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Chapter 37: Respiratory Drug Test, Asthma Attack, Pharmacology for Nurses: Practical Applications

The key terms in this Pharmacology course include Respiratory Drug Test, Asthma Attack, Pharmacology for Nurses: Practical Applications

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment?

An anticholinergic such as ipratropium

A short-acting beta2 agonist such as albuterol

A long-acting beta2 agonist such as salmeterol

A corticosteroid such as fluticasone

The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for quick relief of asthma attacks? (Select all that apply.)

Salmeterol (Serevent) inhaler

Montelukast (Singulair)

Intravenous systemic corticosteroids

Albuterol (Proventil) nebulizer solution

Fluticasone (Flovent) Rotadisk inhaler

Albuterol (a short-acting beta2 agonist) and intravenous systemic corticosteroids are used to provide quick relief for asthma. See Box 37-2. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.

When evaluating a patient’s use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time?

Obtain an order for a spacer device.

Ask the prescriber if the medication can be given orally.

Notify the prescriber that the patient is unable to use the MDI.

Obtain an order for a peak flow meter.

The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.

After receiving a nebulizer treatment with a beta agonist, the patient states she is feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse’s best response?

“I will notify the physician about this adverse effect.”

“We will hold the treatment for 24 hours.”

“This is an expected adverse effect. Let me take your pulse.”

“The next scheduled nebulizer treatment will be skipped.”

Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.

The prescriber has changed the patient’s medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication?

The proper technique for inhalation must be followed.

It needs to be taken every day on a continuous schedule, even if symptoms improve.

When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

The patient needs to keep it close by at all times to treat acute asthma attacks.

LTRAs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.