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