Asthma - EXAM 3 Flashcards
albuterol (Proventil)
Classification:
- Beta-adrenergic agonist, bronchodilator, abbreviated SABA (short acting beta-adrenergic agonist)
Mechanism of Action:
- Bronchodilates by activating beta 2 receptors in the SNS on bronchial smooth muscle. This causes the smooth muscles to relax and the broncial tree to open.
Side/Adverse Effects:
- Tachycardia
- Palpitations
- Nervousness
- N/V
- Muscle tremors
- Dry mouth
- HA
- Hypokalemia
- Paradoxic bronchospasm
Nursing Implications:
- Considered a rescue medication
- Stop drug immediately if paradoxic bronchospasm occurs
- Limit caffeine products
- Use of a spacer is recommended
Speed of Action:
- Very rapid onset 1-3 minutes
- Effective for 4-8 hours
ipratropium (Atrovent)
Classification:
- Anticholinergic-bronchodilator
Mechanism of Action:
- Inhibits the effect of acetycholine at receptor sites of bronchial smooth muscle, resulting in bronchodilation
Use:
- A secondary rescue agent
- Additive effect when used with Albuterol
- Promotes bronchodilation during bronchospasm in those with COPD and asthma
- Decreases bronchial secretions
Side/Adverse Effects:
- Overuse may cause bronchospasm
- Palpitations
- N/V
- Dry mouth
- Cough
- Anxiety
- Dizziness
- HA
- Nervousness
Nursing Implications:
- Teach patient/family correct method of inhalation
- Evaluate therapeutic response. If symptoms worsen, notify MD.
- Is used in the MDI or nebulization, alone and/or in combination
Speed of Action:
- Onset of action peaks at 30 minutes-1 hour
- Effective up to 4-6 hours
fluticasone (Flovent)
Classification:
- Inhaled corticosteriod, anti-inflammatory
- Abbreviated ICS (inhaled corticosteroid)
Mechansim of Action:
- Decreases swlling and irritation in the bronchial airways. Effective in late phase reaction of asthma
Use:
- Not effective for an acute asthma attack
- Used in preventative management of persistent asthma symptoms (mild-severe)
Side/Adverse Effects:
- Acts locally in R. tract with relatively rare systemic side effects.
- HA
- Nasal congestion
- Diarrhea
- Difficulty speaking
- Back/joint pain
Nursing Implications:
- May take 2 weeks or longer to feel full benefit
- Reinforce need to rinse mouth after medication administration to prevent opportunistic oral fungal infections (thrush)
- Use of a spacer may lower incidence of thrush
- Applicator and spacer must be cleaned regularly
Speed of Action:
- Onset is 12 hours with speak in several days
montelukast (Singulair)
Classification:
- Leukotriene receptor antagonist
- Abbreviated LTRA
Mechanism of Action:
- Inhibits bronchoconstriction by selectively antagnoizing leukotriene receptors
Use:
- Leukotrienes induce bronchoconstriction and mucus production and are important inflammatory agents
- Montelukast is used to control the bronchoconstriction and mucus production associated with asthma
Side/Adverse Effects:
- Anorexia
- Nausea
- Diarrhea
- Dizziness
- HA
- Cough
- Influenza
- Laryngitis
- Pharyngitis
- Drowsiness
Nursing Implications:
- Give in the evening for max effectiveness, as leukotriene levels are higher at night
- Better to take when breathing is more controlled
- Not a rescue drug - do not use for an acute asthma attack
- Periodic LFTs
Speed of Action:
- Rapidly absorbed. Peak effect in 3-4 hours.
salmeterol/fluticasone (Advair)
Classficiation:
- Long acting beta adrenergic agonist in combination with an inhaled corticosteroid.
- Abbreviated LABA
Mechanism of Action:
- Binds to the beta 2 receptors in the lungs, causing bronchodilation along with potent anti-inflammatory activity resulting in reduced swelling and irritation.
Use:
- Prevention and maintence thearpy for bronchospasms in patients with asthma, COPD, and exercise induced asthma
Side/adverse Effects:
- HA
- Tremors
- Tachycardia
- Palpitations
- Bronchospasm
- Pharyngitis
- Upper R. tract infections
Nursing Implications:
- Instruct patient on proper use of a dry powder multiclose inhaler.
- Do not use to stop an asthma attack.
- Teach patient to carry an inhaled, short-acting beta2 antagonist for acute symptoms.
- Rinse mouth after use to decrease incidence of thursh
- Use no more than BID dosing
Green Zone
Doing Well
- Signals all clear
- No cough, wheeze, chest tightness, or shortness or breath during the day or night
- Can do usual actitivites
- PEFR greater than 80% of personal best
- Patient should use daily control medications
Yellow Zone
Asthma is getting worse
- Signals caution
- Cough, wheeze, chest tightness, or shortness of breath
- Waking at night due to asthma
- Can do some but not all usual activities
- PEFR 50%-80% of personal best
- Patient should add rescue medications
Red Zone
Medical Alert!
