Drugs for Control of Asthma

Med Class Med Names Mechanism of Action Side Effects Nursing Considerations

BRONCHODILATOR  Albuterol (Proventil,  Activate the SNS which relaxes  ↑ HR  Preferred Drug for relief of acute symptoms
Short Acting Beta2 Ventolin) the smooth muscle resulting in  Anxiety  Effect act only for 2-6 hrs
Agonist Bronchodilation.  Nausea  Monitor HR
 ↑ Fluid Intake (IV or PO) Chronic use causes
(Rescue Med)  Papitaions
dry mouth/throat
 Tremors 
 Although quite effective at -Teach Client about proper technique for using
Adverse Effects med
relieving bronchospasms they
 Hypokalemia  With Chronic use tolerance my develop
have no anti-inflammatory
 Dysrhythmias  Concurrent use with Beta Blocker will inhibit
properties so other drugs are
 Paradoxical bronchodilation effect
needed  Avoid MAOIs first 14 days
Bronchoconstriction
BRONCHODILATOR  Levalbuterol(Xopenex) SAME SAME  Long Term Prevention of exercise induced
Long Acting Beta2  Pirbuterol (Maxair) asthma
Agonist  Teach patient won’t work for acute attacks
 Salmetrol (Serevent)
(Controller Med)  Terbutaline (Brethine)  Should only be used in pts who cant be
controlled with other meds
 Last up to 12 hrs

BRONCHODILATOR  Ipratropium (Atrovent)  Block PNS which prevent  Headache  Treats acute Asthma attacks
AntiCholinergic vasoconstriction; this causes  Coughing  Often used in combo with B2 Agonist
Comb-Med same effects of SNS stimulation  Anxiety  Increase Fluid Intake for dry mouth
Combivent: comnbines
(Rescue Med) ipratropium &albuterol
vasodilation  Dry Mouth/Throat  Shake container well – drug seperates
 Toxicity : Headache, Blur Vision, Eye Pain,
Palpitations, Nervousness, Nausea

BRONCHODILATOR  theophylline (TheoDur)  Chemically Related to Caffeine  Tachycardia  Used for LT prophylaxis of asthma
Methylaznthines  Aminophylline IV  N/V  Infreq prescribed due to narrow safety margin
 Headache  Used when asthma unresponsive to B2
(Controller Med)  CNS Stimulation Agonist and inhaled steroids
 Insomnia
 Seizures
 Hypokalemia
 Hyperglycemia
 Med Class Med Names Mechanism of Action
ANTI-INFLAMMATORY  Methylprednisolone sodium  Sensitize bronchial smooth
Corticosteroids IV (SoluMedrol) muscle to be more responsive to
B2 Agonist stimulation
 Reduce hyper-responsiveness to
allergens responsible for attack
 Decreases lung inflammation
ANTI-INFLAMMATORY  Prednisone  Sensitize bronchial smooth
Corticosteroids PO muscle to be more responsive to
B2 Agonist stimulation
 Reduce hyper-responsiveness to
allergens responsible for attack
 Decreases lung inflammation
ANTI-INFLAMMATORY  Fluticsone (Flovent)  Suppress Inflammation w/o
Corticosteroids  Beclomethasone (Vanceril, serious s/e
Inhaled  Acts locally on bronchial tissue to
QVAR)
(Controller Med)  Triamcinalone (Azamacort) ↓inflammation: Inhibits cytokine
production
ANTI-INFLAMMATORY  Montelukast (Singulair)  Reduces Inflammation
Leukotriene Modifiers  Zafirlukast (Accolate)  Eases bronchoconstriction
 Zileuton (Ayflo)  Block leukotriene receptors in
(Controller Med) airways preventing edema and
inflammation
 Hep cases reported
Side Effects Nursing Considerations
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 Depression  For Acute exacerbation of Asthma
 Euphoria  Give initially then change to Oral prednisone
 HTN  Never stop suddenly, taper doses
 Hyperglycemia  Push over 1 min or more
 Peptic Ulcer  Do not give acetate form of drug
 Cushing Syndrome  Monitor Respiration Status and Lung Sound
 ↑ infection
susceptibility
 Depression  Given on tapered schedule following IV
 Euphoria  Q daily for severe/debilitating resp disease
 HTN  Chronic Use avoided if possible due to LT S/E
 Hyperglycemia  Tx limited to 5-7 days
 Peptic Ulcer  Witched to inhalants for LT management
 Cushing Syndrome
 ↑ infection
susceptibility
 Hoarseness  Preferred med for attack prevention
 Oralpharyngeal  Do not use in cute attack
candidasis  Symptoms improve in 1-2 week
 Sore throat  4-8 weeks req for man benefit
 Long-term use can cause systemic
manifestations of prolonged steroid use
 Can mask signs of infection
 Headache  Prophylaxis for chronic persistent asthma
 Cough  Oral med
 Nasal congestion  Less effective than Corticosteroids
 GI upset  Notify HCP of s/s of liver dysfunction
 Caution with liver disease & warfarin therapy
 Med Class Med Names Mechanism of Action Side Effects Nursing Considerations

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ANTI-INFLAMMATORY  Cromolyn Sodium (Intal)  Blocks early and late reaction to  Cough  Prophylaxis for asthma attack
Mast cell stabalizer allergen  Irritation  Max therapy takes several weeks 4-6 wks
 Inhibits mast cells from releasing  Bitter Unpleasant  Less effective than steroids
(Controller Med)
histamine and othe inflammation taste
mediators
 Inhibits inflammatory response to
old air dry air and exercise

Immunomodilator  Omalizumab (Xolair)  Attaches to IgE cell preventing  Pain  SubQ injection q 2-4 wks
Monoclonal Antibody inflammation and dampens body’s  Skin reaction 
allergy response  Anaphylaxis

5-Lipoxygenase  Zyflo  Inhibits Leukotrienes production   Can inhibit metabolism of warfarin and
Inhibitor theophylline

Mucolytics  Acetylcyteine (Mucomyst)  Controls excess mucus production  Unpleasant odor  Admin MDI. IV. Oral
 Loosens thick viscous bronchial  Nausea
secretions