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112 Cards in this Set
- Front
- Back
What is the purpose of bronchodilators? How is this achieved?
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Purpose is to increase size of smooth muscle bands by relaxing and opening bronchial and bronchiole airways.
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Name three types of bronchodilators, includes short & long-acting.
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Beta2 agonists, cholinergic antagonists, & Methylxanthines
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A Beta2 Agonist is a ______ _____.
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sympathomimetic bronchodilator
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How does a Beta2 Agonist work?
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The drug binds to Beta2-adrenergic receptors.
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What is the purpose of a Beta2 Agonist? Waht does it trigger?
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The purpose is to increase the level of cyclic adenosine monophosphate (cAMP)which triggers smooth muscle relaxation & dilates bronchial bands of the airway.
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What effect does the Beta2 agonist cause? Explain why this happens.
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It also has a dilating effect on peripheral vaxcular vessels which decreases diastolic BP (Shifts K+ ions from bloodstream to cells which results in a temporary hypokalemia).
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What are Beta2 agonists contraindicated for?
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Allergy & uncontrolled cardiac dysrhythmias.
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What are side effects of Beta2 Agonists?
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HTN or hypotension, vascular headaches, & tremor
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Name the types of Beta2 Agonists.
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Short-acting & Long-acting
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What do Short-acting Beta2 Agonists do?
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Provide rapid but short-term relief.
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When are Short-acting Beta2 Agonists most useful?
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When inhaled at beginning of asthmatic attack or as a premedication prior to activities that trigger or induce an asthmatic attack.
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Name some common short-acting Beta2 agonistic agents.
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Albuterol (Proventil, Ventolin); Bitalterol (Tornalate), & Pirbuterol (Maxair)
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How are the long & short-acting Beta2 agonistic agents delivered?
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Directly to the site of action by a Metered Dose Inhaler (MDI) or Dry Powder Inhaler.
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How can you tell a DPI is empty?
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(without a mouthpiece) it will float in water.
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When might you observe systemic effects from the use of a short-acting Beta2 agonistic agent?
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When it is overused or abused.
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If the client is using other drugs, when do you administer the Beta2 agonist bronchodilator?
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Five minutes prior to other inhaled drugs (i.e. steroids).
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How is a long-acting Beta2 Agonist different from a short-acting one?
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It takes more time to build up effects, but lasts longer. Useful to prevent attack, but of no value during an asthmatic attack since they take time for effects to accumulate.
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Name some common long-acting Beta2 agonistic agents.
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Salmeterol (Serevent); Formoterol Fumarate (Foradil Aerolizer)
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Why does the client need to shake the inhaler before each dose?
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Because the drug separates easily.
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Why should the client not exhale into the inhaler device?
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This will cause drug clumping.
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What is a cholinergic antagonist?
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It is an anticholinergic agent.
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What does a cholinergic antagonist do? What does it cause?
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It blocks the parasympathetic nervous system which results in bronchodilation & decreased mucus production.
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What side effects can occur with the use of cholinergic antagonists?
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dry mouth/throat, GI distress, headache, coughing & anxiety
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Name a cholinergic antagonist that is commonly used for asthma, but is also used for COPD. Is this agent long or short-acting.
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Ipratopium (Atrovert. short-acting.
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Name a long-acting cholinergic antagonist agent that is used once a day.
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Tiotropium.
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Name a cholinergic antagonist agent that is a combination of albuterol & atrovent.
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Combivent.
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Client teaching regarding cholinergenic antagonist agent use includes:
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Increase fluid intake & Report blurred vision, eye pain, headache, nausea, nervousness, or palpitations.
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Methylxanthines a.k.a.?
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xanthine derivatives
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When are methylxanthines used?
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When other agents are ineffective to relax smooth muscles of the respiratory tract.
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What are methylxanthines used to treat?
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asthma, chronic bronchitis, emphysema, & bronchospasm.
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Name possible side effects of methylxanthines.
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excessive cardiac and CNS stimulation.
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What are methylxanthines contraindicated for?
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allergy, uncontrolled cardiac dysrhythmias & seizure disorders.
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What is the method of delivery for methylxanthines?
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systemically by oral or parenteral route.
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Name some priority interventions for long-term use of methylxanthines?
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Need to monitor blood levels because they have a narrow therapeutic range. Observe for toxicities esp. w/parenteral administration. RN should be assigned to client since frequent assessments will need to be performed.
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What are s/s of toxicity w/methylxanthines?
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restlessness, insomnia, irritability, tremors, & N/V
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What agents can enhance metabolism of xanthines?
