NUR2474 Exam 2 Review
NUR2474 Test # 2 Review
Please review general tips from Quiz review document (test taking strategies, select all that apply
questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No notes
or textbook allowed on the test. Calculator will be enabled in the browser.
General tips for studying:
1. Memorize names of medication categories from the presentation
2. Memorize key drugs from categories above (there are many questions with specific drug
names)
3. Use generic names
4. When reviewing particular drugs note category, indications, common side effects,
toxicity signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or
antagonizing which receptors)
5. Read question instructions (there will be ‗select all that apply‘ questions)
Topics to review:
1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs,
etc.).
a. Metered dose inhaler: (MDI) handheld device delivering a measured dose of a
drug with each actuation
i. Dosing is usually accomplished with 1-2 inhalations
ii. When 2 inhalations are needed, 1-minute interval is needed in
between
iii. Begin inhalation before activating device
iv. Even with optimal use, only about 10% of the drug reaches the lungs, 80%
is swallowed, and 10% is left in the device or exhaled.
v. Spacers- attach directly to MDI to increased delivery of drugs to the lungs
vi. After inhaler use rinse mouth and gurgle, especially with
glucocorticoids (steroid), can cause the steroid to be absorbed through
membrane
2. Know the difference between short and long term treatments for asthma and COPD
a. Long term treatments
i. Anti-inflammatory drugs (Glucocorticoids: inhaled or oral, leukotriene
modifiers, cromolyn, omalizumab)
1. Corticosteroid
2. Minimize systemic effects
ii. Bronchodilators (Long acting beta2 agonists, theophylline)
iii. Drugs are taken daily for long term control
iv. Glucocorticoids for long term prophylaxis (prednisone)
b. Short term treatments
i. bronchodilators (short acting beta2 agonists, anticholinergics:
Tiotropium)
, 1. albuterol
ii. Provide symptomatic relief but do not alter the underlying disease process
(inflammation)
iii. Asthma patients taking bronchodilators should also be taking
glucocorticoids for long-term suppression of inflammation
3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and
what is for long term management)
a. Rescue inhaler
i. Bronchodilator-beta 2adrenergic agonist
1. Albuterol (Proventil, Ventolin)
2. Terbutaline sulfate (brethine)
3. Indicated for acute exacerbations of asthma, relief of
bronchoconstriction due to bronchitis and emphysema and long-
term control of chronic airway disease.
4. Effects start within minutes and last for 2-4 hours.
b. Long-term treatment
i. Corticosteroids (glucocorticoids) –long term and prophylaxis
1. Fluticasone (flonase)
2. Budesonide (Pulmicort, rhinocort)
3. Prednisone (deltasone)
4. Methylprednisolone (solu-medrol)
ii. Bronchodilators (antileukotriene-leukotriene receptor antagonists)
1. Montelukast (singulair)
2. Zafirlukast (accolate)
4. Treatment of acute asthma
i. may have to give IV corticosteroid glucocorticoid short term; and give
rescue inhaler.
1. May need to add albuterol, nebulizer treatment, oxygen, or
ipratropium
ii. Bronchodilators: beta2 adrenergic agonist
1. Action: activation of beta2 receptors in the smooth muscle of the
lungs, promotes bronchodilation, relieving bronchospasm
a. Beta2 agonist have a limited role in suppressing histamine
release in the lung and increasing ciliary motility
iii. Use: asthma and COPD
1. Inhaled short acting beta2 agonists (SABAs)
a. Taken PRN to abort an ongoing attack
b. EIB: taken before exercise to prevent an attack
, c. Hospitalized patients undergoing a severe acute attack-
nebulized SABA in the traditional treatment of choice
d. Delivery with an MDI in the outpatient setting may be
equally effective
2. Inhaled long acting beta2 agonist (LABAs)
a. Long term control of patients who experience frequent
attacks
b. Dosing in not PRN. It is on a fixed schedule
c. Effective in treating stable COPD
d. When used for asthma, must be combined with
glucocorticoids
e. Use alone in asthma is contraindicated
3. Adverse effects:
a. Inhaled- systemic effects: tachycardia, angina, tremor
b. Oral- excessive dosage: angina pectoris,
tachydysrhythmias, tremor
4. Other treatments of acute asthma
a. Nebulizer (Albuterol), ipotropium, oxygen, IV
glucocorticoids
5. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt.
education)
a. Anti-inflammatory drugs: Glucocorticoids (long term treatment for asthma)
b. Mechanism of action: most effective antiasthma drugs
i. Prophylaxis to prevent exacerbations with opioid use, there is a good
chance they will develop constipation
ii. Docusate is a good option.
iii. Gentle softener to help them with constipation
iv. Prophylaxis until they do develop severe constipation, then go for more
intense treatment options
v. Decrease synthesis and release of inflammatory mediators
vi. Reduce infiltration and activity of inflammation cells
vii. Decrease edema of the airway mucosa caused by beta2 agonists
viii. Usually administered by inhalation, but emergency situation- IV/oral
routes also available
c. Side effects:
NUR2474 Test # 2 Review
Please review general tips from Quiz review document (test taking strategies, select all that apply
questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No notes
or textbook allowed on the test. Calculator will be enabled in the browser.
