1|Page
TEST BANK FOR PHARMACOLOGY AND THE NURSING PROCESS
10TH EDITION BY LINDA LILLEY, SHELLY COLLINS, JULIE SNYDER
CHAPTER 1-58 QUESTIONS (VERIFIED ANSWERS) GRADED A+
Indications of anti cholinergics - ANSWER-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 - ANSWER-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 - ANSWER-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.
,2|Page
Drug interactions anticholinergics - ANSWER-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) - ANSWER-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 aclidinium (Tudorza) are similar drugs. Spiriva is given once a day,
whereas Tudorza is given twice daily. Many patients also benefit from taking both a beta2
agonist and an anticholinergic drug, with the most popular combination being albuterol and
ipratropium. Although many patients receive the two drugs separately, two combination
products are available containing both of these drugs: Combivent (an MDI) and DuoNeb (an
inhalation solution). (Lilley 584)
Route : inhaler
Xanthine Derivatives overview - ANSWER-The natural xanthines consist of the plant alkaloids
caffeine, theobromine, and theophylline, but only theophylline and caffeine are currently
used clinically. Synthetic xanthines include aminophylline and dyphylline. Caffeine, which is
actually a metabolite of theophylline, has other uses described later in the chapter. (Lilley
584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
,3|Page
Xanthine mechanism of action - ANSWER-Xanthines cause bronchodilation by increasing the
levels of the energy-producing substance cAMP. They do this by competitively inhibiting
phosphodiesterase, the enzyme responsible for breaking down cAMP. In patients with COPD,
cAMP plays an integral role in the maintenance of open airways. Higher intracellular levels of
cAMP contribute to smooth muscle relaxation and also inhibit IgE-induced release of the
chemical mediators that drive allergic reactions (histamine, slow-reacting substance of
anaphylaxis, and others).
Theophylline is metabolized to caffeine in the body, whereas aminophylline is metabolized to
theophylline. Theophylline and other xanthines stimulate the CNS, but to a lesser degree than
caffeine. This stimulation of the CNS has the beneficial effect of acting directly on the
medullary respiratory center to enhance respiratory drive. In large doses, theophylline may
stimulate the cardiovascular system, which results in both an increased force of contraction
(positive inotropy) and an increased heart rate (positive chronotropy). The increased force of
contraction raises cardiac output and hence blood flow to the kidneys. This, in combination
with the ability of the xanthines to dilate blood vessels in and around the kidney, increases
the glomerular filtration rate, which produces a diuretic effect. (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Xanthine Indications - ANSWER-Xanthines are used to dilate the airways in patients with
asthma, chronic bronchitis, or emphysema. They may be used in mild to moderate cases of
acute asthma and as an adjunct drug in the management of COPD. Xanthines are now
deemphasized because of their potential for drug interactions and the interpatient variability
in therapeutic drug levels in the blood. Because of their relatively slow onset of action,
xanthines are used for the prevention of asthmatic symptoms and COPD, not for the relief of
acute asthma attacks.
Caffeine is used without prescription as a CNS stimulant, or analeptic (see Chapter 13), to
promote alertness (e.g., for long-duration driving or studying). It is also used as a cardiac
stimulant in infants with bradycardia and for enhancement of respiratory drive in infants.
(Lilley 585)
, 4|Page
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Xanthine contraindications - ANSWER-Contraindications to therapy with xanthine derivatives
include known drug allergy, uncontrolled cardiac dysrhythmias, seizure disorders,
hyperthyroidism, and peptic ulcers. (Lilley 585)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Xanthine adverse effects - ANSWER-The common adverse effects of the xanthine derivatives
include nausea, vomiting, and anorexia. Cardiac adverse effects include sinus tachycardia,
extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and
hyperglycemia are other possible adverse effects. Overdose and other toxicity of xanthine
derivatives are usually treated by the repeated administration of doses of activated charcoal.
