Lilley Chapter 38: Respiratory Drugs Flashcards
The nurse receives laboratory values for a patient with a theophylline level of 75 mmol/mL. The nurse interprets this theophylline level as being which of the following?
A. Therapeutic
B. Life-threatening
C. Toxic
D. Subtherapeutic
A. Therapeutic
The therapeutic theophylline level is 55 to 110 mmol/L.
Discharge teaching to a patient receiving a β-agonist bronchodilator should emphasize reporting which side effect?
A. Tachycardia
B. Sedation
C. Nonproductive cough
D. Hypoglycemia
A. Tachycardia
A β-agonist bronchodilator stimulates the β-receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.
Which herbal product, when taken with theophylline, can decrease theophylline’s serum drug levels?
A. Peppermint oil
B. St. John’s wort
C. Echinacea
D. Garlic
B. St. John’s wort
St. John’s wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.
The nurse is providing care to a patient prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the patient’s medical history would alert the nurse to question this prescription?
A. Chronic obstructive pulmonary disease
B. Coronary artery disease
C. Thrombocytopenia
D. Mycobacterium tuberculosis
B. Coronary artery disease
Nonselective adrenergic agonist bronchodilators stimulate β1-receptors in the heart and β2-receptors in the lungs. Stimulation of β1-receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patients with coronary artery disease.
A nurse is providing education to a patient taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent®) over other β2 agonists?
A. Quicker peak action
B. Longer duration of action
C. Extended time of action
D. Shorter onset of action
B. Longer duration of action
Salmeterol has a longer duration of action, requiring the patient to use it only twice a day instead of three or four times a day with other β2 agonists making it more manageable for most patients.
Patient teaching regarding the use of leukotriene receptor antagonists (LTRAs) such as zafirlukast (Accolate®) would include which statement by the nurse?
A. “Take the medication when you are short of breath and begin wheezing.”
B. “This medication works by preventing the inflammation that causes your asthma attack.”
C. “Increase fibre and fluid in your diet to prevent the common adverse effect of constipation.”
D. “It will take about 3 or 4 weeks before you notice a therapeutic effect.”
B. “This medication works by preventing the inflammation that causes your asthma attack.”
LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast.
What is the role of corticosteroids in the treatment of acute respiratory disorders?
A. To stimulate the immune system
B. To decrease inflammation
C. To increase gas exchange in the alveoli
D. To directly dilate the bronchi
B. To decrease inflammation
Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.
Which statement by a patient best indicates an understanding of the teaching on flunisolide?
A. “I will not use my albuterol inhaler while I am taking AeroBid.”
B. “I will rinse my mouth with water after each use.”
C. “I will take two puffs to treat an acute asthma attack.”
D. “I will wash the plastic inhaler casing once a month.”
B. “I will rinse my mouth with water after each use.”
Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the patient’s bronchodilator medications. The plastic inhaler casing should be washed in warm soapy water every week.
Which statement by the nurse should be included when teaching a patient about the proper use of metered-dose inhalers?
A. “Make sure that you puff out air several times after you inhale the medication.”
B. “Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler.”
C. “Wait 1 to 2 minutes before you take a second puff of the same drug.”
D. “After you inhale the medication once, repeat until you obtain relief.”
C. “Wait 1 to 2 minutes before you take a second puff of the same drug.”
If a second puff of the same drug is ordered, instruct the patient to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the patient to wait 2 to 5 minutes between the medications or to take as prescribed.
The nurse performs discharge teaching with a patient who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent®). Which statement by the patient indicates to the nurse that the teaching has been successful?
A. “This inhaler is not to be used alone to treat an acute asthma attack.”
B. “I will not drink grapefruit juice while taking this drug.”
C. “Nausea and vomiting are common adverse effects of this medication.”
D. “I may gain weight as a result of taking this medication.”
A. “This inhaler is not to be used alone to treat an acute asthma attack.”
Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.
Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a patient?
A. Cardiac enzymes
B. Complete blood count
C. Liver enzymes
D. Renal function
C. Liver enzymes
Because the use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.
