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Drugs for Control of Asthma

Med Class
BRONCHODILATOR
Short Acting Beta2
Agonist
(Rescue Med)

BRONCHODILATOR
Long Acting Beta2
Agonist
(Controller Med)

BRONCHODILATOR
AntiCholinergic
(Rescue Med)

BRONCHODILATOR
Methylaznthines
(Controller Med)

Med Names

Mechanism of Action

Side Effects

Nursing Considerations

Albuterol (Proventil, Ventolin) Activate the SNS which relaxes HR


the smooth muscle resulting in Anxiety
Nausea
Bronchodilation.
Papitaions
Tremors
Although quite effective at
Adverse Effects
relieving bronchospasms they Hypokalemia
Dysrhythmias
have no anti-inflammatory
properties so other drugs are Paradoxical
needed
Bronchoconstriction

Preferred Drug for relief of acute symptoms


Effect act only for 2-6 hrs
Monitor HR
Fluid Intake (IV or PO) Chronic use causes dry
mouth/throat
-Teach Client about proper technique for using
med
With Chronic use tolerance my develop
Concurrent use with Beta Blocker will inhibit
bronchodilation effect
Avoid MAOIs first 14 days

Long Term Prevention of exercise induced


asthma
Teach patient wont work for acute attacks
Should only be used in pts who cant be controlled
with other meds
Last up to 12 hrs

Levalbuterol(Xopenex)
Pirbuterol (Maxair)
Salmetrol (Serevent)
Terbutaline (Brethine)

Ipratropium (Atrovent)
Comb-Med
Combivent: comnbines
ipratropium &albuterol

theophylline (TheoDur)
Aminophylline IV

SAME

SAME

Block PNS which prevent


vasoconstriction; this causes
same effects of SNS
stimulation vasodilation

Headache
Coughing
Anxiety
Dry Mouth/Throat

Chemically Related to Caffeine

Tachycardia
N/V
Headache
CNS Stimulation
Insomnia
Seizures
Hypokalemia
Hyperglycemia

Treats acute Asthma attacks


Often used in combo with B2 Agonist
Increase Fluid Intake for dry mouth
Shake container well drug seperates
Toxicity : Headache, Blur Vision, Eye Pain,
Palpitations, Nervousness, Nausea

Used for LT prophylaxis of asthma


Infreq prescribed due to narrow safety margin
Used when asthma unresponsive to B2 Agonist
and inhaled steroids

Med Class

Med Names

Mechanism of Action

Side Effects

Nursing Considerations

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ANTI-INFLAMMATORY
Corticosteroids IV

Methylprednisolone sodium Sensitize bronchial smooth


(SoluMedrol)
muscle to be more responsive
to B2 Agonist stimulation
Reduce hyper-responsiveness to
allergens responsible for attack
Decreases lung inflammation

Depression
Euphoria
HTN
Hyperglycemia
Peptic Ulcer
Cushing Syndrome
infection
susceptibility

For Acute exacerbation of Asthma


Give initially then change to Oral prednisone
Never stop suddenly, taper doses
Push over 1 min or more
Do not give acetate form of drug
Monitor Respiration Status and Lung Sound

Depression
Euphoria
HTN
Hyperglycemia
Peptic Ulcer
Cushing Syndrome
infection
susceptibility

Given on tapered schedule following IV


Q daily for severe/debilitating resp disease
Chronic Use avoided if possible due to LT S/E
Tx limited to 5-7 days
Witched to inhalants for LT management

Preferred med for attack prevention


Do not use in cute attack
Symptoms improve in 1-2 week
4-8 weeks req for man benefit
Long-term use can cause systemic
manifestations of prolonged steroid use
Can mask signs of infection

Prophylaxis for chronic persistent asthma


Oral med
Less effective than Corticosteroids
Notify HCP of s/s of liver dysfunction
Caution with liver disease & warfarin therapy

ANTI-INFLAMMATORY Prednisone
Corticosteroids PO

Sensitize bronchial smooth


muscle to be more responsive
to B2 Agonist stimulation
Reduce hyper-responsiveness to
allergens responsible for attack
Decreases lung inflammation

ANTI-INFLAMMATORY Fluticsone (Flovent)


Corticosteroids
Beclomethasone (Vanceril,
Inhaled
QVAR)
Triamcinalone (Azamacort)
(Controller Med)

Suppress Inflammation w/o


Hoarseness
Oralpharyngeal
serious s/e
Acts locally on bronchial tissue to
candidasis
inflammation: Inhibits cytokine Sore throat
production

ANTI-INFLAMMATORY Montelukast (Singulair)


Leukotriene Modifiers Zafirlukast (Accolate)
Zileuton (Ayflo)
(Controller Med)

Reduces Inflammation
Eases bronchoconstriction
Block leukotriene receptors in
airways preventing edema and
inflammation
Hep cases reported

Headache
Cough
Nasal congestion
GI upset

Med Class

Med Names

Mechanism of Action

Side Effects

Nursing Considerations

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ANTI-INFLAMMATORY Cromolyn Sodium (Intal)
Mast cell stabalizer
(Controller Med)

Blocks early and late reaction to Cough


Irritation
allergen
Inhibits mast cells from releasing Bitter Unpleasant
taste
histamine and othe
inflammation mediators
Inhibits inflammatory response to
old air dry air and exercise

Prophylaxis for asthma attack


Max therapy takes several weeks 4-6 wks
Less effective than steroids

Immunomodilator
Monoclonal Antibody

Omalizumab (Xolair)

Attaches to IgE cell preventing


inflammation and dampens
bodys allergy response

Pain
Skin reaction
Anaphylaxis

SubQ injection q 2-4 wks

5-Lipoxygenase
Inhibitor

Zyflo

Inhibits Leukotrienes production

Can inhibit metabolism of warfarin and


theophylline

Mucolytics

Acetylcyteine (Mucomyst)

Controls excess mucus


production
Loosens thick viscous bronchial
secretions

Unpleasant odor
Nausea

Admin MDI. IV. Oral