Pharm Asthma

Asthma - paroxysmal (comes and goes) bronchoconstriction with bronchial inflammation

• Tx -
• - Bronchodilators (resuce inhalters)
• - anti-inflammatories (maint/ prevention)

• - suffix -terol
• albuterol/ ventolin
• short onset, short duration
• Beta2 agonists

• SE/ADR - jittery-also have beta 1 effects - increase HR, increase BP (systolic up a little bit)
• -assess HR & BP

Albuterol syrup (for kids) - systemic - don't give after 4 pm (wired)

• - preferred are steroids - suffix sone or solone
• beclomethosone/ Beclovent
• Pulmacort/ Aerobid/ Asmanex

• -preferred for long-term management in both children and adults
• -oral or nose (for allergic rhinitus)

• Teaching:
• -use after resuce inhalers (bronchodilators open things up so steroids can get in)
• -keep capped and clean
• *rinse mouth after use (rinse and spit)
• - risk of oral candida/ thrush
• -do not take to terminate an acute attack (max benefit may not be achieved for 1 to 3 weeks)

• - suffix -meterol
• -long acting beta2 agonist
• solmeterol/ serervent
• fometerol/ foralil

-use in combination with inhaled corticosteroids for prophylaxis of moderate to severe asthma

BLACK BOX WARNING - sudden astham related death-occurs from overuse or long use-decreases albuteral efficacy-use only for prevention - dont use in acute attack

• -Ipretropium/ Atrovent
• -Tiotropium/ Spireva
• PNS antagonists - anticholenergic -prevents bronchospasm
• used for COPD including bronchitis and asthma - not used often in asthma

-quick but peak can take 1-2 hours - bronchodilation lasts up to 6 hours

• - SE/ADR - dry mouth
• -rinse mouth

• Theophylline (PO)
• -Aminophylline (IV)

• natrual substance found in tea - not as effective as other beta2 agonists
• -relaxes bronchial smooth muscle which promotes bronchodilation
• -narrow therapeutic window
• Teach - dont double up on doses
• -same family of compounds as caffine
• -risk of overdose is seizure -

• -obtained from diet
• -synthesized in liver
• -Liver packs excess as LDL's & sends out to storage
• -HDL - cholsterol going back to liver to be broken down
• -exercise is main way to increase HDL's

• suffix - Statins
• simvastatin/ zocoratorvastatin/ Lipitor
• - Inhibit HMG CoA reductase
• - prevent liver from synthesizing cholesterol

• -SE/ADR - risk of liver damage
• -discuss ETOH consumption with Dr
• -avoid acetaminophen
• -yellow skin, eyes (sclera), grey/ ashen colored stools
• - CALL DR
• 1:10,000 - rhabdomyolysis - striated muscle breakdown (skeletal muscle breakdown)
• - can lead to renal failure and death
• - report unexplained muscle pain and weakness

• quiz:4 clients all taking statins
• dark urine after multi vit
• muscle pain for no good reason
• weakness

• PAIN
• - 5th vital sign
• - unpleasant yet useful sensation
• - can persist beyond being useful

• Types:
• Acute pain
• - pain during healing
• - large SNS component-adreniline (increase HR) -
• - small psychological component

• - Chronic pain
• - pain after healing phase
• - blunted SNS component
• - VS not good as showing chronic pain-
• - large psychological component
• - wounded bird syndrome / green poultice - aflack
• -group therapy, OT, PT

Viseral pain - tissue -opiates preferred

Bones/ Joint/ Dental - NSAIDs - acetaminophen