Pharm CH 37

Question 1

Beta-adrenergic Agonists

Answer 1

albuterol (Proventil), terbutaline (Brethren), salmeterol (Serevant)

Question 2

Beta-adrenergic agonists action

Answer 2

activates sympathetic nervous system that relaxes bronchial smooth muscle= bronchodilation- widens airways and makes breathing easier

Question 3

Beta-adrenergic agonists Use and tolerance

Answer 3

prevents/relieves bronchospasm associated with asthma
- associated with chronic use and may need to up the dose or add a second drug

Question 4

Beta-adrenergic agonists Adverse and contraindications

Answer 4

Adverse: oral= hyperglycemia, nervousness, tachycardia and tremor
Contra: patients with history of cardiac disease or HTN

Question 5

Beta-adrenergic agonists Nursing considerations

Answer 5

Assess vital signs, respiratory effort, skin color, oxygen saturation & lung sounds

Question 6

Beta-adrenergic agonists Pt. Teaching

Answer 6

-take the drug as prescribed- do not up or lower doses
-hold your breath for 10 seconds after inhaling and wait 1-2 minutes before the second inhalation
-may benefit from a spacer device if having difficulty using a metered-dose inhaler
-limit or abstain caffeine intake

Question 7

Anticholinergic

Answer 7

ipratropium (Atrovent) & tiotropium (Spiriva)

Question 8

Anticholinergic Action and Use

Answer 8

Action: blocks cholinergic receptors in bronchial smooth muscle–> bronchodilation
Use: prevent/relieve bronchospasm associated with asthma and COPD

Question 9

Anticholinergic Adverse and Contraindication

Answer 9

-anxiety, cough, dry mouth, GI distress, headache, urine retention
-use caution in pts. w/ history of BPH and narrow-angle glaucoma

Question 10

Anticholinergic Nursing consideration and Pt Teaching

Answer 10

Nursing: assess VS, respiratory effort, skin color, oxygen saturation, lung sounds
Pt Teaching: inhaler use follow instructions
wait 2-5 minutes between different inhalants
rinse mouth after- eliminates bitter taste

Question 11

Methylxanthines

Answer 11

aminophylline & theophylline (Theo-Dur)

Question 12

Methylxanthines Action and Use

Answer 12

Action: relax bronchial smooth muscle
-Suppress airway responsiveness to stimuli that promote bronchospasm
Use: long-term management of persistent asthma unresponsive to other agents

Question 13

Methylxanthines Adverse Effects and Contraindication

Answer 13

Adverse: anorexia, CNS stimulation, dizziness, headache, n/v
Serious: circulatory failure, dysrhythmias, hypotension, respiratory arrest, seizures, tachycardia
Contra: Use caution in pts. with cardiac dysrhythmias, HF or seizure disorders

Question 14

Methylxanthines Nursing Considerations

Answer 14

-Administer through oral, IV, rectal routes
-Assess VS, skin color, etc.
-monitor blood levels of drug (therapeutic range for theophylline is 10-20mcg/mL

Question 15

Methylxanthines Pt Teaching

Answer 15

-take as prescribed
-do not take OTC meds w/o contacting physician
-eliminate smoking (affects drug metabolism)
-limit caffeine intake

Question 16

Corticosteroids

Answer 16

beclomethasone (Beclovent), fluticasone (Flovent) & budesonide (Pulmicort Turbhaler)

Question 17

Corticosteroids Actions

Answer 17

-inhibit synthesis and release of inflammatory mediators (diminish edema and mucus production to reduce airway obstruction
- sensitize bronchial smooth muscle (more responsive to beta-agonist stimulation
-reduce bronchial hyperresponsiveness to allergens that trigger asthma attacks

Question 18

Corticosteroids Use

Answer 18

inhalants: long-term prevention of asthmatic attacks (not terminate in progress)
oral agents: short-term management of acute asthma attacks (limit treatment time to 5-7 days)

Question 19

Corticosteroids Adverse

Answer 19

Local: cough, dry mouth, oral fungal infections & pharyngeal irritation
Systemic: Cushing’s syndrome, hyperglycemia, osteoporosis, peptic ulcers & sodium/fluid retention ( limit therapy to <10 days)

Question 20

Corticosteroids Contraindications

Answer 20

Use caution in pts. with DM, GI disease, HF and HTN

Question 21

Corticosteroids Nursing Considerations

Answer 21

-asses for s/s of infection (drugs inhibit inflammatory response; masks them
-obtain daily VS like BP and temp
-administer inhaled bronchodilator before corticosteroid if prescribed for concurrent use

Question 22

Corticosteroids Pt Teaching

Answer 22

-do not use drugs to terminate acute asthma attacks
-rinse mouth after use
-monitor weekly weight
-monitor blood glucose levels if diabetic

Question 23

Leukotriene Modifiers

Answer 23

zafirlukast (Accolade, montelukast (Singulair), zileuton (Zyflo)

Question 24

Leukotriene Modifiers Action

Answer 24

block lipoxygenase (zilueton) or leukotriene receptors (zafirlukast and montelukast)- reduces inflammation and ease bronchoconstriction

Question 25

Leukotriene Modifiers Use

Answer 25

Prophylaxis of persistent, chronic asthma- unable to terminate acute attacks

Question 26

Leukotriene Modifiers Adverse and Contraindications

Answer 26

Adverse; cough, GI upset, headache & nasal congestion Contraindications: patients with chronic alcoholism or significant hepatic dysfunction (drugs extensively metabolized by the liver) -Use caution in patients older than 65 years (drugs may increase risk of infection)

Question 27

Leukotriene Modifiers Pt teaching

Answer 27

-take med as prescribed on schedule even if symptom improves -do not use drug to terminate acute asthma attacks -report abdominal pain, dark-colored urine, fatigue, itching & nausea

Question 28

Mast Cell Stabilizers

Answer 28

cromolyn (Intal), nedocromil

Question 29

Mast Cell Stabilizers Actions

Answer 29

inhibits mast cells from releasing histamine and other chemical mediators of inflammation (reduces inflammation)

Question 30

Mast Cell Stabilizers Uses

Answer 30

-prevent (not terminate) acute asthma attacks (less effective than inhaled corticosteroids in preventing chronic asthma -allergic rhinitis

Question 31

Mast Cell Stabilizers Adverse and Nursing Consideration

Answer 31

Adverse: intranasal: burning or stinging of nasal mucosa, nasal congestion & throat irration Nursing Cons: pts. often experience bitter unpleasant taste (common cause for discontinuation of therapy)

Question 32

Pharmacotherapy of COPD Goal

Answer 32

relieve symptoms and avoid complications

Question 33

COPD Anticholinergic and Beta-adrenergic agonists

Answer 33

cause bronchodilation

Question 34

COPD Inhaled corticosteroids

Answer 34

exhibit anti-inflammatory effects

Question 35

COPD Expectorants and mucolytics

Answer 35

reduce the viscosity of bronchial mucus; aid in its removal

Question 36

COPD Antibiotics

Answer 36

for patients with multiple bouts of pulmonary infections

Question 37

COPD Avoid

Answer 37

-barbiturates and opioids (act as respiratory depressants) -drugs with beta-adrenergic antagonist activity (cause bronchoconstriction)