Andoloy, Lea Mae September 9, 2021

BSN 202N

CLO2 – WW2: Critical Thinking Exercise

Drugs that Affect 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?
- The xanthine derivatives are bronchodilator medications that stimulates the central
nervous system (CNS). They induce the smooth muscles of the bronchi to relax
directly. It is used to treat reversible bronchospasm associated with chronic
bronchitis and emphysema, as well as for symptomatic relief or prevention of
bronchial asthma. Mrs. Perillo has bronchial asthma, and her serum theophylline
level has risen over 20 mcg/mL in the given scenario. When theophylline serum
concentrations are exceeded, the risk of toxicity increases, and these are the
adverse effect of this drug.
a) CNS: seizures, anxiety, headache, and insomnia.
b) CV: arrhythmias, angina, tachycardia, and palpitations.
c) GI: nausea, vomiting, anorexia, and cramps.
d) Neuro: tremor.
e) Behavioral disturbances and epileptic seizures.
2. Because albuterol (Proventil) is a Beta2 agonist drug, you would expect to see what kind
of response related to androgenic receptors?
- As the situation that indicated below it stated that she uses an albuterol (Proventil)
inhaler to improve her breathing and she use it every 4 hours to improve her
breathing. Bronchospasm tends to happen when the lumen or inside diameter of the
bronchi narrows, which reducing the amount of air that can be taken into the lungs
with each breath. Respiratory distress is caused by a reduction in the amount of air
 absorbed into the lungs. The bronchodilator relaxes the smooth muscles in the
bronchi, allowing more air to enter the lungs and also relieving respiratory distress
fully or partially. The beta 2 adrenergic drugs which is the sympathetic nervous
system it is a treatment for chronic respiratory problems caused by a
bronchoconstriction. And these are the expected adverse reaction of this drug.
a) CNS: nervousness, restlessness, tremor, headache, insomnia (happens
more frequently in young children than in adults); hyperactivity in children.
b) CV: chest pain, palpitations, angina, arrhythmias, and hypertension
c) GI: nausea and vomiting
d) Endo: hyperglycemia
e) F an E: hypokalemia
f) Neuro: tremor
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 doctors prescribe to consider?
- The medication that I expect to prescribe the doctor is prednisone it is a classified
drug of corticosteroid. It is a maintenance treatment for asthma that used to prevent
an occurring disease, the possible decrease in requirement for or elimination of
systemic use in client with asthma. It is locally acting as an anti-inflammatory and
immune modifier. Moreover, prednisone is typically given for a patient that having an
acute case of asthma because it helps to calm and reduce the inflammation in the
airways in people who are experiencing an asthma attack. It is an effective drug to
recurrence if the patient has these kinds of symptoms as soon as possible go to the
emergency or hospital. Many adverse effects that associated with prednisone is
during long term use. Before taking this, it is important to consult your doctor to avoid
any complications.

Reference:
Ford, S. M. (2017). Roach’s Introductory Clinical Pharmacology 11E (Eleventh, International
ed.). Wolters Kluwer.
 Drugs Affecting Digestive System

Case Scenario B:

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 is:

- Ferrous sulfate (Feosol) 325 mg PO, bid. - Docusate sodium (Colace) 100 mg PO, bid

- Terazosin (Hytrin) 10 mg PO, hs - Calcitriol (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.

Name of Rx Drug Drug Classification

Sucralfate (Carafate) Gastrointestinal Agents, other.

Docusate sodium (Colace) Laxatives, Stool Softener

2. Reviewing the case scenario, Mr. Nover is suffering from renal problems. What antacid are
contraindicated for patient Nover and why?

- Based on the Narrative, Mr. Nover is suffering from a renal stage disease and he had
several transplants a year ago and he rejected it and the antacid prescription that
has been given to him is calcium carbonate. This drug is taken by mouth every three
times a day and the dosage are 420 mg. Before administering the antacid, there are
several important contraindications in the calcium compounds that should be
considered with the patient who has hypercalcemia and hypercalciuria, severe renal
disease, renal calculi, dehydration, GI bleeding, or obstruction.
3. Identify the reason why Mr. Nover is taking docusate sodium (Colace).

- Docusate Sodium is the first method for preventing and treating constipation, and it
can be administered rectally to soften fecal impaction and make bowel movements
easier if the patient has difficulty pooing or a rupture in the lining of the patient's
intestinal tract near the anus (anal fissure). However, docusate should be avoided
after a heart attack or recent rectal surgery, and docusate work by increasing the
amount of water in the stool that can absorb in the stomach, making the stool softer
and easier to pass.

