chp. 35 study guide: drugs affecting the lower respiratory system – Flashcards
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acetylcysteine is a mucolytic used to break up thick, tenacious sputum in patients whose physical conditions make it difficult to cough up these secretions (e.g., COPD, cystic fibrosis, pneumonia, TB). it is most frequently given by
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nebulizer, usually in an acute care setting. it is a fast-acting drug with onset of action within 1 minute. main adverse effects are respiratory (bronchospasm, bronchoconstriction, chest tightness, burning in upper airway, and rhinorrhea). acetylcysteine is the antidote for severe acetaminophen overdosage
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albuterol is a relatively selective beta-2 agonist used as a bronchodilator for patients with COPD and asthma. it may be given orally or inhaled by way of a metered-dose inhaler or nebulizer. bronchodilation occurs quickly, in 15 minutes or less, after inhalation. because of this, inhaled albuterol is considered a "rescue drug" when there is an acute attack of bronchoconstriciton. it is the drug patients should use first when they begin to experience
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symptoms. long-acting beta-2 agonists have been associated with a higher risk for asthma-related deaths. teach the patient that long-acting drugs are not appropriate for acute symptoms because the onset of action is too slow
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although albuterol is relatively selective for beta-2 receptors, some stimulation of beta-1 receptors occurs. adverse effects are related to these
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sympathomimetic effects, such as tachycardia, anxiety, and tremor. oral doses are more likely to cause systemic adverse effects
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ipratropium is an anticholinergic that decreases the formation of cyclic guanosine monophosphate (cGMP), creating
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relaxation of the smooth muscle in the bronchial tree. it is used as maintenance treatment for bronchospasm from chronic asthma, bronchitis, emphysema, or COPD. it is given by inhalation or intranasal spray
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ipratropium is taken daily to decrease the frequency and severity of future asthma attacks. it will not provide
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"rescue relief" for an attack in progress. patient education is important to achieve the full therapeutic effect
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theophylline, a xanthine, has a direct effect on the smooth muscle of the respiratory tract and produces bronchodilation. it is used to treat or prevent
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bronchial asthma and bronchospasms in COPD. it is given orally. aminophylline, a very similar drug that is water soluble, is given IV when acute symptoms occur
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adverse effects of theophylline are GI (n/v, diarrhea), CNS stimulation (headache, insomnia, irritability), and possibly CV (hypotension and arrhythmias)
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adverse effects most frequently occur when serum levels are elevated above the therapeutic range, although they may occur with therapeutic levels. monitor serum levels throughout therapy
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cromolyn sodium is a mast cell stabilizer that is used in prophylaxis for mild to moderate asthma. it prevents the mast cell from rupturing and spilling its contents (degranulation) after it has contact with an antigen. thus, it has
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anti-inflammatory effects. It is administered through inhalation or intrana- sal spray. Cromolyn sodium must be taken daily as prophylaxis; it is not effective during an acute asthmatic attack. However, it may be used before exercise to prevent exercise- induced bronchospasm.
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Zafirlukast blocks the receptors for leukotri- enes, which are potent bronchoconstrictors. This is how zafirlukast improves the wheez- ing, coughing, and dyspnea symptoms of asthma. Zafirlukast is used in the treatment of
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chronic asthma; it does not relieve the symptoms of an acute asthmatic attack. It is given orally. Food impairs the absorption of zafirlukast; give 1 hour before or 2 hours after eating.
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Glucocorticoid steroids are the most effective anti-inflammatory drugs used in the manage- ment of respiratory disorders. They may be given orally, parenterally, or by inhalation. Inhaled glucocorticoids need to be used daily for their peak effect to occur. Intravenous doses may be used in acute respiratory flare- ups, in combination with a xanthine or a beta-2 agonist.
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Inhaled glucocorticoids do not have the systemic adverse effects that occur with oral and parenteral forms. The adverse effects from inhaled steroids are localized in the respiratory tract (sore throat, hoarseness, and cough).
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The action of acetylcysteine (Mucomyst) is to
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break down mucoproteins in the airways that block airflow -Acetylcysteine (Mucomyst) splits disul- fide bonds that are responsible for hold- ing the mucous material together. The result is a decrease in the tenacity and viscosity of the secretions.
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Acetylcysteine (Mucomyst) is the drug of choice in the treatment of
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cystic fibrosis -In this disorder, the thick, sticky mucus accumulates in the lungs, plugging the bronchi and making breathing difficult.
