TEST BANK FOR PHARMACOLOGY AND THE
NURSING PROCESS 10TH EDITION QUESTIONS
WITH CORRECT ANSWERS
bronchodilators overview - ANS-Bronchodilators are an important part of the pharmacotherapy for all
respiratory diseases. These drugs relax bronchial smooth muscle, which causes dilation of the bronchi
and bronchioles that are narrowed as a result of the disease process. There are three classes of such
drugs: beta adrenergic agonists, anticholinergics, and xanthine derivatives.
beta andregenic drug overview - ANS-The beta-adrenergic agonists are a group of drugs that are
commonly used during the acute phase of an asthmatic attack to quickly reduce airway constriction and
restore airflow to normal. They are agonists of the adrenergic receptors in the sympathetic nervous
system. The beta and alpha adrenergic receptors are discussed in Chapters 18 and 19. The beta agonists
imitate the effects of norepinephrine on beta receptors. For this reason, they are also called
sympathomimetic bronchodilators. The beta agonists are categorized by their onset of action. Short-
acting beta agonist (SABA) inhalers include albuterol (Ventolin), levalbuterol (Xopenex), pirbuterol
(Maxair), terbutaline (Brethine), and metaproterenol (Alupent). Long-acting beta agonist (LABA) inhalers
include arformoterol (Brovana), formoterol (Foradil, Perforomist), and salmeterol (Serevent). The
newest long-acting beta agonists are indacterol (Arcapta Neohaler); vilanterol in conjunction with
fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholinergic umeclidinium (Anoro
Ellipta). The term Ellipta refers to a new delivery system. Because the long-acting beta agonists (LABAs)
have a longer onset of action, they must never be used for acute treatment. Patients must be taught to
use the short-acting beta agonist (SABA) as rescue treatment.
short acting beta agonist - ANS-albuterol (Ventolin), levalbuterol (Xopenex), pirbuterol (Maxair),
terbutaline (Brethine), and metaproterenol (Alupent).
Albuterol - ANS-Class : beta 2 agonist (short acting)
Indications and mechanisms of action: is a short-acting beta2-specific bronchodilating beta agonist.
Other similar drugs include bitolterol (Tornalate), levalbuterol (Xopenex), pirbuterol (Maxair), and
terbutaline (Brethine). Albuterol is the most commonly used drug in this class. If albuterol is used too
frequently, dose-related adverse effects may be seen, because albuterol loses its beta2-specific actions,
especially at larger dosages
,Contraindications :. As a consequence, the beta1 receptors are stimulated, which causes nausea,
increased anxiety, palpitations, tremors, and an increased heart rate.
Route: po and inhalation
Other facts: levorotatory isomeric form of albuterol, levalbuterol, is sometimes prescribed as an
albuterol alternative for patients with certain risk factors (e.g., tachycardia, including tachycardia
associated with albuterol treatment). (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
long acting beta agonist - ANS-arformoterol (Brovana), formoterol (Foradil, Perforomist), and salmeterol
(Serevent). The newest long-acting beta agonists are indacterol (Arcapta Neohaler); vilanterol in
conjunction with fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholinergic
umeclidinium (Anoro Ellipta)
beta andregenic mechanism of action and drug effect - ANS-The beta agonists relax and dilate airways
by stimulating the beta2-adrenergic receptors located throughout the lungs.
582
There are three subtypes of these drugs, based on their selectivity for beta2 receptors:
1. Nonselective adrenergic drugs, which stimulate the beta, beta1 (cardiac), and beta2 (respiratory)
receptors. Example: epinephrine. (NOTE: Epinephrine inhalers were taken off the market in 2012
because they did not comply with FDA requirements). Epinephrine is available as a prefilled syringe for
self-administration by patients with severe allergic reactions and is called EpiPen (Figure 37-2).
2. Nonselective beta-adrenergic drugs, which stimulate both beta1 and beta2 receptors. Example:
metaproterenol.
