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

The key terms in this Pharmacology course include Respiratory Drug Test, Theophylline, Patient, Oral Theophylline (Theo-Dur), Inhaled Corticosteroids, Adverse Effects, Pharmacology for Nurses: Practical Applications

A patient will be receiving oral theophylline (Theo-Dur), 600 mg/day, in three divided doses. Identify how many milligrams the patient will receive per dose. __

Correct Answer

200 mg

600 mg/day divided by 3 doses per day = 200 mg/dose

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects?

Headache and rapid heart rate

Fatigue and depression

Oral candidiasis and dry mouth

Anxiety and palpitations

Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.)

“I will use this inhaler for asthma attacks.”

“I will continue to use this inhaler, even if I am feeling better.”

“I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling.”

“I will gargle after using the inhaler and then swallow.”

“I will use a peak flow meter to measure my response to therapy.”

“I will rinse my mouth with water after using the inhaler and then spit out the water.”

The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient’s response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.

The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be:

at a toxic level.

above the therapeutic level.

at a therapeutic level.

below the therapeutic level.

Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.

A patient has a metered-dose inhaler that contains 200 actuations (‘puffs’), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, identify how many days will this inhaler last at the prescribed dose. __

Correct Answer

50 days

Note the number of doses in the canister, and then calculate the number of days that the canister will last. For this question, assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four divided into 200 yields 50; that is, the inhaler will last approximately 50 days.