Respiratory

Question 1

Therapeutic Use

Beta2-Adrenergic Agonist - albuterol

Answer 1

Long-term management of asthma
Prevention of exercise-induced bronchospasm
Treatment of ongoing asthma exacerbations

Question 2

Adverse Effects

Beta2-Adrenergic Agonist - albuterol

Answer 2

Chest pain, palpitations

Nervousness, restlessness, tremors

Question 3

Medication Administration

Beta2-Adrenergic Agonist - albuterol

Answer 3

Follow manufacturer’s instructions for using delivery devices
Use short-acting preparations for acute exacerbations
Use long-acting preparations for long-term control
Inhale beta2-adrenergic agonists before inhaling glucocorticoids
Follow dosage limits and schedules
Watch for signs and triggers of impending exacerbations of asthma
Keep a log of the frequency and intensity of exacerbations
Notify the provider of changes in patterns of exacerbations

Question 4

Therapeutic Use

Anticholinergics - ipratropium

Answer 4

Relief of bronchoconstriction in clients who have COPD

Decrease secretions in clients with COPD

Question 5

Expected Pharmacological Action

Anticholinergics - ipratropium

Answer 5

Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchodilation

Question 6

Adverse Effects

Anticholinergics - ipratropium

Answer 6

Dry mouth, irritation of pharynx
Increased intraocular pressure
Urinary retention

Question 7

Medication Administration

Anticholinergics - ipratropium

Answer 7

Follow manufacturer’s instructions for using delivery devices
Follow the dosage limits and schedules
Allow the prescribed time between puffs
Delay use of other inhalants for 5 minutes
Do not use as an emergency rescue medication
Rinse the mouth after use to reduce unpleasant taste

Question 8

Contraindications

Anticholinergics - ipratropium

Answer 8

Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide, history of sensitivity to soy or peanuts- avoid Combivent (ipratropium/albuterol combination) MDI form of drug

Question 9

Adverse Effects

Methylxanthines - theophylline

Answer 9

Rare at therapeutic levels
When therapeutic levels are exceeded: restlessness, insomnia
Nausea, vomiting, diarrhea

Question 10

Toxicity Symptoms

Methylxanthines - theophylline

Answer 10

Seizures, dysrhythmias

Question 11

Client Education

Methylxanthines - theophylline

Answer 11

Reduce or eliminate caffeine intake
Have periodic laboratory testing of drug levels
Stop takin the drug and notify provider if experiencing seizure
Stop taking the drug and notify provider if experiencing dysrhythmias

Question 12

Contraindications

Methylxanthines - theophylline

Answer 12

Clients with impaired metabolism
Tobacco or marijuana use
Caffeine
Heart disease
Liver dysfunction
Acute pulmonary edema

Question 13

Adverse Effects

Glucocorticoids - beclomethasone dipropionate

Answer 13

Inhaled: oral candidiasis
Oral: Suppression of adrenal function, bone demineralization, muscle wasting, hyperglycemia, peptic ulcer disease, infection, fluid and electrolyte imbalances
Nasal: dry mucous membranes, epistaxis, sore throat, headache

Question 14

Client Education

Glucocorticoids - beclomethasone dipropionate

Answer 14

Rinse mouth or gargle water after use
Monitor for redness, sores, or white patches and report to provider if they occur. Treat candidiasis with nystatin oral suspension

Question 15

Therapeutic Use

Mast Cell Stabilizers - cromolyn

Answer 15

Long-term treatment of allergy-related asthma
Prophylaxis for exercise-induced bronchospasm
Prophylaxis for seasonal allergy symptoms
Management of allergic rhinitis (intranassaly)

Question 16

Medication Administration

Mast Cell Stabilizers - cromolyn

Answer 16

Use with a nebulizer or metered-dose inhaler
Expect several weeks of use for full effects to become apparent
Administer four times daily on a fixed schedule
Use the inhaler 15 minutes before exercising to prevent exercise-induced bronchospasms
Do not use to relieve an acute asthma exacerbation

Question 17

Nursing Interventions

Mast Cell Stabilizers - cromolyn

Answer 17

Administer epinephrine and/or antihistamines to reverse anaphyaxis

Question 18

Adverse Effects

Leukotriene Modifiers - Montelukast

Answer 18

Leukotriene modifiers zileuton and zafirlukast can cause liver damage. Does not occur with Montelukast
Neuropsychiatric effects such as suicidal ideations

