NUR2474 Exam 2 Review
NUR2474 Test # 2 Review Please review general tips from Quiz review document (test taking strategies, select all that apply questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No notes or textbook allowed on the test. Calculator will be enabled in the browser. General tips for studying: 1. Memorize names of medication categories from the presentation 2. Memorize key drugs from categories above (there are many questions with specific drug names) 3. Use generic names 4. When reviewing particular drugs note category, indications, common side effects, toxicity signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or antagonizing which receptors) 5. Read question instructions (there will be ‗select all that apply‘ questions) Topics to review: 1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.). a. Metered dose inhaler: (MDI) handheld device delivering a measured dose of a drug with each actuation i. Dosing is usually accomplished with 1-2 inhalations ii. When 2 inhalations are needed, 1-minute interval is needed in between iii. Begin inhalation before activating device iv. Even with optimal use, only about 10% of the drug reaches the lungs, 80% is swallowed, and 10% is left in the device or exhaled. v. Spacers- attach directly to MDI to increased delivery of drugs to the lungs vi. After inhaler use rinse mouth and gurgle, especially with glucocorticoids (steroid), can cause the steroid to be absorbed through membrane 2. Know the difference between short and long term treatments for asthma and COPD a. Long term treatments i. Anti-inflammatory drugs (Glucocorticoids: inhaled or oral, leukotriene modifiers, cromolyn, omalizumab) 1. Corticosteroid 2. Minimize systemic effects ii. Bronchodilators (Long acting beta2 agonists, theophylline) iii. Drugs are taken daily for long term control iv. Glucocorticoids for long term prophylaxis (prednisone) b. Short term treatments i. bronchodilators (short acting beta2 agonists, anticholinergics: Tiotropium)
1. albuterol ii. Provide symptomatic relief but do not alter the underlying disease process (inflammation) iii. Asthma patients taking bronchodilators should also be taking glucocorticoids for long-term suppression of inflammation 3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what is for long term management) a. Rescue inhaler i. Bronchodilator-beta 2adrenergic agonist 1. Albuterol (Proventil, Ventolin) 2. Terbutaline sulfate (brethine) 3. Indicated for acute exacerbations of asthma, relief of bronchoconstriction due to bronchitis and emphysema and longterm control of chronic airway disease. 4. Effects start within minutes and last for 2-4 hours. b. Long-term treatment i. Corticosteroids (glucocorticoids) –long term and prophylaxis 1. Fluticasone (flonase) 2. Budesonide (Pulmicort, rhinocort) 3. Prednisone (deltasone) 4. Methylprednisolone (solu-medrol) ii. Bronchodilators (antileukotriene-leukotriene receptor antagonists) 1. Montelukast (singulair) 2. Zafirlukast (accolate) 4. Treatment of acute asthma i. may have to give IV corticosteroid glucocorticoid short term; and give rescue inhaler. 1. May need to add albuterol, nebulizer treatment, oxygen, or ipratropium ii. Bronchodilators: beta2 adrenergic agonist 1. Action: activation of beta2 receptors in the smooth muscle of the lungs, promotes bronchodilation, relieving bronchospasm a. Beta2 agonist have a limited role in suppressing histamine release in the lung and increasing ciliary motility iii. Use: asthma and COPD 1. Inhaled short acting beta2 agonists (SABAs) a. Taken PRN to abort an ongoing attack b. EIB: taken before exercise to prevent an attack
c. Hospitalized patients undergoing a severe acute attacknebulized SABA in the traditional treatment of choice d. Delivery with an MDI in the outpatient setting may be equally effective 2. Inhaled long acting beta2 agonist (LABAs) a. Long term control of patients who experience frequent attacks b. Dosing in not PRN. It is on a fixed schedule c. Effective in treating stable COPD d. When used for asthma, must be combined with glucocorticoids e. Use alone in asthma is contraindicated 3. Adverse effects: a. Inhaled- systemic effects: tachycardia, angina, tremor b. Oral- excessive dosage: angina pectoris, tachydysrhythmias, tremor 4. Other treatments of acute asthma a. Nebulizer (Albuterol), ipotropium, oxygen, IV glucocorticoids 5. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt. education) a. Anti-inflammatory drugs: Glucocorticoids (long term treatment for asthma) b. Mechanism of action: most effective antiasthma drugs i. Prophylaxis to prevent exacerbations with opioid use, there is a good chance they will develop constipation ii. Docusate is a good option. iii. Gentle softener to help them with constipation iv. Prophylaxis until they do develop severe constipation, then go for more intense treatment options v. Decrease synthesis and release of inflammatory mediators vi. Reduce infiltration and activity of inflammation cells vii. Decrease edema of the airway mucosa caused by beta2 agonists viii. Usually administered by inhalation, but emergency situation- IV/oral routes also available c. Side effects:
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i. Can slow growth in children/adolescents. However, does not decrease adult height ii. Promotion of bone loss iii. Increased risk for cataracts iv. Increased risk for glaucoma Discontinuing medication: must be done slowly i. Recovery of adrenocortical function may take months ii. Dosage of exogenous sources must be reduced gradually iii. Must be given supplemental oral or IV glucocorticoids at times of severe stress Use: not a PRN (as needed) medication i. Prophylaxis of chronic asthma ii. Not used to abort an ongoing attack because beneficial effects develop slowly Inhaled use i. First line therapy for management of inflammatory component of asthma ii. Those with persistent asthma should use these drugs daily iii. Inhaled glucocorticoids are very effective and much safer than systemic glucocorticoids iv. Adverse effects: adrenal suppression (prevents the body from producing glucocorticoids on its own), oropharyngeal candidiasis(infection), dysphonia (rough voice changes) IV use i. Compensating for adrenal insufficiency ii. Patients on prolonged glucocorticoid therapy have a decrease endogenous production of glucocorticoids iii. If use is stopped suddenly or when switching from oral to IV therapy, the patient can die iv. During times of severe physical stress when the body would normally produce high levels of glucocorticoids, if the dose is not increased to meet the needs, the patient can die v. IV glucocorticoids are given at times of severe stress to compensate for adrenal insufficiency Oral use i. For those with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD ii. Potential for toxicity; should be used only when symptoms cannot be controlled with safer medications (inhaled glucocorticoids, inhaled beta 2 agonist) iii. Treatment should be as brief as possible iv. Adverse effects: short term therapy, long term therapy, adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, growth suppression in young
i. Patient education i. To minimize adverse effects patients should rinse mouth with water and gargle after each administration or use a spacer ii. To prevent bone loss patients should ensure adequate intake of calcium, vitamin D, and participate in weight bearing exercises 6. Tiotropium administration, onset, and therapeutic level timeframes a. Anticholinergic b. Long acting, inhaled agents approved for maintenance therapy of bronchospasm associated with COPD c. Not approved for asthma d. Action: relieves bronchospasms by blocking muscarinic receptors in the lungs e. Therapeutic levels: therapeutic effects begin about 30 minutes after inhalation, peaks in 3 hours, and persists about 24 hours i. With subsequent doses: bronchodilation continues to improve, reaching a plateau after 8 consecutive doses (8 days) ii. Adherence is very important f. Adverse effects: dry mouth (eating hard candy may help), minimal anticholinergic effects 7. Treatment principles of cold symptoms in children (treat individual symptoms) a. When treating pediatric upper respiratory infection, colds, allergies etc. avoid combination medications. Treat individual symptoms. b. One medication at a time for once symptom at a time, no combination drugs. i. If child has a cough, give med that is only used to treat cough. c. Avoid OTC cold remedies in children younger than 4-6 years d. Use only products labeled for pediatric label e. Avoid the use of antihistamine containing products to sedate children 8. Ulcer prevention with chronic NSAID use (identify specific med class) a. Most common cause of peptic ulcer- H. pylori bacteria. 2nd is NSAIDs b. Ulcer prevention with chronic NSAID use i. Drugs act in 3 basic ways to promote ulcer healing/prevent reoccurrence: (1) eradicate H. Pylori, (2) reduce gastric acidity, and (3) enhance mucosal defenses ii. NSAID-induced ulcers can be treated with any ulcer medication. However, histamine2 receptor blockers and proton pump inhibitors are preferred. c. Antiulcer drugs i. Antibiotics 1. Amoxiciilin (Amoxil), Busmuth (pepto-bismol), Calrithromycin (Biaxin), Metronidazole (Flagyl), Tetracycline, Tinidazole (Tindamax) 2. Action: eradicate H.Pylori