Chapter 37, 38 Pharmacology PDF

lOMoARcPSD|40099567 Chapter 37: Antihistamines, Decongestants, Antitussives, and Expectorants Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which instruction is correct for a patient taking an antihistamine?...

lOMoARcPSD|40099567 Chapter 37: Antihistamines, Decongestants, Antitussives, and Expectorants Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which instruction is correct for a patient taking an antihistamine? a. Eat chocolate bars to ease the discomfort of dry mouth. b. Antihistamines are generally safe to take with over-the-counter (OTC) medications. c. Take the medication on an empty stomach to maximize absorption of the drug. d. Take the medication with food, even though doing so may slightly reduce the absorption of the drug. ANS: D Antihistamines should be taken with food to minimize the gastrointestinal upset that can occur, even though doing so slightly reduces the absorption of the drug. The patient can suck on candy or chew gum to ease dry mouth discomfort. OTC medications should not be taken with an antihistamine unless approved by the physician; taking antihistamines with OTC medications may lead to serious drug interactions. DIF: Cognitive Level: Analysis 2. How does the antitussive dextromethorphan (Benylin DM-E®) work to suppress the cough reflex? a. By causing central nervous system (CNS) depression b. By anaesthetizing the stretch receptors c. Through a direct action on the cough centre d. By decreasing the viscosity of the bronchial secretions ANS: C Dextromethorphan suppresses the cough reflex through direct action on the cough centre. DIF: Cognitive Level: Knowledge 3. Which antihistamine is commonly used in the treatment of motion sickness? a. cyproheptadine hydrochloride b. Loratadine (Claritin) c. Reactine® d. Codeine phosphate ANS: A Cyproheptadine hydrochloride is commonly used in the treatment of motion sickness. DIF: Cognitive Level: Knowledge 4. During a routine checkup, the patient reports an inability to take the prescribed antihistamine because of one of its most common adverse effects. The physician prescribes another antihistamine, loratadine (Claritin ®). What adverse effect has probably been bothering this patient? a. Diarrhea b. Urticaria c. Drowsiness d. Decreased libido ANS: C People who take antihistamines chiefly report drowsiness. Loratadine is a unsedating antihistamine which eliminates many of the adverse effects of the older antihistamines, particularly drowsiness. DIF: Cognitive Level: Comprehension 5. A gardener needs a decongestant because of seasonal allergy problems. Which is a benefit of orally administered decongestants? a. Onset is immediate. b. The effect is more potent. c. Rebound congestion is almost nonexistent. d. The adverse effects of restlessness and nervousness are reduced. ANS: C Rebound congestion is almost nonexistent with the use of oral decongestants. Compared with topically applied decongestants, the onset of orally administered decongestants is more delayed, and the effect is less potent. Nervousness is an adverse effect of decongestants. DIF: Cognitive Level: Comprehension 6. A patient is taking guaifenesin (Balminil®) as part of treatment of influenza. What should the nurse also instruct the patient to do? a. Increase fluids to help loosen and liquefy secretions. b. Report a fever to the doctor if body temperature is above 38.3°C. c. Avoid driving a car or operating heavy machinery, because of the drug’s sedating effects. d. To retain the effects of the medication for a longer period, avoid coughing. ANS: A Increasing fluids helps to loosen and liquefy secretions. DIF: Cognitive Level: Application Copyright © 2021, Elsevier Inc. All rights reserved. 