Bronchodilators & Beta-Agonists
What is the common bronchodilator used for acute asthma attacks?
Albuterol
Rationale: Albuterol is a short-acting beta-2 adrenergic agonist that provides rapid bronchodilation by relaxing the smooth muscles of the airways. It is the preferred rescue medication used during acute asthma attacks to quickly relieve bronchospasm and improve airflow.
Name two inhaled anticholinergic drugs used for COPD or asthma.
Ipratropium and tiotropium (Spiriva)
Rationale: Both ipratropium and tiotropium are inhaled anticholinergic medications used as bronchodilators in the management of COPD and asthma. They work by blocking the parasympathetic nervous system’s effects on the airways, leading to relaxation of bronchial smooth muscle and decreased mucus secretion.
What is a major adverse effect of inhaled corticosteroids?
Oral thrush (fungal infection in mouth)
Rationale:
Inhaled corticosteroids suppress the local immune response in the mouth and throat, which can lead to the overgrowth of Candida albicans, causing oral thrush (a fungal infection). Patients should be taught to rinse their mouth after each use to reduce this risk.
What symptoms would you expect in a client diagnosed with pneumonia?
Fever, difficulty breathing, low oxygen saturation
Rationale:Infection in the lungs causes inflammation, fever, poor oxygenation, and difficulty breathing.
What dietary teaching is important for a patient taking theophylline?
Avoid caffeine
Rationale:Caffeine and theophylline are both xanthines and can cause toxicity when combined.
What receptor does albuterol primarily stimulate?
Beta-2 receptor causing bronchodilation
Rationale:
Albuterol is a selective beta-2 adrenergic receptor agonist. Activation of beta-2 receptors in the smooth muscle of the airways causes bronchodilation, which helps open the airways and relieve bronchospasm in conditions like asthma and COPD. Because it targets beta-2 receptors specifically, it has fewer cardiac side effects compared to non-selective beta agonists that also stimulate beta-1 receptors in the heart.
What is the most common side effect of anticholinergic drugs like tiotropium?
Dry mouth
Rationale: Anticholinergic drugs block parasympathetic nerve impulses, reducing secretions throughout the body, including saliva production. This reduction in saliva commonly causes dry mouth, which is the most frequent side effect of drugs like tiotropium.
Which anti-inflammatory agent is used for long-term asthma control by stabilizing mast cells?
Cromolyn sodium
Rationale:
Cromolyn sodium is a mast cell stabilizer that prevents the release of histamine and other inflammatory mediators. It is used prophylactically for long-term control of asthma, especially in children or those who cannot tolerate corticosteroids. It does not provide immediate relief during an acute asthma attack.
What is a common symptom of laryngitis?
Hoarseness
Rationale:Laryngitis affects the vocal cords, leading to changes in voice and hoarseness.
What is the correct sequence for multiple inhalers (e.g., albuterol and fluticasone)?
Bronchodilator first, then steroid
Rationale:Opening airways first improves steroid delivery to lower respiratory tract.
What is a common side effect of beta-agonists like albuterol?
Rationale:
Beta-agonists like albuterol stimulate beta-2 receptors in the lungs to cause bronchodilation, but they can also mildly stimulate beta-2 receptors in skeletal muscles, leading to muscle tremors or shakiness. Additionally, some beta-1 receptor stimulation can occur, potentially causing an increased heart rate (tachycardia). Tremors are a common and expected side effect.
Why are anticholinergic drugs contraindicated in glaucoma?
They increase intraocular pressure, worsening glaucoma
Rationale: Anticholinergic drugs cause pupil dilation (mydriasis), which can narrow the anterior chamber angle in the eye, reducing aqueous humor outflow and thus increasing intraocular pressure. This can worsen or precipitate acute angle-closure glaucoma, so these drugs are contraindicated in patients with glaucoma.
Why must corticosteroids be used cautiously in children?
