Asthma and COPD

Question 1

Pharmacotherapy of asthma

Answer 1

a) relieve the symptoms by causing bronchodilation

b) prevent recurrence of attacks by suppressing inflammatory response in the airways

Question 2

pharm goals of nebulisation salbutamol:ipratropium bromide:sodium chloride

Answer 2

relieve the symptoms of broncodilation

Question 3

pharm goals of prednisolone , symbicort

Answer 3

prevent the recurrence of attacks by suppressing inflammatory response in the airway

Question 4

pharm goals of augmentin

Answer 4

to eradicate the infection, reduce morbidity, and prevent complications

Question 5

mechanism of action of beta-2 adrenergic agonist

Answer 5

stimulates b2 receptors, resulting in bronchial smooth muscle relaxation and bronchodilation

Question 6

examples of beta-2 adrenergic agonist

Answer 6

salbutamol, salmeterol, fenoterol

Question 7

adverse effects of beta-2 adrenergic agonist

Answer 7

dry mouth, hypertension, palpitations, hyperkalemia

Question 8

pharm class of salbutamol, salmeterol, fenoterol

Answer 8

bega-2 adrenergic agonist

Question 9

pharm class of ipratopium, tiotropium

Answer 9

anticholinergic

Question 10

MOA of anticholinergic

Answer 10

blocks the cholinergic receptors, resulting in smooth muscle relaxation and bronchodilation

Question 11

Adverse effects of anticholinergic medications

Answer 11

dry mouth, palpitation, hypertension, urinary retention

Question 12

pharm class of beclomethasone, fluticasone, prednisolone, budesonide

Answer 12

corticosteroids

Question 13

MOA of corticosteroids

Answer 13

Inhibits migration of leukocytes and phagocytes and decreases inflammatory mediators which leads to decreases airway mucus secretion and oedema

Question 14

examples of corticosteroids medications

Answer 14

beclomethasone, fluticasone, prednisolone, budesonide

Question 15

adverse effects of corticosteroids

Answer 15

cushing’s syndrome, oral fungal infection/ oral candidiasis, adrenal insufficiency

Question 16

identify nursing considerations the nurse will render pt to minimize the adverse effects of both prednisolone and symbicort inhaler

Answer 16

1. assess oral cavity for fungal infection . ensure patient rinses mouth with water immediately after administration.
2. monitor sign and symptoms of infection such as increase body temperature, flu-like symptoms, mouth ulcer,
3. monitor’s patient for signs of cushing’s syndrome such as moon face, buffalo humps and central obesity and report to doctor
4. ensure corticosteroid therapy is not stopped abruptly

Question 17

rationale (assess oral cavity for fungal infection . ensure patient rinses mouth with water immediately after administration)

Answer 17

minimise side effect of oral candidiasis

Question 18

rationale (monitor sign and symptoms of infection such as increase body temperature, flu-like symptoms, mouth ulcer)

Answer 18

corticosteroids may increase susceptibility to infection

Question 19

rationale (monitor’s patient for signs of cushing’s syndrome such as moon face, buffalo humps and central obesity and report to doctor)

Answer 19

corticosteroids may cause cushingoid side effects, which may require medical attention and review of drugs

Question 20

rationale (ensure corticosteroid therapy is not stopped abruptly)

Answer 20

dosage of corticosteroids needs to be tapered down gradually before discontinuation. abrupt discontinuation may trigger adrenal insufficiency and shock.

Question 21

health education related to prednisolone and budesonide

Answer 21

1. Advice pt to rinse mouth with water and maintain a good oral hygiene
2. Advise patient to monitor and report signs and symptoms of infections such as increased body temperature, mouth ulcers, sore throat or flu-like symptoms
3. Advise pt to report signs of cushing syndrome such as moon face, buffalo hump and central obesity
4. inform pt not to stop medication abruptly

Question 22

rationale (Advice pt to rinse mouth with water and maintain a good oral hygiene )

Answer 22

minimise side effect of oral candidiasis

Question 23

rationale ( Advise patient to monitor and report signs and symptoms of infections such as increased body temperature, mouth ulcers, sore throat or flu-like symptoms )

Answer 23

corticosteroids may increase susceptibility to infection

Question 24

rationale (Advise pt to report signs of cushing syndrome such as moon face, buffalo hump and central obesity

Answer 24

corticosteroids may cause cushingoid side effects, which may require medical attention and review of drugs

Question 25

rationale( inform pt not to stop medication abruptly )

Answer 25

dosage of corticosteroids needs to be tapered down gradually before discontinuation. abrupt discontinuation may trigger adrenal insufficiency and shock.

Question 26

pharm class of hydrochlorothiazide

Answer 26

thiazide diuretic

Question 27

eg of thiazide diuretic

Answer 27

furesomide, hydrocholorothiazide

Question 28

eg of calcium channel blocker

Answer 28

amlodipine, felodipine, nifedipine

Question 29

MOA of hydrochlorothiazide and amlodipine

Answer 29

Hydrochlorothiazide is a duiretic. The mOA for hydrochlorothiazide is that it inhibits the sodium and chloride reabsorption in the distal convulated tubule. As a result, it promotes excretion of potassium, chloride, sodium and water

amlodipine is a calcium channel blocker. The MOA for amlodipine is that it inhibits calcium from entering into the cells of vascular smooth muscle and myocardium. This leads to peripheral vasodilation and coronary vasodilation

