

Inhalant combination medications

Combining inhaled medications for convenience and adherence.

Signup and view all the flashcards

SABA/SAMA prototype

Albuterol/Ipratropium.

Signup and view all the flashcards

LABA/LAMA prototype

Vilanterol/Umeclidinium.

Signup and view all the flashcards

Inhaled Glucocorticoid/SABA prototype

Budesonide/Albuterol.

Signup and view all the flashcards

Inhaled Glucocorticoid/LABA prototype

Fluticasone/Salmeterol.

Signup and view all the flashcards

Inhaled Glucocorticoid/LABA/LAMA Prototype

Fluticasone/Vilanterol/Umeclidium.

Signup and view all the flashcards

Theophylline and Coffee

Theophylline interacts with caffeine. Two cups daily may need further instruction.

Signup and view all the flashcards

Glucocorticoids

Medications that suppress the immune system and decrease inflammation.

Signup and view all the flashcards

Glucocorticoid Examples

Beclomethasone dipropionate, prednisone, fluticasone, and budesonide.

Signup and view all the flashcards

Glucocorticoid Action

Suppress inflammation by preventing the release of inflammatory mediators and action of white blood cells.

Signup and view all the flashcards

Oral Candidiasis

Yeast infection of the mouth caused by inhaled glucocorticoids.

Signup and view all the flashcards

Adrenal Insufficiency

Suppression of adrenal function due to long-term oral glucocorticoid use.

Signup and view all the flashcards

Muscle/Bone Effects

Muscle wasting and bone demineralization caused by long-term glucocorticoid therapy.

Signup and view all the flashcards

Hyperglycemia

Elevated blood sugar, a side effect of short- and long-term oral glucocorticoid therapy.

Signup and view all the flashcards

Peptic Ulcer Disease

Stomach ulcers; a side effect of short- and long-term oral glucocorticoid therapy.

Signup and view all the flashcards

Increased risk of infection

Increased risk of infection due to immune suppression from glucocorticoids.

Signup and view all the flashcards

Nasal Glucocorticoid Side Effects

Dry mucous membranes, epistaxis, sore throat, and headaches.

Signup and view all the flashcards

Inhaler Spacer

Attaching a spacer maximizes drug delivery and minimizes contact with mouth tissues.

Signup and view all the flashcards

Oral Glucocorticoid Interventions

Monitor plasma levels, use lowest dose, alternate-day dosing, and gastric protection.

Signup and view all the flashcards

Infection Signs on Steroids

Sore throat, fatigue, tachycardia, and wound discharge.

Signup and view all the flashcards

Analgesic for Nasal Steroids

Administer a non-NSAID analgesic such as acetaminophen.

Signup and view all the flashcards

Sedating Antihistamines

Bind to H1 receptors, blocking histamine release, which can cause drowsiness and other CNS effects.

Signup and view all the flashcards

Nonsedating Antihistamines

Antagonize histamine effects at H1 receptor sites peripherally, without causing significant CNS effects.

Signup and view all the flashcards

Mucolytics

Decrease the viscosity of mucous secretions by breaking down disulfide linkages of proteins in mucus.

Signup and view all the flashcards

Inhaled Glucocorticoid/SABA Action

Decreases inflammation (corticosteroid) and relaxes bronchial smooth muscles (SABA) to prevent acute bronchoconstriction in asthma.

Signup and view all the flashcards

Inhaled Glucocorticoid/LABA Action

Reduces airway inflammation (corticosteroid) and bronchodilation (LABA) for COPD maintenance.

Signup and view all the flashcards

Beta2-Adrenergic Agonist Side Effects

These adverse effects mimic sympathetic nervous system activation.

Signup and view all the flashcards

Anticholinergic Adverse Effects

Dry mouth, increased eye pressure, urinary retention are side effects.

Signup and view all the flashcards

Inhaled Corticosteroid Side Effects

Oral candidiasis and hoarse voice are common side effects.

Signup and view all the flashcards

Combination Inhaler Monitoring

Monitor breathing effort, lung sounds, O2 saturation.

Signup and view all the flashcards

Managing Dry Mouth (Anticholinergics)

Sips of water or hard candy can help.

Signup and view all the flashcards

Oral Candidiasis Treatment

Treat oral candidiasis from inhaled corticosteroids.