3. Selective beta2 drugs, which primarily stimulate the beta2 receptors. Example: albuterol.
These drugs can also be categorized according to their routes of administration as oral, injectable, or
inhaled. The various beta agonist bronchodilators are listed in Table 37-3. The bronchioles are
surrounded by smooth muscle. When the smooth muscle contracts, the airways are narrowed and the
amount of oxygen and carbon dioxide exchanged is reduced. The action of beta agonist bronchodilators
begins at the specific receptor stimulated and ends with the relaxation and dilation of the airways.
However, many reactions must take place at the cellular level for bronchodilation to occur. When a
beta2-adrenergic receptor is stimulated by a beta agonist, adenylate cyclase is activated and produces
cyclic adenosine monophosphate (cAMP). Adenylate cyclase is an enzyme needed to make cAMP. The
increased levels of cAMP cause bronchial smooth muscles to relax, which results in bronchial dilation
and increased airflow into and out of the lungs.
Nonselective adrenergic agonist drugs such as epinephrine also stimulate alpha-ad
,indications of beta andregenics - ANS-The primary therapeutic effect of the beta agonists is the
prevention or relief of bronchospasm related to bronchial asthma, bronchitis, and other pulmonary
diseases. However, they are also used for effects outside the respiratory system. Because some of these
drugs have the ability to stimulate both beta1- and alpha-adrenergic receptors, they may be used to
treat hypotension and shock (see Chapter 18).
contraindications for beta andregenics - ANS-drug allergy, uncontrolled hypertension or cardiac
dysrhythmias, and high risk for stroke (because of the vasoconstrictive drug action)
adverse effects of beta andregenics - ANS-Mixed alpha/beta agonists produce the most adverse effects
because they are nonselective. These include insomnia, restlessness, anorexia, cardiac stimulation,
hyperglycemia, tremor, and vascular headache. The adverse effects of the nonselective beta agonists
are limited to beta-adrenergic effects, including cardiac stimulation, tremor, anginal pain, and vascular
headache. The beta2 drugs can cause both hypertension and hypotension, vascular headaches, and
tremor. Overdose management may include careful administration of a beta blocker while the patient is
under close observation due to the risk for bronchospasm. Because the half-life of most adrenergic
agonists is relatively short, the patient may just be observed while the body eliminates the medication.
interactions with beta andregenics - ANS-When nonselective beta blockers are used with the beta
agonist bronchodilators, the bronchodilation from the beta agonist is diminished. The use of beta
agonists with monoamine oxidase inhibitors and other sympathomimetics is best avoided because of
the enhanced risk for hypertension. Patients with diabetes may require an adjustment in the dosage of
their hypoglycemic drugs, especially patients receiving epinephrine, because of the increase in blood
glucose levels that can occur.
Salmeterol (Serevent Diskus) (Lilley 583) - ANS-Class : long acting beta 2 agonist
is a long-acting beta2 agonist bronchodilator. Other long-acting inhalers include formoterol (Foradil,
Perforomist), arformoterol (Brovana), and indacterol (Arcapta Neohaler). The long-acting inhalers are
never to be used for acute treatment. Salmeterol is used for the maintenance treatment of asthma and
COPD and is used in conjunction with an inhaled corticosteroid. It is given twice daily for maintenance
treatment only. In 2006, a large randomized clinical trial showed that use of salmeterol was associated
with an increase in asthma-related deaths (when added to usual asthma therapy). The risk appears to be
higher in African-American patients. All LABAs have a black box warning regarding this risk. Adverse
effects include immediate hypersensitivity reactions, headache, hypertension, and neuromuscular and
skeletal pain. Salmeterol should never be given more than twice daily nor should the maximum daily
dose (one puff twice daily) be exceeded. It is available as a powder for inhalation either alone (Serevent
Diskus) or combined with a corticosteroid (Advair). The long-acting inhalers, including salmeterol, are
not to be used alone, but in combination with other drugs such as the inhaled corticosteroids. Advair
(salmeterol and fluticasone) is a very popular inhaler for COPD. Symbicort, a newer inhaler consisting of
the corticosteroid budesonide and the bronchodilator formoterol, is similar to Advair as is Dulera, which
is a combination of formoterol and mometasone. (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Anti cholinergics mechanism of action and drug affects - ANS-On the surface of the bronchial tree are
receptors for acetylcholine (ACh), the neurotransmitter for the parasympathetic nervous system (PSNS).
