* beta 2 -adrenergic agonists)
* inhaled anticholinergics
2. anti-inflammatory agents:
* mast cell
* leukotriene modifiers.
2. Formoterol (Foradil Aerolizer)
3. Salmeterol (Serevent)
4. Terbutaline (Brethine)
act by selectively activating the beta 2 -receptors in the
bronchial smooth muscle, resulting in bronchodilation. As a result of this:
■Bronchospasm is relieved.
■Histamine release is inhibited.
■Ciliary motility is increased
2. oral, long-acting
prevention of asthma attack (exercise-induced)
treatment for ongoing asthma attack
long-term control of asthma
2. oral agents can cause tachycardia and angina because of activation of alpha 1 receptors in the heart
-advise clients to observe for signs and symptoms (chest, jaw, -or arm pain or palpitations) and to notify the provider if they occur.
-instruct clients on how to check pulse and to report an increase of greater than 20 to 30 beats/min.
-advise clients to avoid caffeine.
-dosage may need to be lowered
3. tremors caused by activation of beta 2 receptors in skeletal muscle
– tremors usually resolve with continued medication use.
– dosage may need to be reduced
contraindicated in clients with tachydysrhythmia
cautiously in clients who have diabetes, hyperthyroidism, heart disease, hypertension, and angina
2. maoi s and tricyclic antidepressants can increase the risk of tachycardia and angina ==> instruct clients to report changes in heart rate and chest pain
– When a client is prescribed an inhaled beta 2-agonist and an inhaled glucocorticoid, advise the client to inhale the beta 2-agonist before inhaling the glucocorticoid. The beta 2 -agonist
promotes bronchodilation and enhances absorption of the glucocorticoid.
– Advise clients not to exceed prescribed dosages.
– Ensure that clients know the appropriate dosage schedule (if the medication is to be taken on a fixed or a when-necessary schedule).
-Formoterol and salmeterol are both long-acting beta 2-agonist
inhalers. These inhalers are used every 12 hr for long-term control and are not to be used to abort an asthma attack. A
short-acting beta 2 -agonist should be used if clients need to treat an acute attack.
– Advise clients to observe for signs of an impending asthma attack and to keep a log of the frequency and intensity of attacks.
– Instruct clients to notify the provider if there is an increase in the frequency and intensity of asthma attacks.
Prevention of exercise-induced asthma attack.
Resolution of asthma attack as evidenced by absence of shortness of breath, clear breath sounds, absence of wheezing, return of respiratory rate to baseline.
– causes relaxation of bronchial smooth muscle, resulting in bronchodilation
– Oral theophylline is used for long-term control of chronic asthma.
– Route of administration: oral or IV (emergency use only)
2. more severe reactions can occur with higher
therapeutic levels and can include dysrhythmias and seizures
– monitor theophylline serum levels to keep within
therapeutic range (5 to 15 mcg/ml).
– side effects are unlikely to occur at levels less than 20 mcg/ml
– if symptoms occur, stop the medication.
– if necessary, activated charcoal can be used to decrease absorption, lidocaine can be used to treat dysrhythmias, and diazepam can be used to control seizures.
– instruct client that periodic blood levels will be needed.
– advise client to report any symptoms of nausea, diarrhea, or
restlessness that may indicate toxicity
●Use cautiously in clients who have heart disease, hypertension, liver and renal dysfunction, and diabetes.
●Use cautiously in children and older adults
2. increase the dosage of theophylline when theophylline is used concurrently with phenobarbital and phenytoin, bc they decrease theophylline levels
3. decrease the dosage of theophylline when theophylline is used concurrently with Cimetidine (tagamet), ciprofloxacin (Cipro), and other fluoroquinolone antibiotics
Instruct clients not to chew or crush sustained-release preparations. These medications should be swallowed whole.
2. tiotropium (Spiriva)
– block muscarinic receptors of the bronchi, resulting in bronchodilation
– used to relieve bronchospasm associated with chronic obstructive pulmonary disease.
– used for allergen-induced and exercise-induced asthma
– Route: inhalation
=> Advise clients to sip fluids and suck on hard candies to control dry mouth
contraindicated in clients who have an allergy to peanuts because the medication preparations may contain soy lecithin.
