A nurse reviews a new outpatient asthma regimen of salmetero… | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse reviews a new outpatient asthma regimen of salmeterol inhaler twice daily without an inhaled corticosteroid. Which is the nurse's priority action?
1Switch to as-needed dosing
2Administer the dose as ordered
3Double the dose for better control
4Hold the regimen and contact the provider — LABA monotherapy in asthma is contraindicated and carries a boxed warning for severe asthma exacerbation and death✓ Correct answer
Explanation
Correct (2): LABA monotherapy in asthma (salmeterol, formoterol alone) is contraindicated due to an FDA boxed warning — increased risk of severe asthma exacerbation and asthma-related death. LABAs must be combined with an inhaled corticosteroid (e.g., fluticasone/salmeterol, budesonide/formoterol). COPD use without ICS is acceptable. (1,3,4) Unsafe.
In-depth explanation
Memory Tip LABA + ICS = required pair in asthma. Standalone LABA = boxed warning. SABA (albuterol) is appropriate as PRN reliever.
Clinical scenario
Scenario 35-year-old female with persistent asthma. New outpatient prescription: salmeterol DPI 50 mcg inhaled BID as sole controller, no inhaled corticosteroid.
Key concepts
LABA monotherapy boxed warning — FDA warning against single-agent long-acting beta-2 agonist in asthma due to mortality risk.