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In addition to action on the respiratory sys- tem, acetylcysteine (Mucomyst) is used in the management of
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acetaminophen overdose -In acetaminophen overdose, it normal- izes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen.
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The action of albuterol (Proventil) is to
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dilate the bronchioles -Albuterol (Proventil) is a beta-2 agonist. In the sympathetic nervous system, stimulation of beta-2 relaxes bronchial smooth muscle, resulting in bronchodilation
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When albuterol (Proventil) is administered by inhalation, relief of symptoms should occur within
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5 minutes -When given by MDI or nebulizer, the onset is 5 minutes. When given PO, the onset is 30 minutes.
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Adverse effects associated with the use of albuterol (Proventil) include
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tachycardia and palpitations -Albuterol (Proventil) is a beta-2 selec- tive drug; however, some stimulation of beta-1 may also occur, resulting in these symptoms.
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Ipratropium bromide (Atrovent) works by
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blocking the action of the parasympathetic nervous system -An anticholinergic drug blocks the action of the cholinergic (parasympathetic) nervous system.
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Adverse effects of inhaled ipratropium bromide (Atrovent) include
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paradoxic acute bronchospasm -Ipratropium aerosols can produce a paradoxical acute bronchospasm that can be life threatening in some patients. This rare problem, when it occurs, is usu- ally seen with the first inhalation from a newly opened MDI.
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In general, ipratropium bromide (Atrovent) should be used
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3 to 4 times a day -The recommended dose is 2 to 3 puffs 3 to 4 times a day, with a maximum of 12 puffs per day.
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Theophylline (Theo-Dur) works by
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directly affecting the smooth muscle of the respiratory tract -Although the exact mechanism of action is unknown, the resultant effect occurs directly on the smooth muscle of the respiratory tract.
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Which of the following statements concerning theophylline (Theo-Dur) therapy is correct?
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there are many drug-drug interactions with theophylline that may require dosage changes -Theophylline (Theo-Dur) interacts with many significant drugs. It can increase the serum concentration of other drugs and other drugs can increase the serum concentration of theophylline.
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Patients taking theophylline (Theo-Dur) should avoid large amounts of
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charcoal-broiled beef -Theophylline (Theo-Dur) elimination is increased by a low-carbohydrate, high-protein diet and by charcoal-broiled beef.
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Flunisolide (Aerobid) works by
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inhibiting the production of leukotrienes and prostaglandins, decreasing the activity of the inflammatory cells, enhancing the responsiveness of beta receptors in the airway smooth muscle -Flunisolide (Aerobid) also increases the number of beta receptors.
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Flunisolide (Aerobid) should be given cautiously to patients with
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active infection of the respiratory system -Steroids depress the immune system, so serious adverse effects may occur if they are given to patients with an active respiratory infection.
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Which of the following statements concern- ing flunisolide (Aerobid) therapy is correct?
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there are very few drug-drug interactions with flunisolide -Because of its route of administration, no important drug-drug interactions occur.
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cromolyn sodium (Intal) works by
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preventing the release of chemicals that stimulate the inflammatory process -Cromolyn sodium (Intal) inhibits the rupture of mast cells.
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Cromolyn sodium (Intal) is contraindicated for patients
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having an acute asthma attack -Cromolyn sodium (Intal) is another type of maintenance drug and is ineffective for an acute asthma attack.
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Which of the following statements concerning cromolyn sodium (Intal) therapy is correct?
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there are no drug-drug interactions with cromolyn -Like inhaled glucocorticosteroids, there are no significant drug-drug interactions.
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Zafirlukast (Accolate) works by
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blocking leukotriene receptor sites -Zafirlukast (Accolate) blocks receptors for the leukotrienes bound to the amino acid cysteine. The cysteinyl leukotrienes are potent bronchoconstrictors, approxi- mately 100 to 1,000 times more potent than histamine.
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Serious adverse effects to zafirlukast (Accolate) therapy include
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hepatic failure -Although such effects are rare, zafirlukast (Accolate) may elevate hepatic enzymes, cause symptomatic hepatitis, or cause hepatic failure.
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Zafirlukast (Accolate) should not be given to children younger than
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5 years -Zafirlukast (Accolate) is not approved for children younger than 5 years.
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Which of the following drugs is indicated for treatment of an acute asthma attack?
