Beta-adrenergic agonists
Name the three classes of bronchodilators.
1. Beta-adrenergic agonists
2. Anticholinergics
3. Xanthine derivatives
What is the MOA of Anticholinergics?
Bind to the acetylcholine (ACh) receptors, preventing bronchoconstriction (results in dilation of airways).
**ACh is a neurotransmitter that causes bronchial constriction and narrowing of the airways.
Name the Xanthine derivative that is used as a bronchodilator.
Theophylline
**Note: theophylline is a plant alkaloid, just like CAFFEINE
Name 2 classes of nonbronchodilating respiratory drugs.
1. Leukotriene receptor antagonists (LTRAs)
2. Corticosteroids
Name some corticosteroid respiratory drugs.
Fluticasone, beclomethasone.
What are the two drug categories of the beta-adrenergic agonists and which one of these is used for acute asthma episodes?
Short-acting beta agonist (SABA) inhalers**
Long-acting beta agonist (LABA) inhalers
**used as rescue inhalers for acute asthma episodes
Name some anticholinergic medications.
Ipratropium (Atrovent), tiotropium (Spiriva)
**notice the suffix "-tropium"
What is the MOA of xanthine derivates?
Cause smooth muscle relaxation and bronchodilation, resulting in increased airflow.
Name a drug that is a LTRA.
Montelukast
True or false: Corticosteroids are used to treat chronic asthma.
True. They do not relieve symptoms of acute asthma attacks.
Name 2 commonly used SABA inhalers.
Albuterol
Levalbuterol
What are the adverse effects of anticholinergics?
"Don't see, don't pee, don't spit, don't sh_t."
- blurred vision
- urinary retention
- dry mouth or throat
- obstipation (severe form of constipation)
What conditions do xanthine derivatives treat?
Mild/moderate acute asthma (prevent asthma symptoms; NOT for relief of acute asthma attacks)
COPD
chronic bronchitis
emphysema
What is the MOA of LTRAs?
- Block leukotrienes from attaching to their receptors
- Benefits include:
--prevention of smooth muscle contraction of bronchial airways
-- decrease in mucus secretion
-- prevention of vascular permeability
-- inflammation is blocked
What is the mechanism of action of corticosteroids?
Reduce inflammation and relax airways.
Name the suffix used with LABA inhalers.
-moterol (i.e., arformoterol, formoterol)
-meterol (i.e., salmeterol)
What are the adverse effects of xanthine derivatives?
Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias (think of caffeine), insomnia.
What are the indications for taking LTRAs?
- prophylaxis and long-term treatment and prevention of asthma
- Montelukast approved for treatment of allergic rhinitis
Name a commonly used corticosteroids used for persistent asthma.
Fluticasone:
* Flovent -- inhaler
* Flonase - intranasal
What is the MOA of Albuterol?
It is a selective beta2 drug
Stimulates only beta2 receptors in the lungs to cause bronchial dilation.
What nursing implications with the xanthine derivatives should you be aware of?
- Cigarette smoking decreases the effectiveness of theophylline
- Don't consume excessive amounts of caffeinated foods/beverages while taking these drugs -- can produce additive cardiac and CNS stimulation.
What is the Black Box warning for montelukast?
Serious mood related changes and behaviors can occur.
What are the contraindications for taking corticosteroids for asthma?
Patients whose sputum tests positive for Candida organisms
Patients with systemic fungal infection
**Note: Corticosteroids can increase the risk of fungal infections because they can suppress inflammation, promote fungal growth, and increase blood sugar levels.
Why is it important that Albuterol not be used too frequently?
If used too frequently, can cause increased systemic effects due to the loss of its beta2-specific actions (remember, you start to see stimulation of beta 1 receptors).
Sx: palpitations, increased anxiety, tachycardia
What measure is implemented to prevent patients taking theophylline from experiencing theophylline toxicity?
The blood levels of theophylline are drawn to monitor for toxicity.
What should patients be educated about regarding LTRAs?
- Patients should take medications every night on a continuous schedule even if symptoms improve
What should the nurse teach a patient using an inhaled corticosteroid?
1. Gargle and rinse the mouth with lukewarm water after using the inhaler.
2. Corticosteroid inhalers can cause a dry mouth and throat irritation.
3. Proper dental hygiene is important.
4. If a beta agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before corticosteroid administration.
A patient is prescribed fluticason DPI (dry powder inhaler). What would be a contraindication to taking this form of the medication?
A milk protein allergy (some fluticasone formulations contain lactose or milk proteins).