2. Chapter 30 - Drugs used to treat Lower Respiratory Disease482-504 Larynx, trachea, bronchi, bronchioes, alveolar sacs Primary function: ventilatory cycle COMMON DISEASES REsp diseases divided 2 types: obstructive, restrictive Obstruictive airway diseases: narrow air passages, create turbelence, increase resistance to airflow, borcnhcospasm[smooth muscle constriction], from edema, bronchial wall inflammation, excess mucus secretion Ex. asthma, acute bronchitis Restricive: lung expansion is limited from elasticity loss [pulmonary fibrosis]/physcial deformity of chest [kyphoscoliosis]. Both ex. Chronic bronchitis, emphysema COPD: leading disability/death >40 yrs america CALD: chronic airflow limitation disease 484 ABGs partial pressure. Indicate pulmonary function Spirometry fo symptomatic only. Determine bronchodilarot tx: FEV1, FVC 485 ASTHMA: chronic airway. Inflammatory disease of bronchi, bronchioles. Cough, wheeze, sob, chest tightness, increased mucus production. Mild-mod-severe CHRONIC BRONCHITIS: chronic irritation causes inflammation, edema c excess mucus secretion leads to airflow obstruction. Chronic productive cough for 3mths in 2 consecutive yrs. Polycythemia EMPHYSEMA: alveolar tissue destruction without fibrosis. Alveolar sacs lose elasticity, collapse during exhale. Classic: dyspnec c minimal exertion [sob] breathes thru pursed lips, thin, barrel chested, scant sputum c minimal cough. 486 Tx Cough Vaporizer, humidifier, fluids, suck on hard candy, expectorant, antitussive [cough suppressant], mucolytic agent Asthma Meds 2 groups: quick relief, long temr control Quick relief: short acting inhaled bet 2 agonists [SABA], and short acting inhaled anticholinergics Long term control: long acting beta2 agonists LABA, long acting muscarinic [anticholinergic] [LAMA], combination anticholinergic&beta-adrenergic bronchodilators-inhaled corticosteroids Everything int he universe wtf Drug therapy Expectorants: liquify mucus. Stim serous glands. Tx nonproductive cough, bronchitis, pneumonia Antitussives: suppress cough center in brain. Only for dry, hacking, nonproductive cough Mucolytic agents: dissolution. Reduce stickiness,viscosity secretions. Remove mucous plugs. Tx acute&chronic pulmonary disorders, b4andafter bronchoscopy, after chest surgery, tracheostomy care Bronhcodilators: relax smooth muscle of tracheobronchial tree. Tx airway obstructive diseases include beta adrenergic agonists, anticholinergic aerosols. Combo long acting anticholinergic c long acting beta agonist Antiinflammatory agents: tx asthma. Corticosteroids effective. Minimal systemic ae inhaled Immunomodulators: asthma subtypes. 491 PATIENT EDUCATION PEAK FLOWMETER Asthma. Measures peak expiratory flow PEF. yellow zone symptomatic, use quick relief. Red zone report hp asap, quick relief, corticosteroids AVOID IRRITANTS ACTIVITY Inhaled beta 2 agonist 30mins b4 exercise DIET Eat small regular meals . avoid milk, chocolate PREVENT INFECTIONS Annual flu vaccines, pneumonia vaccine MORE FLUIDS ENVIRONMENT: Humidification, ventilation BREATH TECHNIQUES Postural drainage, pursed lip breathing, abdominal breathing, coughing SLEEP Sleep in recliner, upright [position MEDS Exhale completely b4 initiating the 1st inhalation of med and breath held for 10sec during inhalation. Admin bronchodilator 1st, then wait few mins do steroid as 2nd med Rinse and spit after inhaled steroids 493 DRUG CLASS EXPECTORANT guaifenesin Actions Enhance output of resp. Tract fluid. Decreases mucus viscosity, promotes ciliary action Uses Relieve mucus in resp tract c dry, nonproductive cough. Common cold, bronchitis, laryngitis, pharyngitis, sinusitis. Combo c bronchodilators, decongestants, antihistamines, antitussives make nonproductive cough more productive Avoid if dry persistent cough lasts >1wk; chronic, persistent cough; excess phlegm cough To Thin bronchial secretions for expectoration of mucus, reduced frequency of nonproductive cough Nurse implicat Premed assess Cough characteristics Admin Fluids 8-12 8oz water daily Humidifier Common adverse effects Gi upset, nv [rare] DRUG CLASS SALINE SOLUTIONS Actions Hydrate mucus, reduce its viscosity Uses Admined by nebulization [mist inhaled] Hypotonic [0.4%, 0.65% nacl] deeper pentration into distant airways Hypertonic [1.8%] hydrates&stims a productive cough by irritating