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24 Cards in this Set
- Front
- Back
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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?! |
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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 |
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Signs and Symptoms of Asthma
Name 5 |
Breathlessness
Tightening of chest Wheezing – increased mucus Dyspnea Cough – increased mucus |
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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 |
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There are 3 ways to administer these drugs. Name them!
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Metered-Dose inhalers (spacers helpful)
Dry Powder Inhalers Nebulizers (misty) |
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Okay! On to the drugs.
~BECLOMETHASOME [QVAR] & PRESNIZONE~ |
Both are INHALED GLUCOCORTICOIDS so we'll be talking about both of them at one time.
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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. |
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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? |
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Beclomethasome
Inhaled GC SIDE EFFECTS |
--> Adrenal suppression and bone loss (esp in premenopausal women) in long term, high-dose therapy
--> Oropharyngeal candidiasis and dysphonia |
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What would be your nursing interventions for adverse effects of Beclomethasome?
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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 |
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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 |
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~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 |
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Cromolyn
Class Mechanism of Action |
Inhaled
Class - Mast Cell Stabilizer Cromolyn inhibits mast cells from secreting histamine which would have caused an inflammatory effect |
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Cromolyn
Adverse Effects |
SAFEST of all antiasthma medications.
Occasional cough and brochospasm develop. Want to give during pregnancy b/c it is the SAFEST. |
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~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 |
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Montelukast
Adverse Effect |
Montelukast - Adverse Effects:
Well-tolerated (montelukast best tolerated), headache and GI Possible liver toxicity and GC DDI |
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~ALBUTEROL (short-acting inhaled) [Ventolin] & SALMETEROL (long-acting inhaled) [Serevent]~
What are they? |
Albuterol and Salmeterol
Beta 2 Adrenergic Agonists |
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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 |
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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 |
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Last but not least:
~THEOPHYLLINE~ [Uniphyl] Class and NTI |
Theophylline (oral, not inhaled)
Class: Methylxanthine Narrow therapeutic index: plasma level 10-20 ug/ml |
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Theophylline
Mechanism of Action |
Theophylline MOA
Relaxes smooth muscle! |
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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 |
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Wonderful!
That was it! |
Go over these slides again to get a good grasp on everything.
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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 |
