Respiratory

Question 1

Beta 2 adrenergic agonists - mechanism and example

Answer 1

relieve bronchospasms and to prevent exercise-induced bronchospasm (EIB) by inducing brochodilation

(albuterol)

Question 2

Beta 2 adrenergic agonist - adverse effects

Answer 2

• tachycardia, heart palpitations, and tremors
• angina (when cardiac vessels are compromised)

Question 3

Beta 2 adrenergic agonists - intervention

Answer 3

• monitor for wheezing or shortness of breath
• monitor and immediately report chest pain
• inhale 30 minutes before exercise

Question 4

Anticholinergics - mechanism and example

Answer 4

provide relief of bronchoconstriction and reduce secretions in clients who have COPD by inhibiting the action of acetylcholine at the muscarine receptor and inducing bronchodilation

(ipratropium)

Question 5

Anticholinergics - adverse effects

Answer 5

• dry mouth
• pharyngeal irritation
• intraoccular pressure
• urinary retention, tachycardia, headache, dizziness, blurred vision, epistaxis, bronchospasms, and hypotension

Question 6

Anticholinergics - intervention

Answer 6

• monitor for glaucoma
• wait at least 5 minutes after administering anticholinergics to administer other inhalants

Question 7

Glucocorticoids - mechanism and example

Answer 7

long-term management of chronic asthma and COPD and short-term management of post-exacerbation manifestations by suppressing inflammation

(fluticasone)

Question 8

Glucocorticoids - adverse reactions

Answer 8

• oral candidiasis
• suppressed adrenal function
• muscle wasting
• osteoporosis
• hyperglycemia
• peptic ulcers
• fluid and electrolyte imbalances
• suppressed immune system

Question 9

Glucocorticoids - intervention

Answer 9

• use of a spacer can minimize some side effects
• administer on schedule, not as needed
• caution when giving glucocorticoids to clients who have peptic ulcer disease, diabetes mellitus, hypertension, renal dysfunction, or are taking NSAIDs regularly

Question 10

Mast cell stabilizers - mechanism and example

Answer 10

reduce bronchial inflammation prophylactically in mild to moderate asthma by preventing the release of leukotrienes and histamine to moderate inflammation

(cromolyn)

Question 11

Mast cell stabilizers - adverse effects

Answer 11

Minimal

Question 12

Mast cell stabilizers - intervention

Answer 12

• assess for allergies before administering

Question 13

Leukotriene modifiers - mechanism and example

Answer 13

treatment of allergic rhinitis, asthma, and exercise-induced bronchospasm by suppressing the effect of leukotrienes

(montelukast)

Question 14

Leukotriene modifiers - adverse effects

Answer 14

• liver damage
• slight risk of adverse neuropsychiatric manifestations such as suicidal thoughts or behaviors

Question 15

Leukotrienes modifiers - interventions

Answer 15

• report abdominal pain or tenderness, nausea, or anorexia immediately to their provider
• use over-the-counter analgesics as needed
• be aware of any behavioral changes such as anxiety, agitation, insomnia, or irritability

Question 16

First-gen antihistamines - mechanism and example

Answer 16

bind to H1 receptors, effectively blocking the release of histamine

(diphenhydramine)

Question 17

First-gen antihistamines - adverse reactions

Answer 17

• drowsiness and dizziness
• dry mouth
• urinary hesitancy
• constipation

Question 18

first-gen antihistamines - intervention

Answer 18

• monitor patient when ambulating
• advise not to drive or operate heavy machinery
• take with food to reduce GI discomfort
• sip water/hard candy for dry mouth, fiber for constipation

Question 19

Difference between first- and second-gen antihistamines

Answer 19

First-gen antihistamines are sedating, second-gen aren’t

Question 20

Second-gen antihistamines - mechanism and example

Answer 20

antagonize histamine effects at H1 receptor sites, without binding to or inactivating histamine

(cetrazine)

Question 21

Second-gen antihistamines - adverse effects

Answer 21

• mild drowsiness possible
• some anticholinergic effects

Question 22

Second-gen antihistamines - intervention

Answer 22

• monitor when ambulating (esp. doses over 10 mg)
• provide water/hard candy
• do not administer with other OTC antihistamines
• theophylline can reduce the excretion of second-gen antihistamines and lead to toxicity

Question 23

Sympathomimetics - mechanism and example

Answer 23

activate alpha 1 adrenergic receptors in the nose to induce vasoconstriction of the blood vessels, which then causes the nasal turbinates to shrink, opening the nasal passages and relieving nasal congestion

(phenylephedrine)

Question 24

Sympathomimetics - adverse effects

Answer 24

• CNS stimulation (anxiety, insomnia, agitation)
• systemic vasoconstriction can cause hypertension, arrhythmias, and heart palpitations

Question 25

Sympathomimetics - interventions

Answer 25

- administer only when necessary - monitor for CNS disturbances - patients may need sleep aids

Question 26

Antitussives - mechanism and example

Answer 26

Both opioid and nonopioid antitussives work by suppressing the cough reflex in the brain (codeine, dextromethorphan)

Question 27

Antitussives - adverse effects

Answer 27

- drowsiness (opiates) - dizziness, lightheadedness (opiates) - GI distress (opiates)

Question 28

Antitussives - interventions

Answer 28

- monitor patients when they ambulate - administer with food or milk - administer short-term only

Question 29

Expectorants - mechanism and example

Answer 29

Reduce surface tension of secretions to thin mucous (guaifenesin)

Question 30

Expectorants - adverse effects

Answer 30

Uncommon dizziness, drowsiness, headache, gastrointestinal distress in the form of nausea and diarrhea

Question 31

Expectorants - interventions

Answer 31

- monitor patients when the ambulate - administer with food or 8 oz of water to minimize GI distress - combination medications may contain guifenesin

Question 32

Mucolytics - mechanism and example

Answer 32

work by breaking the disulfide linkages of proteins in mucus, subsequently decreasing the viscosity of mucus (acetylcysteine)

Question 33

Mucolytics - adverse reactions

Answer 33

- bronchospasm - GI distress

Question 34

Mucolytics - interventions

Answer 34

- monitor lung sounds for indications that fluid is still trapped in lungs - patients may need bronchodilator to help remove - advise patient to report worsening cough or difficulty breathing