Chapter 55 Resp Pharm

Question 1

Actions of Xanthines

Answer 1

Direct effect on the smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels.

Question 2

Indications of Xanthines

Answer 2

Symptomatic relief or prevention of the bronchial asthma and for reversal of bronchospasm associated with COPD

Question 3

Pharmacokinetics of Xanthines

Answer 3

Narrow therapeutic margin, rapidly absorbed for the GI tract, metabolized in the liver and excreted in the urine.

Question 4

Contraindications of Xanthines

Answer 4

GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, or hyperthyroidism

Question 5

Adverse effects of Xanthines

Answer 5

Related to theophylline levels in the blood. GI upset, nausea, irritability and tachycardia to seizure, brain damage, and even death.

Question 6

Drug to drug interactions of Xanthines

Answer 6

Many drugs interact with xanthines, nicotine increases the metabolism

Question 7

Nursing considerations of Xanthines

Answer 7

History and physical exam and know allergy. Peptic ulcer, gastritis, renal or hepatic dysfunction, and coronary disease. Monitor blood pressure, pulse, cardiac auscultation, peripheral perfusion, and baseline electrocardiogram. Skin, BS, liver and renal function, appropriate lab values well as theophylline levels.

Question 8

Sympathomimetics

Answer 8

Mimic thee effects of the sympathetic nervous system. One of the actions of the sympathetic nervous system is dilation of the bronchi with increased rate and depth of respiration. Albuterol, arfomoterol, rpherdrine, epinephrine.

Question 9

Actions of Sympathomimetics

Answer 9

Beta2 selective adrenergic agonists.

Question 10

Indications of Sympathomimetics

Answer 10

acute asthma, bronchospasm in acute or chronic asthma, prevention of exercise-induced asthma.

Question 11

Pharmacokinetics of Sympathomimetics

Answer 11

Rapidly distributed after injection, transformed in the liver to metabolites that are excreted in the urine.

Question 12

Contraindications of Sympathomimetics

Answer 12

Depends on the severity of the underlying condition.

Question 13

Adverse effects of Sympathomimetics

Answer 13

Sympathomimetic stimulation, CNS stimulation, GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing.

Question 14

Drug to drug interactions of Sympathomimetics

Answer 14

General anesthetics

Question 15

Nursing considerations for Sympathomimetics

Answer 15

Asses history and physical exam and known allergy, cigarette use, pregnancy and lactation, cardiac disease, vascular disease, arrhythmias, diabetes, and hyperthyroidism. Reflexes and orientation, VS, reflexes and orientation and appropriate lab values.

Question 16

Anticholinergic

Answer 16

Patients who cannot tolerate the sympathetic effects of anticholinergic drugs. Ipratropim (atrovent) tiotropium (spiriva) Aclidinium (Tudorza Preessair) Umeclinidium (Incruse, Ellipta)

Question 17

Actions of Anticholinergic

Answer 17

Blocks vaguely mediated reflexes by antagonizing the action of acetylcholine.

Question 18

Indications of Anticholinergic

Answer 18

Maintenance treatment of bronchospasm associated with COPD

Question 19

Pharmacokinetics of Anticholinergic

Answer 19

Onset of action is 15 minutes when inhaled, peaks in 1-2 hours, duration of action is 3-4 hours.

Question 20

Contraindications of Anticholinergic

Answer 20

Any condition that would be aggravated by the anticholinergic effects of the drug.

Question 21

Adverse effects fo Anticholinergic

Answer 21

Related to Anticholinergic effects of the drug. dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpations, and urinary retention.

Question 22

Nursing considerations for Anticholinergic

Answer 22

Assess history and physical exam and known allergy. Acute bronchospasm bladder neck obstruction, or prostatic hypertrophy, orientation , affect, and reflexes. Pulse and B/P respiration and adventitios sounds and urinary output.

Question 23

Inhaled steroids

Answer 23

Very effective for treatment for bronchospasm.
Buedsonide (Symbicort) 
Beclomethasone (Beconase AQ)
Budesonide (pulmicort respules)
Ciclesonide (alvesco) 
Fluticasone 
Triamcincolone

Question 24

Actions of Inhaled steroids

Answer 24

decreases the inflammatory response in the airway.

Question 25

Indications for Inhaled steroids

Answer 25

Prevention and treatment of asthma.

Treat chronic steroid-dependent bronchial asthma.

Question 26

Pharmacokinetics of Inhaled Steroids

Answer 26

Well absorbed from the respiratory tract. Metabolized by natural systems, mostly within the liver, excreted in the urine.

Question 27

Contraindications and adverse effects of Inhaled steroids.

Answer 27

Not used fro emergency during an acute attack or status asthmatics. Pregnancy or lactation.
Adverse- sore throat, hoarseness, coughing, dry mouth, pharyngeal and laryngeal fungal infections.

Question 28

Leukotriene Receptor Antagonists

Answer 28

Act more specifically at the site of the problem with asthma. Zafirlukast (accolate) Montelukast (Singulair) Zileuton (zyflo)

Question 29

Actions of Leukotriene Receptor antagonists

Answer 29

Selectively and competitively block or antagonize receptors for the production of leukotrienes.

Question 30

Indications of Leukotriene receptor antagonists

Answer 30

Prophylacis and chronic treatment of bronchial asthma in adults and in patients younger than 12 years of age.

Question 31

pharmacokinetics or Leukotriene Receptor Antagonists

Answer 31

Rapidly absorbed from the GI tract, extensively metabolized in the liver and primarily excreted in feces.

Question 32

Cation and Adverse effects of Leukotriene Receptor antagonists

Answer 32

hepatic or renal impairment. pregnancy and action.

Headache, dizziness, myalgia, nausea, diarrhea and abdominal pain, elevated and generalized pain.

Question 33

Lung Surfactants

Answer 33

naturally occurring compounds or lipoproteins contains lipids and pro proteins that reduce the surface tension within the alveoli, allowing expansion of the alveoli for gas exchange. Breactant (surventa)
Infasurf the news drug of the class.
Lucinant (surfacxin)
Poractant (Curosurf)

Question 34

Actions and indications of Lung Surfactants

Answer 34

Actions - replace the surfactant that Is missing in the lungs of neonates with RDS
Indications - Reescue treatment of infants who have developed RDS

Question 35

Pharmacokinetics of Lung Surfactants

Answer 35

Begins to act immediately on installation into the trachea, metabolized in the lungs.

Question 36

Contraindications and Adverse effects of Lung surfactants.

Answer 36

Emergency drugs there are no contraindications.
Patent ductus arteriosus, hypotension, intraventriuclar hemorrhage, pneumothorax, pulmonary air leak, hyperbilrubinemia, sepsis.

Question 37

Which of the following is a contraindication to using lung surfactants. 
A) prematurity 
B) Older Adult
C) None
D) COPD

Answer 37

C) no contraindications as it is an emergency drug.

Question 38

The nurse is caring for a patient taking Budesonide. wHat would be an appropriate nursing diagnosis for this patient?
A) Risk for injury related to immunosuppression.
B) Risk for injury related to CNS effects
C) Risk for injury related to CVS effects
D) Risk for injury related to age and risk of infection

Answer 38

A)Risk for injury related to immunosuppression.
Rationale: Nursing diagnoses related to drug therapy might include: risk for injury related to immunosuppression; acute pain related to local effects of the drug; deficient knowledge regarding drug therapy.

Question 39

The adverse effects of the Xanthines are related to theophylline levels in the blood and include brain damage.
True or flase

Answer 39

TRUE
Rationale: Adverse Effects: Related to theophylline levels in the blood; GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death.