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NRSG Pharm Ch 40
Asthma
| Question | Answer |
|---|---|
| Sympathetic branch | B2 adrenergic receptors, cause bronchiolar smooth muscle relaxation -> bronchodilation |
| Parasympathetic branch | Bronchiolar smooth muscle contraction -> bronchoconstriction |
| Inhalation admin | Aerosol therapy, rich blood supple allows for quick absorption and rapid onset - immediate relief of bronchospasm. Delivers drug directly to site of action, reducing systemic effect |
| Oral | Longer duration, freq side effects, tolerance may develop |
| Nebulizer | Vaporizes liquid drug, small machine and face mask |
| MDI | Propellant delivers measured dose, pt times inhalation to puffs of drug |
| DPI | Dry powder inhaler, inhales powdered drug, device activated by inhalation |
| Asthma | Chronic, both inflammatory and bronchospasm. s/sx occur from exposure to triggers or upon exertion, status asthmaticus = prolonged attack |
| Rapid acting medications | B2 adrenergic agonists, anticholinergics, systemic corticosteroids |
| Long acting | inhaled corticosteroids, leukotriene modifiers, mast cell stabilizers, long acting B2 agonists, methylxanthines, immunomodulators |
| Bronchodilators | SABAs, anticholinergics, LABAs, methylxanthines |
| antinflammatory | Corticosteroids, mast cell stabilizers, leukotriene modifiers, |
| Immunomodulators | Monoclonal antibody |
| Beta-adrenergic agonists | Most effective for acute bronchospasms, activate B2 receptors in bronchial smooth muscle -> bronchodilation, fewer cardiac signs than non-selective, range from ultrashort to long-acting |
| albuterol (Proventil, Ventolin HFA) considerations | short acting, rapid onset, excellent safety profile. Inhaled 15-30 prior to exercise, otherwise not recommended for prophylaxis |
| albuterol (Proventil, Ventolin HFA) classes, mech | bronchodilator, B2 agonist, selective, relieve bronchospasm in asthma |
| albuterol (Proventil, Ventolin HFA) side/adverse | serious adverse from inhaled are uncommon, tachy, palp, tremor, nervousness, restlessness, headache, throat irritation. Cautious use if pt has hx dysrhythmia, MI |
| Anticholinergics | Block parasymp, bronchodilation effect, occasionally used as alternative to B2 agonist, used in inhaled |
| ipratropium (Atrovent) classes, mech | Bronchodilator, anticholinergic, relief of acute bronchospasm sometimes combines w/ B agonist or glucocorticoids, also prescribed for chronic bronchitis and s/sx nasal congestion |
| ipratropium (Atrovent) MDI | Instruct pt, inhibits nasal secretions but does not have decongestant, treatment limited to 3 wk |
| ipratropium (Atrovent) side/adverse | few systemic, irritation in URT = cough, drying OT nasal mucosa, hoarseness. bitter taste - rinse after use! IN - epistaxis, drying |
| Anticholinergic considerations | Hx narrow angle glaucoma, benign prostatic hyperplasia, renal disorders, urinary bladder neck obstruction. RR before and after first dose MDI |
| Corcicosteroids | Most potent natural anti-inflammatory drug inhaled: drug of choice for long-term prophylaxis of asthma - taken daily, systemic side rarely observed. Oral = short-term of severe, acute exacerbations |
| beclomethasone (QVAR) classes, mech | Anti-inflammatory for asthma, inhaled corticosteroid, primary use to reduce freq of asthma attacks. + allergic rhinitis, NOT for acute asthma attacks. 1st line drug for long-term management. 3-4wk for effect. |
| beclomethasone (QVAR) forms | aerosol inhalation for asthma, nasal spray allergic rhinitis |
| beclomethasone (QVAR) side/adverse | inhaled: few systemic, Local: hoarseness, dry mouth, taste change Oropharyngeal candidiasis - fungal infection in throat. Rinse after use, avoid swallowing to avoid systemic absorption. |
| corticosteroid application | Asses for hx- asthma, allergic rhinitis, hypertension, heart disease, fungal infection, DM, infections |
| corticosteroid inhaled primary | Prevention, NOT acute - monitor for infections, rinse mouth after steroid inhalers, monitor BGL |
| Leukotriene modifiers | Primarily for prophylaxis, reduce inflammatory component of asthma, oral medication |
| montelukast (Singulair) | anti-inflammatory drug for asthma prophylaxis. Leukotriene modifier. Prevent airway edema/inflammation by blocking leukotriene receptors in airway. |
| montelukast (Singulair) uses, admin | prophylaxis/maintenance of persistent, chronic asthma PO, rapid acting Not for acute bronchospasm |
| montelukast (Singulair) side/adverse | Few serious adverse, headache, nausea, diarrhea |
| COPD | Obstructed airflow, commonly caused by chronic bronchitis, asthma, emphysema pharm goals: relieve s/sx, avoid complications |
| COPD drug classes | bronchodilators, mucolytics/expectorants, oxygen therapy, antibiotics |
Created by:
kmulla
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