12 ASTHMA PREVENTION INTAL (cromolyn sodium) Action: slows destruction of mast cell which releases the histamine resulting in decreased histamine circulationONLY for prophylaxisNOT A RESCUE MEDICATIONMust be inhaled on a set scheduleSymptoms improve within 4 weeksSee MD at weeks 2 & 4Do not stop drug abruptly
13 Types of Asthma Bronchodilators Sympathomimetic(Rescue Drugs)Proventil / Ventolin(albuterol***)Adrenalin Chloride(epinephrine)Isuprel(isoproterenol)Alupent(metaproterenol)Serevent (salmeterol)Brethine (terbutaline)Xanthine (-phylline)AminophyllineSlo-Phyllin(theophylline)*** albuterol has less cardiacside effects & longer bronchodilationthan remainder of drugs listed
14 Action of Bronchodilators Open the airway by stimulating Beta 2 receptorsSome drugs have greater effects on Beta 1 (heart) than othersSympathomimetic drugs mimic epinephrine stimulation as side effectsTachycardia and insomnia are frequently seen.
15 Additional Asthma meds Leukotriene receptor inhibitors (for chronic use); decreases the interleukine release from the injured tissues. NOT a rescue medicationSingulair(montelukast)Accolate(zafirlukast)
16 Corticosteroid Use for Asthma/ COPD SystemicmethylprednisoloneprednisoloneprednisoneInhaledBeclovent(beclomethasone)Pulmicort (cortisone for pulmonary tract)(budesonide)Aerobid (flunisolide)Flovent (fluticasone propionate)Azmacort (triamcinolone acetonide)
17 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 applicationEffects are topical unless swallowed
18 Actions of Corticosteroid Usage ‘… the most potent and consistently effective medication for long term control of asthma.”Anti-inflammatory; decrease reaction to allergensSystemic 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 useRINSE the mouth after steroid inhalation to prevent thrush
19 Remember: COME -TAPE- FIGS C = CataractsO = OsteoporosisM = Mood changesE = Elevated blood sugarT = Thin skinA = Addison’s diseaseP = Peptic ulcersE = Electrolyte imbalanceF = Fluid retentionI = Increased risk of infectionG = Gain WeightS = Short stature (if taken as a child)
20 DecongestantsAffect 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 drainNOT to be used in infants and toddlersSystemic decongestants work better than topical but also have more side effects than topical drugs.
21 Nasal Decongestants Sympathomimetic bronchodilators Inhalers ephdrineEpinephrine ** denotes drug used by MDs on a daily basisInhalersAfrin / Dristan(oxymetazoline)Neo-Synephrine(phenylephrine)Sudafed(pseudoephedrine sulfate)
22 ExpectorantsDecrease 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 anticoagulantsSSKI (iodine products) – use infrequently
23 PracticeA 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?