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Asthma Part II. Team Blue:. Heather Carballo, Dana Horton, Claudette Johnson, Kimberly Kusch. Grand Canyon University: NUR: 641 November 21, 2012. PharmacoTherapy. Goals. Types. ( Lehne, 2013 ). Relievers. Contr0llers. Long Acting Bronchodilators (LABA). Short Acting Bronchodilators - PowerPoint PPT Presentation
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Team Blue:Heather Carballo, Dana Horton,
Claudette Johnson, Kimberly Kusch
Grand Canyon University: NUR: 641November 21, 2012
Asthma Part II
PHARMACOTHERAPYGoals Types
Quick relief of symptoms
Controlling inflammation
Easing flare-ups
Controller (LABA)• Corticosteroids • Long Acting Beta
Agonists (LABA’s)• Leukotriene modifiers
(LTRA)• Cromolyn & Nedocromil• Methylxanthines:
(Sustained-release theophyllineRelievers
(SABA)• Short acting
bronchodilators• Corticosteroids• Anticholinergics
(Lehne, 2013)
RELIEVERSLong Acting Bronchodilators
(LABA)
Keeps swelling and mucus from developing in the
airways
Must be taken EVERY day even when not having
symptomsInhaled corticosteroids (ICS’s)
are the most common and effective way to control
asthmaHelp prevent asthma exacerbations from
developing!
CONTR0LLERS Short Acting Bronchodilators
SABA
(Lehne, 2013)
MEDICATION: DETERMINED BY SEVERITY
Mild Intermittent
• Reliever only prn
Mild Persistent• Controller/Reliever
Moderate Persistent
• Controller plus long-acting bronchodilator and reliever
Severe Persistent
• Controller plus long-acting bronchodilator and reliever
Both control and rescue medications come in MDI (metered dose inhalers)
and nebulized forms
Control medications are also available in dry powder discs, breath actuated inhalers and pill
form
(Asthma Organization, 2012) (Lehne, 2013; Schiffman & Szeftel, 2012)
RELIEVERSSystemic Corticosteroids
PediapredPrelone
PrednisoneOrapred
Prevents progression of moderate to severe exacerbations, reduces inflammation
Potential adverse effects
Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache
Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts
Short-acting Inhaled Bronchodilators
Proventil, Ventolin (Albuterol)Xopenex (Levalbuterol)
Maxair Autohaler (Pirbuterol)Alupent (Metaproterenol) For relief of acute symptoms
or as preventive treatment prior to exercise
Potential adverse effects
Tremors, tachycardia, headache
Therapeutic issues
Drugs of choice for acute bronchospasm
(Lehne, 2013; Mayo Clinic, 2012; McCance & Huether, 2010)
RELIEVERSHerbal Therapy
Ephedra (Ma Huang) Dangerous and should
be avoided Potent CNS and CV
stimulant Can be a precursor for
methamphetamine FDA recently banned
its use
Many other herbal folk remedies used by different
cultures
(Lehne, 2013; McCance & Huether, 2010)
(Schiffman & Szeftel, 2012)
CONTROLLER MEDICATIONSCorticosteroids: Pulmicort, QVAR, Alvesco,
AeroSpan, Flovent
Pharmacokinetics: Peak concentration in thirty minutes for inhaled therapy, 34% distributed in the lungs and systemic availability is 39%. Rapidly metabolized and excreted in urine and feces (Pulmicort Pharmacology, 2006).
Pharmacodynamics: Rapid onset of action, asthma improvement demonstrated within 24 hours after starting treatment although full benefits may take one to two weeks to be seen. When orally inhaled there is a direct effect on the respiratory system(Pulmicort Pharmacology, 2006).
Drug Interactions: certain antibiotics, antidepressants, and ketoconazole (Pulmicort Pharmacology, 2006).
Side effects: Runny nose, sore throat, white patches in mouth, nose bleed, headache(Pulmicort Pharmacology, 2006).
Adverse effects: Worsening respiratory symptoms, wheezing, vision changes and weakness(Pulmicort Pharmacology, 2006).