4. In regard to his other medication, when would you give him sucralfate (Carafate) and why?

- sucralfate (Carafate) is an anti-ulcer medication. It is not greatly absorbed into the body
through the digestive tract. It works mainly in the lining of the stomach by sticking to ulcer sites
and protecting them from acids, enzymes, and bile salts. However, sucralfate may heal an
active ulcer, but it will not prevent future ulcers from occurring. When taking this medication,
leave 1 hr. prior to meals on an empty stomach and avoid taking any other medication within 2
hours before or after you take sucralfate because it can make it harder to absorb other
medication that taken by mouth. Also, it may decrease the effectiveness of some medication
although, it may take 2 to 8 weeks before you receive a full benefit of this drug. Use medicine
for the full prescribed length of time, even if the symptoms quickly improve.

References:

Ford, S. M. (2017). Roach’s Introductory Clinical Pharmacology 11E (Eleventh, International

ed.). Wolters Kluwer.

Calcium Stool Softener Oral: Uses, Side effects, Interactions, Pictures, Warnings, & Dosing –
WebMD. (n.d.). WebMD. Retrieved September 9, 2021, from
https://www.webmd.com/drugs/2/drug-9796/calcium-stool-softener-oral/details
Carafate. (n.d.). Drugs.Com. Retrieved September 9, 2021, from
https://www.drugs.com/carafate.html

Drugs Affecting the Endocrine System

Case Scenario C:

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?

- This case illustrates how a commonly used medication can lead to severe
adverse events when not used judiciously and cautiously, especially in
vulnerable patients. Specifically, the case highlights some of the risks associated
with diuretics. Hydrochlorothiazide is used to manage mild-to-moderate
hypertension and it can increase excretion of sodium and water by inhibiting
sodium reabsorption in the distal tubule. It promotes the excretion of chloride,
potassium, magnesium, and bicarbonate. Also, it may produce arteriolar dilation.
When taking this medicine make sure that the patient’s potassium is low because
a low level of potassium can lead to constipation, fatigue, and any other
illnesses. Therefore, make sure the potassium is normal, one of the best ways to
do this is to eat a banana, it is rich in potassium and it can help and avoid mixing
beta-blockers with hydrochlorothiazide. In addition, seek a doctor's advice to
 know the benefits and risks of taking hydrochlorothiazide and any other
antihypertensive drug.

2. When is the best time to give your hydrochlorothiazide and why?

- Taking this medication too close to bedtime may cause you to wake up to
urinate, therefore, the best time to take it is usually in the morning, with or without
meals. It is recommended to take the medication at least 4 hours before bedtime.
Furthermore, this medication does not cure high blood pressure, but it does help
to regulate it. As a result, if you want to lower and keep your blood pressure, you
must continue to take it as directed. However, the mechanism of action occurs
within 2 hours after dosage, and the drug's efficacy is observed about 4 hours
and activity persisting up to 24 hours. To receive the maximum benefit from this
drug, use it on a regular basis.

3. If Mrs. Bernardo takes her NPH insulin at 7:00am, during what time period should the
drug peak?

- Patient with diabetes mellitus requires a lifelong insulin therapy. Mostly it requires 2
or more injections of insulin daily, given 30 to 60 minutes before a meal or bedtime.
However, the doses may adjust on the basis of self-monitoring of blood glucose
levels. NPH insulin provides a slower onset of action and longer duration of action
than regular insulin. The onset usually occurs at 1-2 hours, the effectiveness is noted
at 4-12 hours, and the duration of action is normally 14-24 hours.

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?

- Hot flashes are symptoms of the menopausal transition, it happens at night and it
can last for many years because the earlier hot flashes begin the longer you may
endure it. Before taking this medication there are various changes that you might
experience and during menopausal, the ovaries begin to work less and less well, and
the production of hormones like estrogen and progesterone declines over time. By
taking these hot flashes for hormones, it should be used at the lowest dose and also
for the shortest period of time the effectiveness of hormones is reducing the number
and severity of hot flashes. It can help to reduce vaginal dryness and bone loss.
 However, it is important to consult the doctor before taking this medication to avoid
any other complications.

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?

- Humalog insulin is a type of insulin that is used to treat diabetes mellitus. It works by
increasing glucose absorption in skeletal muscle and fat while also inhibiting hepatic
glucose production. Using an insulin replacement, a balanced diet, and exercise can
also help to regulate blood glucose levels and prevent complications. This
medication is an antidiabetic agent that has a very rapid-acting onset is 5-15 min with
a peak of 30-60min. Therefore, it is important to manage the syringes uses with a
solution containing 100 units/mL. sick days are required to monitor and also watch
for the signs and symptoms of hypoglycemia and know what to do if it occurs.

References:

Ford, S. M. (2017). Roach’s Introductory Clinical Pharmacology 11E (Eleventh, International

ed.). Wolters Kluwer.

Hot Flashes: What Can I do? (n.d.). National Institute on Aging. Retrieved September 9, 2021,
from https://www.nia.nih.gov/health/hot-flashes-what-can-i-do

Humalog (insulin lispro [rDNA origin]) FOR Type 1 Diabetes: Uses, Dosages, Side Effects,
Interactions, Warnings. (n.d.). RxList. Retrieved September 9, 2021, from
https://www.exlist.com/humalog-drug.htm