resp. Passages. Isotonic [0.9%] hydrate resp. Secretions Saline nose drops/sprays restore moisture, relieve nasal congestion To Moisturized mucus membranes fromdryness, more productive cough Nurse impic Premed Cough, mucus traits 494 DRUG CLASS ANTITUSSIVE AGENTS benzonatate, codeine, dextromethorphan, diphenhydramine Actions Cough suppressant in brain/by topical anesthetic on resp. Stretch receptors Uses Decrease frequency of dry, hacking, nonproductive cough, suppress severe spasms at night. AVOID in productive cough Codeine: standard. Low doses, short duration. No addiction. Tolerance from long term use. Avoid in chronic pulmonary disease who have resp. Depression or allergy codeine MED SAFETY ALERT aVOID codeine in kids <12yrs old, 12-18yrs obese c tonsillectomy, adenoidectomy, high metabolism, breathing problems Benzonatate: anesthetic resp. Stretch sensors. Begins within 15-20mins. Duration 3-8hrs. Avoid in kids <10yrs old[overdose,d earth] Dextromethorphan: doesnt cause resp. Depression or addiction. Avoid in kids <4yrs [death] Diphenhydramine: anticholinergic c antihistamine, antitussive. Sedative. Suppress cough during sleep. Avoid in closed-angle glaucoma, prostatic hyperplasia To Reduced frequency of nonproductive cough Common adverse effects Drowsy [diphenhydramine most sedative], constipation [codeine most constipating, stool softerners if use >1-2 days] Di, cns depressants 495 DRUG CLASS MUCOLYTIC AGENTS acetylcysteine Actions Dissolve chemical bonds within mucus, causes it to separate and liqufey, reducing viscosity Uses Dissolve viscous mucus in chronic emphysema, emphysema c bronchitis, asthmatic bronchitis, pneumonia. Tx acetaminophen toxicity To Improved airway flow Nurse implic Premed 1. Traits cough, secretions 2. Baseline vs, resp assessment, pulse oximetry, pulmonary function tests 3. Gi symptoms 4. Baseline mental status, degree anxiety, nervous, alert Admin Nebulization 3-5ml of 20% solution 3-4xdaily Direct applciatication into intratracheal catheter or tracheostomy-1-2ml q1-4hrs Nebulizer: ¾ used, dilute remaining solution c sterile water. Concentrates. After therapy, wash pts face &hands Storage: store opened solution in refrigerator up to 96hrs Discolorization: store in plastic/glass. Contact c metal discolors Common adverse effects Nv [smells like rotten eggs Serious adverse effects Bronchospasm. [use brochodilator concurrent] di , antibiotics inactivated. Inhalation antibiotics 1hr after acetylcysteine 496 DRUG CLASS BETA-ADRENERGIC BRONCHODILATING AGENTS Actions Stims beta receptorsin smooth muscle of tracheobronchial tree, opens airway passages Uses Reverse airway constriction from acute&chronic bronchial asthma, bronchitis, emphysema Inhaled fewer systemic effects Short-acting beta agonists [albuterol, levalbuterol]: rapid onset, tx acute bronchospasm q3-4hrs long -acting inhaled bronchodilators LABAs [salmeterol, arformoterol, indacaterol, olodaterol, vilanterol] onset 10-15mins. Duration 12hrs, so bid. Salmeterol tx asthma, COPD. arformoterol tx COPD LABAs reduce frequency asthma attacks. More severe attacks. Use c asthma controller medicine [inhaled corticosteroid] To Bronchodilation, reduced wheezing, ez breathing Nurse impl Premed assess 1. Baseline vs, resp assess, pulse oximetry, pulmonary function tests 2. Palpitations, dysryhtmias 3. Baseline mental status Admin Inhaled bronchodilators wait 10mins between inhalations Htn, hyperthyroidism, dm, cardiac dyshrthmias No common Serious adverse effects Tachycardia, palpitations [report 20bpm increase] Tremors, nervousness, anxiety, restless, headache, dizzy, nv [admin c food/milk] Di, toxic-tricyclic antidepressants, MOI, sympathomimetics Reduce therapy effects, beta blcokers Antihypertensives reduced 497 DRUG CLASS ANTICHOLINERGIC BRONCHODILATING AGENTS Aclidinium, glycopyrrolate, ipratropium, revefenacin, tiotropium, umeclidinium Actions Inhibit cholinergic receptors on bronchial smooth muscle, block bronchoconstriction action of vagal efferent impulses. Minimal effect on ciliary activity, mucus secretion, sputum volume, viscosity Uses Ipratropium short acting. Others long ating. Long term tx of reversible bronchospasm c COPD, bronchitis, emphysema Ipratropium c albuterol manage asthma exacerbations. Also tiotropium. Avoid as rescue medicine in acute episodes of bronchospasm Inhaled anticholinergic bronchodilators Combo anticholinergic and beta adrenergic bronchodilators To Bronchodilation, reduced wheezing, ez breathing Nurse implic Premed assess 1. Baseline vs, resp assess, pulse oximetry, pulmonary function tests 2. Check hx closed angle glaucoma Admin CAUTION in closed angle glaucoma, prostatic hyperplasia, bladder neck obstruction Common adverse effects Mouth dryness, throat irritation [suck on ice chips/hard candy] [resolve own] Serious adverse effects Tachycardia, urinary retnetion, exacerbatoion of pulmonary symptoms 499 DRUG CLASS: RESPIRATORY ANTIINFLAMMATORY AGENTS—CORTICOSTEROIDS USED FOR OBSTRUCTIVE AIRWAY DISEASE Beclomethasone dipropionate, budesonide phosphate, ciclesonide, fluticasone propionate, mometasone Actions Smooth muscle relaxation, enhance beta adrenergic bronchodilators, inhibit inflammatory responses Uses Tx asthma inflammation long term. Severe COPD Exacerbation astham/COPD, short course 5-7days systemic corticosteroids [prednisone]-avoid long term use Avoid for rapid relief of bornchospasm To Decreased pulmonary inflammation Nurse implic Premed assess Inspect oral cavity for infection Admin Effects not immediate. Continue even when asymptametic. 4wks max benefit Prep: use bronchodilator 1st b4 corticosteroid inhalant stress/severe asthma attack - tx systemic steroids. Avoid corticosteroid inhaler c systemic steroids Common adverse effects Hoarseness, dry mouth [mild, resolve own] Serious adverse effects Thrush [fungal infections] [rinse mouthwash after] Pneumonia 501 DRUG CLASS: ANTILEUKOTRIENE AGENTS Montelukast Actions selective&competitive receptor antagonist of cysteinyl leukotriene receptor=-stimulated by leukotriene D4 triggers asthma symptoms Uses Combo c others for prophylactic&chronic tx asthma Reduces early & late-phase bronchoconstriction, bronchial hyperresponsiveness, daytime asthma symptoms, nightime awakening, reduce beta-adrenergic agonist use, improve pulmonary fucntion tests. Mild persistent asthma & c low-med doses inhaled corticosteroids for moderate persistent asthma Not a bronchodilator, avoid to tx acute episodes asthma, can continue in acute exacerbations of asthma ???? Continuous To Fewer episodes of acute asthma symptoms Nurse implic Premed assess Baseline vs, resp assess, pulse oximetry, pft MED SAFETY ALERT: serious neuropsychiatric events [agitation, aggression, depression, sleep distrubances, suicidal thoughts&behavior. Risk in mild asthma or exercise-induced bronchoconstriction Common adverse effects Nausea, dyspepsia [food/milk] Headache 502 DRUG CLASS: PHOSPHODIESTERASE-4 INHIBITOR Roflumilast Actions Intracellular cyclic adenosine monophosphate [cAMP] block inflammation. PDE-4 inhibitor blocks pde-4 from metabolizing cAMP Uses Reduce flare ups of inflammation c chronic bronchitis, severe COPD Not a bronchodilator, nothing value in acute tx of bronchospasms Combo c bronchodiulators & corticosteroids for COPD Avoid in severe liver impairment To Fewer execarebtioons COPD Nurse implic Premed assess 1. Baseline vs, resp assess, pulse oximetry, pfts 2. Hx bowel elimination patterns, gi symptoms, heache frequency, dizzy, fatigue 3. Baseline depression lvl, insomnia, anxiety 4. Baseline weight, schedule weekly weight measurement Common adverse effects Dyspepsia, cramps, nausea, diarrhea, weight loss, headache Serious adverse efefcets Insomnia, anxiety, depression, suicidal ideation adn behavior Di, toxic, ciprofloxacin, ketcoonoazle, fluvoxamine, cimetidine Reduce therapy effects, rifampin, phenobarbital, carbamazepine, phenytoin 503 DRUG CLASS: IMMUNOMODULATOR AGENTS omalizumab, dupilumab Actions Dupilamb: human monoclonal antibody inhibits interleukin-4&13, blocks biologic action, reduce cytokine-induced inflammation Omalizumab: dna-derived humanized immunoglobulin G monoclonal antibody, binds to IgE antibodies in blood, decrease # of IgE antibodies avaliable to bind to mast cells, inhibits mast cells release of inflammatory chems lead to asthma symptoms Uses Dupilumab: comb c other asthma meds maintenance tx severe eosinophilic asthma, prevent severe asthma attacks used in >12yrs. Tx mod-severe atopic dermatitis adults, kids 6yrs and odler. Tx chronic rhinosinusitis in presence of nasla polyposis Omalizumab: used in at least 12yrs old, mod-severe persistent asthma, have a +skinr eaction to perennial airborne allergen, and have symptoms not controlled c inhaled corticosteroids; decreases incidence of asthma exacerbations Dont stop acute exacerbations of asthma. Dont use to tx acute bronchospasm or status asthmaticus. Take wks for effect Avoid abrupt stop of systemic/inhaled corticosteroids if using immunomodualtor To Reduced frequency acute asthmatic exacerbations. Dupilamb: control atopic dermatitis, chronic rhinusinusitis Nurse impic Premed assess 1. Allergies immunomodulators? 2. Ensure pt hyas + skin reactuions to 1 airborne allergen or been dx c eosinophilic asthma 3. B4 1st dose omalizumab, serum IgE lvls. After admin, lvls elevated 4. Baseline vs, resp assess, pulse oximetry, pfts Admin Avoid shaking dissolving powder MED SAFETYA LERT Allergic reactions, anaphylaxis [urticaria, throat/tongue edema Common and serious advers effects ??????????? Injection site reaction [hypersensitivity]=bursing, redness, warmth, bruning, stinging, itching, hives, pain, indurations, mass, inflammation. Within 1hr after injhection, lasts <8days Report rash/pruritus Dupilamb: oropharyngeal pain Di Dupilamb enhance adverse/toxic of live vaccines During the respiratory assessment of the patient in the scenario who was admitted to the hospital, the nurse noted the patient was coughing frequently and appeared to have difculty beathing. Which of the following should be included in the respiratory assessment? (Select all that apply.) 1. Observe the patient’s general appearance 2. Determine the nutrition status of the patient 3. Observe the patient’s degree of respiratory impairment 4. Inquire about the patient’s activity tolerance 5. Take and record baseline vital signs 6. Determine whether there is any loss of hearing 7. Take and record pulse oximetry level 8. Auscultate the patient’s lung elds 1, 3, 4, 5, 7, 8 During the evaluation of the patient in the scenario who was admitted to the hospital complaining of shortness of breath and increased sputum production, the nurse asks the patient for further information by which of the following statements? (Select all that apply.) 1. “Tell me about your cough. Does it wake you at night?” 2. “What activities would you say make you short of breath?” 3. “When you cough up sputum, what color is it?” 4. “Is there anyone at home to help you?” 5. “Have you had any constipation or diarrhea recently?” 123 1. **Stimulates an increase in bronchial gland secretions** → **Expectorants (e.g., Guaifenesin)** 2. **Hydrate respiratory secretions** → **Expectorants (e.g., Guaifenesin with water intake)** 3. **Dissolves thick, sticky mucus** → **Mucolytics (e.g., Acetylcysteine/N-acetylcysteine (NAC))** 4. **Numbs the respiratory stretch sensors** → **Antitussives (e.g., Benzonatate)** 5. **Suppress the cough center in the brain** → **Antitussives (e.g., Codeine, Dextromethorphan)** The nurse is preparing to administer the beta-adrenergic bronchodilator albuterol but 1st performs which of the following preassessments on the patient? (Select all that apply.) 1. Checks liver function test results 2. Checks for a history of glaucoma 3. Performs an assessment of the baseline mental status (level of anxiety, nervousness, alertness) 4. Asks about concurrent use of antihistamines or nasal decongestants 5. Checks for history of diabetes mellitus 6. Assesses for the presence of palpitations and dysrhythmias 7. Checks for history of peptic ulcer disease 8. Obtains baseline vital signs and pulse oximetry 3, 4, 5, 6, 8 The nurse instructing the patient in the scenario on the drug tiotropium bromide (Spiriva), which was being started instead of continuing ipratropium bromide (Atrovent), realized further teaching was needed after the patient made which statement? 1. “As I understand it, the effects of Spiriva last much longer than Atrovent so I only have to take it once a day.” 2. “This drug is used to treat an acute attack, like a rescue drug.” 3. “I can follow the instructions on the package for how to use this drug.” 4. “When I take this drug, I should notice a reduced amount of wheezing and easier breathing.” 2 6. The nurse instructing a patient on the corticosteroid inhalant budesonide (Pulmicort) realized further teaching was needed after the patient made which statement? 1. “This drug is used to treat an acute attack, like a rescue drug.” 2. “You mentioned that this may cause hoarseness and dry mouth.” 3. “I understand I need to rinse my mouth after taking this drug so I do not get any oral fungus infection like thrush.” 4. “I know that I need to use my bronchodilator before I use this med so that I get the full therapeutic benet.” 1 1. Which response by thenurse is thebest when a patient has questions regarding a recently prescribed antitussive agent? a. ―It will eliminate your cough at night.‖ b. ―It will reduce thefrequency of your cough.‖ c. ―It should be used in themorning.‖ d. ―It should be taken before sleep.‖ B 2. Which is a common expectorant in over-the-counter medications? a. Dextromethorphan b. Diphenhydramine c. Guaifenesin d. Codeine C Guaifenesin is used for symptomatic relief of conditions characterized by a dry, nonproductive cough such as thecommon cold, bronchitis, laryngitis, pharyngitis, and sinusitis. Guaifenesin is also used to remove mucous plugs from therespiratory tract. Dextromethorphan is an antitussive. Diphenhydramine is an anticholinergic agent with antihistaminic and antitussive properties. Codeine is an antitussive. 3. Which reason is correct for administering sodium chloride to a patient with emphysema? a. Increases blood sodium levels b. Decreases mucus viscosity c. Reduces metabolic needs of thebody d. Decreases bronchial irritation B 4. Which action will thenurse take when within minutes of theinitiation of a nebulizer treatment with a sympathomimetic bronchodilator, thepatient turns on their call light and states that they feels ―panicky‖ and their heart is racing? a. Reassure thepatient this is expected. b. Add more diluents to thenebulizer. c. Administer a sedative. d. Stop treatment and notify thehealthcare provider. D 5. Which condition will premedication assessments before theuse of anticholinergic bronchodilating agents verify that thepatient does not have in their history? a. Diabetes b. Hypertension c. Liver disease d. Glaucoma D Anticholinergic bronchodilating agents cause mydriasis (dilation of thepupils) and cycloplegia (loss of power in theciliary muscle); therefore, they should not be used in patients with a history of closed-angle glaucoma 8. Which condition is albuterol (Proventil) used to treat? a. Acute bronchospasm b. Acute allergies c. Nasal congestion A The short-acting beta agonists have a rapid onset (few minutes) and are used to treat acute bronchospasm. Beta agonists are not used to treat allergies. Decongestants are used for nasal congestion. Long-acting beta agonists are used for exertional dyspnea 9. Which explanation describes where fluids of therespiratory tract originate? a. Specialized mucous glands called goblet cells b. Lymph fluid drawn across nasal membranes by osmosis c. Specialized beta cells in theislets of Langerhans d. Cells that produce aqueous humor a 10. Which structures in therespiratory tract assist in removing foreign bodies such as smoke and bacteria? a. Villi b. Golgi bodies c. Ciliary hairs d. Erector pili C The nurse is providing instruction about ipratropium (Atrovent) to a patient with chronic obstructive pulmonary disease (COPD). Which common adverse effect tends to resolve with therapy? a. Anxiety b. Dry mouth c. Tachycardia d. Urine retention B 12. An adult patient is admitted for an asthma attack. Which assessment obtained by thenurse would support that albuterol (Proventil) was effective? a. Decrease in wheezing present on auscultation b. Less dyspnea while positioned in a high Fowler‘s position c. Sputum production is clear and watery d. Respiratory rate decreased to 38 breaths/min A 13. Which statement by a mother whose child has been diagnosed with asthma indicates a need for further teaching? a. ―I will place thestuffed animals in thefreezer overnight.‖ b. ―We will confine our dog to thekitchen area.‖ c. ―I should wash bedding in hot water.‖ d. ―A damp cloth should be used when I dust.