Ch. 70

Question 1

Zafirlukast: Adverse Effect

Answer 1

• headache, nausea, diarrhea, liver dysfunction
• depression, suicidal thoughts, hallucinattions
• arthralgia
• can prevent P450 enzymes which can prevent Warfarin metabolism= toxicity

Question 2

Nursing Implications

Answer 2

• not acute asthma only chronic
• improvement in 1 week
• check any OTC meds
• liver function
• should be taken on continuous schedule even it symptoms improve

Question 3

Bronchodilators

Answer 3

• but do not alter
  the underlying disease process
  (inflammation)
• should also be taking a
  glucocorticoid for long-term suppression of
  inflammation
• principal bronchodilators are the beta2-adrenergic agonists

Question 4

B-Adrenergic Agonists

Answer 4

• Used during the acute phase of the attack
• Imitate norepinephrine & stimulate beta2-adrenergic receptors = immediate dilation of airways and airflow restoration
• short and long acting
• epinephrine, salbutamol

Question 5

B-Adrenergic Agonists: Mechanism

Answer 5

– Stimulate specific beta2receptors = dilation of
airways & relief of spasms, no histamine effect
– Non-selective adrenergic agonists = reduction of edema & swelling of mucous membranes = decreased secretions of mucous

Question 6

Inhaled short-acting beta2 agonists

SABAs

Answer 6

• EIB: Taken before exercise to prevent an attack
• Taken PRN to abort an ongoing attack
• MDI in outpatient setting may be equally effective

Question 7

Inhaled long-acting beta2 agonists

LABAs

Answer 7

• Long-term control in patients who experience frequent attacks
• Dosing is on a fixed schedule, not PRN
• Effective in treating stable COPD
• When used to treat asthma, must always be combined with a glucocorticoid

Question 8

β-Adrenergic Agonists: Contraindications

Answer 8

• allergy, uncontrolled cardiac dysrhythmias and high risk of strokes
  adverse effects: insomnia, restlessnes, anoerxia, cardiac stimulation, hyperglycemia, HTN, hypotension, hypokalemia, tremor and vascular h/a

Question 9

B-Agonist Derivaties: Nursing Implications

Answer 9

• get prompt treatment for flu or other illnesses and to get vaccinated against pneumonia or flu
• Salbutamol, if used too frequently, loses its β2 specific actions at larger doses = β1
  receptor stimulation = nausea, increased anxiety & HR, palpitations & tremors

Question 10

Methylxanthines: mechanism of Action

Answer 10

• increase cAMP levels
• Higher intracellular cAMP levels = smooth muscle relaxation, bronchodilation, and increased airflow (also less allergic reactions)
• Slow onset of action; used for PREVENTION rather than tx of acute attacks

Question 11

Xanthine Derivatives: Drug

Effects

Answer 11

• Stimulate cardiovascular system (CVS), increasing force of contraction and heart
  rate, resulting in increased cardiac output and increased blood flow to the kidneys
  (diuretic effect)
• Cause bronchodilation by relaxing smooth muscles of the airways (bronchi)
• stimulate CNS (resp. response centre)

Question 12

Xanthines: Contradications/Agents

Answer 12

• CV disorders and seizures disorders
• hyperthyrodism
• peptic ulcers
• Theophylline and Aminophylline (usually not answer on MC)

Question 13

Xanthines: Adverse Effect

Answer 13

• more urine production
• CVS
• GI

Question 14

Anticholinergics: Mechanism of Action

Answer 14

• Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways
• preventing ACh from binding
• airways dilate

Question 15

Anticholinergics: Indications

Answer 15

• slow and prolonged action
• prevent bronchoconstriction
• are NOT used for acute
  examples:
• Atrovent and Spiriva (long acting)

Question 16

Anticholinergics: Adverse Effects

Answer 16

• dry mouth, nasal congestion, heart palpitations, GI distress, headache, coughing, anxiety, glaucoma