Nurs 615 Pharm Exam 4 Review.
1. What is tiotropium used to treat?
(Spiriva) Tiotropium bromide (INN) is a long-acting, 24-hour,
... [Show More] anticholinergic
bronchodilator used in the management of chronic obstructive pulmonary
disease (COPD). Tiotropium is used for maintenance treatment of chronic
obstructive pulmonary disease (COPD) which includes chronic bronchitis and
emphysema. It is not however used for acute exacerbations. Tiotropium is a
muscarinic receptor antagonist, often referred to as an antimuscarinic or
anticholinergic agent. Although it does not display selectivity for specific
muscarinic receptors, when topically applied it acts mainly on M3 muscarinic
receptors[8] located on smooth muscle cells and submucosal glands. This leads
to a reduction in smooth muscle contraction and mucus secretion and thus
produces a bronchodilatory effect.
2. What are the adverse effects with montelukast (Singular)?
Side effects of Singulair can include skin rash, mood changes, tremors,
headache, stomach pain, heartburn, upset stomach, nausea, diarrhea, tooth
pain, tiredness, fever, stuffy nose, sore throat, cough, and hoarseness.
Singulair may interact with phenobarbital or rifampin
3. What patient teaching should accompany the prescription of montelukast
(Singulair)?
Singulair will not work fast enough to treat an asthma attack that has already
begun. Use only a fast-acting inhalation medicine to treat an asthma attack.
Talk with your doctor if any of your asthma medications do not seem to work
as well in treating or preventing attacks. Call your doctor right away if you
feel that this medicine is not working as well as usual, or if it makes your
condition worse. If it seems like you need to use more of any of your
medications in a 24-hour period, talk with your doctor. If you already take
Singulair to prevent asthma or allergy symptoms, do not use it for exerciseinduced bronchoconstriction. Call your doctor at once if you have any mood
or behavior changes, anxiety, depression, or thoughts about suicide or hurting
yourself. Follow all directions on your medicine label and package. Tell each
of your healthcare providers about all your medical conditions, allergies, and
all medicines you use. It may take up to several weeks before your symptoms
improve. Keep using Singulair as directed and tell your doctor if your
symptoms do not improve after several weeks of treatment.
4. What patient teaching should be provided when prescribing inhaled
corticosteroids?
They should be taken 2x a day every day for the use of prevention of asthma.
Rinse mouth after use to prevent oral thrush.
5. What ethnic background should not be prescribed long-acting beta agonists?
African Americans, increased incidence of death in this population
6. What medication would you prescribe for bronchospasm for a patient taking
propranolol?
Ipratropium
7. What is the mechanism of action of albuterol?
Relaxes bronchial smooth muscle by action on beta2-receptors with little effect
on heart rate, causing dilation of the airways.
8. What is the mechanism of action of inhaled corticosteroids?
Extremely potent vasoconstrictive and anti-inflammatory activity.
9. When is it appropriate to use a short acting beta agonist?
Short-acting beta-2 agonists (SABAs) are the drug of choice for acute
treatment of asthma symptoms and exacerbations.
10. What is the mechanism of action of inhaled muscarinic receptor antagonists?
Atropine (the prototype of muscarinic receptor antagonists) prevents the
effects of ACh by competitively blocking its binding to muscarinic receptors
in the CNS, peripheral ganglia, and at neuroeffector sites on smooth muscle,
cardiac muscle, and secretory glands. Atropine inhibits secretions of the nose,
mouth, pharynx, and bronchi and thus causes dryness of the mucous
membranes of the respiratory tract. This action is especially marked if
secretion is excessive and is the basis for the use of atropine and scopolamine
in preanesthetic medication. This depression of mucous secretion and the
inhibition of mucociliary clearance, however, are undesirable side effects of
atropine in patients with airway disease. Atropine is particularly effective
against bronchoconstriction produced by Para sympathomimetic drugs such as
methacholine; it also partially antagonizes bronchoconstriction induced by
histamine and bradykinin. In general, however, muscarinic receptor
antagonists cause little blockade of the effects of ACh at nicotinic receptor
sites. As a result, extremely high doses of atropine or related drugs are
required to produce any degree of blockade of the predominantly nicotinic
receptors at the neuromuscular junction [2]. [Show Less]