Drugs For Asthma And COPD Flashcards
Glucocorticoids
(eg) budesonide, fluticasone
Most effective drug available or long term control of airway inflammation
Suppresses inflammation
Used for prophylaxis of chronic asthma
Dosing must be done on a fixed schedule not (prn)
Inhaled glucocorticoids
First line therapy for mgmt of the inflammatory component of asthma
Inhaled are very effective and are much safer than systemic glucocorticoids
Inhaled Glucocorticoids
Beclomethasone Budesonide Ciclesonide Fluticasone Mometasone
Oral Glucocorticoids
Prednisone
Methylprednisolone
Prednisolone
Pre Administration Assessment
Therapeutic goal
Glucocorticoid are used on a fixed schedule to suppress inflammation/ not used for an acute attack
Baseline Data
Determine FEV1 and the frequency and severity of attack and attempt to identify trigger factors
Identify High Risk Patients
Inhaled glucocorticoids- Contraindicated or pt with persistently positive sputum cultures for Candida albicans
Oral Glucocorticoids:
Contraindicated for pt with systemic fungal infections or pt receiving live virus vaccines
Caution:
In peds pt and pregnant or breastfeeding
Also pt hypertension heart failure, renal impairment, esophagitis, gastritis, peptic ulcer, myasthenia gravis, diabetes, osteoporosis, or infections that are resistant to treatment, pt receiving potassium depleting diuretics,digitalis glycosides, insulin, oral hypoglycemic and non steroidal antiiflammatory drugs
Implementation: Administration
Route:
Inhalation, oral
Administration
Inform pt that glucocorticoids are intended for preventative therapy- not for an ongoing attack. Instruct pt to administer glucocorticoids on a regular schedule and not PRN
INHILATION:
Administered with MDI DPI or Nebulizer: teach pt how to use these devices. Inform pt that delivery of glucocorticoids to the bronchial tree can be enhanced by inhaling SABA 5 min before inhaling the glucocorticoid.
ORAL:
Alternate day therapy is recommended to minimize adrenal suppression; instruct pt to take one dose every other day in the morning. During long term tx supplemental doses must be given at times of severe stress.
Ongoing Eval and interventions
Evaluating therapeutic effects:
Teach pt with chronic asthma to monitor and record PEF, symptom frequency and symptom intensity, night time awakening, impact on normal activity and SABA use.
Minimizing adverse effects
Inhaled glucocorticoids:
Advise pt to rinse their mouth and gargle after dosing to minimize dysphonia and oropharyngeal candidiasis. If candidiasis develops it can be tx with anti fungal medications
Warn pt who have switched from long term oral glucocorticoids to inhaled glucocorticoids that because of adrenal suppression they must take supplemental systemic glucocorticoids at times o severe stress (trauma, surgery, infections) failure to do so can be FATAL
To minimize possible bone loss pt should use the lowest dose possible. Advise pt to ensure adequate intake of calcium, vit D, and to perform weight bearing excersise.
ORAL GLUCOCORTICOIDS:
Prolonged can cause adrenal suppression and other serious side effects, including osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression, pt taking glucocorticoids long term must be given supplemental oral or IV glucocorticoids at times of stress failure to do so can be FATAL
BETA2-ADRENERGIC AGONIST
INHALED: SHORT ACTING Albuterol Levalbuterol INHALED LONG ACTING Arformoterol Formoterol Indacaterol Salmeterol ORAL Albuterol Terbutaline
Pre administration Assessment
Therapeutic Goal
Short acting inhaled beta 2 agonist are used PRN for prophylaxis o EIB and to relieve ongoing asthma attacks. Oral and inhaled long-acting beta2 agonists are used for maintenance therapy.
BASELINE DATA
Determine FEV and the frequency and severity of attacks and attempt to id trigger factors
IDENTIFYING HIGH RISK PATIENTS
Systemic (oral ,parenteral) beta2 agonists are contraindicated for pt with tachydysrhythmia or tachycardia associated with digitalis toxicity
Caution with pt with diabetes, hyperthyroidism, organic heart disease, hypertension or angina pectorals.
Implementation: Administration
Route:
USUAL: Inhalation
Occasional: Oral, Subcutaneous
Administration:
Inhalation: Administered with MDI DPI or Nebulizer. Teach pt how to use the devices. For pt with difficulty with hand-breath coordination, use a spacer with a one way valve may improve results.
Inform pt who are using MDI or DPI that when 2 inhalation are needed an interval of at least 1 minute should elapse between inhalations.
Warn patients against exceeding the recommended dosage.
Inform pt that inhaled LABAS (Formoterol, arformoterol, and salmeterol) should be taken on a fixed schedule -NOT PRN- and always in combination with and inhaled glucocorticoid, preferably in the same inhalation device.
ORAL
Instruct pt to take oral beta2 agonists on a fixed schedule and not PRN
Instruct pt to swallow sustained release preparations intact without crushing or chewing
Ongoing Evaluation and Intervention
Evaluating therapeutic Effect
Teach pt with chronic asthma to monitor and record PEF, symptom frequency and symptom intensity, nighttime awakenings, impact on normal activity, and SABA use.
MINIMIZING Adverse Effects
Inhaled short acting Beta2 Agonist. When used at recommended doses SABAS are generally devoid of significant adverse effects. Cardiac stimulation and tremors are most likely with systemic therapy.
Inhaled Long Acting Beta 2 Agonist
When used correctly LABAS are safe; however, when used alone or prophylaxis; they may increase the risk of severe asthma attack and asthma related death. To minimize risk these drugs should always be combined with an inhaled glucocorticoid preferably in the same device
ORAL Beta2 Agonist
Excessive dosing can activate beta1 receptors on the heart, resulting in angina like pain and tachydysrhythmia-Instruct pt to report chest pain and changes to heart rate or rhythm
Tremor is common with systemic beta2 agonist and usually subsides with continued drug use. If necessary tremor can be reduced by lowering the dosage
