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Chapter 9

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

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Chapter 9

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  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

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