, When the PSNS releases ACh from its nerve endings, it binds to the ACh receptors on the surface of the
bronchial tree, which results in bronchial constriction and narrowing of the airways. Anticholinergic
drugs block these ACh receptors to prevent bronchoconstriction. This indirectly causes airway relaxation
and dilation. Anticholinergic agents also help reduce secretions in COPD patients. (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Indications of anti cholinergics - ANS-Because their actions are slow and prolonged, anticholinergics are
used for the prevention of bronchospasm associated with chronic bronchitis or emphysema and not for
the management of acute symptoms. (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Contraindications to anticholinergics - ANS-The only usual contraindication to the use of bronchial
anticholinergic drugs is known drug allergy, including allergy to atropine. In the past, an allergy to
peanuts or soy was listed as a contraindication to ipratropium inhalers. This was related to the
propellant used, and the new HFA inhalers have eliminated the concern. Thus, there is no
contraindication using ipratropium in patients with peanut or soy allergies. Caution is necessary in
patients with acute narrow-angle glaucoma and prostate enlargement (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Adverse effects to anticholinergics - ANS-The most commonly reported adverse effects of inhaled
anticholinergics are related to their pharmacology and include dry mouth or throat, nasal congestion,
heart palpitations, gastrointestinal (GI) distress, urinary retention, increased intraocular pressure,
headache, coughing, and anxiety. Ipratropium is classified as a pregnancy category B drug; all others in
this class are pregnancy category C.
(Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Drug interactions anticholinergics - ANS-Possible additive toxicity may occur when anticholinergic
bronchodilators are taken with other anticholinergic drugs.
(Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Ipratropium (Atrovent) - ANS-Class : anticholinergic
Indications and mechanisms of action : is the oldest anticholinergic bronchodilator. It is
pharmacologically very similar to atropine (see Chapter 21). It is available both as a liquid aerosol for
inhalation and as a multidose inhaler; both forms are usually dosed twice daily. Tiotropium (Spiriva) and
NURSING PROCESS 10TH EDITION QUESTIONS
WITH CORRECT ANSWERS
bronchodilators overview - ANS-Bronchodilators are an important part of the pharmacotherapy for all
respiratory diseases. These drugs relax bronchial smooth muscle, which causes dilation of the bronchi
and bronchioles that are narrowed as a result of the disease process. There are three classes of such
drugs: beta adrenergic agonists, anticholinergics, and xanthine derivatives.
beta andregenic drug overview - ANS-The beta-adrenergic agonists are a group of drugs that are
commonly used during the acute phase of an asthmatic attack to quickly reduce airway constriction and
restore airflow to normal. They are agonists of the adrenergic receptors in the sympathetic nervous
system. The beta and alpha adrenergic receptors are discussed in Chapters 18 and 19. The beta agonists
imitate the effects of norepinephrine on beta receptors. For this reason, they are also called
sympathomimetic bronchodilators. The beta agonists are categorized by their onset of action. Short-
acting beta agonist (SABA) inhalers include albuterol (Ventolin), levalbuterol (Xopenex), pirbuterol
(Maxair), terbutaline (Brethine), and metaproterenol (Alupent). Long-acting beta agonist (LABA) inhalers
include arformoterol (Brovana), formoterol (Foradil, Perforomist), and salmeterol (Serevent). The
newest long-acting beta agonists are indacterol (Arcapta Neohaler); vilanterol in conjunction with
fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholinergic umeclidinium (Anoro
Ellipta). The term Ellipta refers to a new delivery system. Because the long-acting beta agonists (LABAs)
have a longer onset of action, they must never be used for acute treatment. Patients must be taught to
use the short-acting beta agonist (SABA) as rescue treatment.
short acting beta agonist - ANS-albuterol (Ventolin), levalbuterol (Xopenex), pirbuterol (Maxair),
terbutaline (Brethine), and metaproterenol (Alupent).
Albuterol - ANS-Class : beta 2 agonist (short acting)
Indications and mechanisms of action: is a short-acting beta2-specific bronchodilating beta agonist.