May suppress growth with long-term use
Rationale:
Long-term use of corticosteroids in children can interfere with the normal secretion of growth hormone, potentially leading to growth suppression. This risk is especially important with systemic corticosteroids, but even inhaled forms (used for asthma) require monitoring over time. Pediatric patients on corticosteroids should have regular growth assessments and use the lowest effective dose for the shortest duration needed.
Name three common upper respiratory infections (URIs).
Pharyngitis, sinusitis, laryngitis
Rationale:
Upper respiratory infections (URIs) affect structures above the chest, such as the nasal passages, throat, and voice box.
Pharyngitis is inflammation of the throat (pharynx), commonly caused by viral or bacterial infections.
Sinusitis is inflammation of the sinuses, often due to infection or allergies.
Laryngitis affects the larynx (voice box), leading to hoarseness or loss of voice, usually from viral infection or vocal strain.
What symptom should be reported when using codeine cough syrup?
Drowsiness
Rationale: Codeine is a CNS depressant and can impair mental alertness. Patients should not drive.
Which type of beta-agonist has a longer duration and is used for maintenance therapy?
Long-acting beta agonists (LABAs), e.g., salmeterol
Rationale:
LABAs, such as salmeterol and formoterol, have a longer duration of action compared to short-acting beta-agonists (SABAs). They are used primarily for maintenance therapy in chronic respiratory conditions like asthma and COPD to provide sustained bronchodilation and help prevent symptoms. LABAs are not intended for immediate relief of acute bronchospasm.
What effect do cholinergic drugs have on the bladder?
Stimulate bladder contraction
Rationale: Cholinergic drugs mimic acetylcholine and activate the parasympathetic nervous system, which promotes smooth muscle contraction, including the detrusor muscle of the bladder, leading to increased bladder emptying.
Which patient population should use corticosteroids cautiously due to blood sugar effects?
Diabetic patients
Rationale: Corticosteroids can raise blood glucose levels by promoting gluconeogenesis and decreasing insulin sensitivity. This makes diabetic patients particularly vulnerable to hyperglycemia and poor glycemic control while on corticosteroid therapy.
Mimics the action of the sympathetic system
What is adrenergic or anticholinergic
Rationale:
Adrenergic drugs, also called sympathomimetics, activate the sympathetic nervous system by stimulating alpha and/or beta receptors. This leads to classic "fight or flight" effects such as:
Increased heart rate
Bronchodilation
Pupil dilation (mydriasis)
Vasoconstriction
These drugs are often used to treat conditions like asthma (e.g., albuterol), anaphylaxis (e.g., epinephrine), or nasal congestion (e.g., pseudoephedrine) due to their stimulating effects.
What should patients be taught when using antihistamines like diphenhydramine or loratadine?
Avoid alcohol; may cause drowsiness (especially first-generation types)
Rationale: First-generation antihistamines cause sedation, which can be worsened by alcohol.
What vital sign should be assessed before administering a beta-agonist?
Heart rate
Rationale:
Beta-agonists can stimulate beta-1 receptors in the heart as well as beta-2 receptors in the lungs, potentially causing tachycardia (increased heart rate). Monitoring heart rate before administration helps identify any pre-existing tachycardia or arrhythmias that could be worsened by the medication.
Name three side effects patients on anticholinergics should report immediately.
Confusion, difficulty urinating, constipation, dry eyes, tachycardia (fast heart rate)
Rationale: These symptoms may indicate serious adverse reactions to anticholinergic medications, such as central nervous system effects or urinary retention, and should be reported to a healthcare provider promptly.
What should a nurse advise a patient with a cough lasting more than 2 weeks?
Refer to clinic for evaluation
Rationale:
A persistent cough lasting more than 2 weeks may indicate an underlying medical condition such as infection, asthma, GERD, or even more serious issues like malignancy. It’s important to identify and treat the cause rather than suppress the symptom with over-the-counter medications. Early evaluation prevents complications and ensures proper management.
What is the emergency condition involving severe asthma?
Status asthmaticus
What should patients know about using a peak flow meter at home?
Record the best of three attempts daily to monitor asthma control
Rationale:It helps track airway status and detect early signs of an asthma attack.