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NUR 311 2022 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are MDIs and how should they

be used?

A 
Metered-dose inhalers. Small, hand-held, 
pressurized devices.  Begin slow 
inhalation before activation, hold 
medicine in lungs for 10 seconds, and 
wait 1 minute between activations.
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2
Q

What are SMIs and how should they

be used?

A

Soft mist inhalers. Begin slow inhalation,
hold medicine in lungs for 10 seconds,
and wait 1 minute between activations.

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3
Q

What is the advantage of DPIs?
Disadvantage? How fast should the
patient inhale?

A

No hand-lung coordination needed,
breath-activated. Must have adequate
inspiratory flow to inhale powder. Inhale
rapidly.

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4
Q

What are SVNs and how are they

used? What are the advantages?

A

Small volume nebulizers. Converts a
solution into a mist. Does not require
timing of dose with inhalation, rapid deep
inspiration, or hand strength.

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5
Q

List three ways glucocorticoids treat

asthma.

A

Suppress inflammation and bronchial
reactivity, decrease mucus production,
increase number and responsiveness of
beta-adrenergic receptors.

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6
Q

What is the first-line treatment for

moderate to severe persistent asthma?

A

Inhaled glucocorticoids

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7
Q

Discuss the proper way to
administer inhaled glucocorticoids.
Why?

A

Gargle & spit after use. Use the beta-
adrenergic inhaler first if one is used. The
beta-adrenergic inhaler opens the airways
so that the glucocorticoid can penetrate
deeper into the lungs. Gargling and
spitting decreases the chance of an
oropharyngeal infection.

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8
Q

Why might oral glucocorticoids be
necessary during stress even if asthma
symptoms are controlled?

A

May need to supplement because stressful
events require bursts of steroids. The
patient may develop adrenal crisis without
supplementation.

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9
Q

How does montelukast (Singular), a

leukotriene modifier, work?

A

Blocks leukotriene receptors.

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10
Q

What are four mechanisms of

action for leukotriene modifiers?

A

Bronchodilation, decreased mucus,
decreased edema, and decreased
eosinophilic infiltration

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11
Q

How does Cromolyn, a mast cell

stabilizer, work?

A

Prevents mast cells from lysing and

releasing histamine and other mediators.

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12
Q

How long must mast cell stabilizers

be used to obtain a therapeutic effect?

A

May take several weeks.

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13
Q

How does omalizumab (Xolair)
work? Why are patients asked to stay
in the clinic after injections?

A

Myoclonal antibody binds free IgE so that
it cannot bind to mast cells and cause their
lysis. Risk for anaphylaxis.

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14
Q

Why are beta2-adrenergic agonists

used?

A

Relieve bronchospasm and prevent

exercise-induced bronchospasm.

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15
Q

What are the three mechanisms of

action for beta2-adrenergic agonists?

A

Bronchodilation, suppression of histamine

release, increased ciliary motility.

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16
Q

What is the difference between
short-acting and long-acting beta2-
adrenergic agonists?

A 
Short-acting: lasts 3-5 hrs, immediate 
effect, used for relief of bronchospasm 
and before exercise.
Long-acting: given every 12 hrs, used to 
prevent bronchospasm.
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17
Q

Discuss the adverse effects of beta2-

adrenergic agonists.

A

Tachycardia, angina, tremor,
hypokalemia, nervousness, insomnia,
seizures, paradoxical bronchospasm.

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18
Q

Discuss three drug-drug
interactions of beta2-adrenergic
agonists.

A 
Decreased potassium levels with diuretics, 
glucocorticoids, and methylxanthines.   
Beta-blockers block their therapeutic 
effects. Use of long-acting inhaled 
glucocorticoids may protect against 
increase in asthma-related deaths with 
inhaled long-acting beta2-adrenergic 
agonists.
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19
Q

Explain how anticholinergic
inhalers work. List three
anticholinergic inhalers.

A 
Interrupt parasympathetic response 
causing bronchodilation and decreased 
mucus.
Atrovent (ipratropium)
Spiriva (tiotropium)
Tudorza Pressair (aclidinium)
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20
Q 
How many minutes should elapse 
between 2 inhalations of a beta-
adrenergic agonist?  How long should 
the patient hold his breath?  In what 
order should you have the patient take 
two inhalations of an inhaled steroid 
and 2 inhalations of a beta-adrenergic 
agonist inhaler?
A

1 minute
Hold breath for 10 seconds
2 inhalations of beta-agonist, then 2
inhalations of inhaled steroid.

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21
Q 
How many times per week can a 
patient have symptoms and still be 
classified as mild intermittent asthma?  
How many night-time symptoms in a 
month?
A

< 2 /week

< 2/month

22
Q

A patient with daily asthma
symptoms is classified as having what
type of asthma?

A

Moderate persistent

23
Q

Explain the PEF zone system. If a
patient’s personal best is 1000 and the
PEF drops to 600, what zone is he in?
What drug should he use?

A

Yellow 50-80%.

Use short-acting beta agonist.

24
Q

In conscious persons with severe
asthmas exacerbations, which drugs
should be administered first?

A

Beta-agonist and ipratropium (Atrovent)

inhalations in a SVN

25
Q

What drug categories are used to

maintain patients who have COPD?

A

Long-acting beta2-adrenergic agonists or

anticholinergic inhalers.

26
Q

What drugs categories are used
initially for acute exacerbations of
COPD?

A

Short-acting beta2-adrenergic agonists

alone or with an anticholinergic inhaler.