- Signals a medical alert
- Very SOB
- Rescue medications have not helped
- Cannot do usual activities
- PEFR less than 50% of personal best
- Patient should increase rescue medications and call physician immediately
Asthma
- Chronic inflammatory disorder of the airways, associated with widespread but variable airflow obstruction that is usually reverisble
- Affects 18.8 million Americans
- Morbidity impacts school, jobs, physical activities
- Public health concern: over 14.2 million lost workdays in adults
- Women are 62% more likely to have asthma than men
- Over 3,300 deaths per year from asthma, but decreasing over the past 10 years
Asthma Triggers
- Allergens
- Respiratory infections/sinus problems
- Certain drugs
- ASA/NSAIDs
- Beta blockers
- Food additives
- Occupational exposures/air pollutants
- Hormones
- GI reflux
- Can also be exercise induced or triggered by emotional stress
Pathophysiology of Asthma
- Involved inflammation and nonspecific hyper-irritability and hyper-responsiveness of tracheal bronchial tree
- Specifically, triggers activate mast cells, causing the release of inflammatory mediators (ex. histamine, leukotrienes)
- This leads to intense inflammation, bronchial smooth muscle contraction, vasodilation, increased capillary permeability, and increased mucus production
- These acute changes lead to epithelial damage which causes a chronic change called remodeling or progressive, irreversible lung damage
What occurs in the airways (asthma)?
- Bronchospasm
- Constriction of bronchial smooth muscle
- Increased mucus production
- Edema and mucosal inflammation
Clinical symptoms of Asthma
- Chest tightness
- Dyspnea
- Cough
- Wheezing
- Symptoms are variable
- All are related to reduced airway diameter and increased airway resistance
Remodeling
Over time, chronic changes occur within the airways
- Bronchial smooth muscle hypertrophy
- Basement membrane thickening
- Mucus gland hypertrophy
- Thick, tenacious sputum
- Hyperinflation and air trapping in lungs
Treatment of Asthma
- Patient education re: self-monitoring of symptoms and daily PEFR measurements
- Avoidance of exposure to triggers
- Daily medication plan, including controllers and rescuers
- Individualized asthma action plan for managing exacerbations
- Treatment of underlying conditions (ex. GERD)
What are the advantages of combination therapy to patients?
- Long acting
- Maintain better control of symptoms
- Patients are more compliant due to decreased number of different inhalers and decreased freqency of dosing
If a patient were prescribed an inhaled corticosteroid, should he/she be concerned about systemic side effects?
When medication delivery device is used correctly, little systemic drug absorption occurs. Local side effects of thrush, hoarseness, and dry cough can be minimized by rinsing mouth after use and using a spacer with MDIs.
What are the advantages of DPIs (dry powder inhalers) VS MDIs (metered-dose inhalers)?
- Less manual dexterity and coordination between puffs and inhalation needed
- Provide long-acting symptom control
- No spacer is required
If a beta-adrenergic agnoist causes bronchodilation, what classfication of medications could result in bronchocontriction?
Beta adrenergic antagonist, AKA beta blockers, could cause bronchospasm and wheezing and should be used cautiously in patients with asthma or COPD
Status Asthmaticus
Life threatening asthma, a medical emergency. Symptoms are more severe, prolonged, and can lead to R. failure. Aggressive interventions, including intubation and mechanical respiration should be anticipated
What are the potential complications of giving anti-anxiety medications to a patient with severe asthma?
Sedatives can cause depression of the R. drive and can result in death. They are not routinely recommended during asthma exacerbations. However, if ordered and administered in small doses, the RN must vigilantly observe for R. and CNS depression.
Aerosolized Nebulizer
- Nebulizers are small machines used to convert drug solutions into mists using either air or oxygen so that the patient can breathe the medication into their lungs
- Inhalation of the mist can be done through a face mask or mouthpiece held between the teeth
- Patients should be put in an upright position and instructed to breathe slowly and deeply through the mouth
- due to the potential for bacterial growth, the medication container should be rinsed with sterile water or normal saline after each treatment in the acute care setting. In the home, a daily cleaning method should be used.
Metered-Dose Inhaler (MDI)
- MDIs are small, hand-held, pressurized canisters that deliver a measured dose of drug with each activation
- MDIs may be used with or without a spacer
- A major problem with MDI drugs is the potential for overuse
- MDIs require the ability to coordinate activation with inspiration
Spacer/Aerochamber
- A spacer is a device that holds the medication in its chamber long enough for the patient to inhale it slowly
- Spacers greatly reduce the amount of medication lost in mouth and throat and increase the effectiveness of inhaler medications
- Spacer can decrease the chance of the patient developing thrush when useing unhaled steroids
Dry Powder Inhalers (DPI)
- DPIs are useful for prophylactic and maintenance therapy on patients with asthma and COPD and are simpler to use than MDIs
- DPIs contain dry, powedered medication and are breath activated