1 Downloaded by Anh Nguy?n ([email protected])  lOMoARcPSD|40099567 7. What systemic effect may occur with the administration of a topically applied adrenergic nasal decongestant? a. Heartburn b. Bradycardia c. Hypotension d. Nervousness ANS: D If a topically administered adrenergic nasal decongestant is absorbed into the bloodstream, CNS effects such as nervousness may occur; hypertension and palpitations may also occur. Heartburn is not an adverse effect of topically applied adrenergic nasal decongestants. DIF: Cognitive Level: Application 8. Which drug is most likely to be chosen to aid in the removal of excessive mucus in the respiratory tract? a. guaifenesin b. benzonatate c. codeine d. dextromethorphan ANS: A Expectorants, such as guaifenesin, work to loosen and thin sputum and bronchial secretions, thereby indirectly diminishing the tendency to cough. Benzonatate, codeine, and dextromethorphan are antitussives (cough suppressants). DIF: Cognitive Level: Knowledge 9. The nurse knows that an antitussive drug is most appropriate for which patient? a. A patient with pneumonia who has a productive cough b. A patient who has a tracheostomy and thick mucus secretions c. A patient who has had a productive cough for 2 weeks d. A patient who has developed bronchitis 2 days after hernia repair surgery ANS: D In a patient who has developed bronchitis 2 days after hernia repair surgery, antitussive drugs help to prevent coughing that is considered harmful rather than useful. Coughing is beneficial in a patient with pneumonia who has a productive cough, in a patient who has a tracheostomy and thick mucus secretions, and in a patient who has had a productive cough for 2 weeks. DIF: Cognitive Level: Analysis 10. A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. What should the nurse tell the patient in regard to the nasal spray? a. Expect the spray’s effects to be delayed for at least 1 week. b. Administer as ordered with no increase in frequency. c. Continue using the spray until the nasal stuffiness has resolved. d. Avoid using the spray if a fever develops. ANS: B Counsel patients to use nasal decongestant dosage forms exactly as ordered and with no increase in frequency. Excessive use of decongestant nasal sprays or drops may lead to rebound congestion. DIF: Cognitive Level: Application 11. Because of many reported adverse events, which groups of children should not be given cough and cold medications? a. Children younger than 2 years of age b. Children younger than 4 years of age c. Children younger than 6 years of age d. Children younger than 8 years of age ANS: C Children younger than 6 years of age should not be given cough and cold medication. Many adverse events have been reported in regard to these medications and children younger than 6 years of age. Insufficient research has been done into the use of these medications in children. DIF: Cognitive Level: Comprehension Copyright © 2021, Elsevier Inc. All rights reserved. 2 Downloaded by Anh Nguy?n ([email protected])  lOMoARcPSD|40099567 Chapter 38: Respiratory Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is taking aminophylline intravenously for a severe exacerbation of chronic obstructive pulmonary disease. Which effect does the nurse expect to note when evaluating for a therapeutic response to the medication? a. Drowsiness b. Increased heart rate c. Increased respiratory rate d. Increased ease of breathing ANS: D The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. DIF: Cognitive Level: Comprehension 2. Which is an adverse effect associated with the use of xanthine derivatives? a. Diarrhea b. Palpitations c. Bradycardia d. Drowsiness ANS: B Common adverse effects of xanthine derivatives include palpitations, sinus tachycardia, extrasystole nausea, vomiting, anorexia, and transient increased urination. DIF: Cognitive Level: Comprehension 3. What is the rationale for using inhaled budesonide (Pulmicort ®)? a. It causes bronchodilation. b. It thins bronchial secretions. c. It inhibits the activity of β-agonists. d. It provides an anti-inflammatory response. ANS: D Inhaled budesonide is administered for its anti-inflammatory effects. Corticosteroids act by stabilizing the membranes that normally release harmful bronchoconstricting substances. DIF: Cognitive Level: Knowledge 4. A patient has been prescribed a respiratory corticosteriod medication. What should the nurse tell this patient about the proper method for taking this medication? a. Rinsing of the mouth after using the inhaler is recommended. b. The tubings and mouthpieces should be cleaned with only hot water. c. The medication is to be inhaled deeply, with the head tipped backward to maximize opening of the airway. d. After taking an inhaler medication, the patient should remove the inhaler and hold the breath for at least 20 