drugs for lower resp. Asthma

• rapid and efficient
• rich blood supply, quick absorption
• delivers drugs directly to site of action

• nebulizer
• MDI metered dose inhaler
• DPI dry dose inhaler

• difficult to measure precise dose (pt usually gets 10-50%)
• some may not understand instruction
• proper administration

if patient doesn't rinse mouth out , these cause yeast infection in mouth, if swallowed they can cause systemic effects

• prevent attacks
• terminate attacks in progress

• 1- mild symptoms less than twice a week- PRN meds only
• 2- mild persistant - symptoms more than twice a week, and at nite more than 2x a month, steroids and beta agonists are used
• 3- moderate persistent- daily symptoms, inhaled glucocoorticoids, with theophylline, oral beta agnoists, and long acting
• 4- severe persistent- continued symptoms that limits activity. all meds mentioned above

• -to terminate acute bronchospasms in progress
• -to reduce frequency

• most effective for bronchospasm
• range from long term to short acting
• fewer cardiac side effects
• cause bronchodilation

• -longer duration of action
• -frequent side effects
• -may develop tolerance may develop

• salmeterol (serevent)
• mech of action- bronchodilation
• use- exerise induced asthma, for acute attack
• adverse reaction- headaches, sore throat, irritaion nervousness, restlessness, tachycardia

• Prototype: ipratropium (atrovent)
• mech of action- brochodilation by blocking cholinergic receptors in smooth muscle
• use- for relief of acute bronchospasm
• sometimes used for chronic bronchitis and nasal congestion
• adverse effects: cough, drying of nasal mucosa, hoarseness, bitter taste

• prototype beclomethasone (beclovent, beconase, bancenase, vanceril)
• mech of action- reduces inflammation
• primary use- decrease frequency of asthma attacks, allergic rhinitis
• not used to terminate attacks in progress
• adverse effects- oropharyngeal candidiasis (teach patient not to swallow and to rinse mouth)

• Prototype- zafirlukast (accolate)
• mech of action- prevents airway edema and inflammation by blocking leukotriene receptors in airway
• Adverse effects- headache, nausea, diarrhea
• use- prophylaxis of persistent chronic asthma

• health history
• s/s respiratory deficiency
• vital signs
• bilateral breath sounds
• pulmonary function with pulse ox, peak flow meter, ABG's

• air pollutants
• allergens
• chemicals and food
• respiratory infections
• stress

• 1. shake well for 5-10 seconds
• 2. remove cap
• 3. breathe out a normal breath
• 4. hold upright
• 5. put in mouth
• 6. activiate inhaler by taking a slow deep breath 3-5 seconds
• 7. hold breath for 10 seconds exhale slowly
• 8. 1 min between inhalations
• 9. rinse mouth

use bronchodilator first then wait 5 min for the corticosteroid

• beta agonists (servent) salmeterol
• methylaxantihines- theophylline
• anticholinergics- atrovent, combivent

• inhaled glucocorticoids (beclovent, vanceril
• mast cell stabilizers- cormolyn
• Leukotriene modifiers- singulair, accolate

• nervousness, tremors, dizziness, headche, nausea, vomiting, anorexia
• tachycardia, dysrhythmias, hypotension, seizures, circulatory failure, respiratory arrest

• headache, cough, drymouth, nasal irritation,
• can make narrow angle glaucoma worse
• sinusitis, pharyngitis, oropharyngeal candidasis

• pH 7.35-7.45
• PaCo2 35-45
• PaO2 75-100
• HCO3 - 22-28

headache, dizziness, tremor, nervousness, throat irritation, drug intolerance, tachycardia, dysrhythmias, hypekalemia, hyperglycemia, paradoxical bronchconstriction, (atrovent headache, cough, dry mouth, irritation, wosening of narrow angle glaucoma, sinusitis, pharyngitis, fungal infection in mouth)