Respiratory Meds

• Albuteral
• Pirbuteral

Bronchodialators

Stimulate Beta Adrenergic receptors in bronchioles to produce bronchodilation and increase muccociliary clearance and inhibit release of histamine

• Rescue drug
• Quick relief....can be used to prevent bronchospasm from exercise and other inflammatory mediators from mast cells

Bronchodilation

• Tremors
• Anxiety
• Tachy
• Palpitations
• Nausea

• 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
• Avoid caffeine

• Salmeterol
• Formoterol

Long term control of moderate to sever persistent asthma/COPD

• NOT A RESCUE MED
• Only use ONCE every 12 hrs
• Instruct patient how to check pulse and report increase greater than 20-30bpm
• Avoid caffeine
• Tremors will stop after use

Before

• Advair and Salmeterol
• Symbicort and Formoterol

Inhaled Corticosteroid

Theophylline

It is a sustained release inhaler used as an alternative therapy for step 2 care in mild/persistent asthma/COPD

• Nausea
• Headache
• Insomnia
• GI distress
• Tachy
• Dysrhythmia
• Seizures

• Drug interactions
• Don't double dose if missed
• Don't drink caffeine
• Report GI distress

• Antibiotic dosage may need to be decreased
• Phenobarbital and Phenytoin may need to increase dosage

You will need to have serum blood levels checked to make sure it stays within therapeutic range

5-15 mcg/ml

Atrovent

It is used for quick relief for patients that cant tolerate SABA's.

Bronchodilation

Blocks the bronchoconstricting influence of the parasympathetic nervous system

Peaks at 30-60 min and lasts 4-6 hours

• Dry mouth
• Hoarseness

*Doesn't get absorbed very well systemically so no many AE's

• Flovent
• Pulmicort

They are anti inflammatories that reduce bronchial hyper-responsiveness.

• Prevents inflammation 
• suppresses airway mucous production 
• Inhibits migration of inflammatory cells

Acute exacerbation and maintenance of asthma and COPD. 

No immediate effect, but decreases frequency and severity of attacks

24 hours to 2 weeks

• Bruising
• Increased Bone Loss
• OROPHARYNGEAL CANDIDIASIS
• Hoarseness
• Dry Cough

• suppression of adrenal gland function
• bone loss
• hyperglycemia
• glycosuria
• myopathy
• muscle weakness
• Peptic Ulcer
• Infection
• Disruption of F&E

• 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

NSAID....report tarry stools

for short term use following an attack

• Singulair
• Accolate

Zileuton

Inhibits the synthesis of leukotrienes

Long term oral therapy as a prophylactic and maintenance med

• Prevents inflammation
• Bronchoconstriction
• Prevents Airway edema
• Prevents mucous production

Liver injury

• Take 1x/day at bedtime
• Get a baseline LFT and monitor it periodically

Xolair

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

• Subcutaneously and q 2-4 weeks
• In the Doctors office cuz of risk of anaphylaxis

anaphylaxis

Have to go to Dr. office to subcutaneous injection

Mast cell stabilizers

Intal and Tilade

they are anti inflammatories

15 min. prior to exercise or known exposure to an allergen

Long term prophylaxis may take several weeks for therapeutic effect to occur.