General tips for studying:
1. Memorize names of medication categories from the presentation
2. Memorize key drugs from categories above (there are many questions with specific drug
names)
3. Use generic names
4. When reviewing particular drugs note category, indications, common side effects,
toxicity signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or
antagonizing which receptors)
5. Read question instructions (there will be ‗select all that apply‘ questions)
Topics to review:
1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs,
etc.).
a. Metered dose inhaler: (MDI) handheld device delivering a measured dose of a
drug with each actuation
i. Dosing is usually accomplished with 1-2 inhalations
ii. When 2 inhalations are needed, 1-minute interval is needed in
between
iii. Begin inhalation before activating device
iv. Even with optimal use, only about 10% of the drug reaches the lungs, 80%
is swallowed, and 10% is left in the device or exhaled.
v. Spacers- attach directly to MDI to increased delivery of drugs to the lungs
vi. After inhaler use rinse mouth and gurgle, especially with
glucocorticoids (steroid), can cause the steroid to be absorbed through
membrane
2. Know the difference between short and long term treatments for asthma and COPD
a. Long term treatments
i. Anti-inflammatory drugs (Glucocorticoids: inhaled or oral, leukotriene
modifiers, cromolyn, omalizumab)
1. Corticosteroid
2. Minimize systemic effects
ii. Bronchodilators (Long acting beta2 agonists, theophylline)
iii. Drugs are taken daily for long term control
iv. Glucocorticoids for long term prophylaxis (prednisone)
b. Short term treatments
i. bronchodilators (short acting beta2 agonists, anticholinergics:
Tiotropium)
, 1. albuterol
ii. Provide symptomatic relief but do not alter the underlying disease process
(inflammation)
iii. Asthma patients taking bronchodilators should also be taking
glucocorticoids for long-term suppression of inflammation
3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and
what is for long term management)
a. Rescue inhaler
i. Bronchodilator-beta 2adrenergic agonist
1. Albuterol (Proventil, Ventolin)
2. Terbutaline sulfate (brethine)
3. Indicated for acute exacerbations of asthma, relief of
bronchoconstriction due to bronchitis and emphysema and long-
term control of chronic airway disease.
4. Effects start within minutes and last for 2-4 hours.
b. Long-term treatment
i. Corticosteroids (glucocorticoids) –long term and prophylaxis
1. Fluticasone (flonase)
2. Budesonide (Pulmicort, rhinocort)
3. Prednisone (deltasone)
4. Methylprednisolone (solu-medrol)
ii. Bronchodilators (antileukotriene-leukotriene receptor antagonists)
1. Montelukast (singulair)
2. Zafirlukast (accolate)
4. Treatment of acute asthma
i. may have to give IV corticosteroid glucocorticoid short term; and give
rescue inhaler.
1. May need to add albuterol, nebulizer treatment, oxygen, or
ipratropium
ii. Bronchodilators: beta2 adrenergic agonist
1. Action: activation of beta2 receptors in the smooth muscle of the
lungs, promotes bronchodilation, relieving bronchospasm
a. Beta2 agonist have a limited role in suppressing histamine
release in the lung and increasing ciliary motility
iii. Use: asthma and COPD
1. Inhaled short acting beta2 agonists (SABAs)
a. Taken PRN to abort an ongoing attack
b. EIB: taken before exercise to prevent an attack
, c. Hospitalized patients undergoing a severe acute attack-
nebulized SABA in the traditional treatment of choice
d. Delivery with an MDI in the outpatient setting may be
equally effective
2. Inhaled long acting beta2 agonist (LABAs)
a. Long term control of patients who experience frequent
attacks
b. Dosing in not PRN. It is on a fixed schedule
c. Effective in treating stable COPD
d. When used for asthma, must be combined with
glucocorticoids
e. Use alone in asthma is contraindicated
3. Adverse effects:
a. Inhaled- systemic effects: tachycardia, angina, tremor
b. Oral- excessive dosage: angina pectoris,
tachydysrhythmias, tremor
4. Other treatments of acute asthma
a. Nebulizer (Albuterol), ipotropium, oxygen, IV
glucocorticoids
5. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt.
education)
a. Anti-inflammatory drugs: Glucocorticoids (long term treatment for asthma)
b. Mechanism of action: most effective antiasthma drugs
i. Prophylaxis to prevent exacerbations with opioid use, there is a good
chance they will develop constipation
ii. Docusate is a good option.
iii. Gentle softener to help them with constipation
iv. Prophylaxis until they do develop severe constipation, then go for more
intense treatment options
v. Decrease synthesis and release of inflammatory mediators
vi. Reduce infiltration and activity of inflammation cells
vii. Decrease edema of the airway mucosa caused by beta2 agonists
viii. Usually administered by inhalation, but emergency situation- IV/oral
routes also available
c. Side effects:
