Chap 37 (exam 4) Flashcards Preview

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Flashcards in Chap 37 (exam 4) Deck (62):
1

The nurse is teaching a group of patients about the use of bronchodilators. It is important to remind them that using bronchodilators too frequently may cause which adverse effects? Select all that apply
Blurred vision
Increased heart rate
Decreased heart rate
Nausea
Nervousness
Tremors

Increased heart rate
Nausea
Nervousness
Tremors

2

For patients taking a leukotriene receptor antagonist, the nurse should include which information in the patient teaching?
If a dose is missed, the patient may take a double dose to maintain blood levels
The patient should gargle or rinse the mouth after using the inhaler
The medication should be taken at the first sign of bronchospasm
Improvement should be seen within a week of use

Improvement should be seen within a week of use

3

Which drug acts by blocking leukotrienes, thus reducing inflammation in the lungs?
Cromolyn (Intal)
Montelukast (Singulair)
Theophylline (Elixophyllin)
Albuterol (Proventil)

Montelukast (Singulair)

4

A patient is experiencing status asthmaticus. The nurse will prepare to administer which drug first?
Epinephrine
Methylprednisolone (Solu-Medrol)
Cromolyn (Intal)
Montelukast (Singulair)

Epinephrine

5

When a patient is taking parenteral xanthine derivatives such as aminophylline, the nurse should monitor for which adverse effect?
Decreased respirations
Hypotension
Tachycardia
Hypoglycemia

Tachycardia

6

A patient who has asthma may be prescribed which type of inhaled drug for its antiinflammatory effects?
Corticosteroid
Anticholinergic
Xanthine derivative
Beta adrenergic

Corticosteroid

7

A patient is to receive a new prescription for an ipratropium (Atrovent) inhaler. The nurse will assess for which potential contraindications? Select all that apply
Allergy to soy lecithin
Allergy to peanuts
Allergy to iodine products
Hypertension
Seizure disorders

Allergy to soy lecithin
Allergy to peanuts

8

Tom, a 70 year old retiree who smoked for 40 years, has been diagnosed with chronic obstructive pulmonary disease (COPD); the treatment regimen prescribed includes theophylline (Theo-Dur). After a few weeks, Tom tells the nurse that he is experiencing nausea and "bad heartburn at night." The laboratory studies show the level of theophylline in his blood to be 30 mcg/mL. What might be wrong with Tom, and how can it be corrected?

Tom is exhibiting some side effects of theophylline therapy, and the level in his blood is too high (the common therapeutic range for theophylline is a blood level of 10-20 mcg/dL). It is likely that the dosage will be decreased.

9

Sylvia has come to the clinic today complaining of nausea, palpitations and anxiety. She says that her heart fee's :as if it's going to fly out of my chest." Physical examination confirms an increased heart rate. Sylvia's records indicate that she as asthma for which she uses an albuterol inhaler. When asked about the inhaler, she states that she uses it "when ever I feel short of breath." What is causing Sylvia's complaints?

Sylvia is exhibiting dose-related adverse effects of the albuterol. If Sylvia is now using the albuterol more frequently as a rescue inhaler, the health care provider will need to review and adjust her medication regimen

10

Mrs. V., a 65-year-old office manager, has arthritis, glaucoma, and emphysema. The health care provider is planning treatment for her emphysema.
What 3 types of drugs might be considered for treatment of COPD?
What factor must the provider keep in mind when determining the best drug for Mrs. V.?

Anticholinergics, corticosteroids, beta agonists
Of concern is Mrs. V's glaucoma. Anticholinergics are to be used cautiously in patients with acute narrow angle glaucoma

11

Several months ago, the physician prescribed an orally administered corticosteroid for Mr. Z., who has chronic bronchial asthma.
What are the disadvantages of administering the corticosteroids orally? Is there an alternative route?
Today the physician adds beclomethasone dipropoinate (Beclovent) to Mr. Z's drug regimen and also reduces the dosage of the oral corticosteroid. Why was the oral corticosteroid not discontinued.

The disadvantage of administering the corticosteroids orally is that they can then lead to systemic effects, such as increased susceptibility to infection, fluid and electrolyte disturbances, endocrine effects, dermatologic effects, and nervous system effects. They can interact with other systemically administered drugs. The advantage of administering corticosteroids by inhalation is that they are delivered directly to the site of action- the lungs. This generally limits, but does not completely prevent, systemic effects.
The use of an inhaled corticosteroid frequently allows for a reduction in the daily dose of the systemic corticosteroid. This reduction should be gradual to prevent Addisonian crisis due to suppression of the adrenal gland.

