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2 Short Acting Beta Adrenergic Agonist
How do SABA's/LABA's work?
Stimulate Beta Adrenergic receptors in bronchioles to produce bronchodilation and increase muccociliary clearance and inhibit release of histamine
What are SABA's good for?
Quick relief....can be used to prevent bronchospasm from exercise and other inflammatory mediators from mast cells
Both SABA's and LABA's cause....
Adverse Effects of SABA's and LABA's
Patient Teaching for SABA's
Used for relief only
Instruct patient how to check pulse....and report an increase greater than 20-30bpm
Tremors will usually resolve with continued use...if not reduce the dose
Name 2 LABA's
What are LABA's used for?
Long term control of moderate to sever persistent asthma/COPD
Patient Teaching for LABA's
NOT A RESCUE MED
Only use ONCE every 12 hrs
Instruct patient how to check pulse and report increase greater than 20-30bpm
Tremors will stop after use
Both SABA's and LABA's need to be taken before of after ICS?
Examples of Combo therapy with LABA and ICS
Advair and Salmeterol
Symbicort and Formoterol
What is ICS?
Name a Methylxantine drug.....
How does it work?
It is a sustained release inhaler used as an alternative therapy for step 2 care in mild/persistent asthma/COPD
Adverse Effects of Methylxanthine (theophylline)
Patient teaching for Methylxanthines (Theophylline)
Don't double dose if missed
Don't drink caffeine
Report GI distress
What are the specific drug interactions to know about with Methlxanthines (Theophylline)?
Antibiotic dosage may need to be decreased
Phenobarbital and Phenytoin may need to increase dosage
Methylxanthine (Theophylline) has a narrow margin of safety...explain
You will need to have serum blood levels checked to make sure it stays within therapeutic range
Name Anticholinergic medication and why is it used?
It is used for quick relief for patients that cant tolerate SABA's.
How does Atrovent work?
Blocks the bronchoconstricting influence of the parasympathetic nervous system
When does Atrovent peak and how long does it last?
Peaks at 30-60 min and lasts 4-6 hours
Adverse effects of Atrovent
*Doesn't get absorbed very well systemically so no many AE's
Name 2 Corticosteroids (ICS)
What do corticosteroids do? (ICS)
They are anti inflammatories that reduce bronchial hyper-responsiveness.
suppresses airway mucous production
Inhibits migration of inflammatory cells
What are ICS used for?
Acute exacerbation and maintenance of asthma and COPD.
No immediate effect, but decreases frequency and severity of attacks
How long does it take for the therapeutic effect to occur with ICS meds?
24 hours to 2 weeks
Adverse effects of ICS
Increased Bone Loss
Long term effects of taking ICS
suppression of adrenal gland function
Disruption of F&E
Patient teaching for ICS
Use a spacer and rinse mouth after admin
If oral....do alternate day schedule
monitor Blood Glucose
Report muscle weakness
Report signs of infection
Report signs of F&E imbalance
What medication do you need to avoid if on an ICS
NSAID....report tarry stools
Oral ICS are given to people .....
for short term use following an attack
Name 2 Leukotriene modifiers
Name 1 Leukotriene Synthesis Inhibitor....what does it do?
Inhibits the synthesis of leukotrienes
What does Zileuton used for?
How does it work?
Long term oral therapy as a prophylactic and maintenance med
Prevents Airway edema
Prevents mucous production
Adverse effect of Zileuton
Patient teaching for Zileuton
Take 1x/day at bedtime
Get a baseline LFT and monitor it periodically
Name an Anti-IgE medication
What does Xolair do and what does it treat?
Treats moderate to persistent allergic asthma and those requiring 5 or 6 care with persistent asthma that CANT be controlled with ICS
It decreases circulating free IgE and prevents them from attaching to mast cells
How do you take Xolair and how often?
Subcutaneously and q 2-4 weeks
In the Doctors office cuz of risk of anaphylaxis
Adverse effects of Xolair
Patient teaching for Xolair
Have to go to Dr. office to subcutaneous injection
What is the safest medication for asthma?
Mast cell stabilizers
Intal and Tilade
How do Intal and Tilade work?
they are anti inflammatories
When does a person take Intal and Tilade?
15 min. prior to exercise or known exposure to an allergen
Patient teaching for Intal and Tilade
Long term prophylaxis may take several weeks for therapeutic effect to occur.
Respiratory, lecture and ATI