Rescue Medication - Asthma and COPD Flashcards
SABA - Meds
albuterol, levalbuterol
SAMA - Meds
ipratropium, ipratropium/albuterol
Systemic Corticosteroid - Meds
methylprednisolone, prednisolone, prednisone, dexamethasone, methylprednisolone acetate
Systemic/Subcutaneous Beta-2 Agonists - Meds
epinephrine, terbutaline
albuterol - Age Group
all ages
albuterol - Dosage Forms
HFA: MDI, Aerosol Powder Inhaler
Nebulizer
albuterol - Adverse Effects
Tachycardia, tremor, hypokalemia (low potassium), irritability
albuterol - Clinical Pearls
- Chronic use (>2x /day) indicates poor asthma control
- May mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
- In mild to moderate exacerbation, MDI plus valved holding chamber is as effective as nebulized therapy w/ appropriate administration technique and coaching by trained personnel
albuterol - Brand Name
ProAir, Ventolin, Proventil, ProAir Respiclick, ProAir Digihaler
levalbuterol - Brand Name
Xopenex
levalbuterol - Age Group
all ages
levalbuterol - Dosage Forms
HFA: MDI
Nebulizer
levalbuterol - Adverse Effects
tachycardia, tremor, hypokalemia (low potassium), irritability
levalbuterol - Clinical Pearls
- Reserved for pts who do not respond to albuterol for quick relief
- Nebulizer solution compatible with budesonide inhalant suspension
- Levalbuterol administered in 1/2 the mg dose of albuterol provides comparable efficacy and safety
- Has not been evaluated by continuous nebulization
ipratropium - Brand Name
Atrovent
ipratropium - Dosage Forms
HFA: MDI
Nebulizer
ipratropium - Age Group
all ages
ipratropium - Adverse Effects
Dry mouth, urinary retention, infection, sinusitis, bronchitis
ipratropium - Clinical Pearls
- Used in combo w/ albuterol for asthma exacerbation treatment
- May mix in same nebulizer w/ albuterol
- Should NOT be used as first-line therapy; should be added to SABA therapy for severe exacerbations
ipratropium/albuterol - Brand Name
Combivent Respimat, DuoNeb
ipratropium/albuterol - Dosage Forms
MDI, nebulizer
ipratropium/albuterol - Age Group
all ages
ipratropium/albuterol (DuoNeb) - Clinical Pearls
May be used for up to 3 hours in initial management of severe exacerbations
prednisolone - Dosage Forms
tablets, oral liquid
Systemic Corticosteroids - Age Group
all ages
prednisone - Dosage Forms
tablets, oral liquid
dexamethasone - Dosage Forms
oral liquid, tablets, injection
methylprednisolone acetate - Dosage Forms
repository injection
Systemic Corticosteroids - Adverse Effects
short-term use - hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances
Systemic Corticosteroids - Contraindications
systemic fungal infections, administration of live vaccines if immunocompromised
Systemic Corticosteroids - Drug Interactions
Warfarin INR (clotting levels) increase, decrease efficacy of inactivated vaccines
Systemic Corticosteroids - Clinical Pearls
- May be used w/ ICS if patient is already taking ICS before hospitalization
- May also be used for chronic therapy in both asthma (and COPD) only in severe stages
- “Bursts” effective for establishing control when initiating therapy or during period of gradual deterioration
- Injection may be used in place of “burst” if adherence is an issue or patient is vomiting
Systemic/Subcutaneous Beta-2 Agonists - Age Group
all ages
Systemic/Subcutaneous Beta-2 Agonists - Comments
No proven advantage of systemic therapy over aerosol
epinephrine: indicated in addition to standard therapy for acute asthma associated w/ anaphylaxis and/or angioedema
magnesium sulfate - Dosage Forms
IV
magnesium sulfate - Age Groups
all ages
magnesium sulfate - Adverse Effects
flushing, hypotension, vasodilation
magnesium sulfate - Contraindications
Heart block, caution in renal dysfunction
magnesium sulfate - Comments
Consider if patient remains in life threatening exacerbation after 1 hour of therapy
