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Team Blue:

Asthma Part II. Team Blue:. Heather Carballo, Dana Horton, Claudette Johnson, Kimberly Kusch. Grand Canyon University: NUR: 641 November 21, 2012. PharmacoTherapy. Goals. Types. ( Lehne, 2013 ). Relievers. Contr0llers. Long Acting Bronchodilators (LABA). Short Acting Bronchodilators

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Team Blue:

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  1. Asthma Part II Team Blue: Heather Carballo, Dana Horton, Claudette Johnson, Kimberly Kusch Grand Canyon University: NUR: 641 November 21, 2012

  2. PharmacoTherapy Goals Types (Lehne, 2013)

  3. Relievers Contr0llers Long Acting Bronchodilators (LABA) Short Acting Bronchodilators SABA (Lehne, 2013)

  4. Medication: Determined By Severity Both control and rescue medications come in MDI (metered dose inhalers) and nebulized forms Control medications are also available in dry powder discs, breath actuated inhalers and pill form (Asthma Organization, 2012) (Lehne, 2013; Schiffman& Szeftel, 2012)

  5. Relievers Short-acting Inhaled Bronchodilators Pediapred Prelone Prednisone Orapred • Prevents progression of moderate to severe exacerbations, reduces inflammation Potential adverse effects • Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache • Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts Proventil, Ventolin(Albuterol) Xopenex(Levalbuterol) MaxairAutohaler(Pirbuterol) Alupent (Metaproterenol) • For relief of acute symptoms or as preventive treatment prior to exercise Potential adverse effects • Tremors, tachycardia, headache Therapeutic issues • Drugs of choice for acute • bronchospasm SystemicCorticosteroids (Lehne, 2013; Mayo Clinic, 2012; McCance & Huether, 2010)

  6. Relievers Ephedra (Ma Huang) • Dangerous and should be avoided • Potent CNS and CV stimulant • Can be a precursor for methamphetamine • FDA recently banned its use • Many other herbal folk remedies used by different cultures Herbal Therapy (Schiffman& Szeftel, 2012) (Lehne, 2013; McCance & Huether, 2010)

  7. Controller Medications Corticosteroids: Pulmicort, QVAR, Alvesco, AeroSpan, Flovent • Pharmacokinetics: Peak concentration in thirty minutes for inhaled therapy, 34% distributed in the lungs and systemic availability is 39%. Rapidly metabolized and excreted in urine and feces (Pulmicort Pharmacology, 2006). • Pharmacodynamics: Rapid onset of action, asthma improvement demonstrated within 24 hours after starting treatment although full benefits may take one to two weeks to be seen. When orally inhaled there is a direct effect on the respiratory system(Pulmicort Pharmacology, 2006). • Drug Interactions: certain antibiotics, antidepressants, and ketoconazole (Pulmicort Pharmacology, 2006). • Side effects: Runny nose, sore throat, white patches in mouth, nose bleed, headache(Pulmicort Pharmacology, 2006). • Adverse effects: Worsening respiratory symptoms, wheezing, vision changes and weakness(Pulmicort Pharmacology, 2006).

  8. Controller medications Long Acting Beta Agonist: Brovana, Perforomist, Arcapta, SereventDiskus • Pharmacokinetics: These medications typically work locally within the lungs. Taking plasma levels will not indicate therapeutic effects. These medications are 96% protein binding and are excreted in the feces and urine. The usual half life of these medications are usually fairly long, on average about 5-7 days (Kim, 2009). • Pharmacodynamics: Effects of these medications usually last about 12 hours. Causes bronchodilation by relaxing smooth muscles in the airway (Kim, 2009) • Drug Interactions: Erithromycin, beta blockers, MAOI’s, antidepressants, non-potassium sparing diuretics (Kim, 2009.) • Side effects: Headache, nasal congestion, nausea/vomiting,skeletal muscle pain. • Adverse effects: Bronchospasms which could cause worsening respiratory effects, irritation or swelling of the airway, hypertension, increased heart rate, hypokalemia (Kim, 2009).

  9. Assessment (Stanley et al., 2008)

  10. Nursing diagnosis (Stanley et al., 2008)

  11. planning (Stanley et al., 2008)

  12. implementation (Stanley et al., 2008)

  13. evaluation (Stanley et al., 2008)

  14. Patient Resources • Health Care Provider • Community Resources • Public Health Department • Patient Education Tools* • Your Voice-Advocacy • School Nurse Take Control of your Asthma

  15. References American Lung Association. (2012). Learning more about Asthma. Retrieved from http://www.lung.org/lung-disease/asthma/ Gulanick, M., & Myers, J. (2011). Nursing Care Plans (7th ed.). St. Louis: Mosby Elsevier. Kaufman, G. (2012). Asthma: assessment, diagnosis, and treatment adherence. Nurse Prescribing, 10(7), 331-338. Kim, D. (2009). Evaluation of Long Acting Beta Agonists. Allergy and Immunology, 8, 933-940. Lehne, R.A. (2013). Pharmacology for nursing care. (8th ed.) St. Louis: Saunders Elsevier. 967-981. Mayo Clinic. (2011). Asthma inhalers: Which one's right for you? Retriever from http://www.mayoclinic.com/health/asthma-inhalers/HQ01081 McCance, K.L. & Huether, S.E.(2010). Pathophysiology: The biologic basis for disease in adults and children. (6th ed.). St. Louis: Mosby Elsevier.1285-1286. Pulmicort Pharmacology. (2006). Retrieved November 9, 2012, from Drug List 1: www.1stdruglist.com/pumicort.html Schiffman, G. & Szeftel, A. (2012). What asthma medications to use. MedicineNet. Retrieved from http://www.medicinenet.com/asthma/page9.htm#what_medications_are_used_in_the_treatment_of_asthma

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