Other similar drugs include bitolterol (Tornalate), levalbuterol (Xopenex), pirbuterol (Maxair), and
terbutaline (Brethine). Albuterol is the most commonly used drug in this class. If albuterol is used too
frequently, dose-related adverse effects may be seen, because albuterol loses its beta2-specific actions,
especially at larger dosages
,Contraindications :. As a consequence, the beta1 receptors are stimulated, which causes nausea,
increased anxiety, palpitations, tremors, and an increased heart rate.
Route: po and inhalation
Other facts: levorotatory isomeric form of albuterol, levalbuterol, is sometimes prescribed as an
albuterol alternative for patients with certain risk factors (e.g., tachycardia, including tachycardia
associated with albuterol treatment). (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
long acting beta agonist - ANS-arformoterol (Brovana), formoterol (Foradil, Perforomist), and salmeterol
(Serevent). The newest long-acting beta agonists are indacterol (Arcapta Neohaler); vilanterol in
conjunction with fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholinergic
umeclidinium (Anoro Ellipta)
beta andregenic mechanism of action and drug effect - ANS-The beta agonists relax and dilate airways
by stimulating the beta2-adrenergic receptors located throughout the lungs.
582
There are three subtypes of these drugs, based on their selectivity for beta2 receptors:
1. Nonselective adrenergic drugs, which stimulate the beta, beta1 (cardiac), and beta2 (respiratory)
receptors. Example: epinephrine. (NOTE: Epinephrine inhalers were taken off the market in 2012
because they did not comply with FDA requirements). Epinephrine is available as a prefilled syringe for
self-administration by patients with severe allergic reactions and is called EpiPen (Figure 37-2).
2. Nonselective beta-adrenergic drugs, which stimulate both beta1 and beta2 receptors. Example:
metaproterenol.
3. Selective beta2 drugs, which primarily stimulate the beta2 receptors. Example: albuterol.
These drugs can also be categorized according to their routes of administration as oral, injectable, or
inhaled. The various beta agonist bronchodilators are listed in Table 37-3. The bronchioles are
surrounded by smooth muscle. When the smooth muscle contracts, the airways are narrowed and the
amount of oxygen and carbon dioxide exchanged is reduced. The action of beta agonist bronchodilators
begins at the specific receptor stimulated and ends with the relaxation and dilation of the airways.
However, many reactions must take place at the cellular level for bronchodilation to occur. When a
beta2-adrenergic receptor is stimulated by a beta agonist, adenylate cyclase is activated and produces
cyclic adenosine monophosphate (cAMP). Adenylate cyclase is an enzyme needed to make cAMP. The
increased levels of cAMP cause bronchial smooth muscles to relax, which results in bronchial dilation
and increased airflow into and out of the lungs.
Nonselective adrenergic agonist drugs such as epinephrine also stimulate alpha-ad
,indications of beta andregenics - ANS-The primary therapeutic effect of the beta agonists is the
prevention or relief of bronchospasm related to bronchial asthma, bronchitis, and other pulmonary
diseases. However, they are also used for effects outside the respiratory system. Because some of these
drugs have the ability to stimulate both beta1- and alpha-adrenergic receptors, they may be used to
treat hypotension and shock (see Chapter 18).
contraindications for beta andregenics - ANS-drug allergy, uncontrolled hypertension or cardiac
dysrhythmias, and high risk for stroke (because of the vasoconstrictive drug action)
adverse effects of beta andregenics - ANS-Mixed alpha/beta agonists produce the most adverse effects
because they are nonselective. These include insomnia, restlessness, anorexia, cardiac stimulation,
hyperglycemia, tremor, and vascular headache. The adverse effects of the nonselective beta agonists
are limited to beta-adrenergic effects, including cardiac stimulation, tremor, anginal pain, and vascular
headache. The beta2 drugs can cause both hypertension and hypotension, vascular headaches, and
tremor. Overdose management may include careful administration of a beta blocker while the patient is
under close observation due to the risk for bronchospasm. Because the half-life of most adrenergic
agonists is relatively short, the patient may just be observed while the body eliminates the medication.
interactions with beta andregenics - ANS-When nonselective beta blockers are used with the beta
agonist bronchodilators, the bronchodilation from the beta agonist is diminished. The use of beta
agonists with monoamine oxidase inhibitors and other sympathomimetics is best avoided because of
the enhanced risk for hypertension. Patients with diabetes may require an adjustment in the dosage of
their hypoglycemic drugs, especially patients receiving epinephrine, because of the increase in blood
glucose levels that can occur.
