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Hello all!
Today, we'll be learning about drugs that can help with controlling Asthma.
Drugs that can be used for short-time and/or long-time support.

Ready?!
Let's go over Asthma.
What causes it? What happens with Asthma?
Asthma is an Immune-mediated airway inflammation, a chronic airway inflammation

Asthma consists of: bronchoconstriction, inflammatory cell activation/inflammation, and bronchial hyperreactivity triggered by an allergen
Signs and Symptoms of Asthma
Name 5
Breathlessness
Tightening of chest
Wheezing – increased mucus
Dyspnea
Cough – increased mucus
There are 7 Major Drugs for Asthma.
4 Anti-inflammatory agents
3 Bronchodilators
Could you name them?
Anti-inflammatory agents --> Beclomethasone,
Prednisone, Cromolyn
Montelukast

Bronchodilators --> Albuterol,
Salmeterol, Theophylline
There are 3 ways to administer these drugs. Name them!
Metered-Dose inhalers (spacers helpful)
Dry Powder Inhalers
Nebulizers (misty)
Okay! On to the drugs.
~BECLOMETHASOME [QVAR] & PRESNIZONE~
Both are INHALED GLUCOCORTICOIDS so we'll be talking about both of them at one time.
Beclomethasome is inhaled and preferred.

Prednisone is given orally but for severe asthma. Thus, there are more systemic effects.

What are their MECHANISMS OF ACTION?
Beclomethasome & Prednisone MOA:

SUPPRESS INFLAMMATION by inhibiting immune response, reducing bronchial hyperreactivity.
Beclomethasome & Prednisone
Used to PREVENT asthma attack (aka prophylaxis).
They are given on a fixed schedule
Inhaled are the 1st line therapy for moderate to severe asthma. Not PRN or treating an ongoing attack.

Oral GC used if other meds not responsive.

Do you remember which drug is what?
Beclomethasome
Inhaled GC
SIDE EFFECTS
--> Adrenal suppression and bone loss (esp in premenopausal women) in long term, high-dose therapy
--> Oropharyngeal candidiasis and dysphonia
What would be your nursing interventions for adverse effects of Beclomethasome?
Adrenal suppression/bone loss -->NI: use low dose, Ca2+ and vit D, weight-bearing exercise

Oropharyngeal candidiasis (fungal infection) and dysphonia (disturbed vocal function)
-->NI: Reduced by gargling after each administration and using a spacer
Prednisone
Oral GC
SIDE EFFECTS
*More severe then inhaled GC*
-Adrenal and bone (worse)
-Pts must be given increased oral/IV GCs in times of severe stress (infection, surgery, trauma)
-Recovery takes several months
~CROMOLYN~ [Intal]
Class - Mast Cell Stabilizer
Also prophylaxis of asthma. Not for ongoing attack
Can be take PRN in anticipation of an episode
1st line of therpay for mod asthma
Cromolyn
Class
Mechanism of Action
Inhaled
Class - Mast Cell Stabilizer
Cromolyn inhibits mast cells from secreting histamine which would have caused an inflammatory effect
Cromolyn
Adverse Effects
SAFEST of all antiasthma medications.
Occasional cough and brochospasm develop.
Want to give during pregnancy b/c it is the SAFEST.
~MONTELUKAST~ [Singular]
Class
Mechanism of Action
Montelukast:
Class - Leukotriene Modifier
MOA: blocks leuko synth/receptors which suppresses inflammation and bronchoconstriction.
MAINTENANCE THERAPY - Does not need fixed schedule, PRN, not for ongoing attack, continually take = better effects
Montelukast
Adverse Effect
Montelukast - Adverse Effects:

Well-tolerated (montelukast best tolerated), headache and GI
Possible liver toxicity and GC DDI
~ALBUTEROL (short-acting inhaled) [Ventolin] & SALMETEROL (long-acting inhaled) [Serevent]~
What are they?
Albuterol and Salmeterol

Beta 2 Adrenergic Agonists
Albuterol (short-acting inhaled) and Salmeterol (long-acting inhaled)
Mechanism of Action
Albuterol and Salmeterol

Action on beta2-adrenergic receptors in lung smooth muscle = bronchodilation

Relieves acute bronchospasm; suppresses histamine release, increases ciliary motility

Prevents exercise-induced bronchospasm
Albuterol (short-acting inhaled) and Salmeterol (long-acting inhaled)

Adverse Effects
Inhaled preparation SEs typically minimal, but can lead to systemic effects (oral preps may inc HR)
Overuse = problematic
Salmeterol shouldn't be given by itself b/c SE w/cardiac
Last but not least:
~THEOPHYLLINE~ [Uniphyl]
Class and NTI
Theophylline (oral, not inhaled)
Class: Methylxanthine
Narrow therapeutic index: plasma level 10-20 ug/ml
Theophylline
Mechanism of Action
Theophylline MOA
Relaxes smooth muscle!
Theophylline
TOXICITY/Side Effects
Theophylline Toxicity/SE:

>30ug/ml = may cause dysrhythmias & convulsions

Multiple DDIs --> Caffeine b/c chemical structure is similar, cimetidine can elevate this drug's levels

2nd or 3rd line of therapy
Wonderful!
That was it!
Go over these slides again to get a good grasp on everything.
Anti-inflammatory agents =
--> Glucocorticoids – easy to get into tissue
Beclomethasone [Beconase, QVAR], inhaled
Prednisone, oral
--> Cromolyn [Intal], inhaled
-->Leukotriene modifiers
Montelukast [Singular], oral
Bronchodilators – inhibit bronchospams =
-->Beta2 agonists
Albuterol [Ventolin], short-acting inhaled
Salmeterol [Serevent], long-acting inhaled
--> Methylxanthines
Theophylline, oral