The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply)

Choice A reason: Salmeterol is a long-acting beta-2 agonist (LABA) used for maintenance therapy in asthma and COPD. It binds to beta-2 receptors, causing prolonged bronchodilation (up to 12 hours). Its slow onset makes it unsuitable for acute bronchospasm, where rapid-acting agents are needed to quickly relax airway smooth muscle.

Choice B reason: Fluticasone is an inhaled corticosteroid that reduces airway inflammation by inhibiting cytokine production and immune responses. It has no bronchodilatory effects and is not used for acute bronchospasm. Its role is in long-term asthma control, preventing exacerbations by reducing chronic inflammation, not providing immediate relief.

Choice C reason: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly binds to beta-2 receptors on airway smooth muscle, stimulating adenyl cyclase to increase cyclic AMP, leading to bronchodilation within minutes. This makes it ideal for acute bronchospasm in asthma, providing quick relief of symptoms like wheezing and shortness of breath.

Choice D reason: Montelukast is a leukotriene receptor antagonist that blocks leukotriene D4 receptors, reducing inflammation and bronchoconstriction. It is used for maintenance therapy in asthma, not for acute bronchospasm, as its onset is too slow (hours to days) to provide immediate relief during an acute asthma attack.

Choice A reason: Aspirin inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1, reducing thromboxane A2 production, which increases bleeding risk. This is critical in patients with bleeding disorders, as it can exacerbate conditions like hemophilia or cause gastrointestinal bleeding, necessitating caution and monitoring during therapy.

Choice B reason: Taking aspirin on an empty stomach does not maximize effectiveness and may increase gastrointestinal irritation. Aspirin’s antiplatelet and analgesic effects are independent of food intake, but taking it with food reduces gastric mucosal damage, making this statement incorrect for patient safety.

Choice C reason: Aspirin is not safe with all medications, as it interacts with anticoagulants, NSAIDs, or corticosteroids, increasing bleeding risk. It also affects drugs like methotrexate by altering renal clearance. Drug interactions are common, requiring careful review of concurrent medications, making this statement misleading and unsafe.

Choice D reason: Moderate alcohol consumption with aspirin is not safe, as both irritate the gastric mucosa, increasing the risk of gastrointestinal bleeding. Aspirin’s antiplatelet effect combined with alcohol’s mucosal damage heightens this risk, making this statement incorrect and potentially harmful for patient education.