Drugs for Asthma Flashcards
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:
a. a chlorofluorocarbon (CFC) propellant is superior to a hydrofluoroalkane (HFA) propellant.
b. the patient should activate the device and then inhale.
c. the patient should store the MDI in the refrigerator between doses.
d. the patient should wait 1 minute between puffs.
D
When 2 puffs are needed, an interval of at least 1 minute should separate the first puff from the second. CFC propellants will be discontinued because of damage to the environment. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.
A patient newly diagnosed with asthma receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?
a. “I should use the glucocorticoid as needed when symptoms flare.”
b. “I will need to use the beta2-adrenergic agonist drug daily.”
c. “The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators.”
d. “The glucocorticoid is used as prophylaxis to prevent exacerbations.”
D
Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta2-adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation.
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?
a. Ask whether the patient is gargling after each dose of the glucocorticoid.
b. Request an order for an antifungal medication.
c. Suggest that the patient be tested for a bronchial infection.
d. Tell the patient to discontinue use of the glucocorticoid.
A
The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid.
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone (Flovent HFA) 110 mcg twice daily and has used 2 puffs of albuterol (Proventil HFA), 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?
a. Four puffs of albuterol, oxygen, and intravenous theophylline
b. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler
c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen
d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
C
Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute exacerbations. During asthma flares, nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated, because oxygen saturations are low despite the increased work of breathing. Increasing the dose of albuterol and giving theophylline are not indicated. Salmeterol is a long-term beta agonist and is not useful in an acute attack.
A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent?
a. Growth may be slowed, but eventual adult height will not be reduced.
b. The growth rate is not impaired, but overall height will be reduced.
c. The growth rate slows while the drug is used but resumes when the drug is stopped.
d. Long-term use of the drug results in a decrease in adult height.
A
Glucocorticoids can slow growth in children and adolescents, but they do not reduce the eventual adult height. The growth rate will return to normal within a year, even when the drug is continued. Long-term use does not affect the eventual adult height.
A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?
a. Lowering her calcium intake and increasing her vitamin D intake
b. Participating in weight-bearing exercises on a regular basis
c. Taking oral glucocorticoids during times of acute stress
d. Using two reliable forms of birth control to prevent pregnancy
B
Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. Patients should increase both their calcium and vitamin D intakes. Patients taking oral glucocorticoids need increased steroids in times of stress. It is not necessary to use two reliable forms of birth control.
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast (Singulair) to the child’s regimen. Which statement by the child’s parent indicates understanding of this medication?
a. “I may notice mood changes in my child.”
b. “I should give this medication twice daily.”
c. “I will give my child one 4-mg chewable tablet daily.”
d. “This drug can alleviate symptoms during an acute attack.”
A
Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent inflammation. Some patients have reported mood changes when taking this drug, so parents should be warned of this effect. The medication is given once daily. The dose for a 7-year-old child is 5 mg daily. The drug does not treat symptoms of an acute attack.
A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching?
a. “Beta2-adrenergic agonists provide quick relief via any formulation.”
b. “Long-acting beta2 agonists may be used alone to prevent attacks.”
c. “Short-acting beta2 agonists are usually given by nebulizer.”
d. “Oral beta2 agonists are not useful for short-term treatment.”
D
Oral beta2 agonists are used only for long-term control. All formulations vary; long-acting beta2 agonists (LABAs) and oral preparations are used for long-term control, whereas short-acting beta2 agonists (SABAs) are useful for acute episodes. LABAs are used in conjunction with inhaled glucocorticoids to prevent attacks. SABAs may be given by MDI or nebulizer and usually are given by MDI.
A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient uses an inhaled glucocorticoid, montelukast (Singulair), and a SABA via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do?
a. Contact the provider to request a systemic glucocorticoid.
b. Contact the provider to suggest using a long-acting beta2 agonist.
c. Evaluate the need for teaching about MDI use.
d. Question the patient about how much albuterol has been used.
D
To determine the next course of action, it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used, that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results, evaluating the MDI technique may be warranted.
A patient who takes theophylline (Theochron) twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:
a. changing to a different antibiotic.
b. reducing the theophylline dose.
c. giving theophylline once daily.
d. switching from theophylline to a LABA.
B
Fluoroquinolone antibiotics increase theophylline levels, so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.
A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication?
a. “After the loading dose has been given, the patient will receive 6 mg/kg/hr.”
b. “Dosing is titrated based on the serum theophylline levels.”
c. “If the patient’s serum theophylline level is less than 15 mcg/mL, the rate should be reduced.”
d. “The patient will receive a loading dose of 180 mg over 5 minutes.”
B
Dosing for aminophylline is based on each patient’s serum theophylline levels. The loading dose usually is 6 mg/kg; after that, the maintenance infusion is titrated according to the theophylline levels. A serum theophylline level of 15 mcg/mL is within the therapeutic range, so dosing would not need to change. The patient’s total loading dose will be 180 mg, but infusions should never be given at a rate faster than 25 mg/min.
A child is receiving a combination albuterol/ipratropium (DuoNeb) inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?
a. Contact the provider to report systemic anticholinergic side effects.
b. Discontinue the aerosol treatment immediately.
c. Notify the provider of a possible allergic reaction.
d. Reassure the patient that these are expected side effects.
D
The most common adverse effects of this combination drug are dry mouth and irritation of the pharynx. The patient should be reassured that these are common and minor effects. Systemic anticholinergic side effects are rare. It is not necessary to discontinue the medication. Patients with peanut allergy may have severe anaphylactic reactions, but the patient’s symptoms are not those associated with anaphylaxis.
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient?
a. LABAs are safer than short-acting beta2 agonists.
b. LABAs can be used on an as-needed basis to treat symptoms.
c. LABAs reduce the risk of asthma-related deaths.
d. LABAs should be combined with an inhaled glucocorticoid.
D
LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.
A patient has just received a prescription for fluticasone/salmeterol (Advair Diskus). What will the nurse include as part of the teaching for this patient about the use of this device?
a. “You do not need good hand-lung coordination to use this device.”
b. “You will begin to inhale before activating the device.”
c. “You will need to use a spacer to help control the medication.”
d. “You will take 2 inhalations twice daily.”
A
The Advair Diskus is a dry powder inhaler and is activated by inhalation; therefore, hand-lung coordination is not required. There is no need for a spacer. Patients who use the Diskus take 1 inhalation twice daily.
A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient’s forced expiratory volume in 1 second (FEV1) is 75% of predicted values. The nurse will expect this patient to be started on which regimen?
a. Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed
b. Daily low-dose inhaled glucocorticoid and a SABA as needed
c. Daily medium-dose inhaled glucocorticoid/LABA combination
d. No daily medications; just a SABA as needed
A
This patient has moderate persistent asthma, which requires step 3 management for initial treatment. Step 3 includes daily inhalation of a low-dose glucocorticoid/LABA combination supplemented with a SABA as needed. A daily low-dose glucocorticoid with an as-needed SABA is used for step 2 management. A daily medium-dose glucocorticoid/LABA is used for step 4 management. Patients requiring step 1 management do not need daily medications.