Question 19

Nursing Interventions

Leukotriene Modifiers - Montelukast

Answer 19

Monitor liver function with periodic testing

Observe for behavioral changes

Question 20

Client Education

Leukotriene Modifiers - Montelukast

Answer 20

Report abdominal tenderness, nausea, or anorexia

Report behavioral changes such as agitation, insomnia, anxiety, or irritability

Question 21

Therapeutic Use

First Generation Antihistamines - diphenhydramine

Answer 21

Management of: mild allergic reactions (seasonal allergic rhinitis, cough, urticaria, mild transfusion reaction), anaphylaxis (hypotension, acute laryngeal edema, bronchospasm), motion sickness, insomnia (short-term use, no longer than 2 consecutive weeks)

Question 22

Expected Pharmacological Action

First Generation Antihistamines - diphenhydramine

Answer 22

Acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site
Decreases allergic response by blocking histamine

Question 23

Adverse Effects

First Generation Antihistamines - diphenhydramine

Answer 23

Drowsiness, dizziness
Anticholinergic effects (dry mouth, constipation)

Question 24

Therapeutic Use

Second Generation Antihistamines - certirizine

Answer 24

Management of: allergic rhinitis, chronic idiopathic urticaria

Question 25

Medication Administration | Second Generation Antihistamines - certirizine

Answer 25

May take with or without food Do not take with other over-the-counter antihistamines Expect dose to be lower in clients who have compromised renal or liver function

Question 26

Client Education | Second Generation Antihistamines - certirizine

Answer 26

Take once-daily dose at time desired Avoid driving and activities that require mental alertness until the drug's effects are known Take frequent sips of water Suck on hard candy

Question 27

Adverse Effects | Sympathomimetics - phenylephrine

Answer 27

CNS stimulation with oral agents (agitation, anxiety, insomnia) Increased blood pressure Tachycardia/palpitations Overdose or systemic absorption: hypertension, tachycardia, and heart palpitations Rebound congestion with prolonged use of topical agents

Question 28

Client Education | Sympathomimetics - phenylephrine

Answer 28

Notify provider of excessive symptoms of CNS stimulation Consult provider regarding alternative therapy or withdrawal of drug Report prolonged tachycardia or heart palpitations Have blood pressure checked while on medication if previously diagnosed with hypertension Do not use for more than 3 to 5 days Taper and discontinue the drug using one nostril at a time

Question 29

Expected Pharmacological Action | Antitussives - codeine and dextromethorphan

Answer 29

Depress pain impulse transmission at the spinal cord level by interacting with opioid receptors Decreases cough reflex, GI motility

Question 30

Adverse Effects | Antitussives - codeine and dextromethorphan

Answer 30

CNS depression (drowsiness, sedation common with opioid antitussives; only occurs in non-opioid antitussives if you give large doses or other CNS depressant drugs concurrently) Dizziness, lightheadedness (more common with opioid antitussives) Gastrointestinal distress (nausea, vomiting) Respiratory depression (opioids only) Potential for abuse

Question 31

Contraindications | Antitussives - codeine and dextromethorphan

Answer 31

Known sensitivity to the drug MAO inhibitors or SSRIs Prostatic hypertrophy Reduce respiratory reserve (emphysema, chronic asthma) History of substance abuse Use cautiously in children and older adults

Question 32

Expected Pharmacological Action | Expectorants - guaifenesin

Answer 32

The expected pharmacological action of expectorants is a reduction in the surface tension of secretions. This thins out thick mucous, making it easier to cough out of the lungs and drain out of the nose and sinuses

Question 33

Client Education | Expectorants - guaifenesin

Answer 33

Do not take before driving or activities requiring mental alertness Sit or lie down if feeling lightheaded Change positions gradually Take the drug with food and/or 8oz of water Stop taking the drug and seek medical care if experiencing an allergic reaction

Question 34

Evaluation of Medication Effectiveness | Expectorants - guaifenesin

Answer 34

Cough is more productive and mucous is easier to expectorate | Chest congestion is decreased

Question 35

Therapeutic Use | Mucolytic - acetylcysteine

Answer 35

Decrease viscosity of mucous secretions | Reverse acetaminophen overdose

Question 36

Client Education | Mucolytic - acetylcysteine

Answer 36

``` Report any difficulty breathing or worsening cough Expectorate secretions Take antiemetic as needed Proper use and cleaning of nebulizer Consume 2,000 to 3,000 mL of water daily ```

Question 37

Contraindications | Mucolytic - acetylcysteine

Answer 37

Risk of actual gastric bleeding