‖ B 14. The nurse is providing nutrition information to a patient diagnosed with a lower respiratory tract disease. Which rationale is correct for limiting caffeine? a. Caffeine increases therespiratory rate. b. Caffeine can result in thicker lung secretions. c. Caffeine will increase theanxiety response associated with dyspnea. d. Caffeine can cause bronchospasm b caffeine is a weak diuretic. Diuresis promotes thickening of lung secretions, making it more difficult to expectorate them The healthcare provider in an outpatient clinic has prescribed omalizumab (Xolair) to a patient. Which primary outcome will thenurse teach thepatient to expect? a. Easier expectoration of phlegm b. Less frequent asthma exacerbations c. Increased moisture of themucous membranes d. Liquefaction of thick secretions B 17. Which number indicates thecorrect calculation of thepack years when a patient reports smoking one pack of cigarettes per day for thepast 20 years? a. 5 b. 10 c. 20 d. 40 ANS: C Pack years is defined as number of packs of cigarettes smoked per day times thenumber of years of smoking; 1 ´ 20 = 20 18. A resident in a long-term care facility diagnosed with COPD has a new medication order for indacaterol. Which information will be included when thenurse is providing medication education to theresident? a. It is a short-acting beta antagonist. b. The patient should wait approximately 5 minutes between inhalations. c. Onset of action is within 5 minutes. d. Duration of action is about 12 hours c Onset of action is within 5 minutes. Indacaterol is an ultra-long-acting beta 2 agonist. Patients using inhaled bronchodilators should wait approximately 10 minutes. Duration of action is about 24 hours. Which statement(s) is/are true regarding thenursing assessment of a patient with a respiratory disorder? (Select all that apply.) a. Central cyanosis typically is observed on thefingers and earlobes. b. Clubbing of thefingernails is a sign of hypoxia. c. As oxygen levels diminish, mental alertness will progressively deteriorate. d. The normal respiratory rate in an adult is 10 breaths/min. e. Episodes of apnea are present in Cheyne-Stokes. Bce 2. Which statement is true about arterial blood gases (ABGs)? (Select all that apply.) a. They are measured from an arterial sample. b. They measure partial pressures of carbon dioxide. c. They measure blood pH. d. They measure partial pressures of sodium. e. They measure partial pressures of oxygen. Abce 3. Which assessments would be most important to include in obtaining thehistory on an older adult patient with a history of COPD whose diagnosis is pneumonia? (Select all that apply.) a. Smoking history and exposure to secondhand smoke b. Current medications c. Chief complaint and onset of symptoms d. Support system e. Home oxygen use f. Liver function Abcde 4. Which physical assessment(s) would be pertinent to thepatient with asthma? (Select all that apply.) a. Lung sounds b. Patient color c. Respiratory rate and effort d. Peak expiratory flow e. Pulse oximetry reading f. Bowel sounds abcde 5. Which principle(s) would be when teaching a patient to use a steroid inhaler? (Select all that apply.) a. Frequent oral hygiene is necessary. b. The inhaler should be used on a PRN basis only. c. Rinse and spit after inhalation of themedication. d. When taking a steroid drug as well as a bronchodilator, thebronchodilator should be administered first. e. Hold thebreath for 10 seconds during inhalation of themedication Acde 6. Which statement(s) about acetylcysteine is/are true? (Select all that apply.) a. It reduces viscosity of secretions. b. It treats acetaminophen toxicity. c. It is stored at room temperature. d. It is given to improve airway flow. e. It is odorless. f. It is administered by inhalation. abdf Acetylcysteine is given to reduce theviscosity of secretions, used to treat acetaminophen toxicity, used to improve airway flow, and is a mucolytic given by inhalation. Acetylcysteine should be refrigerated after opening and has an odor similar to that of rotten eggs. 7. Which statement(s) about ipratropium bromide (Atrovent) is/are true? (Select all that apply.) a. It is administered by aerosol inhalation. b. It relieves nasal congestion. c. It decreases mucus secretion. d. It has minimal effect on ciliary activity. e. It is used for short-term treatment of bronchospasm. f. It may cause tachycardia or urinary retention. Adf 8. Which instructions will be provided to thepatient when administering two inhalations of ipratropium bromide (Atrovent)? (Select all that apply.) a. Hold thecanister horizontally. b. Keep theeyes closed. c. Exhale through themouthpiece. d. Wait 15 seconds before thesecond inhalation. e. Shake thecanister thoroughly prior to use. Bde
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