Pharmacologic Profile

General Use

Management of acute and chronic episodes of reversible bronchoconstriction. Goal of therapy is to treat acute attacks (short-term control) and to ↓ incidence and intensity of future attacks (long-term control). The choice of modalities depends on the continued requirement for short term control agents.

General Action and Information

Adrenergic bronchodilators and phosphodiesterase inhibitors both work by ↑ intracellular levels of cyclic-3', 5'-adenosine monophosphate (cAMP); adrenergics by ↑ production and phosphodiesterase inhibitors by ↓ breakdown. ↑ levels of cAMP produce bronchodilation. Corticosteroids act by ↓ airway inflammation. Anticholinergics (ipratropium) produce bronchodilation by ↓ intracellular levels of cyclic guanosine monophosphate (cGMP). Leukotriene receptor antagonists and mast cell stabilizers ↓ the release of substances that can contribute to bronchospasm.

Contraindications

Inhaled corticosteroids, long-acting adrenergic agents, and mast cell stabilizers should not be used during acute attacks of asthma.

Precautions

Adrenergic bronchodilators and anticholinergics should be used cautiously in patients with cardiovascular disease. Chronic use of systemic corticosteroids should be avoided in children or during pregnancy or lactation. Patients with diabetes may experience loss of glycemic control during corticosteroid therapy. Corticosteroids should never be abruptly discontinued.

Interactions

Adrenergic bronchodilators and phosphodiesterase inhibitors may have additive CNS and cardiovascular effects with other adrenergic agents. Cimetidine ↑ theophylline levels and the risk of toxicity. Corticosteroids may ↓ the effectiveness of antidiabetics. Corticosteroids may cause hypokalemia which may be additive with potassium-losing diuretics and may also ↑ the risk of digoxin toxicity.

Nursing Implications

Assessment

• Assess lung sounds and respiratory function prior to and periodically throughout therapy.
• Assess cardiovascular status of patients taking adrenergic bronchodilators or anticholinergics. Monitor for ECG changes and chest pain.

Potential Nursing Diagnoses

• Ineffective airway clearance (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)
• Noncompliance (Patient/Family Teaching)

Implementation

• Shake inhaler well, and allow at least 1 min between inhalations of aerosol medication. Prime the inhaler before first use. Use of spacer recommended for children.

Patient/Family Teaching

• Instruct patient to take antiasthmatics as directed. Do not take more than prescribed or discontinue without discussing with health care professional.
• Advise patient to avoid smoking and other respiratory irritants.
• Instruct patient in correct use of metered-dose inhaler or other administration devices (see Medication Administration Techniques).
• Advise patient to contact health care professional promptly if the usual dose of medication fails to produce the desired results, if symptoms worsen after treatment, or if toxic effects occur.
• Patients using inhalation medications and bronchodilators should be advised to use the bronchodilator first and allow 5 min to elapse before administering other medications, unless otherwise directed by health care professional.

Evaluation/Desired Outcomes

• Prevention of and reduction in symptoms of asthma.