Chapter 9

1. Chapter 9 Respiratory Drugs

2. Terms to Define • Asthma • Bronchospasm • Status Asthmaticus • Metered dose inhaler (MDI) • Spacer • Nebulizer • Bronchodilator

3. 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

4. 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

5. Characteristics of Asthma • Reversible small airway obstruction • Progressive airway inflammation • Increased airway responsiveness to variety of stimuli • = wheezing, dyspnea, acute & chronic cough

6. 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

7. Asthma Attack: Second Response • Bronchoconstriction with delayed, sustained reactions • Causes self-sustaining inflammation

8. Asthmatic Response

9. 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

10. 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

11. Short-Acting Inhaled Bronchodilators • albuterol • Relaxes bronchial smooth muscle with little effect on heart rate, duration of 3 to 6 hours

12. 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

13. 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

14. 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

15. Dispensing Issues of albuterol • Proventil HFA and ProAir HFA cannotbe interchanged • If Rx for an albuterol inhaler, any of the 3 brands can be used

16. 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

17. 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

18. 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

19. Primary Side Effects of Corticosteroids • Oral candidiasis • Irritation and burning of nasal mucosa • Hoarseness • Dry mouth

20. 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

21. Corticosteroids • Always use lowest effective dose • Add salmeterol to inhaled corticosteroids if needed to decrease the dose of corticosteroid needed for control

22. 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

23. 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

24. fluticasone-salmeterol (AdvairDiskus) • 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

25. 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

26. mometasonefuroate (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

27. Methylprednisolone/Medrol • Steroid- prevents the release of substances in the body that cause inflammation • Tx- allergic disorders

28. Promethazine/Phenergan (antihistamine) • Blocks effects of histamine (which triggers inflammatory response) • Treat allergy symptoms

29. Fexofenadine/Allegra (Antihistamine) • Blocks the effect of histamine in the body • Tx allergy symptoms