Asthma: (partially reversible)

1. Breathe in an allergen (anything that induces an allergic response).

2. Mast cells appear (contain inflammatory chemicals)

3. Mast cells burst --> release of inflammatory mediators and histamine --> inflammation --> can't absorb O2 really well

Iceberg:

Wheezing on top

Inflammatory process on bottom

(swelling that does not go away is most important)

- Beta 2 Agonists (1st step)

- Steroid Inhalers (2nd step)

- Mast Cell Stabilizers (keeps mast cells from bursting)

- Antihistamines

- Smooth muscle is controled by bets receptors

- B2 Activation = bronchodilation (SNS "fight or flight")

- Underlying inflammation & mucus (non irreversible)

- Characteristics: smoker (sometimes), barrel chest from hypoxia, finger clubbing, "air hungry", cyanotic

- Anti Inflammatory (inhaled steroids)

- Anticholinergenics

- Loss of elasticity

- Enlarged inefficient airways (structural changes)

- Short Acting: Albuterol (Proventil) PRN

- Long Acting Salmeterol (Serevent) Scheduled

–Sympathomimetic B2 receptors

–Activation of B2 receptors: bronchodilation

–Also suppresses histamine release (slows down mucous production)

–Short acting last 8 hrs – used only as needed (2 puffs daily)

–Long acting about 12 hours and used every day 

everyday at the same time 2x a day (9AM & 9PM)

-Asthma:

-use of short acting PRN for breakthrough

-Or use long acting daily.

–Also prophylactic use prior to exercis

-COPD:

–Relieve symptoms of COPD

–Inhaled beta2 agonists are tx of choice

- Tachycardia

- Tremor (will go away when medication wears off)

- Angina

- Hyperglycemia

- Monitor HR (not too high) and palpitations (ask pt if feel heart racing)

- Patient teaching:

- differentate between short acting and long acting

- Budesonide, Fluticasone (Flovent): inhalation

- Prednisone: oral

–Suppress inflammation

–Decrease synthesis and release of ↓ inflammatory mediators

–Decrease infiltration and activity of ↓ inflammatory cells

–Decrease ↓ edema of airway mucosa – reduce bronchial hyperactivity

–Decrease ↓ mucous production

–Prophylaxis of chronic asthma

–COPD – inhaled may improve airflow

–Reduce frequency and severity of exacerbations for moderate to severe asthma

–Benefits of inhaled steroids in COPD, are only observed using high range dosing

–Adrenal suppression – decrease ability of adrenal cortex to produce steroid.

can be suppressed for a year UNLESS

-if less than 10 days its not often problem

Withdrawl: adrenal shock

–Means patients will need to be given IV glucocorticoids

tapering medication: 60 mg 3 days --> 50 mg 3 days --> 40 mg 3 days

–Bone loss – use lowest dose possible

–Slow growth in children and adolescents

–Cataracts and glaucoma

–Hyperglycemia and peptic ulcer disease

–When patient switches from oral to inhaled will need supplements steroid in time of stress

–With oral treatment with steroids - patients they will need steroid in times of stress (trauma, surgery and infection)

–Contraindicated in setting of fungal infections

–Adequate intake of vitamin D and calcium and participate in weight bearing exercises

  Suppresses inflammation

  Stabilizes cytoplasmic membrane of mast cell

  Chronic asthma

  Exercise induced bronchospasm (get wheezes when I go to the athletic field)

-Mechanism of action:

–Blocks muscarinic (cholinergic) receptors bronchus (regulate the diameter of the airway)

–Bronchodilation occurs

- used for COPD

- Can't see: ↑ IOP: cataracts & gluacoma

- Can't spit: dry mouth, irritation of pharynx

- Can't pee: urinary retention

- Can't shit: constipation

- Look for side effects

- Treat glaucoma or get off the medication

  Block leukotrienes (inflammatory)

- Montior CBC, PT, LFT

- not for short acting use!!!

-Takes several minutes to deliver the mist

- half unconscious, so sick can't move

- used for acute asthma attack

- Rhinitis: Runny Nose (Histamine)

- Sinusitis: engorged sinuses caused by increased blood supply

Allergies, sinusitis

-Rebound congestion – tolerance develops (Afrin)

  CNS stimulation – oral versus topical

  Cardiac – widespread vasoconstriction

- Sudaphed: ↑ BP

  Congestion from cold

Antidote for tylenol overdose