Respiratory pharm notes for nursing school

Notes for respiratory system

1. IF THE BODY ISN T BREATHING, NOTHING
ELSE MATTERS!
Pharmacology Respiratory
System

2. Ifi.me
cotHa0tiacoz­
I PEEP

3. Airflow Disorders
ä—Asthma
ä—Inflammation
ä—Bronchoconstriction
ä—COPD-emphysema, chronic bronchitis
rit
allergies
Allersies
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4. Respiratory Medications
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I.Bronchodilators-Types
b.Beta2 adrenergic agonists
c.Inhaled Anticholinergics
2. Anti-inflammatory Agents
a.Methylxanthines
b.Glucocorticoids
c.Mast Cell stabilizers
d.Leukotriene modifiers
Adrenergic
Produehistamines
Dirtying
Ptitolandin
left

5. Respiratory Meds
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I.Beta2 adrenergic agonists
MOA- act by selectively activating the beta2 receptors in the
bronchial smooth muscle, resulting in bronchodilation.
a.Bronchospasm is relieved
b.Histamine release is inhibited
c.Ciliary motility is increased
Short-acting-Inhaled examples
Albuterol
Levalbuterol
Long-acting-Inhaled examples
Formoterol
Salmeterol
Long-acting-Oral examples
Terbutaline
Albuterol
brE
Pillform

6. Beta2 Adrenergic Complications
ä—Adverse Effects Include:
Tachycardia-due to alpha1 receptors activation in
heart
Angina due to alpha1 receptor activation in heart
Tremors due to beta2 receptor activation in skeletal
muscle
atachycardiaAngina
batremors

7. Beta2 Adrenergics
ä—Possible Interactions Include:
ä—Propanolol- because it is a beta-adrenergic
blocker negate effects
ä—MAOIs and tricyclic antidepressants can
increase the risk of tachycardia and angina due
to cardiac hypoxia
ä—Administered via MDI, DPI, or nebulizer
tyramine
Pg634
with
spacer

8. Methylxanthines
ä—Relaxes smooth muscle in lungs resulting in
bronchodilation, used rarely due to possible tachycardia
ä—Example/Prototype:
ä—Theophylline (Theolair, Theo-24)
ä—Pregnancy Risk Category C
ä—Administered Oral or IV
ä—Used infrequently now
Main
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9. Caffeine vs Methylxanthines

10. Methylxanthines
ä—Adverse Effects Include:
ä—Mild- GI distress and Restlessness
ä—Severe- dysrhythmias and seizures
ä—Possible Interactions Include:
ä—Caffeine can increase effects
ä—Smoking and marijuana use can increase theophylline metabolism and
decrease its effect.
ä—Phenobarbital, phenytoin, and rifampin decrease effects
ä—Cimetidine (Tagamet), ciprofloxicin (Cipro), and other flouroquinolone
antibiotics increase theophylline levels.
ä—Theophylline increases risk of digitalis toxicity, decreases effects of
lithium and phenytoin (Dilantin)
ä—If theophylline and ²-blocker are administered together, cardiac
dysrhythmias may result
trihicadinchestPainAngina
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oncosidechart

11. Anticholinergics-Inhaled
ä—MOA-Block muscarinic receptors of the bronchi,
resulting in bronchodilation.
ä—Examples include: Ipratropium and Tiotropium
AlbuterolAtrovent3AADro
treatments

12. Anticholinergics-Inhaled
ä—Adverse Effects- dry mouth, hoarseness
ä—Complications/Precautions Anticholinergic effects like
narrow-angled glaucoma, and BPH
ä—May cause anaphylaxis if client has Peanut allergy due to
soy lecithin is from peanut family
ä—A&A Duo Neb treatments often used to treat asthma
attacks

13. Course of Therapy
Albuterol

14. Glucocorticoids
ä—Mechanism of Action- prevent inflammation
blocking prostaglandins, suppresses airway mucus
production, promotes responsiveness of beta2
receptors in the bronchial tree
ä—Doesn t prevent immediate effects, but rather
promotes decreased frequency and severity of
exacerbations and acute attacks.
Ctasteroids
Ionaspossible
bronchodilation
PreventfromgoingtoAsthmaattack

15. Glucocorticoids
ä—Select Prototype meds
ä—Beclomethasone (QVAR)-inhaled
ä—Prednisone- oral
ä—Other meds include
ä—Budesonide and formoterol (Symbicort)
ä—Fluticasone and salmeterol (Advair)
ä—Mometasone furoate and formoterol fumarate dihydrate
(Dulera)
ä—Prednisolone (Prelone)
ä—Hydrocortisone sodium succinate (Solucortef)-IV
ä—Methylprednisolone sodium succinate (Solu-Medrol)-IV
Adrenalstandshutoff

16. Glucocorticoids-Side Effects and Adverse Effects
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17. Glucocorticoid-adverse effects
ä—Beclomethasone can cause Difficulty speaking,
hoarseness, and candidiasis
ä—Prednisone can result in suppressed adrenal gland
function, Bone loss, hyperglycemia, myopathy, peptic
ulcer disease, infection, and fluid and electrolyte
imbalances.
ä—A. hypokalemia with diuretics
ä—B. GI Ulcers with NSAIDS
ä—C. hyperglycemia
ä—D. Decreased phagocytic activity
ä—Pregnancy Risk Category C
Yeast
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18. Leukotriene Modifiers
ä—MOA- Prevent the effects of leukotrienes, thereby
suppressing inflammation, bronchoconstriction,
airway edema, and mucus production.
ä—Montelukast (Singulair)-oral
ä—Zileuton (Zyflo), zafirlukast (Accolate)-oral
ä—Adverse effects- Liver injury
ä—Pregnancy Risk Category B
Gobletcells
suppress
Herate

19. Leukotriene Modifiers-inhibit Lipoxygenase
pathway
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Phospholipidbilayers
de
Aspirin
bloodcloths
h
f

20. Leukotriene Modifiers
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ã¡Description
ä÷Used in prophylaxis and treatment of chronic bronchial asthma;
not used for acute asthmatic episodes
ã¡Side effects
ä÷Headache, nausea and vomiting, dyspepsia, diarrhea, generalized
pain, fever, dizziness
ã¡Interventions
ä÷Monitor lung sounds for rhonchi, wheezing; assess liver function
studies as prescribed
ä÷Zileuton and zafirlukast inhibit metabolism of theophylline,
leading to increased theophylline levels.
ä÷Instruct client to take medication 1 hour before or 2 hours after
meals; instruct client not to discontinue medication, to take as
prescribed
beforeexercise
startday
3months
breakdown

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Other examples of Leukotriene Modifiers:
Clukast

22. Respiratory Meds Continued
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III. Inhaled Nonsteroidal Antiallergy Agents
ã¡Example- Cromolyn sodium
ã¡Description
ä÷Antiasthmatic, antiallergic, mast cell stabilizers inhibit mast cell release
after exposure to antigens
ä÷Used to treat allergic rhinitis, bronchial asthma, exercise-induced
bronchospasm
ã¡Side effects
ä÷Cough, bronchospasm following inhalation
ã¡Interventions
ä÷Instruct client to drink few sips of water before, after inhalation
ä÷Instruct client not to discontinue medication abruptly
ATI
Blockasthma

23. Cromolyn Sodium

24. Respiratory Anti-inflammatory meds
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V. Monoclonal Antibodies
Example- Omalizumab-used to treat allergic-related asthma
ã¡Description
ä÷Immunoglobulins that can be synthesized to have single specificity for
therapeutic regimens, such as immunosuppression
ã¡Side effects
ä÷Immunosuppression to treat the causative agent of disease
ã¡Interventions
ä÷Instruct client to avoid others with infectious disorders
ä÷Instruct client to eat well-balanced diet, get adequate rest and sleep
soE.netY
the
a
Antibody
gunftspecific

25. What are Monoclonal Antibodies?
Antibodies that attack antibodies or antibody receptors!!!
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Is

26. Approved Anti-asthmatic Monoclonal Antibodies
I
intrusan5

27. Upper Respiratory Disorders (ch 17)
ä—Antitussives-Opioids
ä—Antitussives-Nonopioids
ä—Expectorants
ä—Mucolytics
ä—Decongestants
ä—Antihistamines
ä—Nasal Glucocorticoids

28. Upper Respiratory Treatments
respiration

29. Antitussives-Opioids
ä—Codeine and hydrocodone
ä—Suppress cough through its action on the central
nervous system
ä—Can cause CNS effects( dizziness, lightheadedness,
drowsiness, respiratory depression); GI distress;
Potential for abuse
ä—Pregnancy Category Risk C

30. Anti tussive -nonopioid
ä—Prototype- Benzonatate (Tessalon pearls)
ä—Other non-opioid antitussives are
dextromethorphan, promethazine, caramiphen and
carbetapentane, which happen to also be an
anticonvulsant.
Ansient
4m
robitussin

31. Opioid Antagonist
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Narcotic Antagonist
ã¡Description
ä÷Reverses respiratory depression in opioid
overdose
ã¡Side effects
ä÷CNS depression, nausea and vomiting,
tremors, diaphoresis, hypertension, tachycardia
ã¡Interventions
ä÷Monitor vital signs, especially respirations
ä÷Have oxygen, resuscitation equipment
available during administration
Nurcan

32. Narcan
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33. Expectorants
ä—Guaifenesin (Mucinex)
ä—Promotes increased cough production through
increasing mucous secretionãà decrease chest
congestion by coughing out secretions.

34. Guaifenesin
ä—Adverse effects
ä—GI upset
ä— Drowsiness
ä—Allergic reaction (rash)
ä—Pregnancy Risk Category C

35. Mucolytics
ä—Acetylcysteine (Mucomyst, Antidote)
ä—Hypertonic saline agent (see osmotic colloidal pressure)
ä—Enhance the flow of secretions in the respiratory
passages
ä—Used in clients who have acute and chronic pulmonary
disorders exacerbated by large amounts of secretions
ä—Used in patients with cystic fibrosis
ä—Acetylcysteine is the antidote for acetaminophen
poisoning (How?) (Remember Cysteine,Glutamic Acid,
Glycine?)
Destroymucus
Drawwaterintolungs
me
Glutathione

36. N-acetylcysteine
ä—Adverse effects
ä—Possible aspiration and bronchospasm when
administered orally (rotten egg odor)
ä—Pregnancy Risk Category B
here52

37. Decongestants
ä—Phenylephedrine (Neo-Synephrine)
ä—Ephedrine
ä—Naphazoline (Privine)
ä—Pseudoephedrine (Sudafed)
ä—MOA-Sympathomimetic decongestants stimulate
alpha1-adrenergics receptors on nasal blood vessels,
causing vasoconstriction and reduction in the
inflammation of the nasal membranes.

38. Decongestants
ä—To treat allergic or non-allergic rhinitis by relieving
nasal stuffiness
ä—Used for sinusitis and the common cold.
ä—Adverse Effects
ä—Rebound congestion secondary to prolonged use of
topical agents
ä—CNS stimulaton- agitation, nervousness, uneasiness
ä—Vasoconstriction

39. Antihistamines
ä—1
st generation H1 antagonist
ä—Diphenhydramine
ä—Chlorpheniramine (Chlor-Trimeton)
ä—2nd generation
ä—Loratidine (Claritin)
ä—Cetirizine (Zyrtec)
ä—Fexofenadine (Allegra)
ä—Desloratadine (Clarinex)
ä—Intranasal antihistamines
ä—Azelastine (Astelin, Astepro)
ä—Olopatadine (Patanase)
I

