1. Chapter 9
Respiratory Drugs

2. Terms to Define Asthma Bronchospasm Status Asthmaticus
Metered dose inhaler (MDI)
Spacer
Nebulizer
Bronchodilator

3. Asthma
Inflammatory disease in which inflammation causes the airways to tighten
Reversible condition
Intermittent attacks are precipitated by specific triggering events
Causes a decrease in the amount of
oxygen and carbon dioxide exchanged

4. Asthma An asthmatic lung compared to a normal lung
More sensitive
Responds to lower doses of allergens
Studies strongly support genetic predisposition to developing asthma

5. Characteristics of Asthma
Reversible small airway obstruction
Progressive airway inflammation
Increased airway responsiveness to variety of stimuli
= wheezing, dyspnea, acute & chronic cough

6. Asthma Attack: First Response
Triggered by an antigen-antibody reaction
Causes degranulation of mast cells which release histamine
Result: bronchospasm and increased mucus production that plugs the small airways

7. Asthma Attack: Second Response
Bronchoconstriction with delayed, sustained reactions
Causes self-sustaining inflammation

8. Asthmatic Response

9. Devices Used in Asthma Therapy
Metered dose inhaler (MDI)
Contains medication and compressed air
Delivers specific amount of medication with each puff
Spacer
Used with MDIs to get medication into lungs instead of depositing on back of throat

10. Nebulizers
Uses stream of air that flows through liquid medication to make a fine mist for inhalation
Very effective
Must be cleaned and taken care of to reduce risk of contamination
Used for young children

11. Short-Acting Inhaled Bronchodilators
albuterol
Relaxes bronchial smooth muscle with little effect on heart rate, duration of 3 to 6 hours

12. ProAir/Albuterol (Bronchodilator)
Works by widening the airways in the lungs
Indicated usage:
Tx or prevent breathing problems in patients with Asthma
Prevent breathing problems with exercise

13. Proventil/Albuterol (Bronchodilator)
bronchodilator that relaxes muscles in the airways and increases air flow to the lungs
Exercise induced bronchospasm
Prevent bronchospasm in people with reversible obstructive airway disease

14. Ventolin/Albuterol (Bronchodilator)
a bronchodilator that relaxes muscles in the airways and increases air flow to the lungs
Indicated usage
Prevent bronchospasm for people with reversible obstructive airway disease
Prevent exercise induced bronchospasm

15. Dispensing Issues of albuterol
Proventil HFA and ProAir HFA cannot be interchanged
If Rx for an albuterol inhaler, any of the 3 brands can be used

16. Asthma Agents: Leukotriene Inhibitors
Leukotrienes
Increase edema, mucus, and vascular permeability
Substances can pass through blood vessels
100 to 1,000 times more potent than histamine
Block synthesis of, or the body’s inflammatory responses to, leukotrienes

17. Montelukast/Singulair (Leukotriene Inhibitor)
Indicated for prophylaxis and chronic treatment of asthma
Do not use to treat acute attacks
Approved for use in adults and children 12 months and older
Once-daily dosage
Also used to treat seasonal allergies

18. Asthma Agents: Corticosteroids
Anti-inflammatory agents that suppress the immune response
Used for more difficult cases of asthma
Usually prescribed on alternate-day basis or as tapering doses when short-term therapy is indicated
Many patients with asthma still not using

19. Primary Side Effects of Corticosteroids
Oral candidiasis
Irritation and burning of nasal mucosa
Hoarseness
Dry mouth

20. Side Effects of Long-Time Use of Oral Corticosteroids
Growth of facial hair in females
Breast development in males
“Buffalo hump,” “moon face”
Edema
Weight gain
Easy bruising

21. Corticosteroids Always use lowest effective dose
Add salmeterol to inhaled corticosteroids if needed to decrease the dose of corticosteroid needed for control

22. Dispensing Issues of Corticosteroids
Patient should rinse mouth with water after using inhalers to prevent oral candidiasis
Patient should be taught how to correctly use these medications

23. fluticasone (Flonase, Flovent) Corticosteroid
Flonase (Flovent) is same drug in nasal spray Flonase
Flovent comes in 3 strengths
Lowest for mild asthma
Highest to wean patients off oral corticosteroids
1 to 2 weeks to reach maximum benefit

24. fluticasone-salmeterol (Advair Diskus)
Combines corticosteroid (anti-inflammatory) and a beta-2 agonist
Indicated for maintenance therapy in patients 12 years and older
Available in powder for inhalation
Should not be used with a spacer

25. Nasal Corticosteroids
Most effective monotherapy for allergic rhinitis
Must be used daily
Can cause nasal irritation and bleeding; direct spray away from septum
Local infections of Candida albicans may occur in nose with long term use

26. mometasone furoate (Nasonex) (nasal corticosteroids)
Depresses release of endogenous chemical mediators of inflammation
Reverses dilation and permeability of vessels in area
Children over 12 can use to prevent symptoms of allergic rhinitis

27. Methylprednisolone/Medrol
Steroid- prevents the release of substances in the body that cause inflammation
Tx- allergic disorders

28. Promethazine/Phenergan (antihistamine)
Blocks effects of histamine (which triggers inflammatory response)
Treat allergy symptoms

29. Fexofenadine/Allegra (Antihistamine)
Blocks the effect of histamine in the body
Tx allergy symptoms