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Asthma Rescue Medications (3)

Albuterol
Levalbuterol
INH

What is the Class and Action of Asthma Rescue Medications

Bronchodilation by relaxing the airway -- SMOOTH MUSCLE. Also decreases mucous production.

Side Effects of Rescue Asthma Medicaitons

Tachycardia, palpitations, sleeplessness, nausea/vomitting, agitation, headaches

Nursing Implications for a Asthma Rescue Medication

Use inhaler with spacer or in nebulizer. First rescue Medication. Use more than 2x a week == NEED Maintenance Medications. Use for exercise induced asthma

Systemic Corticosteroids
Actions / SE

Example: Prednisone, Prednisolone, Methylprednisone, acetate (Solu-Medrol)

Action: Blocks immune response to allergens, irritants. AIRWAY ANTI-INFLAMMATORY. Enhances Bronchodilation.

SE: Immunosuppression, UNSTABLE BLOOD SUGAR, GI Upset, Nausea, water retention, muscle weakness, K+ LOSS, headache, dizzy, GROWTH RETARDATION

Nursing Implications of Systemic Corticosteroids

Prednisone, Prednisolone, Methylprednisone, acetate (Solu-Medrol)

Use for shortest course to regain control- to avoid long term adverse effects.
**Give in the MORNING, GIVE w/ FOOD. Must use systemic route for rescue treatment. Don't stop long term use suddenly- need to taper to prevent SIDE EFFECTS / REBOUND EFFCTS

Anticholinergics
Actions / SE

Ipatropium (ATROVENT)
Action: Inhibit Bronchoconstriction, DECREASE mucous production.

SE: Dry mouth, nervousness, cough, HA, dizzi, tachycardia, palpitations.

Anticholinergics
Nursing Actions

Ipatropium (ATROVENT)

Inhaled only
Only use as adjunct primary therapy
**Bitter-Rinse mouth after use

Asthma Maintenance Meds:
Inhaled Corticosteroids
Actions / SE

Fluticasone (Flovent)
Budesonide (Pulmicort)

Action: Anti-inflammatory, decreases mucosal edema in airways.

**First choice for control medication for persistent asthma.

SE: Dry mouth, throat irritation, hoarseness, and thrush (yeast infection in mouth), headache, dizziness, GI upset.

Asthma Maintenance Meds:
Inhaled Corticosteroids

Nursing Implications

Fluticasone (Flovent)
Budesonide (Pulmicort)

Rinse mouth and gargle w/ water after to prevent Thrush and Dry Mouth. Use w/ inhaler with spacer or in nebulizer. Not a rescue Med

Asthma Maintenance Meds:
Long Acting Beta2-Agonist
Actions / SE

Salmeterol (Xinafoate), Serevent (INH)

Action:Relaxes airway smooth muscle and increases ciliary motility. Decreases AIRWAY reaction to ALLERGENS

SE:Tachycardia, tremors, agitation, insomnia.

Asthma Maintenance Meds:
Long Acting Beta2-Agonist
Nursing Implications

Salmeterol (Xinafoate), Serevent (INH)
Not used as single therapy in children combine with ICS (Inhaled Corticosteroid-- Fluticasone (Flovent), Budesonide (Pulmicort)

Mast Cell Inhibitors-
Actions / SE

Cromolyn Sodium INH

Action: Block release of histamines from mast cells, which interrupts the immune response to allergens.

SE: Throat Irritation, bronchospasms, congestion, anaphylaxis.

Mast Cell Inhibitors:
Nursing Implications

Cromolyn Sodium INH
May substitute for ICS for mild persistent asthma. May need to take 4x a day, response may take weeks to show.

Leukotriene Receptor Antagonist
Actions / SE

Montelukast (Singulair)
Blocks leukotrienes, Reduces inflammation cascade response. Improves lung function and diminishes symptoms and need for rescue meds.

SE: Headaches, n/v, diarrhea, upset stomach and infections.

Leukotriene Receptor Antagonist
Nursing Implications

Montelukast (Singulair)
Report fevers, acute asthma episodes, flulike symptoms, severe headaches or lethargy. Granules, chewable tablets for young.
ADMINISTER IN EVENING. dont stop medication abruptly, Used for asthma and ALLERGIES.

Immunotherapy
Action / SE

Omalizumab (XOLAIR) SQ

A: Therapuetic antibody that targets IgE and blocks reactions leading to asthma symptoms.

SE: Pain and Bruising at injection site, anaphylaxis.

Immunotherapy
Nursing Implications

Omalizumab (Xolair) SQ
INJECTIONS ADMINISTERED EVERY 2-4 Weeks.
AGE 12yrs. and Up

Allergy Medications
Antihistamines PO + Antihistamine Intranasal
Names / Ages

1st Generation: Diphenhydramine (Benadryl)
2nd Generation Ceterizine (Zyrtec) >6month and Loratadine (Claritin)>2 yo

Antihistamine Intranasal
Azelastine (Astelin) > 5yo

Allergy Medications
Antihistamines PO + Antihistamine Intranasal
Action / SE

1st Generation: Diphenhydramine (Benadryl)
2nd Generation Ceterizine (Zyrtec) >6month and Loratadine (Claritin)>2 yo

Antihistamine Intranasal
Azelastine (Astelin) > 5yo

Action: H1 receptor antagonist which blocks histamine release and alleviates allergic symptoms

SE: 1st Gen: Sedation, paradoxical excitation, hypotension, dry mouth, headache, dizziness, urinary retention, nausea, vomitting, thickening of secretions

2nd Generation: Dry mouth, headache, dizziness, nausea, drowsiness.