40. Antihistamines
ä—Blocks histamine release on the H1 receptors and
suppresses mucous secretion because of its
anticholinergic effect.
ä—Therapeutic uses:
ä—Mild allergic reactions
ä—Anaphylaxis
ä—Motion sickness
ä—Insomnia
ä—Used with sympathomimetic to provide a nasal
decongestant effect

41. Antihistamines
ä—Adverse effects
ä—Sedation in First Generational
ä—Anticholinergic effects (dry mouth, constipation)
ä—GI discomfort
ä—Acute toxicity, excitation, hallucinations,
incoordination, and seizures in children
ä—Respiratory depression and local tissue injury at
intravenous site

42. First or Second Generation?

43. Combination Medication
Is it D or DM ?

44. Nasal Glucocorticoids
ä—Mometasone (Nasonex)
ä—Fluticsone (Veramyst)
ä—Budesonide (Rhinocort Aqua)
ä—Decrease inflammation associated with allergic
rhinitis. Usually the first line of treatment for nasal
congestion
ä—Can cause sore throat, nosebleed, headache,
erythema, sneezing, nasal itching, and runny nose.
ä—Pregnancy Risk Category C
3
5dalmex

45. Expectorant vs Mucolytic vs Antitussive
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46. Upper Respiratory Disorders

47. Antitubercular Medications
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XII. Tuberculosis (TB) Medications
ã¡Description
ä÷Use of multi-drug regimen destroys organisms as quickly as
possible, minimizing emergence of medication-resistant
organisms
ä÷Individuals with active TB should be treated for 6 to 9 months
(longer if human immunodeficiency virus [HIV]-positive)
ä÷After infected individual has received medication for 2 to 3 weeks,
risk of transmission greatly reduced
ä÷Most clients have negative sputum cultures after 3 months
compliance with medication therapy
ä÷Individuals exposed to active TB treated with prophylactic
isoniazid (INH) for 9 to 12 months
1st
In
defense
2nd
1m
m
Multi

48. Dates of TB Meds Inception
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49. First Line Medications for TB
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ã¡Isoniazid (INH, Laniazid, Nydrazid)
ä÷INH contraindicated in clients with hypersensitivity, acute liver disease
ä÷Use INH with caution in clients with chronic liver disease, alcoholism, or
renal impairment, and in those taking hepatotoxic medications
ä÷INH may decrease ketoconazole (Nizoral) concentration
ä÷Monitor for hepatic dysfunction
ä÷Monitor liver function test results
ä÷Monitor for signs of hepatitis
ä÷Monitor for tingling, numbness, burning extremities
Antifungal

50. First-Line Medications for TB
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ã¡Isoniazid (INH, Laniazid, Nydrazid) (cont)
ä÷Monitor for visual changes; notify health care provider if they occur
ä÷Monitor complete blood count (CBC), blood glucose level
ä÷Administer INH 1 hour before or 2 hours after meal
ä÷Administer INH at least 1 hour before antacids
ä÷Instruct client not to skip doses, to take medication for full length of
prescribed therapy
ä÷Instruct client to avoid tyramine-containing foods
ä÷Instruct client in signs of neurotoxicity, hepatitis, hepatotoxicity
P

51. First-Line Medications for TB
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ã¡Rifampin (Rifadin)
ä÷Side effects include vision changes, hepatotoxicity, hepatitis, increased
uric acid levels, blood dyscrasias, colitis
ä÷Assess for hypersensitivity
ä÷Evaluate complete blood count (CBC), uric acid, liver function test results
ä÷Assess for signs of hepatitis
ä÷Instruct client not to skip dose, to take medication for full length of
prescribed therapy
louttorn