Question 30

Pharmacologic goals of beta adrenergic agonist and anticholinergic

Answer 30

reliever the symptoms by bronchodilation

Question 31

examples of beta adrenergic agonist and anticholinergic medications

Answer 31

salbutamol (ventolin)
ipratropium bromide (atrovent)

Question 32

Pharmacological goals of coticosteroids

Answer 32

prevent the reoccurrence of attacks by suppressing inflammatory response in the airway

Question 33

pharmacological goals of penicillin and beta-lactamase inhibitor (clavulanate)

Answer 33

to eradicate the infection, reduce morbidity and prevent complications

Question 34

examples of corticosteroids medications

Answer 34

fluticasone, prednisolone

Question 35

examples of penicillin and beta-lactamase inhibitor

Answer 35

augmentin

Question 36

mechanism of action of salbutamol (Ventolin)

Answer 36

Stimulates beta2-receptor resulting in bronchial smooth muscle relaxation and bronchodilation

Question 37

mechanism of action of ipratropium bromide (atrovent)

Answer 37

Block the cholinergic receptors in the bronchial smooth muscle result in bronchial smooth muscle relaxation and bronchodilation

Question 38

Why is COPD patients given low amount of oxygen

Answer 38

In COPD patients, the hypercapnia drive is blunted and the trigger to the respiratory drive is the low levels of oxygen in their blood. If high concentration of oxygen is given, the stimulus to breathe is reduced, causing hypoventilation and allowing carbon dioxide to accumulate further.

Question 39

side effects of corticosteroids

Answer 39

1) oral fungal infection
2) infection
3) cushing’s sundrome (moon face, buffalo hump, central obesity)
5) adrenal insufficiency and shock

Question 40

MOA of hydrochlorothiazide

Answer 40

the MOA for hydrochlorothiazide is that it inhibits the sodium and chloride reabsorption in the distal convoluted tubule. as a result it promotes excretion of potassium, chloride , sodium and water

Question 41

MOA of amlodipine

Answer 41

MOA for amlodipine is that it inhibits calcium from entering into the cells of vascular smooth muscle and myocardium. This leads to peripheral vasodilation (drops in blood pressure) and coronary vasodilation (increase myocardial oxygen delivery)

Question 42

Ineffective breathing pattern related to increased airways resistance resulting from worsening airway inflammation

Answer 42

Monitor vital signs including heart rate (HR), blood pressure (BP), respiratory rate (RR), and SpO2 hourly/as ordered.

or

Assess the respiratory rate, depth, and rhythm.

Establish baseline data and monitor for disease progress. Increased BP, RR, and HR occur during the initial hypoxia and hypercapnia.

A decrease in BP and HR may indicate respiratory failure

Changes in the respiratory rate and rhythm may indicate an early sign of impending respiratory distress

Assess breath sounds and adventitious sounds such as wheezes and stridor.

To monitor for complications of pneumonia, bronchospasm or respiratory failure.

Place patient in a Fowler’s or high-Fowler’s position.

To promote maximum lung expansion and breathing.

Administer oxygen as ordered, eg. O2 at 3LPM nasal cannula if SpO2 ≤ 90%

Reduce hypoxia and improve tissue perfusion without blunting the hypercapnia drive

Administer medications as ordered :

Nebulisation Salbutamol: Ipratropium Bromide: Sodium Chloride 2:2:2
PO prednisolone 30 mg OM
PO augmentin 500 BD

To stimulate Beta 2 and block cholinergic receptors, resulting in bronchial smooth muscle relaxation and bronchodilation.

To decrease airway mucous secretions and oedema

To bind to the penicillin binding proteins and inhibit cell wall synthesis

Monitor arterial blood gas (ABG)

It provides information about gas exchange and the adequacy of alveolar ventilation.

Provide rest periods between scheduled activities and treatments.

Scheduled rest is important to prevent fatigue and reduce oxygen demands.

Question 43

.Identify four (4) health education advice the nurse will render to Ismail to minimize the adverse effects of both prednisolone and symbicort inhaler .

Answer 43

Oral fungal infection: oral candidiasis

Infection

8. Advise Ismail to rinse mouth with water immediately after inhalation (0.5) and mantain good oral hygiene (0.5)
9. Advise Ismail to monitor and report signs and symptoms of infection ( 0.5)such as incresed body temperature, mouth ulcers, sore throat, flu like symptoms ( 0.5, any 1)

To minimize side effect of oral candidiasis (1)

Corticosteroid increase risk of infection (1)

Cushing syndrome

9. Advise Ismail to report signs of Cushing’s syndrome ( 0.5) such as moon face, bufola hump , central obesity (0.5, any 1)

Corticosteroid can cause cushingoid side effects (0.5) which require medical attention and review of drug ( 0.5)

Adrenal insufficiency and shock

11.Inform Ismail not to stop drug abruptly and to discuss changes of theraphy with doctor (1)

Abrupt discontinution may trigger adrenal insufficiency and shock (0.5). Dosage to be tapered gradually before discontinution ( 0.5)

Question 44

MOA of amlodipine and hydrochlorothiazide

Answer 44

The pharmacologic class of hydroclorothiazide is thiazide diuretic (1) and amlodipine is calcium channel blocker (1)

(b) Amlodipine inhibit calcium from entering into the cells of vascular smooth muscle and myocardium (1). This leads to peripheral and coronary vasodilation thus lowering the BP(1).

Hydrochlorothiazide inhibit sodium and chloride reabsorption in the distal tubule (1). As a result, it promotes excretion of sodium, chloride, potassium and water (1).