[ATI MISC] Medications for Lower Respiratory Airflow Disorders

fluticasone/vilanterol/umeclidium

Classification: Combination of Inhaled Glucocorticoid, LABA, and LAMA

Therapeutic use: Used for maintenance treatment of COPD and severe asthma.

fluticasone/salmeterol

Classification: Respiratory Inhalant Combination Medications

Therapeutic use: Used for maintenance treatment of COPD.

budesonide/albuterol

Classification: Respiratory Inhalant Combination Medications

Therapeutic use: Prevents bronchoconstriction and reduces exacerbations of asthma.

vilanterol/umeclidinium

Classification: Respiratory Inhalant Combination Medications

Therapeutic use: Used for maintenance treatment of COPD.

albuterol/ipratropium

Classification: Respiratory Inhalant Combination Medications

Therapeutic use: Treats COPD.

Mast Cell Stabilizers

Mast cell stabilizers are another anti-inflammatory inhalant-type of medication that is used to reduce bronchial inflammation prophylactically in mild to moderate asthma. They treat long-term allergy-related asthma. They can also be used to prevent exercise induced bronchospasm (EIB) and seasonal allergy manifestations and for the management of allergic rhinitis. In the case of allergic rhinitis, intranasal instillation of cromolyn is required.

Prototype and Other Medications

The prototype mast cell stabilizer that you will use is cromolyn

Expected Pharmacologic Action

Mast cell stabilizers suppress inflammation in a manner similar to corticosteroids. They prevent the release of leukotrienes and histamine, which mediate inflammation. They also keep white blood cells such as leukocytes and eosinophils from stimulating the inflammatory response by attacking foreign cells. Minimizing the actions of these cells decreases inflammation and subsequently, edema of the airways. They do not have bronchodilation effects.

Adverse Drug Reactions

As one of the safest antiasthma medications, cromolyn has minimal adverse drug reactions. Cough or bronchospasm may occur in fewer than 1 out of 10,000 clients using cromolyn.

Interventions

Cromolyn is contraindicated in clients who have demonstrated a previous allergic response to the medication.

Administration

Give mast cell stabilizers with a power-driven nebulizer. Following an initial dosage of 20 mg four times daily, clients should be maintained on the lowest effective dosage. To prevent EIB, administer 10 to 15 min prior to activity and no sooner than 1 hr prior. When used prophylactically to avoid seasonal allergies, take cromolyn prior to exposure (such as performing yardwork).

Client Instructions

Take as prescribed for prevention of exacerbations of asthma. This medication will not be effective against an acute asthma attack. It may take up to several weeks to achieve therapeutic effects.

Safety Alert

Although severe allergic reactions are relatively rare with mast cell stabilizers, instruct the client to seek medical care immediately for sudden rash, swelling of the mouth or throat, or wheezing after use.

Contraindications and Precautions

The use of mast cell stabilizers is contraindicated in clients who are allergic to cromolyn.

Interactions

There are no known medication or food interactions with mast cell stabilizers.

Cromolyn

Classification: Mast Cell Stabilizers

Therapeutic use: Treats allergy-related asthma. Prophylaxis for exercise-induced bronchospasm and seasonal allergy manifestations. Used for management of allergic rhinitis.

Mast Cell Stabilizers – cromolyn

THERAPEUTIC USE • Long-term treatment of allergy-related asthma • Prophylaxis for exercise-induced bronchospasm • Prophylaxis for seasonal allergy manifestations • Management of allergic rhinitis (intranasally)

ADVERSE DRUG REACTIONS • Allergic reaction in clients with known allergy to cromolyn

INTERVENTIONS • Administer epinephrine and/or antihistamines to reverse anaphylaxis.

ADMINISTRATION • Use with a nebulizer or metered-dose inhaler. • Expect several weeks of use for full effects to become apparent. • Administer four times daily on a fixed schedule. • Use the inhaler 15 min before exercising to prevent exercise-induced bronchospasm. • Do not use to relieve an acute asthma exacerbation.

CLIENT INSTRUCTIONS • Seek medical care immediately for sudden rash, swelling of the mouth or throat, or wheezing after use.

CONTRAINDICATIONS AND PRECAUTIONS • Allergy to cromolyn

INTERACTIONS • None known