52. First-Line Medications for TB
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ã¡Rifampin (Rifadin) (continued)
ä÷Advise client to keep all health care provider appointments, appointments
for laboratory work
ä÷Advise client to take medication on empty stomach with 8 oz water 1 hour
before or 2 hours after meal
ä÷Advise client to avoid taking medication with antacids
ä÷Instruct client that bodily fluids will be red-orange
ä÷Instruct client to report signs of jaundice to health care provider

53. First-Line Medications for TB

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ã¡Ethambutol (Myambutol)
ä÷Use with caution in clients with renal dysfunction, gout, ocular defects,
retinopathy, cataracts, or ocular inflammatory disorders, and in those
taking neurotoxic medications
ä÷Side effects include hypersensitivity reactions, dermatitis, optic neuritis,
peripheral neuritis
ä÷Determine baseline visual acuity, color discrimination
ä÷Monitor for visual changes; notify health care provider if they occur

54. First-Line Medications for TB
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ã¡Ethambutol (Myambutol) (continued)
ä÷Administer once every 24 hours with food
ä÷Monitor uric acid concentrations; assess for painful, swollen joints
ä÷Monitor intake and output (I&O), renal function
ä÷Monitor for dizziness; initiate safety precautions
ä÷Assess for peripheral neuritis
ä÷Instruct client not to skip dose, to take medication for full length of
prescribed therapy
ä÷Advise client to keep all health care provider appointments, appointments
for laboratory work

55. First-Line Medications for TB
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ã¡Pyrazinamide
ä÷Used with at least one other antitubercular medication
ä÷Side effects include increased liver function, uric acid levels,
photosensitivity, hepatotoxicity
ä÷Evaluate CBC, liver function test results, uric acid levels
ä÷Observe for hepatotoxic effects
ä÷Evaluate blood glucose levels
ä÷Instruct client to take medication with food
ä÷Instruct client to avoid sunlight, ultraviolet light
ä÷Advise client to keep all health care provider appointments, appointments
for laboratory work

56. Second-Line Medications for TB
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ã¡Capreomycin sulfate (Capastat sulfate)
ä÷Do not administer to clients receiving streptomycin
ã¡Kanamycin (Kantrex) and amikacin
(Amikin)
ä÷Contraindicated in clients with hypersensitivity, neuromuscular disorders,
eighth cranial nerve damage
ä÷Risk of toxicity increases when taken with other aminoglycosides,
nephrotoxic drugs, ototoxic drugs
Antierentive

57. Second-Line Medications for TB
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ã¡Kanamycin (Kantrex) and amikacin
(Amikin)
ä÷Monitor for ototoxic, neurotoxic, nephrotoxic adverse effects
ä÷Monitor liver, renal function test results
ä÷Assess hydration status; maintain hydration
ä÷Advise client to keep all health care provider appointments, appointments
for laboratory work
ä÷Advise to notify health care provider if hearing loss, changes in vision,
urinary problems occur

58. Second-Line Medications for TB
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ã¡Streptomycin-aminoglycoside anti-infective can be used
in First-Line Treatment
ä÷Contraindicated in clients with hypersensitivity, myasthenia gravis,
parkinsonism, eighth cranial nerve damage
ä÷Risk of toxicity increases when taken with other aminoglycosides or
nephrotoxic, ototoxic medications
ä÷Monitor liver, renal function test results
ä÷Monitor for ototoxic, neurotoxic, nephrotoxic reactions
ä÷Assess hydration status; maintain hydration during therapy
ä÷Advise client to keep all physician appointments, appointments for
laboratory work
only
one
to
1starose

59. Second-Line Medications for TB
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ã¡Ethionamide (Trecator-SC)
ä÷Side effects include metallic taste in mouth, orthostatic hypotension,
jaundice, peripheral neuritis
ä÷Administer pyridoxine as prescribed
ä÷Instruct client to take medication with food, meals
ä÷Instruct client to change position slowly
ä÷Instruct client to report signs of rash
BG

