A nurse receives an order to give a patient two puffs of salmeterol and two puffs of beclomethasone dipropionate, by a metered dose inhaler. The nurse should administer the medication by?

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Salmeterol is a long-acting beta-agonist (LABA) bronchodilator, which works by relaxing the muscles around the airways, causing them to open up.
Beclomethasone is an inhaled corticosteroid (ICS) that reduces inflammation and swelling in the airways.
Administering the bronchodilator (salmeterol) first is the correct procedure because it dilates the airways, allowing the corticosteroid (beclomethasone) to be inhaled more deeply into the lungs.
This sequence maximizes the therapeutic effect of the anti-inflammatory medication, ensuring it reaches the site of action effectively.

Option A: Alternating puffs does not allow the bronchodilator sufficient time (typically 2-5 minutes) to take full effect and maximally open the airways before the corticosteroid is administered, reducing the steroid's efficacy.
Option B: Giving the corticosteroid first is incorrect because the airways are still constricted. This limits the amount of steroid medication that can penetrate the lower airways, thus reducing its therapeutic effect.
Option D: This is incorrect for two reasons: the corticosteroid is given before the airways are fully dilated, and alternating puffs is an inefficient method of delivery that doesn't allow either drug to work optimally.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacology: Administration of Inhaled Medications to guide bedside assessment, documentation, and the next nursing action.
Ensuring the correct sequence of inhaler administration is critical for medication efficacy and achieving optimal control of respiratory conditions like asthma or COPD.
A key patient safety instruction is to rinse the mouth with water and spit after using an inhaled corticosteroid to prevent oropharyngeal candidiasis (thrush), a common local side effect.
Patient education on proper inhaler technique, including timing and sequence, directly impacts treatment outcomes and adherence.

How to Approach the Question

First, identify the drugs mentioned in the question: salmeterol and beclomethasone dipropionate.
Next, classify each drug based on its mechanism of action. Salmeterol is a bronchodilator, and beclomethasone is a corticosteroid.
Apply the fundamental principle of inhaled medication administration: always administer the bronchodilator first.
Understand the rationale: The bronchodilator opens the airways, creating a clear path for the corticosteroid to travel deeper into the lungs and be more effective.
Evaluate the options based on this principle. The only option that follows the 'bronchodilator first, then corticosteroid' rule is the correct answer.

Concept Tested & Keywords

Concept Tested: Pharmacology: Administration of Inhaled Medications
Stem keywords: salmeterol, beclomethasone dipropionate, metered dose inhaler, administer
Lead-in keywords: should administer the medication by
Clinical cues: Order for two different types of inhalers (bronchodilator and corticosteroid)

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E6 Pharmacology Nursing Lilley 11e Part 1 p. 322-323

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 193-195

E6 Pharmacology Nursing Lilley 11e Part 2 p. 277-279

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