Signup and view all the flashcards

SABA/SAMA Administration

Albuterol/Ipratropium: MDI or nebulizer, up to 6 times daily for COPD.

Signup and view all the flashcards

LABA/LAMA Administration

Vilanterol/Umeclidinium: Inhaler once daily; NOT for acute bronchospasm.

Signup and view all the flashcards

Inhaled Glucocorticoid/SABA Administration

Give two inhalations as needed.

Signup and view all the flashcards

Inhaled Glucocorticoid/LABA Administration

Fluticasone/Salmeterol: 1-2 inhalations twice daily; NOT for acute bronchospasm.

Signup and view all the flashcards

Inhaled Glucocorticoid/LABA/LAMA Admin

One inhalation daily for COPD/asthma maintenance; NOT for acute bronchospasm.

Signup and view all the flashcards

Inhaled Meds: Client Education

Correct inhaler technique, med action, side effects, triggers to avoid. Keep records and notify changes.

Signup and view all the flashcards

Beta2-Agonist inhaler instructions

Avoid caffeine and report tremors to the provider.

Signup and view all the flashcards

Anticholinergic inhaler instructions

Suck on hard candy and sip water frequently.

Signup and view all the flashcards

Inhaled glucocorticosteroid instructions

Rinse mouth and gargle after use to prevent oral candidiasis.

Signup and view all the flashcards

Use a spacer with MDI devices

Less medication will deposit in the mouth helping to prevent oral candidiasis.

Signup and view all the flashcards

Report these symptoms

Chest pain, heart palpitations, or tachycardia, especially with cardiovascular disease or hypertension

Signup and view all the flashcards

Report these symptoms

Dizziness, blurred vision, urinary retention, or white patches on mucous membranes.

Signup and view all the flashcards

Albuterol/Ipratropium Caution

Cardiovascular disorders, diabetes, glaucoma, hyperthyroidism, renal impairment, seizure disorder.

Signup and view all the flashcards

Anticholinergic driving

Dizziness and blurred vision may occur, therefore caution should be taken when driving.

Signup and view all the flashcards

Vilanterol/Umeclidinium Caution

Cardiovascular disorders, diabetes, glaucoma, hyperthyroidism, renal impairment, seizure disorders, or are taking MAOIs

Signup and view all the flashcards

Budesonide/Albuterol Caution

Diabetes, hyperthyroidism, seizure disorders, or hypokalemia, cardiovascular disorders.

Signup and view all the flashcards

Inhaled Corticosteroid Monitoring

Monitor for oral candidiasis and take precautions for clients who are at risk for osteoporosis.

Signup and view all the flashcards

Fluticasone/Salmeterol Caution

Cardiovascular disorders, liver disease, diabetes, glaucoma, hyperthyroidism, seizure disorders, and clients who are at risk for osteoporosis, or those being treated with MAOIs.

Signup and view all the flashcards

LAMA Caution

Bladder neck obstruction, history of urinary retention, or prostatic hypertrophy.

Signup and view all the flashcards

Beta-blockers and Beta2-agonists

Less bronchodilation since beta2-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists.

Signup and view all the flashcards

Hypokalemia Risk

Concurrent use of beta2-agonists and thiazide diuretics increase risk for this electrolyte imbalance.

Signup and view all the flashcards

MAOI/TCA Risks

MAOIs and tricyclic antidepressants increase the risk of these three conditions.

Signup and view all the flashcards

Antidiabetic Meds & Beta2-Agonists

These medications may require increased dosing with beta2-adrenergic agonists due to hyperglycemic effects.

Signup and view all the flashcards

Glucocorticoid/NSAID Interaction

Monitor for this when using inhaled glucocorticoids and NSAIDs concurrently.

Signup and view all the flashcards

Glucocorticoid/Immunosuppressant Risk

Monitor for this general condition when using inhaled glucocorticoids with immunosuppressives.

Signup and view all the flashcards

Key Monitoring Parameters

This should be closely monitored during medication therapy for upper respiratory disorders.

Signup and view all the flashcards

Antihistamine Use

These treat mild allergic reactions like seasonal allergic rhinitis and urticaria.

Signup and view all the flashcards

Antihistamines for Anaphylaxis

This drug class can be used during severe allergic reactions (anaphylaxis).

Signup and view all the flashcards

Diphenhydramine

This is the prototype first-generation antihistamine.