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albuterol (Proventil) -Albuterol (Proventil) is a short-acting beta-2 agonist. It is the only drug that has a quick onset to abate acute symptoms.
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The most serious adverse effect associated with omalizumab (Xolair) is
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neoplasm -this is especially true in patients with a history of neoplasm
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Your 7-year-old patient has cystic fibrosis and is receiving acetylcysteine therapy. Before the therapy, you should anticipate the need for
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albuterol (Proventil) -Using a beta-2 agonist drug will open the bronchial tree and allow acetylcysteine to penetrate deeper into the lungs.
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Which of these finding, if identified in a client who is being treated with acetylcyste- ine, would indicate that the drug is having the desired effect?
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the respiratory secretions are no longer thick -Acetylcysteine is a mucolytic drug that breaks the bonds of mucus thus decreasing the viscosity of the respiratory secretions.
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Your 16-year-old patient received a diagnosis of asthma at the age of 11 years. The patient uses an albuterol (Proventil) inhaler. The patient comes to the clinic today and states, "This inhaler is worthless. I have to use it every 2 hours." With your knowledge of this drug, you suspect the patient may be
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experiencing rebound bronchoconstriction -Overuse of a beta-2 agonist drug results in rebound. The more you use, the more you need.
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The nurse should assess the patient taking albuterol (Proventil, Ventolin) for adverse effects that include
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tachycardia -Albuterol (Proventil, Ventolin) is a beta-2 agonist. While tachycardia is more prevalent when beta-1 receptors are stimulated, it may still occur when using a beta-2 agonist because selectivity to the Beta-2 receptor is not absolute.
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Your 21-year-old patient has asthma and takes albuterol (Proventil) as needed. The patient is seen at the clinic today, and the health care provider adds ipratropium bro- mide (Atrovent) to the asthma regimen. It is important for you to teach this patient to use this inhaler
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twice a day, regardless of how the patient feels -Maintenance drugs should be taken without regard to symptoms for the drug to reach an adequate level in the bloodstream.
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Your 22-year-old patient has asthma and an order for ipratropium bromide (Atrovent). Before administration, you should assess for allergies to
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legumes -Ipratropium aerosol inhalation is con- traindicated in patients who have soya lecithin hypersensitivity, including patients with a history of peanut oil hypersensitivity or hypersensitivity to related foods and legumes, such as soy- beans and peanuts.
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Your 42-year-old patient has asthma and takes oral theophylline. The patient states, "I hate those pills. I'm up all night and ner- vous." Which of the following interventions would be most helpful to this patient?
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contact the health care provider for an order for an inhaled steroid. -The newest recommendations suggest an inhaled steroid (ICS) for maintenance and the use of oral medications only when the ICS is not sufficient.
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Despite a long history of asthma, your patient continues to smoke a pack of ciga- rettes per day. During theophylline therapy, you would expect to administer
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a higher dose of theophylline -Smoking cigarettes may decrease serum theophylline levels. In fact, some patients who smoke require an increase in the- ophylline dosage of up to 50%.
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Patient teaching for patients receiving inhaled steroids should include which of the following?
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"rinse your mouth after use to avoid adverse effects." -Rinsing the mouth after use will decrease the potential for thrush, as well as decrease the amount of drug swallowed. Although drinking water is always good for patients with asthma, this intervention is not specific to inhaled steroids.
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Your patient has exercise-induced asthma and the health care provider has just pre- scribed cromolyn sodium (Intal). Patient education should include instructions to
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use the inhaler 15 to 20 minutes before participating in exercise -For the management of exercise-induced asthma, cromolyn sodium (Intal) should be taken just prior to exercise.
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Your patient has severe persistent asthma that is not controlled by inhaled steroids. Which of the following should be docu- mented before initiation of omalizumab (Xolair) therapy?
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positive skin test for perennial allergens -This drug interferes with the release of inflammatory mediators and cytokines released from an antigen-antibody reaction.
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Your patient has asthma and uses albuterol (Proventil), ipratropium bromide (Atrovent), and beclomethasone dipropionate (Beclo- vent) inhalers. The patient comes to the clinic for a routine checkup and states, "I can never remember which of these I should take first." Which of the following statements is most appropriate in response?
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"use the albuterol first. that will help the other two disperse further into your lungs." -Use of the beta-2 agonist opens the bron- chial tree, allowing the other drugs to be distributed farther into the lungs.
