Pharm Asthma

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Author:
cswett
ID:
147929
Filename:
Pharm Asthma
Updated:
2012-04-16 14:18:52
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Pharm Asthma
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Pharm Asthma
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  1. Asthma and tx plan
    Asthma - paroxysmal (comes and goes) bronchoconstriction with bronchial inflammation

    • Tx -
    • - Bronchodilators (resuce inhalters)
    • - anti-inflammatories (maint/ prevention)
  2. Rescue inhalters
    • - suffix -terol
    • albuterol/ ventolin
    • short onset, short duration
    • Beta2 agonists

    • SE/ADR - jittery-also have beta 1 effects - increase HR, increase BP (systolic up a little bit)
    • -assess HR & BP

    Albuterol syrup (for kids) - systemic - don't give after 4 pm (wired)
  3. Maintencance inhalers
    • - preferred are steroids - suffix sone or solone
    • beclomethosone/ Beclovent
    • Pulmacort/ Aerobid/ Asmanex

    • -preferred for long-term management in both children and adults
    • -oral or nose (for allergic rhinitus)

    • Teaching:
    • -use after resuce inhalers (bronchodilators open things up so steroids can get in)
    • -keep capped and clean
    • *rinse mouth after use (rinse and spit)
    • - risk of oral candida/ thrush
    • -do not take to terminate an acute attack (max benefit may not be achieved for 1 to 3 weeks)
  4. Follow up/ add-on maintenance - severe asthma
    • - suffix -meterol
    • -long acting beta2 agonist
    • solmeterol/ serervent
    • fometerol/ foralil

    -use in combination with inhaled corticosteroids for prophylaxis of moderate to severe asthma

    BLACK BOX WARNING - sudden astham related death-occurs from overuse or long use-decreases albuteral efficacy-use only for prevention - dont use in acute attack
  5. Drug of choice for COPD
    • -Ipretropium/ Atrovent
    • -Tiotropium/ Spireva
    • PNS antagonists - anticholenergic -prevents bronchospasm
    • used for COPD including bronchitis and asthma - not used often in asthma

    -quick but peak can take 1-2 hours - bronchodilation lasts up to 6 hours

    • - SE/ADR - dry mouth
    • -rinse mouth
  6. Theophylline
    • Theophylline (PO)
    • -Aminophylline (IV)

    • natrual substance found in tea - not as effective as other beta2 agonists
    • -relaxes bronchial smooth muscle which promotes bronchodilation
    • -narrow therapeutic window
    • Teach - dont double up on doses
    • -same family of compounds as caffine
    • -risk of overdose is seizure -
  7. Cholesterol -
    • -obtained from diet
    • -synthesized in liver
    • -Liver packs excess as LDL's & sends out to storage
    • -HDL - cholsterol going back to liver to be broken down
    • -exercise is main way to increase HDL's
  8. Statins
    • suffix - Statins
    • simvastatin/ zocoratorvastatin/ Lipitor
    • - Inhibit HMG CoA reductase
    • - prevent liver from synthesizing cholesterol

    • -SE/ADR - risk of liver damage
    • -discuss ETOH consumption with Dr
    • -avoid acetaminophen
    • -yellow skin, eyes (sclera), grey/ ashen colored stools
    • - CALL DR
    • 1:10,000 - rhabdomyolysis - striated muscle breakdown (skeletal muscle breakdown)
    • - can lead to renal failure and death
    • - report unexplained muscle pain and weakness

    • quiz:4 clients all taking statins
    • dark urine after multi vit
    • muscle pain for no good reason
    • weakness
  9. PAIN
    • PAIN
    • - 5th vital sign
    • - unpleasant yet useful sensation
    • - can persist beyond being useful

    • Types:
    • Acute pain
    • - pain during healing
    • - large SNS component-adreniline (increase HR) -
    • - small psychological component

    • - Chronic pain
    • - pain after healing phase
    • - blunted SNS component
    • - VS not good as showing chronic pain-
    • - large psychological component
    • - wounded bird syndrome / green poultice - aflack
    • -group therapy, OT, PT

    Viseral pain - tissue -opiates preferred

    Bones/ Joint/ Dental - NSAIDs - acetaminophen

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