seconds. ANS: A Rinsing of the mouth after using an inhaler or nebulizer is recommended in order to prevent fungal infections. Nebulizer tubings and mouthpieces should be cleaned with soap, water, and white vinegar. With intranasal dosage forms, the medication should be inhaled with the head tipped slightly forward. DIF: Cognitive Level: Analysis 5. The physician has prescribed fluticasone (Flovent ®) to treat a patient’s asthma. What important information should the nurse emphasize when teaching the patient about this medication? a. The patient must use the proper technique for inhalation. b. The medication should be kept on the patient’s person at all times for treatment of an acute asthma attack. c. The medication is to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued. ANS: C This drug is used for asthma prophylaxis and maintenance treatment. DIF: Cognitive Level: Analysis 6. Which drug is used in the treatment of acute attacks of bronchial asthma? a. nedocromil b. salbutamol (Ventolin®) c. zafirlukast (Accolate®) d. triamcinolone ANS: B Salbutamol is the only drug listed above that is useful in the treatment of acute attacks of bronchial asthma. DIF: Cognitive Level: Knowledge Copyright © 2021, Elsevier Inc. All rights reserved. 1 Downloaded by Anh Nguy?n ([email protected])  lOMoARcPSD|40099567 7. A patient has prescriptions for two inhalers. One inhaler is a bronchodilator; the other is a corticosteroid. Which instruction should the nurse give the patient regarding these inhalers? a. The corticosteroid should be taken first. b. The bronchodilator should be taken first. c. The two drugs should be taken at least 2 hours apart. d. The order of administration does not matter with these two drugs. ANS: B The bronchodilator should be taken several minutes before the corticosteroid so that the airways will be more open when the second drug is administered. DIF: Cognitive Level: Analysis 8. A patient has recently been placed on inhaled corticosteroids. Which common adverse effects should the nurse discuss with the patient? a. Fatigue and depression b. Anxiety and peripheral vasoconstriction c. Headache and rapid heart rate d. Oral candidiasis and dry mouth ANS: D Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. DIF: Cognitive Level: Comprehension 9. After receiving a nebulizer treatment with a β-agonist, the patient reports feeling slightly nervous and wonders whether the asthma is getting worse. What is the nurse’s best answer to the patient’s concern? a. “Feeling a little nervous is an expected adverse effect. Let me take your pulse to check it.” b. “The next scheduled nebulizer treatment should be skipped.” c. “I will notify the physician about this adverse effect.” d. “We will hold the treatment for 24 hours.” ANS: A Nervousness, tremors, and cardiac stimulation are possible adverse effects of β-agonists. DIF: Cognitive Level: Analysis 10. For which condition would the nurse anticipate treatment with montelukast (Singulair ®)? a. Acute bronchospasm b. Exacerbation of chronic obstructive pulmonary disease c. Long-term treatment of emphysema d. Prophylaxis of asthma in children ANS: D Montelukast belongs to the newer class of medications known as antileukotriene drugs and is used for prophylaxis and long-term treatment of asthma in adults and children. DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which drugs are used for acute asthma attacks? (Select all that apply.) a. zafirlukast (Accolate®) tablets b. salbutamol (Ventolin) nebulizer solution c. Cromolyn® metered-dose inhaler (MDI) d. Intravenous (IV) epinephrine e. fluticasone (Flovent) f. beclomethasone (Qvar®) MDI g. aminophylline IV infusion ANS: B, D, G Salbutamol (a β2-agonist) is used for acute bronchospasms. Epinephrine can be used intravenously for relief of bronchospasm. Aminophylline can be used for mild to moderate asthma attacks. Zafirlukast is an antileukotriene drug; Cromolyn is a mast cell stabilizer; and fluticasone and beclomethasone are inhaled corticosteroids. These three types of medications—antileukotrienes, mast cell stabilizers, and inhaled corticosteroids—are used for asthma prophylaxis. DIF: Cognitive Level: Analysis Copyright © 2021, Elsevier Inc. All rights reserved. 2 Downloaded by Anh Nguy?n ([email protected])