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Adrenergic Bronchodilators

Short Acting- duration 4 to 6 hours Indication: Acute reversible airflow obstruction. These drugs are called rescue drugs meaning when a patient is presenting with symptoms that indicate they need a bronchodilator you would give them this for immediate relief. Just think if you were having an asthma attack you would want them to fix your symptoms right away and worry about the maintenance later.

Long Acting- duration 12 hours This is given for the maintenance of bronchodilation and control of bronchospasms, in asthma or other obstructive diseases.

Ultra Short Acting- Racemic Epinephrine: duration less than 3 hours This is given to reduce airway swelling after extubation, or epiglottitis, croup, and bronchiolitis. This can also be given to control airway bleeding during a bronchoscopy.

Common Symptoms you will see for pts having an acute airflow obstruction: Increase HR (meaning above normal range) Increase use of accessory muscles Wheezing or diminished breath sounds Lethargy, fatigue, and or Confusion SOB

Anticholinergic
Indication- These drugs are for bronchodilator therapy, for patients in need of maintenance treatments in COPD or in some asthma cases. The combination of an adrenergic and anticholinergic drug such as DuoNeb is indicated for patients receiving regular TXs but is in need of additional bronchodilation. For instance someone who has asthma and is using albuterol to help treat their symptoms but their acute symptoms are not completely resolved will benefit from DuoNeb because they probably just need addition bronchodilation. Or a pt that is benefiting from albuterol but has adverse side effects from it that they complain a lot about would probably prefer Ipratropium bromide over the albuterol. Ipratropium would fall under the short acting category since its duration is 4-6 hours. Tiotropium is a long acting since its duration is 24 hours. You would never use this in an acute situation.

Xanthines
Indication- Given for management of asthma and COPD, also given for apnea of prematurity. Asthma and COPD- this would be used as an alternative to a Nonsteroidal antiasthma agent, but is not preferred. Meaning you most likely will never use it for this purpose. Apnea of prematurity- indicated to help stimulate the CNS to get the baby to start breathing. Basically wakes them up and gives them the drive to breath if they are able to.

Corticosteroids
Indication- used for a wide variety of conditions, with the therapeutic goal of reducing inflammation. We mainly use this drug to reduce inflammation on pts with asthma and COPD. Shown to be the most affective for long term treatment but does not provide bronchodilation. Studies have shown to start dose high enough to be effective then reduce the dose. If a pt has already been diagnosed with asthma or COPD but is not seeing improvement in their symptoms that would be a good indicator they may benefit from a corticosteroid. Its not that the bronchodilators may not be working but that the pt may have too much inflammation for it to work. If a patient is using a short acting bronchodilator for rescue therapy and a long acting for maintenance but is put on a corticosteroid. Once the pt is being maintained by the steroid and short acting bronchodilator then the pt needs to be taken off the long acting. The long acting bronchodilators are not intended for long term use.

Non Steroidal Antiasthma Agents


Indication- use of a bronchodilator more than twice a week is a good indication for maintenance therapy. This is used in asthma requiring anti-inflammatory drug therapy. Cromolyn is often used in children w/ asthma as an alternative to corticosteroid. Cromolyn and Antileukotrienes can be recommended as alternatives to low dosed corticosteroids for asthma pts. Antileukotrienes can be used to lower the dose of a corticosteroid by combing the two. This drug is mainly intended for pts with asthma because they target the receptors that cause inflammation in asthma pts.

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