Anti-Inflammatory Medications: Bronchodilators

Question 1

Beta2-Adrenergic Agonists: medications

Answer 1

1) prototype = albuterol (Proventil, Ventolin)
-inhaled, short-acting
-oral, long-acting
2) other medications =
-formoterol (Foradil Aerolizer)
inhaled, long-acting
-salmeterol (Serevent)
inhaled, long-acting
-terbutaline (Brethine)
oral, long-acting

Question 2

Beta2-Adrenergic Agonists: expected actions

Answer 2

• bronchospasm relieved
• histamine release inhibited
• ciliary motility increased

Question 3

Beta2-Adrenergic Agonists: therapeutic uses

Answer 3

• prevention of asthma attack
• treatment of ongoing asthma attack
• long-term control of asthma

Question 4

Beta2-Adrenergic Agonists: adverse effects and nursing interventions/client education

Answer 4

1) inhaled agents (short-and long-acting)
- minimal adverse effects
2) oral agents
- tachycardia
- angina
- tremors

i. take pulse. report increases of 20-30/min
ii. notify provider of manifestations
iii. avoid caffeine
iv. tremors usually resolve w/ continued use

Question 5

Methylxanthines: medications

Answer 5

1) prototype = theophylline (Theolair, Theo-24)

Question 6

Methylxanthines: expected action and therapeutic use

Answer 6

1) bronchodilation

2) chronic asthma

Question 7

Methylxanthines: adverse effects and severe reactions

Answer 7

1) -mild toxicity
- GI distress
2) -dysrhythmias
- seizures

Question 8

Methylxanthines: nursing interventions/client education

Answer 8

1) monitor theophylline serum levels
2) if severe reaction occurs stop medication. notify provider.
3) avoid caffeine
4) increase theophylline dosage if used w/ these medications
5) caffeine increases CNS and cardiac effects of theophylline
6) phenobarbital and phenytoin decrease level

Question 9

Methylxanthines: nursing administration

Answer 9

1) take as directed
2) if dose is missed, following dose should not be doubled
3) do not chew or crush sustained-released preparations

Question 10

Inhaled Anticholinergics: medications

Answer 10

1) prototype = ipratropium (Atrovent)

2) other medication = tiotropium (Spiriva)

Question 11

Inhaled Anticholinergics: expected action and therapeutic uses

Answer 11

1) bronchodilation
2) -COPD
- allergen-induced and exercise-induced asthma
- route: inhalation

Question 12

Anticholinergics: adverse effects and nursing interventions/client education

Answer 12

1) -dry mouth
- hoarseness
2) -sip on water and suck on hard candy
- rinse mouth after inhalation
- usual dosage is 2 puffs
- wait between puffs
- wait at least 5 min between medications

Question 13

Glucocorticoids: medications

Answer 13

1) prototype =
- inhalation: beclomethasone dipropionate (QVAR)
- oral: prednisone (Deltasone)
2) other medications =
- inhalation:
a. budesonide (Pulmicort)
b. fluticasone propionate (Advair, Flovent)
c. triamcinolone acetonide (Azmacort)
- oral: prednisolone (Prelone)
- IV: hydrocortisone sodium succinate (Solu-Cortef, Solu-Medrol)

Question 14

Glucocorticoids: expected action

Answer 14

1) prevent inflammation
2) suppress airway mucus production
3) promote decreased frequency and severity of exacerbations and acute attacks

Question 15

Glucocorticoids: therapeutic uses

Answer 15

1) short-term IV agents for status asthmaticus
2) inhaled agents for long-term prophylaxis of asthma
3) short-term therapy following acute asthma attack
4) replacement therapy for primary adrenocortical insufficiency
5) promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth

Question 16

Beclomethasone Dipropionate (QVAR): adverse effects

Answer 16

1) difficulty speaking
2) hoarseness
3) candidiasis

Question 17

Beclomethasone Dipropionate (QVAR): nursing interventions/client education

Answer 17

1) use spacer
2) rinse mouth w/ water or salt water
3) monitor for redness, sores, or white patches. Report to provider.

Question 18

Prednisone Adverse Effects: 10 days or more

Answer 18

1) suppression of adrenal glands
2) bone loss
3) hyperglycemia and glycosuria
4) myopathy (muscle weakness)
5) peptic ulcer disease
6) infection
7) fluid and electrolytes
- weight gain
- edema
- hypokalemia

Question 19

Prednisone: nursing interventions/client teaching

Answer 19

1) administer oral on alternate-day schedule
2) monitor blood glucose levels. Insulin may need to be increased
3) taper client dose
4) perform weight-bearing exercises
5) consume diet w/ sufficient calcium and vitamin D
6) report muscle weakness
7) avoid NSAIDS
8) report black, tarry stools
9) administer w/ food or meals
10) report weight gain, edema

Question 20

Mast Cell Stabilizers: medications

Answer 20

1) prototype = cromolyn sodium (Intal)

2) other medication = nedocromil sodium (Tilade)

Question 21

Mast Cell Stabilizers: expected action and therapeutic uses

Answer 21

1) anti-inflammatory
2) -chronic asthma
- exercise-induced asthma
- prevent allergen-induced attack
- allergic rhinitis by intranasal route
- inhalation

Question 22

Mast Cell Stabilizers: nursing administration

Answer 22

1) very safe
2) take medication 15 min before exercise or exposure to allergen
3) long-term prophylaxis may take several weeks

Question 23

Leukotriene Modifiers: medications

Answer 23

1) prototype = montelukast (Singulair)
2) other medications =
- zileuton (Zyflo)
- zafirlukast (Accolate)

Question 24

Leukotriene Modifiers: expected actions

Answer 24

1) suppresses inflammation
2) bronchoconstriction
3) airway edema
4) mucus production

Question 25

Leukotriene Modifiers: therapeutic uses

Answer 25

1) long-term asthma

2) prevent exercise-induced bronchospasm

Question 26

Leukotriene Modifiers: adverse effects and nursing interventions/client education

Answer 26

1) liver injury
2) -obtain baseline liver function tests. monitor often
- monitor for liver damage:
i. nausea
ii. anorexia
iii. abdominal pain
3) notify providers if this occurs

Question 27

Leukotriene Modifiers: nursing administration

Answer 27

1) take as prescribed
2) give zileuton w/ or w/o food
3) do not give zafirlukast w/ food. administer 1 hr before or 2 hr after
4) take montelukast once daily at bedtime