Asthma and Pulmonary Disorders

Beta 2 adrenergic agonist prototype drug

albuterol

albuterol mechanism of action

selectively binds to beta2 adrenergic receptors in bronchial smooth muscle to cause bronchodilation

albuterol use

termination of acute bronchospasm

albuterol adverse effects

usually none; HA, throat irritation, nervousness, restlessness, tachycardia, chest pain, allergic reactions

albuterol nursing considerations

caution with history of HTN, do not use with beta blockers, avoid caffeine

anticholinergic prototype drug

ipratropium (atrovent)

ipratropium mechanism of action

causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle

ipratropium use

relief of acute bronchospasm (sometimes combines with beta-agonists or glucocorticoids; also prescribed for chronic bronchitis and for symptomatic relief of nasal congestion — wait 2-3 minutes in between doses)

ipratropium adverse effects

(fight or flight) cant spit, cant shit, cant pee, cant see

cough, drying of nasal mucosa, hoarseness, bitter taste (rinse mouth)

ipratropium nursing considerations

bitter taste (rinse mouth), contraindicated for soy allergy, very little systemic effects (absorbed in the lungs)

corticosteroid prototype drug

beclomethasone (QVAR)

beclomethasone mechanism of action

reducing inflammation, minimize risk of exacerbation

beclomethasone use

decrease frequency of asthma attacks (should not be used to terminate asthma attacks in progress)

beclomethasone adverse effects

dry mouth, change in taste, oropharyngeal candidiasis (rinse mouth)

beclomethasone nursing considerations

can masks s/s infection!!! do not administer for acute asthma attack

leukotriene modifiers prototype drug

montelukast (singulair)

montelukast mechanism of action

prevents airway edema and inflammation by blocking leukotriene receptors in airways

montelukast use

prophylaxis of persistent, chronic asthma

montelukast adverse effects

headache, nausea, diarrhea, liver function (hepatotoxicity with chronic use)

montelukast nursing considerations

do not use to terminate acute asthma attacks, some patients have experienced serious neuropsychiatric events, caution with pre-existing hepatic impairment, administered to children

methylxanthines prototype drug

theophylline

theophylline use

long term management of chronic asthma

theophylline adverse effects

rare; restlessness, insomnia, dysrhythmias

theophylline nursing considerations

reduce caffeine intake, contraindicated with impaired metabolism/tobacco or marijuana use/caffeine, caution with heart disease, liver dysfunction, acute pulmonary edema

mast cell stabilizers prototype drug

cromolyn

cromolyn use

long-term treatment of allergy related asthma, prophylaxis for exercise induced bronchospams

cromolyn adverse effects

allergy

cromolyn nursing considerations

several weeks for full effects, do not use to relieve acute asthma exacerbation