Signup and view all the flashcards

H1 Receptor Blockade

Sedating antihistamines block this to reduce allergy symptoms.

Signup and view all the flashcards

Cholinergic Blockade

Sedating antihistamines also act as mild blockers of this system.

Signup and view all the flashcards

Antihistamine Timing

Take this action before activity to prevent motion sickness when using antihistamines.

Signup and view all the flashcards

Urinary Retention

Patients with this condition should use sedating antihistamines with caution and notify their provider.

Signup and view all the flashcards

How Mucolytics Work

Breaks disulfide linkages in mucus, reducing viscosity and making it easier to cough up.

Signup and view all the flashcards

Acetylcysteine

Administered via inhalation to decrease mucus viscosity.

Signup and view all the flashcards

Mucolytic Side Effects

Bronchospasm and gastrointestinal distress.

Signup and view all the flashcards

Mucolytic Interventions

Monitor lung sounds and have suction available.

Signup and view all the flashcards

Client Instructions: Mucolytics

Report breathing difficulty or worsening cough.

Signup and view all the flashcards

Mucolytic Administration

Inhalation (nebulizer) or direct instillation (tracheotomy tube).

Signup and view all the flashcards

Monitoring Mucolytic Use

Monitor respiratory status, lung sounds for adventitious sounds, and administer bronchodilators as needed.

Signup and view all the flashcards

Monitor Respiratory Status:

Respiratory status, adventitious breath sounds.

Signup and view all the flashcards

Expectorant Precautions

Cough lasting more than one week, diabetes, or receiving disulfiram.

Signup and view all the flashcards

Pharmacologic Action of Mucolytics

Breaking disulfide linkages of proteins in mucus, decreasing its viscosity.

Signup and view all the flashcards

Mucolytic Administration Routes

By inhalation through a nebulizer or direct instillation through a tracheotomy tube.

Signup and view all the flashcards

Pre-Administration Check for Mucolytics

Respiratory status and ability to cough.

Signup and view all the flashcards

Contraindications of Oral Mucolytics

Clients at risk of gastric bleeding.

Signup and view all the flashcards

Acetylcysteine Interaction

May decrease the effectiveness of activated charcoal.

Signup and view all the flashcards

Sympathomimetics: Prolonged Use

Relief from nasal congestion is quickly provided, but overuse leads to rebound congestion, needing more frequent usage.

Signup and view all the flashcards

Oral Sympathomimetics: Side Effects

CNS stimulation includes agitation, anxiety, and insomnia. Systemic vasoconstriction may cause hypertension and arrhythmias.

Signup and view all the flashcards

Sympathomimetics: Nursing Actions

Monitor for agitation, anxiety, and insomnia. Report increased heart rate, blood pressure, or palpitations.

Signup and view all the flashcards

Rebound Congestion Treatment

Recommend a nasal glucocorticoid when discontinuing intranasal sympathomimetics after prolonged use.

Signup and view all the flashcards

Sympathomimetics: Cardiac Monitoring

Increased heart rate and blood pressure are side effects. Monitor clients with cardiac issues closely.

Signup and view all the flashcards

Sympathomimetics: Duration of Use

Limit topical use to 3-5 days to avoid rebound congestion.

Signup and view all the flashcards

Sympathomimetics: Client Education

Notify of excessive CNS stimulation, tachycardia, or palpitations. Avoid use >3-5 days due to rebound congestion.

Signup and view all the flashcards

Client Monitoring: Hypertension

Regular BP checks for hypertensive clients on sympathomimetics is very important.

Signup and view all the flashcards

Sympathomimetics: Contraindications

Not for chronic rhinitis or clients with narrow-angle glaucoma, uncontrolled heart disease, hypertension, or dysrhythmia.

Signup and view all the flashcards

Sympathomimetics: Interactions

Do not give MAOIs within 3 weeks of sympathomimetics. Beta2-agonists potentiate hypertensive effects.

Signup and view all the flashcards

Phenylephrine Spray: Rebound Congestion

Limit use to 3-5 days to avoid rebound congestion.

Signup and view all the flashcards

Antitussives

Medications that suppress nonproductive coughing.

Signup and view all the flashcards

Antitussives: Examples

Codeine (opioid) and dextromethorphan (nonopioid); also benzonatate (nonopioid).

Signup and view all the flashcards

Antitussives: Action

Suppress the cough reflex in the brain.

