NURS 6521 ADVANCED PHARMACOLOGY FINAL EXAM 3
LATEST VERSIONS 2024/NURS 6521N WEEK 11
Ipratropium Bromide - Class: Inhaled anticholinergic
Used for: NOT 1st line, supplemental use in acute bronchospasm
MOA: Blocks the muscarinic cholinergic receptors, causes bronchial smooth muscle
relaxation; uses alternate pathway, effects additive with beta receptors
What is asthma? - Chronic inflammatory disorder of the airways, recurrent episodes of
wheezing, breathlessness and chest tightness, airflow obstruction is reversible -
recommendations by Expert Panel III is to take an aggressive approach to gain quick
control
What would you treat mild intermittent asthma with? - Step 1 therapy:
1. Use short acting B2 agonists PRN for symptoms - patients may have symptoms
when exposed to triggers (URI, allergens, chemical inhalents, exercise)
2. Educate on annual flu shot
What would you treat mild persistent asthma with? - Step 2 therapy:
1. Long-term/low dose inhaled corticosteroids such as Fluticasone or Budesonide
2. Use short acting B2 agonist PRN, if using more than 2 days/week, then step up
therapy
What would you treat moderate persistent asthma with? - Step 3 therapy:
1. Treat with medium dose inhaled corticosteroids (Fluticasone or Budesonide) OR
1. Low dose inhaled steroid (Fluticasone or Budesonide) plus long acting B2 agonist
(Advair or Salmeterol) OR
1. Medium dose inhaled steroid (Fluticasone or Budesonide) plus leukotriene receptor
antagonist (Zafirlukast)
2. May use short acting B2 agonists (Albuterol or Terbutaline)
What would you treat severe persistent asthma with? - Step 4 therapy:
1. Medium dose inhaled corticosteroid (Fluticasone or Budesonide) AND long-acting B2
agonist (Salmeterol) OR
1. Medium dose inhaled corticosteroid (Fluticasone or Budesonide) AND a leukotriene
modifier (Zafirlukast) OR Theophylline
Albuterol - Class: Short acting B2 agonist with minor B1
Used for: Bronchospasms associated with asthma, bronchitis (acute or chronic), and
COPD
ADR: Potential drug-induced hyperglycemia, cardiac arrhythmias, some CNS excitation
effects (tremors, dizziness), HA, tachycardia, palpitations
,Comments: Safe for children and pregnancy; may combine with ipratropium; least
expensive
Terbutaline - Class: Short acting B2 agonist with minor B1
Used for: Bronchospasms associated with asthma, bronchitis (acute or chronic), and
COPD
ADR: Potential drug-induced hyperglycemia, cardiac arrhythmias, some CNS excitation
effects (tremors, dizziness), HA, tachycardia, palpitations
X: Pregnancy category B or C
Salmeterol - Class: Long acting B2 agonist, more selective
Used for: Bronchospasms associated with asthma, bronchitis (acute or chronic), and
COPD
ADR: Potential drug-induced hyperglycemia, cardiac arrhythmias, some CNS excitation
effects (tremors, dizziness), HA, tachycardia, palpitations
Comments: Do not use alone for persistent asthma, combine with an inhaled
corticosteroid; don't wash it, powder can get clogged
What are some things you can educate your patients on regarding beta agonist
inhalers? - 1. Demonstrate and have patient do return demonstration
2. Check correct inhaler use if patient says it's not working
3. Encourage use of spacer
Fluticasone - Class: Inhaled corticosteroid
Used for: 1st line treatment for persistent asthma
MOA: Anti-inflammatory, minimal systemic exposure
Budesonide - Class: Inhaled corticosteroid
Used for: 1st line treatment for persistent asthma
MOA: Anti-inflammatory, minimal systemic exposure
Zafirlukast - Class: Leukotriene modifier/antagonist
Used for: 2nd line to decrease bronchoconstriction, edema
MOA: Works similar to prostaglandins in r/t to inflammation, blocks lipoxygenase
Theophylline - Class: Xanthine; stimulant
Used for: Asthma
MOA: Bronchial smooth muscle relaxation
ADR: cardiovascular effects, increased gastric acid production, CNS effects (irritability,
