ASTHMA PREVENTION INTAL (cromolyn sodium) Action: slows destruction of mast cell which releases the histamine resulting in decreased histamine circulation ONLY for prophylaxis NOT A RESCUE MEDICATION Must be inhaled on a set schedule Symptoms improve within 4 weeks See MD at weeks 2 & 4 Do not stop drug abruptly
Types of Asthma Bronchodilators Sympathomimetic (Rescue Drugs) Proventil / Ventolin (albuterol***) Adrenalin Chloride (epinephrine) Isuprel (isoproterenol) Alupent (metaproterenol) Serevent (salmeterol) Brethine (terbutaline) Xanthine (-phylline) Aminophylline Slo-Phyllin (theophylline) *** albuterol has less cardiac side effects & longer bronchodilation than remainder of drugs listed
Action of Bronchodilators Open the airway by stimulating Beta 2 receptors Some drugs have greater effects on Beta 1 (heart) than others Sympathomimetic drugs mimic epinephrine stimulation as side effects Tachycardia and insomnia are frequently seen.
Additional Asthma meds Leukotriene receptor inhibitors (for chronic use); decreases the interleukine release from the injured tissues. NOT a rescue medication Singulair (montelukast) Accolate (zafirlukast)
Corticosteroid Use for Asthma/ COPD Systemic methylprednisolone prednisolone prednisone Inhaled Beclovent (beclomethasone) Pulmicort (cortisone for pulmonary tract) (budesonide) Aerobid (flunisolide) Flovent (fluticasone propionate) Azmacort (triamcinolone acetonide)
Intranasal Steroids (Sprays) Beconase (beclomethasone dipropionate) Rhinocort Aqua (Budesonide) Aerobid (flunisolide) Flonase (fluticasone propionate) Nasonex (mometasone furoate) Nasocort AQ (triamcinolone acetonide) Many are the same as inhaler medications but reformulated for spray application Effects are topical unless swallowed
Actions of Corticosteroid Usage ‘… the most potent and consistently effective medication for long term control of asthma.” Anti-inflammatory; decrease reaction to allergens Systemic steroids are used to get quick control of the airway then inhaled steroids will be used to maintain the effect. Inhaled drugs have a local effect; better for long term use RINSE the mouth after steroid inhalation to prevent thrush
Remember: COME -TAPE- FIGS C = Cataracts O = Osteoporosis M = Mood changes E = Elevated blood sugar T = Thin skin A = Addison’s disease P = Peptic ulcers E = Electrolyte imbalance F = Fluid retention I = Increased risk of infection G = Gain Weight S = Short stature (if taken as a child)
Decongestants Affect alpha cells in blood vessels in nose tissue = vasoconstriction, decreased fluid movement and edema. Prolonged use can lead to rebound vasodilation causing more congestion. Used for congestion in nose, middle ear and Eustachian tube. Decreasing congestion around the auditory tube allows the middle ear to better drain NOT to be used in infants and toddlers Systemic decongestants work better than topical but also have more side effects than topical drugs.
Nasal Decongestants Sympathomimetic bronchodilators ephdrine Epinephrine * * denotes drug used by MDs on a daily basis Inhalers Afrin / Dristan (oxymetazoline) Neo-Synephrine (phenylephrine) Sudafed (pseudoephedrine sulfate)
Expectorants Decrease the thickness of the mucus (by increasing the water content) in the respiratory tract to aid in the ability to remove it. Increases ciliary movement so cough is effective. Anti- tuss/ Robitussin/ Mucinex (guaifenesin) Used often; may increase bleeding tendency. Monitor for bruising or bleeding especially if taking anticoagulants SSKI (iodine products) – use infrequently
Practice A 29 year old male comes to the ED with c/o SOB, wheezing and chest pain when he coughs. 1. What assessments do you perform? 2. What lab tests should be ordered? 3. Would you start an IV (assume orders are present)? What kind? Why? 4. What medications would the nurse anticipate being ordered? 5. What patient teaching should be considered?