Signup and view all the flashcards

Antitussives: Side Effects

Opioids: drowsiness and sedation. Nonopioids: rare, unless high doses or combined with other CNS depressants.

Signup and view all the flashcards

Sedating Antihistamine Client Advice

Avoid activities requiring alertness due to drowsiness.

Signup and view all the flashcards

Sedating Antihistamine Contraindications

Newborns, breastfeeding women, narrow-angle glaucoma, prostatic hypertrophy, acute asthma exacerbation.

Signup and view all the flashcards

Sedating Antihistamine Interactions (CNS)

Increases risk of CNS depression; potentially life-threatening.

Signup and view all the flashcards

Nonsedating Antihistamine Uses

Allergic rhinitis and chronic idiopathic urticaria.

Signup and view all the flashcards

Prototype Nonsedating Antihistamine

Cetirizine is the prototype of nonsedating antihistamines.

Signup and view all the flashcards

Nonsedating Antihistamine Action

Antagonizes histamine effects at H1 receptor sites. Minimal anticholinergic effects.

Signup and view all the flashcards

Nonsedating Antihistamine Side Effects

Less drowsiness, fatigue, mild dry mouth/nose/throat.

Signup and view all the flashcards

Nonsedating Antihistamine Interventions

Check for drowsiness, ensure hydration, use hard candy for dry mouth.

Signup and view all the flashcards

Nonsedating Antihistamine Instructions

Take once daily, avoid driving if drowsy, hydrate for dry mouth.

Signup and view all the flashcards

Nonsedating Antihistamine Precautions

Infants under 6 months, breastfeeding, H1 antihistamine allergy.

Signup and view all the flashcards

Nonsedating Antihistamine Interactions

Theophylline reduces clearance, sedative/hypnotics potentiate CNS depression.

Signup and view all the flashcards

Sympathomimetic Action

Reduces nasal congestion by vasoconstriction in the nose.

Signup and view all the flashcards

Sympathomimetic Effects

Mimic sympathetic nervous system, activating alpha1-adrenergic receptors.

Signup and view all the flashcards

Prototype Sympathomimetic

Phenylephrine is the prototype sympathomimetic medication.

Signup and view all the flashcards

Opioid Antitussive Side Effects

Common side effects include dizziness, lightheadedness, and gastrointestinal distress (nausea, vomiting).

Signup and view all the flashcards

Serious Opioid Antitussive Side Effects

Include constipation and respiratory depression due to CNS depression.

Signup and view all the flashcards

Interventions for Opioid Antitussives

Monitor position changes, administer with food, limit use to 'as needed', encourage fluids and fiber.

Signup and view all the flashcards

Signs of Respiratory Depression

Respiratory rate below 12 breaths/min or low oxygen saturation.

Signup and view all the flashcards

Actions for Respiratory Depression

Stop the opioid, stimulate breathing, administer naloxone if needed.

Signup and view all the flashcards

Antitussive Administration Guidelines

Use for short term at lowest effective dose, administer only as needed.

Signup and view all the flashcards

Client Instructions for Antitussives

Slow position changes, take with food/milk for GI distress, increase fluids and fiber.

Signup and view all the flashcards

Opioid Antitussive Precautions

Avoid activities requiring alertness, alcohol, and other CNS depressants due to sedation and respiratory depression.

Signup and view all the flashcards

Antitussive Contraindications

Sensitivity to medication, concurrent use of MAOIs or SSRIs, reduced respiratory reserve.

Signup and view all the flashcards

Antitussive Interactions

Increased CNS depression, increased analgesic effects of opioids, fever/hypotension with MAOIs, increased sedation with St. John’s Wort.

Signup and view all the flashcards

Contraindication for Codeine

Emphysema

Signup and view all the flashcards

Dextromethorphan Monitoring

Medication misuse

Signup and view all the flashcards

Expectorants

Medications that reduce the surface tension of secretions, thinning mucus for easier removal.

Signup and view all the flashcards

Adverse Effects of Expectorants

Dizziness, drowsiness, headache, GI distress, allergic rash.

Signup and view all the flashcards

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

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

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.

More Like This

Pharmacology Lab Quiz for Pharm
5 questions
PHARM 5.0 Pharmacology Made Easy: Key Concepts
88 questions
Use Quizgecko on...
Browser
Browser