restlessness, seizures, insomnia), GI effects (reflux, worsens heartburn), cardiac effects
(palpitations, tachycardia, hypotension, life-threatening arrhythmias)
X: GERD, HTN, ischemic heart dx, coronary insufficiency, CHF, history of stroke,
cardiac arrhythmias; smoking increases clearance
Comments: Stay away from charcoal-broiled foods (accelerates the hepatic
metabolism), avoid large amounts of caffeine containing beverages; elimination is
influenced by diet
, What are the signs of Theophylline toxicity? - Vomiting, insomnia, jitteriness, HA, severe
GI pain, irregular heartbeat
Step 5 therapy:
1. High dose inhaled corticosteroid AND long acting B2 agonist
Step 6 therapy:
1. High dose inhaled corticosteroid AND long acting B2 agonist AND oral corticosteroid
**Severe persistent asthma requires consultation with asthma specialist
What drugs would you consider for pregnant patients who have asthma? - Inhaled beta
agonists are acute drug of choice; inhaled corticosteroids are the long term drug of
choice
When would you refer a child with asthma to a specialist? - At step 3 therapy
When would you consider using a long acting B2 agonists as monotherapy? - If your
patient has COPD
Systematic antibiotics are required for ____? - Moderate to severe impetigo, boils,
abscesses, perianal strep, cellulitis, MRSA suspected skin infections
Mupirocin - Class: Topical ATB
Used for: Mild impetigo, nasal MRSA carriers
Comments: Generic Mupirocin is less expensive
Bacitracin - Class: Topical ATB
Used for: Mild impetigo
Comments: Can be combined to make double or triple ATB
Retapamulin - Class: Topical ATB
Used for: Mild impetigo or nasal MRSA carriers
Comments: Cannot be given intranasal or will destroy sense of smell
Polymixin B - Class: Topical ATB
Used for: Mild impetigo
Comments: A double and triple ATB
Neomycin - Class: Topical ATB
Used for: Mild impetigo
Comments: May cause sensitivity in triple ATB
Cephalexin - Class: Oral ATB
LATEST VERSIONS 2024/NURS 6521N WEEK 11
Ipratropium Bromide - Class: Inhaled anticholinergic
Used for: NOT 1st line, supplemental use in acute bronchospasm
MOA: Blocks the muscarinic cholinergic receptors, causes bronchial smooth muscle
relaxation; uses alternate pathway, effects additive with beta receptors
What is asthma? - Chronic inflammatory disorder of the airways, recurrent episodes of
wheezing, breathlessness and chest tightness, airflow obstruction is reversible -
recommendations by Expert Panel III is to take an aggressive approach to gain quick
control
What would you treat mild intermittent asthma with? - Step 1 therapy:
1. Use short acting B2 agonists PRN for symptoms - patients may have symptoms
when exposed to triggers (URI, allergens, chemical inhalents, exercise)
2. Educate on annual flu shot
What would you treat mild persistent asthma with? - Step 2 therapy:
1. Long-term/low dose inhaled corticosteroids such as Fluticasone or Budesonide
2. Use short acting B2 agonist PRN, if using more than 2 days/week, then step up
therapy
What would you treat moderate persistent asthma with? - Step 3 therapy:
1. Treat with medium dose inhaled corticosteroids (Fluticasone or Budesonide) OR
1. Low dose inhaled steroid (Fluticasone or Budesonide) plus long acting B2 agonist
(Advair or Salmeterol) OR
1. Medium dose inhaled steroid (Fluticasone or Budesonide) plus leukotriene receptor
antagonist (Zafirlukast)
2. May use short acting B2 agonists (Albuterol or Terbutaline)
What would you treat severe persistent asthma with? - Step 4 therapy:
1. Medium dose inhaled corticosteroid (Fluticasone or Budesonide) AND long-acting B2
agonist (Salmeterol) OR
1. Medium dose inhaled corticosteroid (Fluticasone or Budesonide) AND a leukotriene
modifier (Zafirlukast) OR Theophylline
Albuterol - Class: Short acting B2 agonist with minor B1
Used for: Bronchospasms associated with asthma, bronchitis (acute or chronic), and