Inhaled: HA, drowsi, rhinitis, cough, nasal burning

Allergy Medications
Antihistamines PO + Antihistamine Intranasal
Nursing Implications

Effectiveness may diminish w/ Long term use.
Fewer side effects w/ 2nd Gen meds
USE FOR ALLERGIC RHINITIS / CHRONIC UTICARIA (hives).
Daily dosing w/ 2nd gen meds
Benedryl q 6hr

**Bitter taste w/ Inhaled= rinse-mouth
***Tilt head forward to ADMINISTER spray

Intranasal Steroids

Fluticasone (Flonase) >4yo
Mometasone ( Nasonex) >2yo
Budesonide (Rhinacort)>6yo

Intranasal Steroids
Action / SE

Fluticasone (Flonase) >4yo
Mometasone ( Nasonex) >2yo
Budesonide (Rhinacort)>6yo

Blocks immune response to allergens and decreases inflammation. Transient nasal irritation, burning, and sneezing.

Intranasal Steroids
Nursing Implications

Fluticasone (Flonase) >4yo
Mometasone ( Nasonex) >2yo
Budesonide (Rhinacort)>6yo

Bitter taste and risk for thrush-rinse mouth
Tilt head forward to administer spray
Blow nose prior to administration.

Lead Poisioning Tx:
Chelation

Succimer (Chemet)
10mg/kg tid x 5 days *AND* bid x 14 days
Beads in capsule, sprinkled on food, swallowed whole.

AE: N/V, diarrhea, loss of appetite, rash, ELEVATED LIVER F TEST, neutropenia, arrythmias.

NA: Promote renal excretion-hydration
Labs: Urinanalyis, BUN, creatinine, live FX, CBC w/ diff, platelets, BLL

Deforoxamine - lead poisoning antidote.

Lead Poisoning Tx:
Started on?

Ca EDTA
IV/IM if fluid restricted
BLL>45ug/dl
SE: Proteinuria, hematuria, nephrotoxicity w/ tubular necrosis, increased BUN and/or creatinine, HA, parethesias, anorexia, elevated Liver Fx test, ECG changes, sudden fever, N/V/Chills, fatigue, EXTREME THIRST, sneezing nasal...

Labs: Electrolytes, BUN/Creatinine, CBC, plateletts, liver FX, urine specific gravity, BP, I&O, BLL

**Taken w/ BAL when BLL>70

Deforoxamine - lead poisoning antidote.

Lead poisoning Tx:
Never used as single agent

BAL in Oil
**Always with EDTA, Deep IM
Contraindictions:
G6PD screen prior to Tx. Peanut allergy, No iron supplementation
SE: B/P, tachycardia, N/V, burning sensation in lips/mouth/throat, ABD Pain, dysuria, fever, HA, pain in throat/chest/hands/parethesias/muscle pain/weakness, mild conjunctivitis, lacrimation (crying), elevated liver

Precautions for BAL+EDTA

ECG, neuro assess, seizure precautions >100ug/dl

Diabetes type 2 Medication

Metformin, and 60 min/day of exercise. Take w/ food

Rapid Acting
Aspart

Novolog 100u/ml
Can be mixed w/ NPH
Onset: 10-20
Peak: 1-3
Duration: 3-5
Administration in Relation to Meals: 5-10 before
Clear

Rapid Acting
Lispro

Humalog 100u/ml
Can be mixed w/ NPH
Onset: 15-30
Peak: 1-2
Duration: 3-5
Administration in Relation to Meals: 15 before or after
Clear

Short Acting
Regular

Novolin 100u/ml NPH Mixer
Humilin R 500U/ml **Dont Mix w/ Other insulins
Humilin R 100u/ml NPH MIXER
Onset 30-60
Peak 2-4
Duration 4-8
30 min before meals

Intermediate Acting
NPH

Novolin N-- Mix w/ Aspart, regular
Humilin N-- Mix w/ lispro, regular
Onset 1-2 hours
Peak 6-14
Duration 16-24
Aspart Mix- 5-10 before meals
Lispro Mix - 15 mins before meals or right after

CLOUDY

Long Acting
Glargine

Lantis-- Dont mix
100 U/ ML
Onset 1-2 hours
Peak: None
Duration: 24hr

70 Aspart Protamine
30 Aspart

NovoLog Mix 70/30
Dont mix,
Onset: 10-20
Peak 1-4
Duration: 15-18 hours
Adm w/ in 15 mins

70 NPH
30 Regular

Onset 30-60
Peak 2-12
Duration 10-16
30 mins before meals

50 NPH
50 Regular

Onset 30-60
Peak 2-5.5
Duration 10-16
30 mins before meals

70 NPH
30 Regular

Humilin 70/30
Onset 30-60 mins
Peak 2-12 hours
Duration 10-16 hours
30 mns before meals

75 Lispro Protamine
25 Lispro

Onset 15-30 mins
Peak 1-6.5
Duration Up to 24 hrs
Within 15mins of meal initiation

status asthmaticus

epinephrine .1mL/kg max=.3

Stridor = Airway Edema = Epinephrine

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