Danica Mae B.

Bianito BSN – 202N

Written Works (WW2)

Drugs Acting on the Respiratory, Digestive and Endocrine System
Case Scenario: Critical Thinking

Drugs that Affects the Respiratory System

Case Scenario A:
Mrs. Perillo, is a 34-year-old woman with a long standing history of bronchial asthma. She is
currently maintained on theophylline (Theo-Dur) 200 mg twice a day. She uses a fluticasone
(Flonase) inhaler, one puff b.i.d. . When respiratory wheezing increases, she uses an albuterol
(Proventil) inhaler, two puffs q4h, until her breathing improves.
          1. What clinical manifestation would you expect to see in Mrs. Perillo if her serum
theophylline level was above 20 mcg/mL?

                    a. persistent vomiting _____________

                    b. cardiac arrhythmias _____________

                    c. intractable seizures _____________

                    d. ____________
                    e. ____________
         2. Because albuterol (Proventil) is a Beta2 agonist drug, your would expect to see what
kind of response related to adrenergic receptors?
                     a. ___________
                     b. ___________
                     c. ___________
         3. After an acute attack of asthma during which Mrs. Perillo was treated with aerosolized
albuterol and systemic corticosteroid, you as her primary nurse is considering adding an
additional medication she hopes will prevent future attacks. What medications would you expect
the doctor's prescribe to consider?
                    a. ________
                    b. ________

Drugs Affecting Digestive System

Case Scenario B
Danica Mae B. Bianito BSN – 202N

Mr. Nover, is a 55 year old man wit end stage renal disease(ESRD). He was hospitalized when
his AV access clotted off. He had a renal transplant several years ago that he rejected. He has
been dependent on hemodialysis since his rejection. Mr. Nover's past medical history includes
hypertension, ESRD, cardiomyopathy related to alcoholism , history of ventricular tachycardia
and atrial fibrillation, chronic pancreatitis, anemia, staphylococcus aureus sepsis and steroid
induced diabetes mellitus. A Tenckhoff catheter was inserted during the current hospitalization
and Mr Nover was placed on continuous cycling-assisted peritoneal dialysis with plan to
discharge him on continuous ambulatory peritoneal dialysis. The current medication are:
          - ferrous sulfate (Feosol) 325 mg PO, bid.                - docusate sodium (Colace) 100 mg
PO, bid
          - terazosin (Hytrin) 10 mg PO, hs                              - calcitrol (Rocatrol) 25 mcg, 2 tabs
PO bid
          - amiodarone (Cordarone) 200 mg, PO, od               - calcium carbonate (Tums) 420 mg,
PO, tid
          - sucralfate (Carafate) 1 gram, PO, bid                      - nifedipine (Procardia XL) 120 mg,
PO, bid
              1. In the above case scenario, identify drugs acting on the digestive system and
provides its drug classification.
                       a. Name of Rx drug_____________           Drug Classification ____________
                       b. Name of Rx drug ____________            Drug Classification ____________
              2. Reviewing the case scenario, Mr. Nover is suffering from renal problems. What
antacid are contraindicated for patient Nover and why?
                        a. Name of drug __________________________
                        b. why? _________________________________
               3. Identify the reason why Mr. Nover is taking docusate sodium (Colace).
                         a. ___________________________
                         b. __________________________
                4. In regard to his other medication, when would you give him sucralfate (Carafate)
and why?
                          a. When? _____________________________
                          b. Why? __________________________

Drugs Affecting the Endocrine System

Case Scenario C:
Danica Mae B. Bianito BSN – 202N

Mrs. Bernardo, is 78 year-old, woman with a history of hypertension and adult onset diabetes
mellitus. She has just moved to the area and has come for an initial visit. Mrs. Bernardo has had
hypertension for 20 years and diabetes mellitus for 10 years. Until 8 months ago, the DM was
treated with diet and an oral hypoglycemic agent. However, she began to lose weight , her thirst
and urine output increased, and her blood pressure increased substantially, despite decreasing
doses of the hypoglycemic agent. She was then started with insulin. Mrs. Bernardo monitors her
blood glucose at home twice a day. Five years ago, she had breast cancer and a left radical
mastectomy was performed. She now has metastasis to the bones. Mrs. Bernardo's current
medications are:
          - enalapril (Vasotec) 5 mg PO, od
          - hydrochlorothiazide 50 mg PO, qd
          - tamoxifen 20 mg PO, bid
          - NPH insulin 20 IU before breakfast, 5 IU before supper
          - Humalog insulin 5 IU before breakfast, 2 IU before supper
             1. Hydrochlorothiazide (HCTZ) is one of the drugs ordered for Mrs. Bernardo's
hypertension. Given she has diabetes mellitus, what priority health teaching would be done for
this patient?
                     a. ________________
                     b. _______________
                     c. _______________
            2. When is the best time to give your hydrochlorothiazide and why?
                      a. When? _____________________
                      b. why? ________________________
            3. If Mrs. Bernardo takes her NPH insulin at 7:00am, during what time period should the
drug peak?
                       a. _________________
             4. Mrs. Bernardo is complaining about severe hot flashes. She has a bottle of unused
estrogen in her medicine cabinet and she says she is going to start taking it. How would you
respond?
                        a. ________________________
                        b. _______________________
                        c. ____________________
                 5. Mrs. Bernardo's family knows to be alert to a possible hypoglycemic reaction
around supper time related to her NPH insulin, but they are uncertain if they should anticipate a
similar reaction to the Humalog insulin and, if so, when that would be. What do you tell them?
                        a. _____________________
Danica Mae B. Bianito BSN – 202N