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cigarettes & St. John's Wort
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What might happen if the client quits smoking during xanthine therapy?
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The dose could be to high and may need to be reduced.
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What meds can cause an increase in drug levels of xanthine?
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allopurinol, cimetidine, erythromycin, flue vaccine, & oral contraceptives
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Why is xanthine given w/ caution in elderly clients?
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They tend to have decreased drug metabolism. Be sure to observe for toxicity.
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What should client teaching include for xanthines?
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Take med at same time each day.
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Name the classic drug in the methylxanthine class.
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theophylline (Theo-Dur)
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Name some drugs (other than the classic one) in the methylxanthine class. [per v.s.-these parenteral meds are used to treat bronchospasms.
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aminophylline (Truphylline); oxtriphylline (Choledyl); & diphylline (Dilor, Lufyllin)
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What are anti-inflammatory agents used for?
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To decrease the inflammatory responses in the airways.
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What does the anti-inflammatory class consist of? includes what delivery methods?
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corticosteroids; inhaled anti-inflammatory agents; mast cell stabilizers; monoclonal antibodies; & leukotriene antagonists. systemic and inhalants
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What do corticosteroids do?
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Decrease inflammatory and immune response by preventing mediator synthesis.
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What problems can a client have with the use of inhaled corticosteroids? What is an appropriate intervention to teach the client?
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Increased risk of oral infections. Teach the client to rinse mouth after administration to prevent fungal infections.
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How often are short-term corticosteroid inhalers used?
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frequently.
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How often are long-acting corticosteroid inhalers used?
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Once a day.
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Name some short-term corticosteroid inhalers.
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Beclomethasone (Vanceril); Triamcinolone (Azmacort); & Flunisolide (AeroBid)
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Name some long-acting once a day corticosteroid inhalers.
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Budesonide (Pulmocort); & Fluticasone (Flovent)
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What are systemic corticosteroids used to treat?
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Severe asthma
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Why should systemic corticosteroids be taken w/food?
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To decresase GI ulceration.
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Name two important side effects to be aware of and monitor for.
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immunosuppression & increased blood glucose levels (hyperglycemia)
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What is the most common oral systemic corticosteroid agent?
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Prednisone
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What should client education about systemic corticosteroids include?
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Never abruptly discontinue drug, slowly taper only; Need medical alert bracelet; Report weight gain of 5 pounds in 1 week; Take w/food.
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Name a new category of inhaled agents?
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Inhaled Anti-inflammatory agents
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How do inhaled anti-inflammatory agents work?
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Inhibit release of inflammatory mediators from respiratory cells & WBCs which stabilizes the mast cell wall.
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What do inhaled anti-inflammatory agents effect?
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decrease lung nerve stimulation.
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What are inhaled anti-inflammatory agents used for?
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Prevents asthma events, but not useful during an asthmatic attack.
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How long before inhaled anti-inflammatory agents are effective?
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4 weeks
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What should a client do if symptoms worsen?
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discontinue medication
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Name the primary agent in the inhaled anti-inflammatory agent class.
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Nedocromil (Tilade)
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How do mast cell stabilizers prevent asthma attacks?
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By preventing mast cell membranes from opening when and allergen binds to the IgE molecule (provides and anti-inflammatory effect)
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When are mast cell stabilizers not useful?
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during an asthmatic attack.
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Mast cell stabilizers used regularly for a _____ _____.
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prophylactic effect
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How are mast cell stabilizers used to relieve seasonal allergy attacks?
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Start tx 3-4 weeks before the season.
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What is the most common mast cell stabilizer agent?
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Cromolyn Sodium (Intal)
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What is the MOA of Monoclonal Antibodies?
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Binds to IgE receptor sites on mast cells & basophils thus preventing allergens from triggering release of mediators from these cells.
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When/How are monoclonal antibodies effective?
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Will prevent attack, but not useful during asthmatic attack.
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How are monoclonal antibodies administered?
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Administered subcutaneously. Roll vial gently since drug is slow to dissolve.
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What is the most common monoclonal antibody agent?
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Omalizumab (Xolair)
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What do Leukotriene Receptor Agonists do?
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Block leukotriene production during inflammation, thus preventing asthma symptoms
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What are some side effects of leukotriene receptor agonists?
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headache; GI symptoms, dizziness; & insomnia
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What is an priority intervention with a client on a leukotriene receptor agonist?
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Monitor liver enzymes w/these agents.
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Name some leukotriene receptor agonists.
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zileuton (Zyflo); zafirlukast (Accolate); montelkast (Singular)
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What does zileuton (Zyflo) do?