(Lilley 585)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
bronchodilators overview - ANSWER-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 - ANSWER-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
TEST BANK FOR PHARMACOLOGY AND THE NURSING PROCESS
10TH EDITION BY LINDA LILLEY, SHELLY COLLINS, JULIE SNYDER
CHAPTER 1-58 QUESTIONS (VERIFIED ANSWERS) GRADED A+
Indications of anti cholinergics - ANSWER-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 - ANSWER-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 - ANSWER-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.
,2|Page
Drug interactions anticholinergics - ANSWER-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) - ANSWER-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 aclidinium (Tudorza) are similar drugs. Spiriva is given once a day,
whereas Tudorza is given twice daily. Many patients also benefit from taking both a beta2
agonist and an anticholinergic drug, with the most popular combination being albuterol and
ipratropium. Although many patients receive the two drugs separately, two combination
products are available containing both of these drugs: Combivent (an MDI) and DuoNeb (an
inhalation solution). (Lilley 584)
Route : inhaler
Xanthine Derivatives overview - ANSWER-The natural xanthines consist of the plant alkaloids
caffeine, theobromine, and theophylline, but only theophylline and caffeine are currently
used clinically. Synthetic xanthines include aminophylline and dyphylline. Caffeine, which is
actually a metabolite of theophylline, has other uses described later in the chapter. (Lilley
584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
,3|Page
Xanthine mechanism of action - ANSWER-Xanthines cause bronchodilation by increasing the
levels of the energy-producing substance cAMP. They do this by competitively inhibiting
phosphodiesterase, the enzyme responsible for breaking down cAMP. In patients with COPD,
cAMP plays an integral role in the maintenance of open airways. Higher intracellular levels of
cAMP contribute to smooth muscle relaxation and also inhibit IgE-induced release of the
chemical mediators that drive allergic reactions (histamine, slow-reacting substance of
anaphylaxis, and others).
Theophylline is metabolized to caffeine in the body, whereas aminophylline is metabolized to
theophylline. Theophylline and other xanthines stimulate the CNS, but to a lesser degree than
caffeine. This stimulation of the CNS has the beneficial effect of acting directly on the
medullary respiratory center to enhance respiratory drive. In large doses, theophylline may
stimulate the cardiovascular system, which results in both an increased force of contraction
(positive inotropy) and an increased heart rate (positive chronotropy). The increased force of
contraction raises cardiac output and hence blood flow to the kidneys. This, in combination
with the ability of the xanthines to dilate blood vessels in and around the kidney, increases
the glomerular filtration rate, which produces a diuretic effect. (Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Xanthine Indications - ANSWER-Xanthines are used to dilate the airways in patients with
asthma, chronic bronchitis, or emphysema. They may be used in mild to moderate cases of
acute asthma and as an adjunct drug in the management of COPD. Xanthines are now
deemphasized because of their potential for drug interactions and the interpatient variability
in therapeutic drug levels in the blood. Because of their relatively slow onset of action,
xanthines are used for the prevention of asthmatic symptoms and COPD, not for the relief of
acute asthma attacks.
Caffeine is used without prescription as a CNS stimulant, or analeptic (see Chapter 13), to
promote alertness (e.g., for long-duration driving or studying). It is also used as a cardiac
stimulant in infants with bradycardia and for enhancement of respiratory drive in infants.
(Lilley 585)
, 4|Page
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Xanthine contraindications - ANSWER-Contraindications to therapy with xanthine derivatives
include known drug allergy, uncontrolled cardiac dysrhythmias, seizure disorders,
hyperthyroidism, and peptic ulcers. (Lilley 585)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Xanthine adverse effects - ANSWER-The common adverse effects of the xanthine derivatives
include nausea, vomiting, and anorexia. Cardiac adverse effects include sinus tachycardia,
extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and
hyperglycemia are other possible adverse effects. Overdose and other toxicity of xanthine
derivatives are usually treated by the repeated administration of doses of activated charcoal.
(Lilley 585)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
bronchodilators overview - ANSWER-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 - ANSWER-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
