Rescue Medications

Question 1

inhaled short acting B2 agonists - increase cAMP, antagonizes bronchoconstriction –> smooth muscle relaxation (reverse obstruction and improve airflow)

Answer 1

albuterol HFA, albuterol, levalbuterol HFA, levalbuterol

Question 2

albuterol HFA

Answer 2

proAir, ventolin, proventil: metered dose inhaler
proAir respiclick, proAir digihaler: aerosol powder inhaler
for 0-4 year olds, 5-11 year olds, and adults
AE: tachycardia, tremor, hypokalemia, irritability
chronic use (>2 times per day) indicates poor asthma control
may mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
in mild to moderate exacerbations, MDI plus valved holding chamber is as effective as nebulized therapy with appropriate administration technique and coaching by trained personnel

Question 3

albuterol

Answer 3

dosage form: nebulizer solution
for 0-4 year olds, 5-11 year olds, and adults
AE: tachycardia, tremor, hypokalemia, irritability
chronic use (>2 times per day) indicates poor asthma control
may mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
in mild to moderate exacerbations, MDI plus valved holding chamber is as effective as nebulized therapy with appropriate administration technique and coaching by trained personnel

Question 4

levalbuterol HFA

Answer 4

xopenex
dosage form: MDI
for 0-4 year olds, 5-11 year olds, and adults
AE: tachycardia, tremor, hypokalemia, irritability
reserved for patients who don’t 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

Question 5

levalbuterol

Answer 5

dosage form: nebulizer solution
for 0-4 year olds, 5-11 year olds, and adults
AE: tachycardia, tremor, hypokalemia, irritability
reserved for patients who don’t 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

Question 6

short acting anticholinergics: competitively inhibit cholinergic receptors in bronchial smooth muscle –> decrease cGMP –> bronchodilation

Answer 6

ipratropium HFA, ipratropium, ipratropium/albuterol, ipratropium/albuterol duoNeb

Question 7

ipratropium HFA

Answer 7

atrovent
dosage form: MDI
for 0-4 year olds, 5-11 year olds, and adults
AE: dry mouth, urinary retention, infection, sinusitis, bronchitis
used in combo with albuterol for asthma exacerbation treatment
may mix in same nebulizer with albuterol
should not be used as first-line therapy; should be added to SABA therapy for sever exacerbations

Question 8

ipratropium

Answer 8

dosage form: nebulizer solution
for 0-4 year olds, 5-11 year olds, and adults
AE: dry mouth, urinary retention, infection, sinusitis, bronchitis
used in combo with albuterol for asthma exacerbation treatment
may mix in same nebulizer with albuterol
should not be used as first-line therapy; should be added to SABA therapy for sever exacerbations

Question 9

ipratropium/albuterol

Answer 9

combivent respimat
dosage form: MDI
for 0-4 year olds, 5-11 year olds, and adults
AE: see individual products

Question 10

ipratropium/albuterol duoNeb

Answer 10

dosage form: nebulizer solution
for 0-4 year olds, 5-11 year olds, and adults
may be used for up to 3 hours in initial management of severe exacerbation

Question 11

systemic corticosteroids: decrease inflammation and increase response to B2 agonists

Answer 11

methylprednisone, prednisolone, prednisone, dexamethasone, methylprednisolone acetate

Question 12

adverse effects and clinical pearls

Answer 12

AE: short term use - hyperglycemia, increased appetite, fluid retention, demargination of WBC’s, psychiatric disturbances
CI: systemic fungal infections, administration of live vaccines if immunocompromised
DI: warfarin INF increase; decrease efficacy of inactivated vaccines
may be used with ICS if patient is already taking ICS before application
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

Question 13

methylprednisolone

Answer 13

dosage form: tablets
for 0-4 year olds, 5-11 year olds, and adults

Question 14

prednisolone

Answer 14

dosage form: tablets and oral liquid
for 0-4 year olds, 5-11 year olds, and adults

Question 15

prednisone

Answer 15

dosage form: tablets and oral liquid

Question 16

dexmethasone

Answer 16

dosage form: oral liquid, tablets, injection
for 0-4 year olds

Question 17

methylprednisolone acetate

Answer 17

dosage form: repository injection
for 0-4 year olds, 5-11 year olds, or adults

Question 18

additional medications for asthma exacerbations

Answer 18

epinephrine, terbutaline, magnesium sulfate IV

Question 19

epinephrine

Answer 19

for children and adults
no proven advantage of systemic therapy over aerosol
indicated in addition to standard therapy for acute asthma associated with anaphylaxis and/or angiodema

Question 20

terbutaline

Answer 20

for children and adults
no proven advantage of systemic therapy over aerosol

Question 21

magnesium sulfate IV

Answer 21

smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells
for children and adults
AE: flushing, hypotension, vasodilation
CI: heart block, caution in renal dysfunction
consider if patient remains in life threatening exacerbation after 1 hour of therapy