12

Alice has been treated for asthma for several months and has the following inhalers: albuterol (Proventil) and fluticasone (Flovent). Which one should she choose if she experiences an asthma attack? Explain your answer

The albuterol is a beta agonist that can be used to treat acute bronchospasms. The fluticasone is a corticosteroid and is not effective for acute bronchospasm. Fluticasone us useful for long-term management of asthma and works to reduce inflammation

13

Justin calls the nurse at the office because he experiences "palpitations and a racing heart" every morning after breakfast. He is taking theophylline (Theo-Dur) as part of his treatment for asthma. Upon questioning, he states that he has been drinking an extra cup of coffee in the morning "to get going" because his coughing has kept him from sleeping well. What could be his problem?

He needs to be reminded to avoid foods and beverages that contain caffeine (e.g., chocolate, coffee, cola, cocoa, tea) because their consumption can exacerbate CNS stimulation

14

Jennie has been treated for adult-onset asthma for 3 years. She has been doing fairly well with her inhalers, but today she receives a prescription for montelukast (Singulair), one 10 mg tablet daily.
How does this medication differ from corticosteroids that are used to reduce inflammation?

Montelukast, a leukotriene receptor antagonist, works to reduce the inflammatory response in the lungs but does not have the adverse effects that corticosteroids have

15

Jennie has been treated for adult-onset asthma for 3 years. She has been doing fairly well with her inhalers, but today she receives a prescription for montelukast (Singulair), one 10 mg tablet daily.
Jennie says, "I hope this medicine works better than the other one I took when I has an asthma attack." How will you reply?

Leukotriene receptor antagonists are primarily used for prophylaxis and chronic management of asthma and are not appropriate for treatment of acute asthma attacks; however, they should decrease the frequency of the attacks

16

Jennie has been treated for adult-onset asthma for 3 years. She has been doing fairly well with her inhalers, but today she receives a prescription for montelukast (Singulair), one 10 mg tablet daily.
Jennie takes ibuprofen (Advil) on occasion for arthritic pain. How do you advise Jennie regarding taking over the counter drugs with montelukast?

You should tell Jennie that she needs to check with her health care provider before taking any over the counter medications

17

Jennie has been treated for adult-onset asthma for 3 years. She has been doing fairly well with her inhalers, but today she receives a prescription for montelukast (Singulair), one 10 mg tablet daily.
After 3 months, Jennie stops taking the montelukast. She says, "my symptoms are better, and I don't want to take medicine unless I need it." Is this appropriate?

These drugs should be taken every night on a continuous schedule, even if symptoms improve

18

A patient who has a history of asthma is experiencing an acute episode of shortness of breath and needs to take a medication for immediate relief. The nurse will choose which medication that is appropriate for this situation?
A beta agonist, such as albuterol
A leukotriene receptor antagonist, such as montelukast
A corticosteroid, such as fluticasone
An anticholinergic, such as ipratropium

A beta agonist, such as albuterol

19

After a nebulizer treatment with the beta agonist albuterol, the patient complains of feeling a little "shaky", with slight tremors of the hands. The patient's heart rate is 98 beats/min, increased from the pretreatment rate of 88 beats/min. The nurse knows that this reaction is an:
Expected adverse effect of the medication
Allergic reaction to the medication
Indication that he has received an overdose of the medication
Idiosyncratic reaction to the medication

Expected adverse effect of the medication

20

A patient has been receiving an aminophylline (xanthine derivative) infusion for 24 hours. The nurse will assess for which adverse effect when assessing the patient during the infusion?
CNS depression
Sinus tachycardia
Increased appetite
Temporary urinary retention

Sinus tachycardia

21

During a teaching session for a patient who will be receiving a new prescription for the LTRA montelukast (Singulair), the nurse will tell the patient that the drug has which therapeutic effect?
Improves the respiratory drive
Loosens and removes thickened secretions
Reduces inflammation in the airway
Stimulates immediate a bronchdilation

Reduces inflammation in the airway

22

After the patient takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the patient needs to do next?
Hold the breath for 60 seconds
Rinse out the mouth with water
Follow the corticosteroid with a bronchodilator inhaler, if ordered
Repeat the dose in 15 minutes if the patient feels short of breath

Rinse out the mouth with water

23

The nurse is teaching a patient about the inhaler Advair (salmeterol/ fluticasone). Which statements by the patient indicate a correct understanding of this medication? Select all that apply:
"I will rinse my mouth with water after each dose"
"I need to use this inhaler whenever I feel short of breath, but not less than 4 hours between doses"
"This medication is taken twice a day, every 12 hours"
"I can take this inhaler if I get short of breath while exercising"
"I will call my doctor if I notice white patches inside my mouth"

"I will rinse my mouth with water after each dose"
"This medication is taken twice a day, every 12 hours"
"I will call my doctor if I notice white patches inside my mouth"

24

what are the classes of bronchodilators

Beta adrenergic adonists
anticholinergic
xanthine derivatives

25

albuterol

Ventolin, Proventil
SABA
beta2 specific bronchodilating beta agonist
Dose-related effects (beta1 stimulated): nausea, increased anxiety, palpitations, tremors, increased heart rate