CONTROLLER MEDICATIONSLong Acting Beta Agonist: Brovana,
Perforomist, Arcapta, Serevent Diskus Pharmacokinetics: These medications typically work locally within the
lungs. Taking plasma levels will not indicate therapeutic effects. These medications are 96% protein binding and are excreted in the feces and urine. The usual half life of these medications are usually fairly long, on average about 5-7 days (Kim, 2009).
Pharmacodynamics: Effects of these medications usually last about 12 hours. Causes bronchodilation by relaxing smooth muscles in the airway (Kim, 2009)
Drug Interactions: Erithromycin, beta blockers, MAOI’s, antidepressants, non-potassium sparing diuretics (Kim, 2009.)
Side effects: Headache, nasal congestion, nausea/vomiting, skeletal muscle pain.
Adverse effects: Bronchospasms which could cause worsening
respiratory effects, irritation or swelling of the airway, hypertension, increased heart rate, hypokalemia (Kim, 2009).
ASSESSMENT
Assess respiratory status.
Overall physical exam with vital signs should be conducted.
Assess patient’s knowledge of medication administration and lab
values as needed.
Assess for side effects and knowledge of side effects as well as compliance
with medication regimen.
(Stanley et al., 2008)
NURSING DIAGNOSISRisk for ineffective breathing pattern
related to noncompliance with medication regimen
Risk of ineffective airway clearance related to improper use
of asthma medicationsAnxiety related to inability to manage disease process as
evidenced by patient stating they are overwhelmed
Deficient knowledge related to medication administration as evidenced by improper use of
metered dose inhaler.
(Stanley et al., 2008)
PLANNING
Patient will identify 5 signs of worsening respiratory status.
Patient will identify 5 potential side effects of each medication
they are taking.Patient will verbalize their asthma treatment plan and discuss why it
is important along with any concerns.
Patient will demonstrate proper administration of a metered dose
inhaler.
(Stanley et al., 2008)
IMPLEMENTATION
Nurse will provide written and verbal education on respiratory status.
Nurse will provide written and verbal education on the patient’s
medications and side effects.Nurse will discuss treatment plan with patient and discussion of any anxiety as well as provide written
information.Nurse will provide videos to patient
on use of meter dose inhaler and will assist with return demonstration by
patient.
(Stanley et al., 2008)
EVALUATION
Patient’s condition improved.
Patient’s condition stabilized.
Patient’s condition deteriorated.
(Stanley et al., 2008)
Patient Resources Health Care Provider Community Resources Public Health
Department Patient Education
Tools* Your Voice-Advocacy School Nurse
Take Control of your Asthma
REFERENCESAmerican Lung Association. (2012). Learning more about Asthma. Retrieved from
http://www.lung.org/lung-disease/asthma/
Gulanick, M., & Myers, J. (2011). Nursing Care Plans (7th ed.). St. Louis: Mosby Elsevier.
Kaufman, G. (2012). Asthma: assessment, diagnosis, and treatment adherence. Nurse Prescribing, 10(7), 331-338.
Kim, D. (2009). Evaluation of Long Acting Beta Agonists. Allergy and Immunology , 8, 933-940.
Lehne, R.A. (2013). Pharmacology for nursing care. (8th ed.) St. Louis: Saunders Elsevier. 967-981.
Mayo Clinic. (2011). Asthma inhalers: Which one's right for you? Retriever from
http://www.mayoclinic.com/health/asthma-inhalers/HQ01081
McCance, K.L. & Huether, S.E.(2010). Pathophysiology: The biologic basis for disease in adults and children.
(6th ed.). St. Louis: Mosby Elsevier.1285-1286.
Pulmicort Pharmacology. (2006). Retrieved November 9, 2012, from Drug List 1:
www.1stdruglist.com/pumicort.html
Schiffman, G. & Szeftel, A. (2012). What asthma medications to use. MedicineNet. Retrieved from
http://www.medicinenet.com/asthma/page9.htm#what_medications_are_used_in_the_treatment_of_asthma