COPD
ADR: Potential drug-induced hyperglycemia, cardiac arrhythmias, some CNS excitation
effects (tremors, dizziness), HA, tachycardia, palpitations
,Comments: Safe for children and pregnancy; may combine with ipratropium; least
expensive
Terbutaline - Class: Short acting B2 agonist with minor B1
Used for: Bronchospasms associated with asthma, bronchitis (acute or chronic), and
COPD
ADR: Potential drug-induced hyperglycemia, cardiac arrhythmias, some CNS excitation
effects (tremors, dizziness), HA, tachycardia, palpitations
X: Pregnancy category B or C
Salmeterol - Class: Long acting B2 agonist, more selective
Used for: Bronchospasms associated with asthma, bronchitis (acute or chronic), and
COPD
ADR: Potential drug-induced hyperglycemia, cardiac arrhythmias, some CNS excitation
effects (tremors, dizziness), HA, tachycardia, palpitations
Comments: Do not use alone for persistent asthma, combine with an inhaled
corticosteroid; don't wash it, powder can get clogged
What are some things you can educate your patients on regarding beta agonist
inhalers? - 1. Demonstrate and have patient do return demonstration
2. Check correct inhaler use if patient says it's not working
3. Encourage use of spacer
Fluticasone - Class: Inhaled corticosteroid
Used for: 1st line treatment for persistent asthma
MOA: Anti-inflammatory, minimal systemic exposure
Budesonide - Class: Inhaled corticosteroid
Used for: 1st line treatment for persistent asthma
MOA: Anti-inflammatory, minimal systemic exposure
Zafirlukast - Class: Leukotriene modifier/antagonist
Used for: 2nd line to decrease bronchoconstriction, edema
MOA: Works similar to prostaglandins in r/t to inflammation, blocks lipoxygenase
Theophylline - Class: Xanthine; stimulant
Used for: Asthma
MOA: Bronchial smooth muscle relaxation
ADR: cardiovascular effects, increased gastric acid production, CNS effects (irritability,
restlessness, seizures, insomnia), GI effects (reflux, worsens heartburn), cardiac effects
(palpitations, tachycardia, hypotension, life-threatening arrhythmias)
X: GERD, HTN, ischemic heart dx, coronary insufficiency, CHF, history of stroke,
cardiac arrhythmias; smoking increases clearance
Comments: Stay away from charcoal-broiled foods (accelerates the hepatic
metabolism), avoid large amounts of caffeine containing beverages; elimination is
influenced by diet
, What are the signs of Theophylline toxicity? - Vomiting, insomnia, jitteriness, HA, severe
GI pain, irregular heartbeat
Step 5 therapy:
1. High dose inhaled corticosteroid AND long acting B2 agonist
Step 6 therapy:
1. High dose inhaled corticosteroid AND long acting B2 agonist AND oral corticosteroid
**Severe persistent asthma requires consultation with asthma specialist
What drugs would you consider for pregnant patients who have asthma? - Inhaled beta
agonists are acute drug of choice; inhaled corticosteroids are the long term drug of
choice
When would you refer a child with asthma to a specialist? - At step 3 therapy
When would you consider using a long acting B2 agonists as monotherapy? - If your
patient has COPD
Systematic antibiotics are required for ____? - Moderate to severe impetigo, boils,
abscesses, perianal strep, cellulitis, MRSA suspected skin infections
Mupirocin - Class: Topical ATB
Used for: Mild impetigo, nasal MRSA carriers
Comments: Generic Mupirocin is less expensive
Bacitracin - Class: Topical ATB
Used for: Mild impetigo
Comments: Can be combined to make double or triple ATB
Retapamulin - Class: Topical ATB
Used for: Mild impetigo or nasal MRSA carriers
Comments: Cannot be given intranasal or will destroy sense of smell
Polymixin B - Class: Topical ATB
Used for: Mild impetigo
Comments: A double and triple ATB
Neomycin - Class: Topical ATB
Used for: Mild impetigo
Comments: May cause sensitivity in triple ATB
Cephalexin - Class: Oral ATB