27
Q

What two drugs may be added for

control of severe COPD?

A

Longterm inhaled glucocorticoids and

Roflumilast (Daliresp)

28
Q

What Drug is for Respiratory Disorders:

A

Potassium (K)

29
Q

Drugs for Upper Gastrointestinal Disorders:

A
  • Complete blood count (CBC) with differential and platelets
  • potassium (K)
  • magnesium (Mg)
30
Q

Drug ending -terol

What is the drug classification and an example?

A

Classification: Bronchodilator
Example: Albuterol

31
Q

List and explain the 4 defensive
factors which protect the stomach and
duodenum from self-digestion.

A 
Mucus – forms a barrier to protect 
underlying cells from gastric acid and 
pepsin. 
Bicarbonate – neutralizes any acid which 
penetrates the mucus. 
Blood flow – maintains integrity or health 
of the mucosa 
Prostaglandins – Stimulates mucus and 
bicarbonate, vasodilates blood vessels, 
suppresses gastric secretion
32
Q 
Mucus – forms a barrier to protect 
underlying cells from gastric acid and 
pepsin. 
Bicarbonate – neutralizes any acid which 
penetrates the mucus. 
Blood flow – maintains integrity or health 
of the mucosa 
Prostaglandins – Stimulates mucus and 
bicarbonate, vasodilates blood vessels, 
suppresses gastric secretion
A 
Helicobacter pylori (H. pylori) – gram-
negative bacillus which lives between the 
mucus layer and the mucosa.  Produces 
CO2 and ammonia from urea which 
damages the mucosa. 
NSAIDs – decreases the production of 
prostaglandins which decreases blood 
flow, decreases bicarbonate and mucus 
secretion, and increases gastric acid. 
Gastric Acid – injures cells of the mucosa 
and activates pepsin. 
Pepsin – breaks down protein of the gut 
wall. 
Smoking – delays healing of ulcers and 
increases risk of recurrence.
33
Q

What are three mechanisms of

action for antacids?

A

Binds gastric acid and forms a neutral salt,
decreases pepsin if pH > 5, and stimulates
prostaglandins.

34
Q

How are antacids administered in
relation to meals, sleep, or other drugs?
If not eating, how often are they given?

A

1 and 3 hrs after meals and at bedtime, 1
hour before another drug, or every 2 hours
if not eating

35
Q

Which antacids can cause
complications in heart failure and renal
disease?

A

Aluminum hydroxide and sodium
bicarbonate – heart failure, magnesium
hydroxide – CNS toxicity in renal patients

36
Q

How do histamine2 receptor

antagonists work?

A

Block H2 receptors on parietal cells which
suppress gastric acid secretion and
decrease the hydrogen ion concentration
in gastric acid.

37
Q

How are histamine2 receptor
antagonists administered in relation to
meals?

A

May be taken without regard to meals,

except take Tagamet with food

38
Q

Which histamine2 receptor
antagonist is noted for drug-drug
interactions caused by inhibition of
hepatic drug-metabolizing enzymes?

A

cimetidine (Tagamet)

39
Q

Which histamine2 receptor
antagonist is known for its ability to
block androgen effects?

A

cimetidine (Tagamet)

40
Q

Proton-pump inhibitors may
decrease the absorption of antifungals
by what action?

A

Decreased gastric acid production

41
Q

When are proton pump inhibitors

given?

A

Esomeprazole (Nexium) is given one hour
before a meal. Omeprazole (Prilosec) and
lansoprazole (Prevacid) are given directly
before a meal. Others may be given at any
time.

42
Q 
How long does it take for full 
recovery of the H+, K+-ATPase pump 
after stopping a proton pump 
inhibitor? 
Why? How long for partial recovery?
A

Weeks due to irreversible inhibition. 3-5

days

43
Q

Why is misoprostol (Cytotec) used?

What are the mechanisms of action?

A

Prevention of NSAID-caused gastric
ulcers. Stimulates the secretion of mucus
and bicarbonate, vasodilates blood
vessels, suppress gastric acid secretion.
Replaces prostaglandins.

44
Q

Why is misoprostol (Cytotec) not

given during pregnancy?

A

Stimulates uterine contractions.

45
Q

How does sucralfate (Carafate)

work? When should it be given?

A

Polymerization and cross-linking occurs
when the pH is < 4. It adheres to the
crater for 6 hours. Given on an empty
stomach.

46
Q

How many hours must elapse
between an antacid and sucralfate
(Carafate)? Between other drugs and
sucralfate (Carafate)?

A

1 hour between an antacid and sucralfate.

2 hours between drugs and sucralfate.

47
Q

In order to kill Helicobacter pylori,

what combination of drugs is given?

A

2-3 antibiotics with a proton pump
inhibitor or histamine-2 receptor
antagonist

48
Q

How does bismuth (Pepto-Bismol)
work? What are two common side
effects?

A

Disrupts the cell wall of H. pylori, inhibits
urease, and keeps H. pylori from adhering
to the mucosa. Black tongue and stools.

49
Q

At what pH will pepsin be

decreased?

A

> pH 5

50
Q

What is the preferred drug category
for the prevention of NSAID-induced
ulcers?

A

Proton Pump Inhibitors

51
Q

What are two signs of

gastrointestinal bleeding?

A

Black, tarry stools and coffee-ground

vomitus.

52
Q

What is the acid-neutralizing

capacity (ANC)?

A

The number of mEq of hydrochloric acid
that is neutralized by a given amount of
the antacid.

NUR 311 2022 (5 decks)

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