drugs for lower resp. Asthma

  1. advantages to administration by inhalation
    • rapid and efficient
    • rich blood supply, quick absorption
    • delivers drugs directly to site of action
  2. devices for aerosol therapy
    • nebulizer
    • MDI metered dose inhaler
    • DPI dry dose inhaler
  3. disadvantages to aerosol therapy
    • difficult to measure precise dose (pt usually gets 10-50%)
    • some may not understand instruction
    • proper administration
  4. disadvantage to steroid inhalers
    if patient doesn't rinse mouth out , these cause yeast infection in mouth, if swallowed they can cause systemic effects
  5. goals of asthma therapy
    • prevent attacks
    • terminate attacks in progress
  6. catagories of asthma
    • 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
  7. goal of asthma therapy
    • -to terminate acute bronchospasms in progress
    • -to reduce frequency
  8. beta adrenergic agonist
    • most effective for bronchospasm
    • range from long term to short acting
    • fewer cardiac side effects
    • cause bronchodilation
  9. oral therapy for asthma
    • -longer duration of action
    • -frequent side effects
    • -may develop tolerance may develop
  10. bronchodilators- beta adrenergic agonists
    mech of action
    • salmeterol (serevent)
    • mech of action- bronchodilation
    • use- exerise induced asthma, for acute attack
    • adverse reaction- headaches, sore throat, irritaion nervousness, restlessness, tachycardia
  11. bronchodilators---anticholinergic
    mech of action
    adverse effect
    • 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

  12. anti inflammatory agents- glucocorticoids
    mech of action
    primary use
    adverse effects
    • 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)
  13. Leukotriene modifiers
    mech of action
    adverse effects
    • 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
  14. assessment of asthma pts
    • health history
    • s/s respiratory deficiency
    • vital signs
    • bilateral breath sounds
    • pulmonary function with pulse ox, peak flow meter, ABG's
  15. causes of asthma
    • air pollutants
    • allergens
    • chemicals and food
    • respiratory infections
    • stress
  16. intructions on MDI administratation
    • 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
  17. sequence of inhalers and bronchodilators
    use bronchodilator first then wait 5 min for the corticosteroid
  18. bronchodilators for asthma include
    this are rescue inhalers
    • beta agonists (servent) salmeterol
    • methylaxantihines- theophylline
    • anticholinergics- atrovent, combivent
  19. anti inflammatory for asthma
    maintence- preventers
    • inhaled glucocorticoids (beclovent, vanceril
    • mast cell stabilizers- cormolyn
    • Leukotriene modifiers- singulair, accolate
  20. theophylline side effects (mthylaxanthines)
    • nervousness, tremors, dizziness, headche, nausea, vomiting, anorexia
    • tachycardia, dysrhythmias, hypotension, seizures, circulatory failure, respiratory arrest
  21. anticholinergics (atrovent, combivent)
    side effects
    • headache, cough, drymouth, nasal irritation,
    • can make narrow angle glaucoma worse
    • sinusitis, pharyngitis, oropharyngeal candidasis
  22. labs of respiratory drugs ABG's
    • pH 7.35-7.45
    • PaCo2 35-45
    • PaO2 75-100
    • HCO3 - 22-28
  23. adverse reactions of bronchodilators
    -beta agonists- servent
    -methylxanthines- on different card
    -anticholinergic- atrovent, combivent
    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)
Card Set
drugs for lower resp. Asthma
lower resp