Bronchodilators

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Bronchodilators

• Barbara Hays, RN
• Winter 2006

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Asthma

• Bronchospasm
• Viscous mucus
• Vasodilation and edema of airways
• Eosinophillia (allergic basis in many clients)

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Some chemicals to consider

• Histamine
• Slow Reactive Substance of Allergy (SRS-a)
• Cyclic AMP

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Histamine

• Stored in granules of mast cells, basophils, and
  platelets (and many other tissues)
• Large number of primed mast cells are located
  close to bronchial muscle cells
• Allergic clients IgE is produced
• Attaches to surface of mast cells, triggers
  them
• Associated with bronchial muscle contraction,
  increased secretions, edema

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Slow Reactive Substance of Allergy

• Formation occurs after immunologic reaction
• Produced by mast cells and basophils
• Causes
• Direct, profound, slow, prolonged constriction of
  bronchial muscles
• Increases vascular permeability
• Potentiates action of histamine

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Cyclic 5, 5 adenosine monophosphate (c-AMP)

• Produced in response to first messenger
  (adrenalin)
• Begins a chemical reaction that finally inhibits
  contraction of bronchial muscles relaxation

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Medications to treat asthma(Easy p 269)

• Beta2 adrenergic agonists (p 270)
• Ipratropium Atrovent (p 272)
• Corticosteriods (p 275)
• Leukotriene modifiers (p 278)
• Mast cell stabilizers (p 280)
• Methylxanthines (p 282)

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Inhaled Beta2 adrenergic agonists

• Short acting
• Albuterol (Proventil, Ventolin)
• Metoproterenol (Alupent)
• Terbutaline (Brethine)
• Long acting
• Salmeterol (Serevent)
• Combination
• Advair discus (Serevent fluticasone)

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Beta 2 adrenergic agonists

• Increase levels of cyclic AMP resulting in
  bronchodilation
• Fewer adverse effects than systemically used
  sympathomimetics
• Wait at least two minutes between meds
• Side effects can include tachycardia, dry mouth,
  paradoxical bronchospasm

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Inhaled Anticholinergics

• Ipratropium (Atrovent)
• Blocks parasympathetic system rather than
  stimulating the sympathetic system
• Often used in combination with selective beta2
  agonists
• Side effects are what youd expect
• Nervousness
• tachycardia

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Corticosteroids

• Inhaled
• Beclomethasone (Beclovent Vanceril)
• Fluticasone (Flonase)
• By mouth
• Prednisolone
• Prednisone
• By IV
• Methylprednisolone
• Hydrocortisone

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Corticosteriods

• Things to consider
• Bones
• Stunts growth in children
• Osteoporosis in adults
• Diabetes
• Out of control
• Infections
• Mouth irritation/candidiasis (Thrush)
• Upper respiratory infections

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Leukotrienes

• Substances released from
• Mast cells
• Eosinophils
• Basophils
• Cause
• Smooth muscle contraction of airways
• Increased blood vessel permeability
• Increased secretions
• Activation of other inflammatory mediators

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Leukotrienes

• Can be blocked by
• Leukotriene receptor antagonists
• Zafirlukast (Accolate)
• Montelukast (Singulair)
• Leukotriene formation inhibitors
• Zileutron
• (these meds prevent rather than treat
  bronchospasm)

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Mast Cell Stabilizers

• Prototype Cromolyn sodium
• Used for prevention and long-term control of
  asthma (especially exercise-induced asthma)

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Methylxanthines

• caffeine
• Theophylline
• Aminophylline
• Relieve bronchospasm
• Stimulate respiratory center in brain
• Treat neonatal sleep apnea
• (guess what the side effects are)

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Other respiratory meds

• Expectorants
• Antitussives
• Mucolytics

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Expectorants (Easy p 286)

• SSKI
• Guiafenesin (Robitussin)
• Increase secretions in respiratory tract
• Reduces thickness/adhesiveness
• Allows more productive cough

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Antitussives (Easy p 289)

• Codeine
• Dextromethorphan
• Hydrocodone
• Suppress cough center in medulla
• Unfortunate street value

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Mucolytics (Easy p 292)

• Acetylcysteine (Mucomyst)
• Breaks down mucus chains
• Irritates mucosa to stimulate clearance
• Restores glutathione which we need to metabolize
  Tylenol, etc
• Adverse effects
• That awful, rotten egg smell
• Bronchospasm, nausea

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Decongestants (Easy p 294)

• Sympathomimetics
• Ephedrine
• Pseudoephedrine
• Topicals nasal alpha receptors in mucosal
  blood vessels. Vasoconstriction less
  congestion
• Ephedrine rebound effect