Salmeterol (Serevent Diskus) (Lilley 583) - ANS-Class : long acting beta 2 agonist
is a long-acting beta2 agonist bronchodilator. Other long-acting inhalers include formoterol (Foradil,
Perforomist), arformoterol (Brovana), and indacterol (Arcapta Neohaler). The long-acting inhalers are
never to be used for acute treatment. Salmeterol is used for the maintenance treatment of asthma and
COPD and is used in conjunction with an inhaled corticosteroid. It is given twice daily for maintenance
treatment only. In 2006, a large randomized clinical trial showed that use of salmeterol was associated
with an increase in asthma-related deaths (when added to usual asthma therapy). The risk appears to be
higher in African-American patients. All LABAs have a black box warning regarding this risk. Adverse
effects include immediate hypersensitivity reactions, headache, hypertension, and neuromuscular and
skeletal pain. Salmeterol should never be given more than twice daily nor should the maximum daily
dose (one puff twice daily) be exceeded. It is available as a powder for inhalation either alone (Serevent
Diskus) or combined with a corticosteroid (Advair). The long-acting inhalers, including salmeterol, are
not to be used alone, but in combination with other drugs such as the inhaled corticosteroids. Advair
(salmeterol and fluticasone) is a very popular inhaler for COPD. Symbicort, a newer inhaler consisting of
the corticosteroid budesonide and the bronchodilator formoterol, is similar to Advair as is Dulera, which
is a combination of formoterol and mometasone. (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Anti cholinergics mechanism of action and drug affects - ANS-On the surface of the bronchial tree are
receptors for acetylcholine (ACh), the neurotransmitter for the parasympathetic nervous system (PSNS).
, When the PSNS releases ACh from its nerve endings, it binds to the ACh receptors on the surface of the
bronchial tree, which results in bronchial constriction and narrowing of the airways. Anticholinergic
drugs block these ACh receptors to prevent bronchoconstriction. This indirectly causes airway relaxation
and dilation. Anticholinergic agents also help reduce secretions in COPD patients. (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Indications of anti cholinergics - ANS-Because their actions are slow and prolonged, anticholinergics are
used for the prevention of bronchospasm associated with chronic bronchitis or emphysema and not for
the management of acute symptoms. (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Contraindications to anticholinergics - ANS-The only usual contraindication to the use of bronchial
anticholinergic drugs is known drug allergy, including allergy to atropine. In the past, an allergy to
peanuts or soy was listed as a contraindication to ipratropium inhalers. This was related to the
propellant used, and the new HFA inhalers have eliminated the concern. Thus, there is no
contraindication using ipratropium in patients with peanut or soy allergies. Caution is necessary in
patients with acute narrow-angle glaucoma and prostate enlargement (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Adverse effects to anticholinergics - ANS-The most commonly reported adverse effects of inhaled
anticholinergics are related to their pharmacology and include dry mouth or throat, nasal congestion,
heart palpitations, gastrointestinal (GI) distress, urinary retention, increased intraocular pressure,
headache, coughing, and anxiety. Ipratropium is classified as a pregnancy category B drug; all others in
this class are pregnancy category C.
(Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Drug interactions anticholinergics - ANS-Possible additive toxicity may occur when anticholinergic
bronchodilators are taken with other anticholinergic drugs.
(Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby,
022016. VitalBook file.
Ipratropium (Atrovent) - ANS-Class : anticholinergic
Indications and mechanisms of action : is the oldest anticholinergic bronchodilator. It is
pharmacologically very similar to atropine (see Chapter 21). It is available both as a liquid aerosol for
inhalation and as a multidose inhaler; both forms are usually dosed twice daily. Tiotropium (Spiriva) and