Use cautiously in clients who have narrow-angle glaucoma and
benign prostatic hypertrophy (due to anticholinergic effects).
Usual adult dosage is two puffs. Instruct clients to wait the length of time directed between puffs
If clients are prescribed two inhaled medications, instruct clients to wait at least 5 min between medications.
* beclomethasone dipropionate (QVAR)
* Budesonide (Pulmicort Flexhaler)
* Fluticasone propionate (Advair, Flovent)
* Triamcinolone acetonide (Azmacort
2. Oral: prednisone: Deltason, Prelone
* Hydrocortisone sodium succinate (Solu-Cortef)
* Methylprednisolone sodium succinate (Solu-Medrol)
– prevent inflammation, suppress airway mucus production, and promote responsiveness of beta 2 receptors in the bronchial tree.
– promotes decreased frequency and severity of exacerbations and acute attacks
– Short-term IV agents are used for status asthmaticus.
– Inhaled agents are used for long-term prophylaxis of asthma.
– Short-term oral therapy is used to treat symptoms following an acute asthma attack.
– Long-term oral therapy is used to treat chronic asthma.
– Replacement therapy is used for primary adrenocortical insufficiency.
– Promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth
– advise clients to use a spacer with mdi•
– advise clients to rinse mouth or gargle with water or salt water after use.
– advise clients to monitor for redness, sores, or white patches and to report to provider if they occur. Candidiasis may be
treated with nystatin oral suspension
2. prednisone when used for 10 days or more can result in:
– suppression of adrenal gland function, such as a decrease in the ability of the adrenal cortex to produce glucocorticoids: Can occur with inhaled agents and oral agents ==> administer oral glucocorticoid on an alternate-day dosing schedule. Monitor the client’s blood glucose levels. Taper the client’s dose
– bone loss (can occur with inhaled agents and oral agents) ==> advise clients to perform weight-bearing exercises. advise clients to consume a diet with sufficient calcium and vitamin D
intake. use the lowest dose possible to control symptoms. oral medications should be given on an alternate-day dosing schedule
– hyperglycemia and glucosuria ==> Clients with diabetes should have theirblood glucose monitored. Clients may need an increase in insulin dosage
– myopathy as evidenced by muscle weakness => instruct clients to report signs of muscle weakness. Medication dosage should be decreased.
– peptic ulcer disease => advise clients to avoid NSAID. Advise clients to report black, tarry stools. Check stool for occult blood periodically. Administer with food or meals
– Infection => advise clients to notify the provider if early signs of infection occur (sore throat, weakness, malaise)
isturbances of fluid and electrolytes (fluid retention as evidenced by weight gain, and edema and hypokalemia as evidenced by muscle weakness) => instruct clients to observe for symptoms and report to the provider
● Contraindicated in clients who have received a live virus vaccine
● Contraindicated in clients with systemic fungal infections
● Use cautiously in children, and in clients who have diabetes, hypertension, peptic ulcer disease, and/or renal dysfunction.
● Use cautiously in clients taking NSAIDs
– Concurrent use of NSAIDs increases the risk of GI ulceration => advise clients to avoid use of nsaids. If GI distress occurs, instruct clients to notify the provider.
– Concurrent use of glucocorticoids and hypoglycemic agents (oral and insulin) will counteract the effects => Clients should notify the provider if hyperglycemia occurs. the client may
need increased dosage of insulin or oral hypoglycemics
● Glucocorticoids are not to be used to treat an acute attack.
● Administer using an MDI device, DPI, or nebulizer.
● Clients should use a spacer with all preparations except budesonide.
● When a client is prescribed an inhaled beta 2 -agonist and an inhaled glucocorticoid, advise the client to inhale the beta 2
-agonist before inhaling the glucocorticoid. The beta 2 -agonist
promotes bronchodilation and enhances absorption of the glucocorticoid.
● Oral glucocorticoids are used short-term, 3 to 10 days following an acute asthma attack.
● If client is on long-term oral therapy, additional dosages of oral glucocorticoids are required in times of stress (infection, trauma).
● Clients who discontinue oral glucocorticoid medications or switch from oral to inhaled agents require additional doses of glucocorticoids during periods of stress.
