Virina, Wella S.

BSN II

PHARMACOLOGY

Critical Thinking

1. Ephedrine, albuterol, isoproterenol and terbutaline are bronchodilators,

which are used for temporary relief of shortness of breath, chest
tightness, and wheezing due to bronchial asthma. It works by reducing
swelling and constricting blood vessels in the nasal passages and
widening the lung airways, allowing you to breathe more easily.

With large doses of ephedrine sulfate most patients will experience

nervousness, insomnia, vertigo, headache, tachycardia, palpitation and
sweating.
Side effects of albuterol include nervousness or shakiness, headache,
throat or nasal irritation, and muscle aches. More-serious — though
less common — side effects include a rapid heart rate (tachycardia) or
feelings of fluttering or a pounding heart (palpitations).
Isoproterenol’s side effects are headache, dizziness, feeling nervous,
upset stomach, flushing and feeling tired or weak.
With terbutaline, nervousness, shaking (tremor), dizziness, drowsiness
or headache may occur. This medication may raise your blood
pressure. Improper usage of this medication has caused severe (rarely
fatal), sudden worsening of breathing problems/asthma (paradoxical
bronchospasm).
Bronchodilators all have side effects but it depends on the type of
drug. With proper use of dosage, the side severe side effects can be
avoided.
Using ephedrine together with albuterol may increase cardiovascular
side effects such as elevations in heart rate and blood pressure or
irregular heart rhythm.
2. Albuterol or ipratropium was given on two separate mornings using an
MDI with extender. Subjects inhaled two puffs initially and then one
puff every 30 min to a total of six puffs. Pulmonary function, blood
 pressure, and pulse were measured at baseline and every 30 min for 3
h.
All subjects had a greater than 15 percent increase in FEV1 with one
or both drugs. More patients responded to albuterol than to
ipratropium in both age groups.

Both drugs are effective bronchodilators in young and old asthmatic

subjects, but albuterol results in a greater magnitude of response in
both age groups. Age is not a predictor of response to either drug.

1. Prazosin, propranolol, metoprolol, and acebutolol are beta-blocker

drugs that are used to treat hypertension and other cardiovascular
conditions—may be problematic in people with severe asthma. This
was due in large part to studies from the 1970s and 1980s, which
suggested that the drugs amplify the sensitivity of lung tissues and,
by doing so, increased the risk of bronchial spasms. But many of
those assertions have since been challenged, with most experts
today agreeing that the benefits of beta-blockers far outweigh the
potential consequences.
Beta-blockers, also known as beta-adrenergic receptor blockers,
ultimately decrease the amount of oxygen the heart needs to properly.
The problem is that beta receptors are also found on lung tissue. The
activation of these molecules, known as beta-2 receptors, causes air
passages to relax under the influence of epinephrine. When blocked,
the lung tissues can contract, causing air passages to narrow.
On the surface of things, these converse effects would suggest that
beta-blockers are "harmful" to people with asthma or COPD,
particularly since the some of drugs aren't adept at differentiating
between beta-1 and beta-2 receptors. Recent research suggests that
may not be the case, though.

2. What needs to be included when teaching mt about using adrenergic

blockers?

You can take them in the morning, at meals, and at bedtime. When
you take them with food, you may have fewer side effects because
your body absorbs the drug slower.
Follow the label directions on how often to take it. The number of
doses you take each day, the time allowed between doses, and how
long you need to take the medication will depend on your condition.
Older people typically take lower doses. Ask your doctor what to do if
you miss a dose.

While you're taking a beta-blocker, you may need to check your pulse
every day. If it's slower than it should be, contact your doctor about
taking your beta-blocker that day.
1. How does pilocarpine differ from pyridostigmine? Explain.

Pilocarpine is used alone or with other medications to treat high

pressure inside the eye due to glaucoma or other eye diseases (e.g.,
ocular hypertension). Lowering high pressure inside the eye helps to
prevent blindness, vision loss, and nerve damage. This medication may
also be used during certain eye surgeries and to reverse the effects of
drugs used to enlarge the pupil (e.g., during an eye exam). Pilocarpine
works by causing the pupil of the eye to shrink and decreasing the
amount of fluid within the eye.

Pyridostigmine is by mouth with or without food as directed by your

doctor. If you are using the liquid form of this medication, carefully
measure the dose using a special measuring device/spoon. Do not use
a household spoon because you may not get the correct dose.

If you are using the extended-release tablets, take as directed by your

doctor, usually 1 to 2 times daily (at least 6 hours apart). Do not crush
or chew extended-release tablets. Doing so can release all of the drug
at once, increasing the risk of side effects. Swallow the whole or split
tablet without crushing or chewing.

2. What client teaching should you include to jm related to the use of

pilocarpine? Explain.

To apply eye drops, wash your hands first. To avoid contamination, be

careful not to touch the dropper to any surface or let it touch your eye.

If you are wearing contact lenses, remove them before using eye
drops. Wait at least 15 minutes before replacing your contact lenses.

Tilt your head back, look upward, and pull down the lower eyelid to
make a pouch. Hold the dropper directly over your eye and place one
drop into the pouch. Let go of the eyelid and gently close your eyes.
Place one finger at the corner of your eye (near the nose) and apply
gentle pressure for 1 to 2 minutes. This will prevent the medication
from draining out. Try not to blink and do not rub your eye. Repeat
these steps for your other eye if so directed or if your dose is for more
than 1 drop.

Remove extra solution around the eye with a tissue and wash your
hands to remove any medicine that may be on them. Do not rinse the
dropper. Replace the dropper cap after each use.

If you are using another kind of eye medication (e.g., drops or

ointments), wait at least 5 minutes before using the other medication.
Use eye drops before ointments to allow the eye drops to enter the
eye.

If your doctor has prescribed this medication to treat glaucoma or high

pressure in the eyes, use it regularly in order to get the most benefit
from it. Most people with glaucoma or high pressure in the eyes do not
have any symptoms. To help you remember, use it at the same time(s)
each day.