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Beta Adrenergic Agonists

Mechanism of action Therapeutic uses Side Effects/Precautions Interactions Nursing/Patient Teachings activates beta-receptors in bronchial smooth muscle, results in bronchodilation. Histamine release is inhibited, chiliary motility is increased. prevention of asthma attack, treatment for ongoing asthma or long term asthma control tachycardia, angina betablockers can negate effects of both meds, MAOIs and tricyclic antidepressants can increase risk of tachycardia and angina : observe for signs of angina, check pulse before and after, avoid caffeine. Formoterol and salmeterol are long acting and not to be used for short term asthma attack. albuterol (Proventil, Ventolin), Formoterol(Foradil Aerolizer), Salmeterol (Serevent), Terbutaline. Note: most end in erol

Common Drugs

Methylxanthines
Mechanism of action Therapetutic uses Side Effects/Precautions Interactions Nursing/Patient Teachings Common Drugs causes relaxation of bronchial smooth muscle, resulting in bronchodilation used for long term control of chronic asthma GI distress, restlessness, dysrhythmias, seizures caffeine increases CNS and cardiac adverse effects, Phenobarbital and phenytoin decrease theophylline levels. Tagamet, Cipro, increase theophylline levels avoid caffeine, monitor theophylline serum levels (therapeutic range is 5 to 15 mcg/ml) Theophylline, Aminophylline

Inhaled Anticholinergics
Mechanism of action Therapetutic uses Side Effects/Precautions Interactions Nursing/Patient Teachings Common Drugs block muscarinic receptors of the bronchi, resulting in bronchodilation Relieve bronchospasm from COPD, allergen/exercise induced asthma Anticholinergic effects: Dry mouth, hoarseness Caution with narrow-angle glaucoma, and BPH Rinse mouth after inhalation for unpleasant taste, adult dosage is usually 2 puffs, wait five minutes between other inhaled meds. Ipratropium (Atrovent), tiotropium (Spiriva)

Glucocorticoids
Mechanism of action Therapetutic uses Side Effects/Precautions Interactions Prevent inflammation, suppress airway mucus propuction, promote responsiveness of beta receptors in bronchial tree Status asthmaticus, prophylaxis of asthma, therapy following asthma attack, chronic asthma, promote lung maturity in fetuses Suppression of adrenal gland function, bone loss, hyperglycemia, peptic ulcer disease, infection, Concurrent use of diuretics increase risk of hypokalemia, concurrent use of NSAIDS increase risk of GI ulceration, glucocorticoids and hypoglycemic agents counteract each other.

Nursing/Patient Teachings Common Drugs

Inhale beta agonist first before inhaling glucocorticoid if both are prescribed (bc the beta agonist will help enhance absorption), Inhalation: Budesonide (Pulmicort Flexhaler), Fluticasone propionate (Advair, Flovent). Oral: Prednisolone IV: hydrocortisone sodium succinate, Solu- Medrol

Leukotriene Modifiers
Mechanism of action Therapetutic uses Side Effects/Precautions Interactions Nursing/Patient Teachings Common Drugs Prevent effects of leukotrienes, suppressing inflammation, bronchoconstriction, airway edema, and mucus production Long term therapy of asthma Caution with liver disease Inhibit metabolism of warfarin (could lead to increased warfarin levels, inhibit metabolism of theophylline Zafirlukast cannot be taken with food Zileuton (Zyflo), zafirlukast (Accolate), montelukast (Singulair)