chapter 9
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Chapter 9. Respiratory Drugs. Terms to Define. Asthma Bronchospasm Status Asthmaticus Metered dose inhaler (MDI) Spacer. Nebulizer Bronchodilator. Asthma. Inflammatory disease in which inflammation causes the airways to tighten Reversible condition - PowerPoint PPT PresentationTRANSCRIPT
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Chapter 9
Respiratory Drugs
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Terms to Define
• Asthma• Bronchospasm• Status Asthmaticus• Metered dose inhaler
(MDI)• Spacer
• Nebulizer• Bronchodilator
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Asthma
• Inflammatory disease in which inflammation causes the airways to tighten
• Reversible condition• Intermittent attacks are precipitated by
specific triggering events• Causes a decrease in the amount of
• oxygen and carbon dioxide exchanged
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Asthma
• An asthmatic lung compared to a normal lung– More sensitive– Responds to lower doses of allergens
• Studies strongly support genetic predisposition to developing asthma
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Characteristics of Asthma
1. Reversible small airway obstruction2. Progressive airway inflammation3. Increased airway responsiveness to variety of
stimuli4. = wheezing, dyspnea, acute & chronic cough
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Asthma Attack: First Response
• Triggered by an antigen-antibody reaction• Causes degranulation of mast cells which
release histamine• Result: bronchospasm and increased mucus
production that plugs the small airways
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Asthma Attack: Second Response
• Bronchoconstriction with delayed, sustained reactions
• Causes self-sustaining inflammation
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Asthmatic Response
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Devices Used in Asthma Therapy
• Metered dose inhaler (MDI)– Contains medication and compressed air– Delivers specific amount of medication with each puff
• Spacer– Used with MDIs to get medication into lungs instead of
depositing on back of throat
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Nebulizers
• Uses stream of air that flows through liquid medication to make a fine mist for inhalation
• Very effective• Must be cleaned and taken
care of to reduce risk of contamination
• Used for young children
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Short-Acting Inhaled Bronchodilators
• albuterol– Relaxes bronchial smooth muscle with little effect
on heart rate, duration of 3 to 6 hours
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ProAir/Albuterol (Bronchodilator)
• Works by widening the airways in the lungs• Indicated usage:– Tx or prevent breathing problems in patients with
Asthma– Prevent breathing problems with exercise
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Proventil/Albuterol (Bronchodilator)
• bronchodilator that relaxes muscles in the airways and increases air flow to the lungs– Exercise induced bronchospasm– Prevent bronchospasm in people with reversible
obstructive airway disease
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Ventolin/Albuterol (Bronchodilator)
• a bronchodilator that relaxes muscles in the airways and increases air flow to the lungs
• Indicated usage– Prevent bronchospasm for people with reversible
obstructive airway disease– Prevent exercise induced bronchospasm
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Dispensing Issues of albuterol
• Proventil HFA and ProAir HFA cannot be interchanged
• If Rx for an albuterol inhaler, any of the 3 brands can be used
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Asthma Agents:Leukotriene Inhibitors
• Leukotrienes– Increase edema, mucus, and vascular permeability– Substances can pass through blood vessels– 100 to 1,000 times more potent than histamine
• Block synthesis of, or the body’s inflammatory responses to, leukotrienes
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Montelukast/Singulair (Leukotriene Inhibitor)
• Indicated for prophylaxis and chronic treatment of asthma
• Do not use to treat acute attacks• Approved for use in adults and
children 12 months and older• Once-daily dosage• Also used to treat seasonal
allergies
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Asthma Agents:Corticosteroids
• Anti-inflammatory agents that suppress the immune response
• Used for more difficult cases of asthma• Usually prescribed on alternate-day basis or as
tapering doses when short-term therapy is indicated
• Many patients with asthma still not using
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Primary Side Effects of Corticosteroids
• Oral candidiasis• Irritation and burning of nasal mucosa• Hoarseness• Dry mouth
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Side Effects of Long-Time Use of Oral Corticosteroids
• Growth of facial hair in females• Breast development in males• “Buffalo hump,” “moon face” • Edema• Weight gain• Easy bruising
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Corticosteroids
• Always use lowest effective dose• Add salmeterol to inhaled corticosteroids if
needed to decrease the dose of corticosteroid needed for control
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Dispensing Issues of Corticosteroids
• Patient should rinse mouth with water after using inhalers to prevent oral candidiasis
• Patient should be taught how to correctly use these medications
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fluticasone (Flonase, Flovent) Corticosteroid
• Flonase (Flovent) is same drug in nasal spray Flonase• Flovent comes in 3 strengths– Lowest for mild asthma– Highest to wean patients off oral corticosteroids
• 1 to 2 weeks to reach maximum benefit
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fluticasone-salmeterol (Advair Diskus)
• Combines corticosteroid (anti-inflammatory) and a beta-2 agonist
• Indicated for maintenance therapy in patients 12 years and older
• Available in powder for inhalation• Should not be used with a spacer
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Nasal Corticosteroids
• Most effective monotherapy for allergic rhinitis
• Must be used daily• Can cause nasal irritation and bleeding; direct
spray away from septum• Local infections of Candida albicans may occur
in nose with long term use
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mometasone furoate (Nasonex) (nasal corticosteroids)
• Depresses release of endogenous chemical mediators of inflammation
• Reverses dilation and permeability of vessels in area
• Children over 12 can use to prevent symptoms of allergic rhinitis
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Methylprednisolone/Medrol
• Steroid- prevents the release of substances in the body that cause inflammation
• Tx- allergic disorders
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Promethazine/Phenergan (antihistamine)
• Blocks effects of histamine (which triggers inflammatory response)
• Treat allergy symptoms
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Fexofenadine/Allegra (Antihistamine)
• Blocks the effect of histamine in the body• Tx allergy symptoms