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Short-acting beta2 adrenergic agonists (SABAs) provide
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Short-acting beta2 adrenergic agonists (SABAs) are most useful when:
- an attack begins (rescue therapy)
- premedication when the patient is going to begin an activity that is likely to induce an attack
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What do we need to teach asthma patients regarding rescue inhalers?
- always carry a relief inhaler
- ensure that it has enough med in it to deliver a quick dose when needed.
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Long-acting beta2 adrenergic agonists (LABAs) need time to
build up an effect
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Long-acting beta2 adrenergic agonists (LABAs) are useful in ? an asthma attack, but of no value ?
- Preventing
- during an attack (rescue)
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How do beta2 adrenergic agonists ACT?
Selectively activate beta2-receptors in the bronchial smooth muscle = bronchodilation (relaxes bronchiolar smooth muscle)
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Is INHALED ALBUTEROL a SABA or LABA?
SABA
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Is PO ALBUTEROL a SABA or LABA?
LABA
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Is INHALED LEVALBUTEROL a SABA or LABA?
SABA
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Is INHALED SALMETEROL a SABA or LABA?
LABA
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Is INHALED FORMOTEROL a SABA or LABA?
LABA
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Is PO TERBUTALINE a SABA or LABA?
LABA
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Name the common side effects of both PO and inhaled beta2 adrenergic agonists:
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What nursing education should be given to patients regarding tachycardia while taking PO or inhaled beta2 adrenergic agonist?
monitor their pulse and report and increase of 20 to 30 beats per minute
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Why should a client NOT concurrently take beta2 adrenergic blockers and beta2 adrenergic agonists?
Can negate effects of both medications
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LABAs are prescribed in combination with an inhaled glucocorticosteroid. Why does a client need to use an inhaled beta2 adrenergic agonist before an inhaled glucocorticosteroid?
Inhaling beta2 adrenergic agonist promotes bronchodilation and enhances the absorption of the glucocorticoid
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Evidence of the effectiveness of beta2 adrenergic agonists includes the following:
- Long-term control of asthma
- Prevention of exercise induced asthma
- Resolution of asthma exacerbations (no SOB, clear breath sounds, no wheezing, respiratory rate returns to baseline)
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The expected pharmacological action of theophylline is
bronchodilation
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What is the therapeutic range of theophylline?
5 – 15 mcg/mL
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Signs and symptoms of theophylline toxicity include:
- GI distress
- Restlessness
- Dysrhythmias
- Seizures
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Ipratropium and Tiotropium are examples of
inhaled anticholinergics (AKA cholinergic antagonists)
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Two side effects/complications of inhaled anticholinergics (Ipratropium and Tiotropium) are:
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Inhaled anticholinergics (Ipratropium and Tiotropium) should be used with caution in clients with:
- narrow-angle glaucoma
- benign prostatic hyperplasia (BPH)
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Inhaled anticholinergics (Ipratropium and Tiotropium) cause bronchodilation by
inhibiting the parasympathetic system
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Inhaled anticholinergics (Ipratropium and Tiotropium) can be used to both ?
- RELIEVE (rescue therapy) an asthma attack
- PREVENT (controller therapy) an asthma attack
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Corticosteroids disrupt production pathways of
inflammatory mediators
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Do Inhaled or Oral glucocorticosteroids have fewer side effects?
Inhaled
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Name high-potency steroid inhalers that may be used once a day for maintenance.
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Daily oral glucocorticosteroids may be used for clients with
severe asthma
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Are corticosteroids used for prevention or rescue relief for asthma?
prevention
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The use of glucocorticosteroids promotes decreased frequency and severity of
exacerbation and acute asthma attacks
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What is used to treat status asthmaticus?
Glucocorticosteroids via the IV route
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Complications related to inhaled glucocorticosteroids, such as beclomethasone, include:
- Difficulty speaking
- hoarseness
- candidiasis
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Nursing considerations in regard to complications of inhaled glucocorticosteroids, such as beclomethasone include:
- Rinse mouth or gargle with water after use
- monitor for redness, sores, white patches for thrush
- treat with nystatin oral suspension
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Concurrent use of potassium-depleting diuretics and prednisone increase the risk of
hypokalemia
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Concurrent use of NSAIDS and prednisone increases the risk of
GI Ulceration
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Concurrent use of glucocoricosteroids and hypoglycemic agents results in ?
- hyperglycemic serum glucose level
- because the effects of hypoglycemic agents are counteracted
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If a client is on long-term prednisone therapy to treat chronic, severe asthma, additional doses may be needed during times of
Stress (ex. infection, trauma)
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Zafirlukast (Accolate), montelukast (Singulair), and zileuton (Zyflo) are leukotriene modifiers.
What is the expected pharmacological action of leukotriene modifiers?
- Reduce:
- inflammation
- bronchoconstriction
- airway edema
- mucus production
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What is a complication of all leukotriene modifiers (Singulair)?
depression and possible suicidal ideation
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Clients taking zileuton or zafirlukast must be monitored for possible injury to what organ?
Liver injury
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Clinical manifestations of liver damage include:
- nausea
- anorexia
- abdominal pain
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Zileuton and zafirlukast inhibit metabolism of warfarin leading to increased warfarin levels. As such, which lab tests need to be closely monitored?
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Cromones stabilize the membrane of mast cells and prevents the release of
- inflammatory mediators
- They are used to prevent an asthma attack.
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