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You are the nurse providing a nebulizer treat- ment of acetylcysteine for a patient with bilateral lower lobe pneumonia. Which of the following should you remember while administering drug therapy and caring for the patient?
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a sticky residue may form on the patient's face from therapy -This sticky residue should be removed with water after drug administration. Diluted acetylcysteine should be refrig- erated, not left at room temperature. Nebulization of acetylcysteine causes an unpleasant, transient smell. The purpose of the therapy is to loosen thick secretions so that they may be expelled via cough. Therefore, coughing is expected and to be encouraged, not discouraged.
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A patient has been started on an IV drip of aminophylline, a xanthine bronchodilator, for an acute COPD exacerbation. Which of the following should be included in the nurs- ing care of this patient while he receives IV aminophylline?
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assess breath sounds every 2 to 4 hours; assess for insomnia, tachycardia, and irritability; inform him that he will have blood drawn regularly while taking the drug -Breath sounds should clear if therapy is effective; assessment throughout therapy is important. Insomnia, tachycardia, and irritability are signs of adverse effects and should be assessed. Blood will need to be drawn so blood levels of theoph- ylline can be measured to determine if therapeutic or toxic levels have been achieved.
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A patient with asthma has been prescribed zafirlukast (a mast cell stabilizer), beclometh- asone (a glucocorticoid steroid) metered- dose inhaler, and albuterol (a beta-2 agonist) metered-dose inhaler. The patient says, "Why do I need three medications, including two inhalers? Can't I just take one pill?" Patient education should include
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the drugs work in different ways to provide better, more complete treatment; the zafirlukast and the beclomethasone work to prevent asthmatic attacks, and the albuterol works to provide quick relief of asthmatic attacks; giving beclomethasone and albuterol by inhalers helps to reduce their adverse effects -All of the above are true and should be included in patient education.
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A female patient has been prescribed cromo- lyn sodium as part of the treatment for her asthma. She has a history of irregular men- strual periods and lactose intolerance. What teaching does this patient need regarding the cromolyn sodium?
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contact the providers if nausea, bloating, or abdominal cramps occur while taking this drug. -Because this patient has a history of lactose intolerance, she may have the same type of problems with the use of cromolyn sodium. She needs to contact the pre- scriber if she has any of these symptoms of lactose intolerance. Cromolyn sodium is used as prophylaxis, not to treat an acute episode of asthma. Metered-dose inhalers require the patient to exhale, trigger the release of medication, and then inhale. (Irregular menstrual periods pose no additional risk for adverse effects from cromolyn sodium, and no special teaching is required.)
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Your patient begins a regimen of oral the- ophylline. In your patient education, you will need to tell this patient that he needs to avoid, or limit, the intake of which of these favorite foods and beverages?
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iced tea (drinks daily) -Iced tea contains caffeine. Caffeine, like theophylline, is a xanthine. Adverse effects from the theophylline are more likely if caffeine is taken also. If the patient drinks several glasses a day, he needs to avoid it, although an occasional glass would be acceptable. Sprite soda does not contain caffeine. Although lemon meringue pie and fettuccine alfredo are high in carbohydrates, eating these occasionally is acceptable, as long as his protein intake is normal. Overall, he should avoid a high-carbohydrate, low-protein diet because this can decrease urinary elimination of theoph- ylline. One particular food item does not alter the overall dietary pattern: Cheerios cereal would have no effect on theophylline.
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A patient returns for a checkup after begin- ning a regimen of zafirlukast for asthma. Which of these findings would alarm you, the nurse, the most?
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whites of the eyes are yellowed -Yellowing of the whites in the eyes is a sign of jaundice and may indicate that hepatitis or hepatic failure is develop- ing. These are serious adverse effects of zafirlukast. Absence of wheezing is a positive effect from the drug, indicat- ing that the therapeutic effect is being achieved. A mild headache and an upset stomach can be common adverse effects from zafirlukast, not signs of serious problems.
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Your patient is prescribed albuterol inhaler, flunisolide inhaler, and cromolyn sodium inhaler for management of asthma (nonexercise induced). You should teach the patient to
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take the flunisolide and the cromolyn sodium daily but the albuterol should be used when they are having an asthma attack -Flunisolide and cromolyn are mainte- nance drugs for asthma, they are taken daily to help prevent the occurrence of asthma attacks. The albuterol is a quick acting bronchodilator. It is considered a rescue drug, and is taken during an asthma attack.
