Bronchodilators, asthma

Albuterol Selective B2 agonist Prompt, efficacious bronchodilation Asthma, chronic obstructive pulmonary disease (COPD) drug of choice in acute asthmatic bronchospasm Aerosol inhalation duration several hours also available for nebulizer and parenteral use Toxicity. Tremor, tachycardia t overdose arrhythmias... 

Aminophylline - bronchodilator asthma, chronic bronchitis Amiodarone - anti-arrhythmic Amisulpiride - antipsychotic Amitriptyline - antidepressant... 

Ipratropium - anti-muscarinic bronchodilator asthma, chronic bronchitis... 

Theophylline - bronchodilator asthma, chronic bronchitis Thipental - intravenous general anaesthetic Tiabendazole - anthelmintic Tioconazole - antifungal... 

A) Both are hydrolyzed by acetylcholinesterase Both inhibit nicotinic receptors Both may decrease sweating Both may increase gastrointestinal motility Neither causes tachycardia Actions of chohnoceptor agonists and their clinical uses include which one of the following (A) Bronchodilation (asthma)... 

A Bronchodilation (direct effect, remember that norepinephrine doesn t cause bronchodilation). Asthma, nasal congestion, narcolepsy. Used as a mydriatic (dilates pupil). Less CNS toxicity than amphetamine. Longer duration, but less potent than epinephrine. 

Most of the drugs such as epinephrine and albuterol used to treat asthma attacks are bronchodilators—substances that expand the bronchial passages Newer drugs are designed to either inhibit the enzyme 5 lipoxygenase which acts on arachidomc acid m the first stage of leukotriene biosynthesis or to block leukotriene receptors... 

The modern usage of P2" go Asts for the treatment of asthma dates to 1903 when the effect of injected epinephrine [51-43-4] (adrenaline) C2H23NO2, (1 R = CH3) was investigated (see Epinephrine and norepinephrine) (33). As in some other modem treatments, eg, xanthines and anticholinergics, the roots of P2" go Ast therapy for asthma can be found in historical records which document the use of herbal extracts containing ephedrine [299-42-3] C qH NO, (2) as bronchodilators. Epinephrine and ephedrine are stmcturaHy related to the catecholamine norepinephrine [51-41-2] CgH NO, (1, R = H), a neurotransmitter of the adrenergic nervous system (see Neuroregulators). 

The bronchodilating effect of caffeine has been recognized for hundreds of years. In the western world the first description of a caffeine preparation for asthma was made in 1859 (59) by a Scottish physician who recommended strong black coffee as a bronchodilator. In many parts of the world, however, use of xanthines is less frequent than in the United States. 

At this writing anticholinergic agents are not widely used for the symptomatic treatment of asthma, although compounds such as atropine [51 -55-8] C17H23NO3, (18) have been used for centuries (111). Inhalation of the smoke produced by burning herbal mixtures, such as Datura Stramonium provided bronchodilation and rehef from some of the symptoms of asthma. The major active component in these preparations was atropine or other closely related alkaloids (qv). 

The action of epinephrine and related agents forms the basis of therapeutic control of smooth muscle contraction. Breathing disorders, including asthma and various allergies, can result from excessive contraction of bronchial smooth muscle tissue. Treatment with epinephrine, whether by tablets or aerosol inhalation, inhibits MLCK and relaxes bronchial muscle tissue. More specific bronchodilators, such as albuterol (see figure), act more selec-... 

Beta adrenergic agonists also exert bronchodilating effects. These drugs are thus often used in conjunction with theophiline in asthma therapy. A drug that combines both moieties, reproterol (40), has interestingly proved... 

Leukotrienes are rapidly produced and released during a Type I reaction (Fig. 3). They are responsible for a massive bronchoconstriction in allergic bronchial asthma and attract leukocytes, thus being proinflamma-tory. Consequently, antagonists of the LTC recqDtor have been proven useful in the therapy of bronchial asthma, often in combination with bronchodilators (example montelukast). 

Asthma attacks more than twice a week FEV1 60-80% daily use of bronchodilators. Rapid-acting inhaled p2-agonist Inhaled glucocorticoid... 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

An acute and life-threatening exacerbation of asthma that does not respond to standard treatments of bronchodilators and corticosteroids. 

Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking the bronchodilators or anti asthma drugs. 

List some nursing diagnoses particular to a patient taking a bronchodilator or an anti asthma drug. 

W ithin the past few years a number of new drugs have been introduced to treat respiratory disorders, such as bronchial asthma and disorders that produce chronic airway obstruction. This chapter discusses the bronchodilators, dragp that have been around for a long time but are still effective in specific instances, and the newer antiasthma drugs that have proven to be highly effective in the prophylaxis (prevention) of breathing difficulty. 

Along with the bronchodilators, several types of dragp are effective in Hie treatment of asthma. These include corticosteroids, leukotriene formation inhibitors, leukotriene receptor agonists, and mast cell stabilizers. 

Salmeterol is a long-acting inhaled bronchodilator and is not used to treat acute asthma symptoms. It does not replace the fast-acting inhalers for sudden symptoms. Salmeterol should not be used more frequently than twice daily (morning and evening). 

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