2. nedocromil sodium (Tilade)
* Anti-inflammatory action
– These medications stabilize mast cells, which inhibits the release of histamine and other inflammatory mediators.
– These medications suppress inflammatory cells (eosinophils, macrophages).
* Therapeutic Uses
– Management of chronic asthma
– Prophylaxis of exercise-induced asthma
– Prevention of allergen-induced attack
– Allergic rhinitis by intranasal route
– Route of administration: inhalation
*Safest of all asthma medications & Safe to use for children
● Fluorocarbons in aerosols make this medication contraindicated for clients who have coronary artery disease, dysrhythmias, and status asthmaticus.
● Use cautiously in clients with liver and kidney impairment.
Advise clients that long term prophylaxis may take several weeks for full therapeutic effects to be established
Advise clients that this is not a bronchodilator and is not intended for aborting an asthmatic attack.
Instruct clients in the proper use of administration devices (nebulizer, MDI)
2. zileuton (Zyflo)
3. zafirlukast (Accolate)
Expected pharmacological action: prevent the effects of leukotrienes thereby suppressing inflammation bronchoconstriction, airway, edema, and mucus production.
Therapeutic Uses: used for long term therapy of asthma in adults and children 15 years and older and to prevent exercise-induced bronchospasm
– Obtain baseline liver function tests and monitor periodically.
– Advise clients to monitor for signs of liver damage (nausea, anorexia, abdominal pain).
– Instruct clients to notify the provider if symptoms occur
– Zileuton and Zafirlukast inhibit metabolism of theophylline, leading to increased theophylline levels => monitor theophylline levels. Advise clients to observe for signs of
theophylline toxicity (nausea, vomiting, seizures), and to notify the provider
● Advise clients that zafirlukast should not be given with food, and to administer it 1 hr before or 2 hr after meals.
● Advise clients to take montelukast once daily at bedtime.
1. Take the medication 15 min before exercising.
2. Follow a fixed-dosage schedule for long-term control of asthma.
3. Expect to lose weight while taking this medication.
4. Observe for adverse effects such as tremors, restlessness, and palpitations.
5. Do not crush or chew tablets.
Cromolyn is used for prophylactic treatment of asthma. It should not be used to abort an asthma attack but can be used to prevent exercise induced bronchospasm. For long-term
control, cromolyn should be taken on a fixed-dose schedule. Cromolyn does not promote weight loss, has no significant side effects, and is only given by inhalation
Rinse mouth and gargle after inhaling the dose (prevents oropharyngeal candidiasis).
Engage in weight-bearing exercises and ensure adequate intake of calcium and vitamin D (inhaled glucocorticoids promote bone loss).
A. Alternate which inhaler is used so that both are not taken the same time of day.
B. Use the albuterol inhaler 5 min before using the beclomethasone inhaler.
C. Only use beclomethasone if experiencing an acute attack.
D. Use the beclomethasone inhaler first and immediately follow with the albuterol inhaler
When a client is prescribed an inhaled beta2 -agonist, such as albuterol, and an inhaled glucocorticoid, such as beclomethasone, the beta2 -agonist should be administered first. The beta2 -agonist promotes bronchodilation and enhances absorption of the glucocorticoid
A. decrease inflammation.
B. promote bronchodilation.
C. decrease airway mucus production.
D. suppress the effects of leukotriene compounds
Beta2 -adrenergic agonists promote bronchodilation; glucocorticoids and cromolyn decrease inflammation; montelukast (Singulair), a leukotriene modifier, decreases airway mucus production and suppresses the effects of leukotriene compounds.
client to watch for which of the following?
A. Weight gain and fluid retention
B. Nervousness and insomnia
C. Chest pain and tachycardia
D. Drowsiness and activity intolerance
Weight gain and fluid retention can result from oral glucocorticoid use. Nervousness, nsomnia, chest pain, tachycardia, drowsiness, and activity intolerance are not side effects of oral glucocorticoids.
A. Take this short-acting beta2-agonist to abort an acute asthma attack.
B. Take this medication once daily at bedtime.
C. Avoid caffeine when using this oral methylxanthine medication.
D. Take this inhaled beta 2-agonist every 12 hr.
2 – A
3 – D
4 – B