Short Acting Beta Agonist
albuterol (Proventil, Ventolin)
- Bronchodilation; relaxes bronchial smooth muscle
- Fast acting RESCUE DRUG during asthma attack or before activity that triggers attack.
- When used with other inhaled drugs, use 5 mins. before other drugs.
- Teach pt. to carry at all times.
- Shake inhaler well & allow 1 min between inhalations.
- Prime inhaler first before use.
- nervousness, restlessness, tremor, insomnia, chest pain, palpitations
Long Acting Beta Agonist
- Bronchodilation; relaxing bronchial smooth muscle by binding to the pulmonary beta 2 receptors
- Slow onset with long duration.
- Used to PREVENT asthma attack.
- Monitor for hypersensitivity reaction (rash, face, swelling).
- Teach pt. how to use powder inhaler (never exhale into diskus, keep mouthpiece dry).
- Once opened, use within 6 weeks or discard.
NOT USED FOR ACUTE ATTACK!
- H/A, nervousness, palpitations, tachycardia
ipratopium (Atrovent), tiotropium (Spiriva)
- Bronchodilation; inhibiting parasympathetic nervous system, allowing SNS to dominate.
- Resuce & asthma attack prevention.
- Assess degree of dyspnea before administering & at peak (1-2hr).
- Assess for allergy to atropine.
- Pt. to drink at least 4L of fluid/day.
- Shake MDI well & monitor use of MDI.
- dizziness, H/A, nervousness, blurred vision (systemic symptoms), mouth dryness
theophylline (Theo-Dur, Theolair)
NOT REALLY USED ANYMORE
- CNS stimulant causing bronchodilation.
- Used for long-term asthma prevention.
- Monitor chest pain & ECG changes if hx of CVD.
- Monitor drug levels routinely.
- Watch for S/S of toxicity (anorexia, N/V/D, confusion).
- Administer around the clock to maintain blood levels.
- Administer oral dose with food or full glass of water.
- Higher doses are required at start of therapy.
- Avoid caffeine.
- seizures, anxiety, tachycardia, arrhythmias, N/W, narrow margin of safety with many drug-drug interactions.
fluticasone (Flovent, Pulmioncort)
prednisone (Deltasone, Solu-Medrol, Decadron) -> Systemic IV; only used short-term for acute asthma exacerbation.
- Inhaled steriods disrupt inflammatory mediators preventing asthma attacks caused by inflammation or allergies.
- Decrease inflammatory & immune responses.
- Preventing manifestations of asthma.
- S/S of local infections especially yeast infections.
- Slow onset of action, use drug daily even when no symptoms.
- Good mouth care & check for lesions.
- Use bronchodilator 1st wait 5 mins before corticosteriod.
- Oropharyngeal fungal infections can be prevented by using a space with inhaler.
- local throat irritation, hoarseness, dry mouth, coughing, oropharyngeal fungal infections (Candida albicans), nasal stuffiness/sinusitis.
- *SE of systemic steriods
- hyperglycemia, GI ulcer, wt. gain, increased R/F infection.
Mast Cell Stabilizer
cromolyn (Intal), nedocromil (Tilade)
- Stabilizes membranes of mast cells and prevents release of inflammatory mediators (histamine).
- Preventing asthma attack triggered by inflammation or allergies.
- Assess lung sounds, respiratory status
- Taken daily by inhalation.
- NOT USED DURING ASTHAM ATTTACK
- Should be taken on scheduled basis.
- H/A, sore throat, unpleasant taste, cough, anaphylaxis.
montelukast (Singulair), omalizumab (Xolair)
- Blocks the luekotriene receptor, preventing inflammatory mediators from stimulating inflammation.
- Prevents asthma attack triggered by inflammation or allergens.
- Assess allergy symptoms (rash, urticarial).
- May cause increased liver enzymes.
- Xolair associated with anaphylaxis (assess for allergic reactions - tongue, throat edema, urticaria within 2 hrs of administration).
- Use daily even when no symptoms.
- Slow onset of action for long-term asthma control.
- Provide adequate hydration.
- Xolair administered SQ q2-4weeks.
- fatigue, fever, H/A, cough
- Injection site; bruising, redness, warmth, burning.
Advair Diskus, Symbicort, Combivent, DuoNeb
Advair; used daily with inhalation in am & pm
DuoNeb; delivered via nebulzier
Combivent; MDI, 2 puffs tid/qid