26

levalbuterol

Xopenox
SABA
For pts w/ tachycardia

27

Formoterol

Foradil, Perforomist
LABA

28

Salmetrol

Serevant
LABA
Never for acute treatment
Used w/ inhaled corticosteroid twice daily
Adverse effects: immediate hypersensitivity reactions, headache, HTN, neuromuscular & skeletal pain

29

Beta adrenergic agonist indications

prevention or relief of bronchospasm related to bronchial asthma, bronchitis, other pulmonary diseases

30

Beta adrenergic agonist contraindications

Drug allergy
uncontrolled HTN or cardiac dysrhythmias
high risk of stroke

31

Beta adrenergic agonist adverse effects

alpha/ beta agonists combos produce most: insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache
beta2 drugs: HTN, hypotension, vascular headaches, tremor

32

Beta adrenergic agonist interaction

Nonselective beta blockers w/ beta agonist bronchodilator: beta agonist bronchodilation diminishes
Beta agonists w/ MAOIs: enhanced risk of HTN
Pts w/ diabetes need lower hypoglycemic drugs due to increased blood glucose may occur

33

ipratropium

Atrovent
Anticholinergic bronchodilator

34

tiotropium

Spiriva
Anticholinergic bronchodilator

35

Anticholinergic bronchodilator contraindications

drug allergy
Allergy to atropine or soy lecithin
Allergy to peanuts, peanut oils, soybeans, other legumes

36

Anticholinergic bronchodilator adverse effects

dry mouth or throat
nasal congestion
heart palpitations
GI distress
Urinary retention
Increased intraocular pressure
headache
coughing
anxiety

37

Xanthine derivatives

Theophylline (metabolized to caffeine in body)
Caffeine
Aminophylline (metabolized to theophylline in body)

38

Xanthine derivatives mechanism of action

Inhibit phosphodiesterase, which increases cAMP levels, causes bronchodilation

39

Xanthine derivatives indications

dilate airways of pts w/ asthma, chronic bronchitis, emphysema
Mild to moderate causes of acute asthma
Adjunct drug managing COPD

40

Xanthine derivatives contraindications

Drug allergy
uncontrolled cardiac dysrhythmias
seizure disorders
hyperthyroidism
peptic ulcers

41

Xanthine derivatives adverse effects

nausea
vomiting
anorexia
gastroesophageal refluc
sinus tachycardia
palpitations
extrasystole
ventricular dysrhythmias

42

Theophylline

metabolized to caffeine in body
therapeutic blood level 10-20 mcg/mL

43

Leukotriene receptor antagonists

LTRAs

44

Montelukast

Singulair
LTRA
Bind to D4 leukotriene receptor subtype in respiratory tract tissues & organs
Only oral

45

Zafirlukast

Accolate
LTRA
Bind to D4 leukotriene receptor subtype in respiratory tract tissues & organs
Adverse effects: headache, nausea, diarrhea

46

Zileuton

Zyflo
LTRA
Indirect mechanism
Inhibits enzyme 5-lipoxygenase
Adverse effects: headache, nausea, dizziness, incomnia

47

LTRA indications

prophylaxis & long-term treatment & prevention of asthma in adults & children 12 and up
Not for acute attacks
Improvement in about 1 week

48

LTRA contraindications

drug allergy
allergy to povidone, lactose, titanium dioxide, cellulose derivatives,

49

Corticosteroids
Mechanism of action

Glucocorticoids
dual effect of reducing inflammation & enhancing activity of beta agonists

50

Beclomthasone diproprionate

Beclovent
Corticosteroids

51

Budesonide

Pulmicart Turbuhaler
Corticosteroids

52

Dexamethasone sodium phosphate

Decardon Phosphate Respihaler
Corticosteroids

53

Flunisolide

AeroBid
Corticosteroids

54

Fluticasone

Flovent (oral inhalation)
Flonase (intranasal)
Corticosteroids

55

Triamcinolone acetonide

Azmacort
Corticosteroids

56

Ciclesonide

Omnaris
Corticosteroids

57

Prednisone

oral
Corticosteroids

58

Nethylprednisolone

IV or oral
Corticosteroids

59

Corticosteroids contraindications

Drug allergy
Inhaled w/: sputum tests for candida organisms, systemic fungal infection

60

Corticosteroids adverse effects

Inhaled: pharyngeal irritation, Coughing, Dry mouth, Oral fungal infections, *wash mouth after use*
Systemic effects: adrenocortical insufficiency, increased susceptibility to infection, fluid & electrolyte disturbances, endocrine effects, insomnia, nervousness, seizures, brittle skin, bone loss, osteoporosis, cushing's syndrome
bone growth suppressed in children & adolescents

61

Phosphodiesterase 4 inhibitor indications

Prevent coughing, excess mucus from worsening, decrease frequency of life threatening COPD exacerbations

62

Phosphodiesterase 4 inhibitor adverse effects

nausea
diarrhea
headache
insomnia
dizziness
weight loss
psychiatric symptoms