60. Second-Line Medications for TB
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ã¡Para-aminosalicylic acid (Paser)
ä÷Contraindicated with hypersensitivity
ä÷Side effects include hypersensitivity, bitter taste in mouth, blood
dyscrasias, crystalluria
ä÷Assess for hypersensitivity
ä÷Offer clear water to rinse mouth, chewing gum, hard candy following
medication
ä÷Encourage fluid intake
ä÷Instruct client to take medication with food
ä÷Instruct client not to take over-the-counter aspirin without health care
provider s approval
ä÷Instruct client to report immediately signs of blood dyscrasia
Aspirin
crustalurine
P

61. Second-Line Medications for TB
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ã¡Cycloserine (Seromycin)
ä÷Side effects include central nervous system (CNS) reactions, neurotoxicity,
altered level of consciousness
ä÷Monitor for changes in mental status, thought processes
ä÷Monitor serum drug level; peak, 2 hours after dosing, 25 to 35 mcg/mL
ä÷Advise client of need for weekly serum drug levels
ä÷Teach client about signs indicating adverse effects
Physiotic
true

62. Influenza Medications
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Types:
H is short for hemagglutinin.
N is short for neuraminidase.
Hemagglutinin and neuraminidase are little protein spikes on the
flu's surface that help it invade cells. Mutations in virus will
change the virion types and numbers.
ã¡Vaccines
ä÷Administered annually
ä÷Contraindicated in hypersensitivity, chicken egg allergy, active infection
or illness, Guillain-Barré syndrome, pregnancy (live activated vaccine),
age younger than 6 months.

63. Influenza Vaccines
ä—Inactivated-Dead virion (IM administration)
Afluria
Fluarix
FluLaval
Flucelvax
Flubok
Fluvirin
Fluzone
ä—Live, Attenuated (Nasal Administration)
FluMist

64. Influenza Antivirals
ã¡Antivirals-TAMIFLU (Oseltamivir) is a prescription medicine
used to treat the flu (influenza) in people 2 weeks of age and older
who have had flu symptoms for no more than 2 days.
ä÷Administered as prophylaxis but do not replace vaccine or prevent
transmission
ä÷Administered within 24 to 48 hours of onset of symptoms
ä÷Contraindicated in hypersensitivity
ä÷Safe for pregnancy except the nasal (live attenutated)

65. Pneumococcal Vaccine
ä—Pneumococcal conjugate vaccine (PCV13)- used for
children and infants
ä—Pneumococcal polysaccharide vaccine (PPSV23)
used for adults and high risk children older than 2
years.
ä—Side effects: erythema, swelling, pain and tenderness
at the injection site.
ä—Fever, irritability, drowsiness, and reduced appetite

66. PCV13 vs PPSV23 Schedule
https://www.pharmacytimes.com/publications/supplementals/2018
/diabetessupplementjuly2018/understanding-the-importance-of-
pneumococcal-disease-prevention-in-patients-with-diabetes

67. COVID-19 (Retrovirus)
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ä—Novel Coronavirus first identified in Wuhan China in 2019
ä—Element Zinc-is showing promise in inhibiting reproduction of the
virus by blocking the protease enzyme that duplicates the RNA into
proteins.
ä—Ionophores enable the channels to open and allow the zinc to enter the
cells. Hydroxychloroquine is antimalarial that is showing promise with
no adverse effects. Quercetin is another ionophore showing promise in
allowing zinc into the cells. https://www.macleans.ca/news/canada/a-
made-in-canada-solution-to-the-coronavirus-outbreak/

68. Retroviral medications
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Remdesivir- an HIV medication is being trialed in several studies in
China and parts of Europe for its effects against retroviruses.
https://www.nih.gov/news-events/news-releases/nih-clinical-trial-
remdesivir-treat-covid-19-begins