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prevents leukotriene synthesis, but increases plasma concentration of theophylline (Need to decrease theophylline dose)
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What do zafirlukast (Accolate) & montelukast (Singular) do?
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Block the leukotriene receptor.
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If the client is taking aspirin, which leukotriene receptor agonist dosage should be changed? Will it be increased or decreased?
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Zafirludast (Accolate) dose should be decreased.
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What do mucolytics do?
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thin thick, tenacious mucus secretions
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Name the commonly used aerosol mucolytics.
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acetylcysteine (mucosil, mucomyst); dornase alfa (pulmozyme)
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Name an oral systemic mucolytic agent.
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guaifenesin.
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During mucolytic therapy, what must a client be taught to do?
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increase fluid intake
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What are antitubercular medication used to treat?
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All forms of infection from mycobacterium.
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How long does antitubercular treatment last?
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Therapy is usually for 6 months or longer until 3 negative sputum cultures for TB occur.
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What is antitubercular drug therapy dependent on?
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Drug therapy is dependent upon drug-susceptibility tests.
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What is the cornerstone of drug regimen for antitubercular therapy?
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Client education
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How can the general public be protected from TB spread?
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Strict client compliance.
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How is the noncompliant TB client managed?
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Mandate to participate in directly observed therapy (DOT) provide by health clinics.
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How is the emergence of drug resistant TB organisms reduced?
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By combination therapy to maximize destruction of the organism as rapidly as possible.
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Name the primary (first-line) antitubercular agents. What is the cure rate?
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isoniazid (INH); Rifampin, Pyraziniamide (PZA); Ethambutol; & Stretomycin. Combination therapy of these drugs produces a 95% cure rate.
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What is the MOA of Isoniazid (INH)?
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Alters the nicotinamide adenine denucleotide (NAD) of the mycobacterium organism and inhibits cell wall synthesis.
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In what clients is INH therapy contraindicated?
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allergy, hepatic injury or acute liver disease, & optic neuritis clients.
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What are possible side effects of INH?
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Can be hepatotoxic & cause peripheral neuritis (numbness & tingling)
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What drugs are inhibited if INH therapy is implemented?
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phenytoin, carbamazepine, primidone, & warfarin
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What client education needs to be given regarding INH therapy?
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Should be taken on an empty stomach & it can cause a false positive glucose test.
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What is the MOA of Rifampin?
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Inhibits protein synthesis of the cell.
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What side effects can Rifampin cause?
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hepatotoxicity, hepatitis, & hematologic disorders
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What client education needs to be given regarding Rifampin therapy?
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Teach the client that this drug will turn urine, tears, sweat & sputum and orange/reddish color. Soft contact lenses will be permanently discolored. Women taking oral contraceptives should switch to another form of birth control since this drug causes oral contraceptives to become ineffective.
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Why will other medication drug doses have to be adjusted while receiving Rifampin therapy?
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It may enhance elimination of theophylline, steroids, opiods, oral hypoglycemics, warfarin, Vitamin D, beta-blockers, & benzodiazepines.
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What is the MOA of Pyrazinamide?
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Drug action is not understood, but believed to serve as a bacteriostatic or bacteriocidal agent, therby destroying the mycobacterium in the macrophages.
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When is Pyrazinamide therapy implemented?
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Usually added to INH for the first two months of therapy. because it will prevent some of the neurologic side effects caused by INH (numbness & tingling of extremities)
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What side effects does the nurse need to be aware of with Pyraziniamide therapy?
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hepatotoxicity and hyperuricemia
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How is Ethambutol used for the TB drug regimen?
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It is used as the 4th drug agent.
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What is the MOA of Ethambutol?
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Inhibition of mycolic acid synthesis in the cell
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What side effects does the nurse need to be aware of with Ethambutol therapy?
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neurotoxicities and blindness.
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How are the side effects of Ethambutol monitored?
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Eye exams should be performed at drug initiation. Clients should immediately report any visual changes to MD.
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Which clients should Ethambutol be used with caution?
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Clients w/diabetes, or liver, renal or hematologic disorders.
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What drug can be used as a substitute for Ethambutol?
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Streptomycin can be used as the 4th agent instead of Ethambutol.
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What is the MOA of Streptomycin?
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Inhibition of cellular protein synthesis.
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What serious side effects can Streptomycin cause?
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ototoxicity, nephrotoxicity, & blood dyscrasias
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How are the side effects monitored?
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Obtain a baseline audiometric test every 1 to 2 months since it can impair the 8th cranial nerve.
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Which clients are more prone for drug complications with Streptomycin?
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Older clients.
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