69. Nirmatrelvir-Ritonavir (Paxlovid)
ä—Nirmatrelvir is an orally bioavailable protease
inhibitor viral protease that plays an essential role in
viral replication It has demonstrated antiviral
activity against all coronaviruses that are known to
infect humans.
2 Nirmatrelvir is packaged with
ritonavir (as Paxlovid), a strong cytochrome P450
(CYP) 3A4 inhibitor and pharmacokinetic boosting
agent that has been used to boost HIV protease
inhibitors.
HE

70. Recommendations-FDA Approved
ä—The COVID-19 Treatment Guidelines Panel (the
Panel) recommends using nirmatrelvir 300 mg
with ritonavir 100 mg (Paxlovid) orally (PO)
twice daily for 5 days in nonhospitalized adults and
pediatric patients aged "e12 years and weighing "e40
kg with mild to moderate COVID-19 who are at high
risk of disease progression;
4 treatment should be
initiated as soon as possible and within 5 days of
symptom onset (AIIa).

71. Bebtelovimab
ä—The Food and Drug Administration today authorized emergency use
of the monoclonal antibody bebtelovimab to treat COVID-19 in
outpatients at risk of progressing to severe disease or
hospitalization. Developed by Eli Lilly Company.
ä—The treatment has been shown to be active against the omicron
variant. Three weeks ago, Lilly s antibody cocktail of bamlanivimab
and etesevimab was banned by the FDA because it was shown to be
ineffective against omicron. Regeneron s antibody, REGEN-COV,
also was grounded that day for the same reason.
ä—The authorized dose of bebtelovimab is 175 mg given as an
intravenous injection over at least 30 seconds. The dosage is
considerably smaller and quicker to administer than previous
antibody treatments approved for COVID-19.

72. Ivermectin FDA approved as anti-parasitic
ä—https://
reader.elsevier.com/reader/sd/pii/S0166354220302
011?token=1CED342ACFA899C5B821FD8C3BAA0D
17FDA9A92067DA7D000E43BF0533C6BF5A1EE83
77B7ECF99CCCDD3559C3B4E86FE
ä—Proving to be highly effective against COVID19 in
vitro, (FDA reviewing research)

73. Pulmocort-inhaled corticosteroid
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fulltext

74. N-acetylcysteine (mucomist)
ä—Mucolytic known to breakdown thick secretions
when proper hydration is present

75. Methylprednisolone
I

76. Fluvoxamine
ä—Antidepressant (SSRI) is showing promise in
lowering the cytokine storm in the inflammatory
stages of Covid19 thus reducing hospitalizations and
deaths.
ä—https://
www.thelancet.com/journals/langlo/article/PIIS221
4-109X(21)00448-4/fulltext
ä—
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC24
24117/

77. Antioxidant Supplements that can aid in the covid
battle by raising immunity
ä—Vitamin C
ä—Vitamin D3
ä—Vitamin E
ä—Vitamin A
ä—Vitamin k2

78. Question 1
Copyright © 2013, 2010, 2006, 2003, 2000 by
Saunders, an imprint of Elsevier Inc.
Slid
e 77
The client taking oral theophylline has a
serum theophylline level of 15 mcg/mL. The
nurse interprets that this result is:
1.Below the therapeutic range
2.In the middle of the therapeutic range
3.Near the top of the therapeutic range
4.In excess of the therapeutic range
10
20

79. QUESTION 2
ä—A nurse is caring for a client who has been taking
phenylephedrine nasal drops for the past 10 days for
sinusitis. The nurse should monitor the client for
which of the following manifestations as an adverse
effect of this medication?
A.Sedation
B.Nasal congestion
C.Productive cough
D.Constipation

80. Question 3
ä—A nurse is reinforcing teaching with a client who has
a new prescription for beclomethasone by inhaler.
Which of the following instruction should the nurse
include?
A. Rinse your mouth after each use of this
medication.
B. Limit fluid intake while taking this medication.
C. Increase your intake while taking this medication.
D. You can take the medication as needed.