Medications to Treat Asthma Airway Problems (Nursing)

00:01 Now, I keep putting in the title both asthma airway problems, both asthma airway problems, both asthma airway problems.

00:10 Because, you have to have the first step, foundational understanding of treating someone with asthma.

00:16 And so i'm gonna have to give them medications that treat the bronchoconstriction and the inflammation.

00:22 So in that first big green bar, you see the word bronchoconstriction.

00:27 Make sure you label that number 1.

00:30 That's what we're gonna deal with first.

00:32 So, we have different types of inhalers.

00:35 By breathing in that medication, I'm gonna get the medication right to my lungs where I need it the most.

00:42 So I have emergency rescue inhalers and I have long term inhalers.

00:47 Now they've laid this out for you here beautifully.

00:50 You have to know the difference.

00:52 This truly is the difference, between life and death for somebody, if you know the difference between their emergency rescue inhaler and their long term inhaler.

01:03 Now, the reason we've named them emergency rescue and long term that's because they're short acting or long acting.

01:11 Now you see the letters there, S-A-B-A, underline that.

01:15 Under emergency rescue inhalers, underline S-A-B-A.

01:20 That's the short hand for saying Short Acting Beta 2 Agonist.

01:25 Now you know that you have receptors all over your body and they do amazing things.

01:30 But you have Beta 1 receptors on your heart, Beta 2 receptors on your lungs.

01:36 Now when an agonist connects to a receptor, then it does what that receptor's intended to do.

01:42 Beta 2 receptors are meant to bronchodilate and if I can't breathe, I need you to give me a short acting one.

01:54 I don't want one that's gonna take forever to kick in.

01:57 That would be a long acting, beta 2 adrenergic agonist.

02:03 So critically important, right your note on this slide that says, "Know which meds are SABAs and which ones are LABAs." We give people long acting Beta 2s, we give them to those everyday to prevent attacks.

02:19 But they will not save someone in an emergency.

02:23 You have to be crystal clear on this point.

02:26 You must know what is a short acting beta 2 adrenergic agonist, an emergency or a rescue inhaler.

02:34 It's important that you know it and it's critically important that you teach a patient and the patient's family if that's appropriate, which one to use in an emergency.

02:45 Now a couple other choices we have for bronchodilators are methylxanthines and you see that we've got anticholinergics.

02:51 Those are also very helpful and we'll talk about how we use those.

02:55 But the most important part of this slide when we're talking about one of the two asthma problems, bronchodilators, knowing the difference between emergency and long term inhalers.

03:07 I promise you, that could be the difference between life and death for your patients.

03:13 Now problem number 2, we're moving into inflammation where we can use inhaled glucocorticoids.

03:20 Glucocorticoids suppress inflammation.

03:23 So by inhaling them, I'm gonna get the medication right down into my lungs which is where, exactly where I wanna target the inflammation.

03:32 I can also use, uh-oh look at that, anti-leukotriene modifiers.

03:39 Sweet.

03:40 Remember that last slide that you did all that workin' and seeing like all of those thing were released and we have those nasty beasties and one of them was leukotrienes.

03:49 So to deal with that inflammatory process, after your patient has been exposed to an allergen, there you have it, there's one of our friends, anti-leukotriene modifiers.

04:00 They're against what the leukotrienes normally do in the body.

04:04 With blocking leukotrienes, I'm gonna have less of that inflammation and nasty respiratory response.

04:13 Mast cell stabilizers.

04:16 Cool. Again, back to that slide.

04:19 Remember the allergen and IgE connects to the mast cell and that stuff starts being released? If I can stabilize that mast cell membrane, I'll prevent those things from being released.

04:31 And last we have IgE antagonists.

04:34 Brilliant! that is so cool.

04:37 Because remember the very first step was IgE connecting to the mast cells.

04:43 So, here is where it pays off with all the hardwork that you did on that slide, looking at the inflammatory process.

04:50 Inhaled glucocorticoids, that will directly suppress the inflammatory response.

04:55 Anti-leukotriene modifiers will block leukotrienes.

04:59 Mast cells stabilizers will calm that mast cell down so it won't release those things.

05:05 And IgE would stop it earlier at step 1.

05:09 So there is almost a complete overview right there.

05:12 Now we just need to go back in and fill in the name of the drugs.

05:15 So if you're feeling like you've really worked hard up to this point, you have.

05:19 But you have a very soild understanding of how we treat asthma, both of the problems, bronchoconstriction and inflammation.

05:29 Now I want you to think, if someone just rolled into the ER, just take your finger and your pencil right now and I want you to put it on the place on the diagram that you feel What would be the most important medication category to give to a patient who rolled into your ER and in an extreme respiratory asthma attack crisis.

05:56 Great.

05:57 I hope you went right to the section that said, "Emergency/rescue inhalers" That's what we're gonna do first.

06:04 That is our top priority 'cause we have to get that airway open.

06:07 Then we'll address the inflammation and all the other problems but I want you to be very solid on that concept.

06:12 That you don't even know any names yet, that's okay.

06:15 We'll lay that in next.

06:17 Okay, so we've got meds to treat, how many problems? Right.

06:22 Both asthma airway problems.

06:25 In your mind, define right now what are the two asthma airway problems? Write it in the margin of your notes to help your brain remember.

06:35 One should be bronchoconstriction, two should be inflammation.

06:40 So with bronchoconstriction, we talked about the emergency rescue inhalers.

06:43 You want the short acting beta 2 agonists.

06:47 You see two examples on your screen now: Albuterol and Levalbuterol.

06:51 Look they end in -erol, so we know those are gonna be beta 2 agonists.

06:57 Now the longer acting ones.

06:59 These are inhaled long acting ones.

07:02 These are LABAs, they hit the same receptors, the beta 2 receptors but they take a lot longer to kick in.

07:09 But look at the names there, uh-oh, okay end in -erol, too.

07:14 But what you have to remember is, all that tells us E-R-O-L, just underline that in the names of the drugs to help you remember that.

07:23 That tells us they are beta 2 agonist, it does not tell you if it's fast or longer acting.

07:30 So you wanna keep that in mind.

07:33 Now remember we talked about the beta agonist that's cholinergic antagonist? This is a combination of a beta 2 agonist, a short acting one: Albuterol and then a cholinergic antagonist.

07:46 Now I want you to look back at that other slide.

07:49 Remember we had that combination that big green box of bronchoconstriction and inflammation? Look for cholinergic antagonist and that's where Ipratropium fits in.

07:59 Put those two together and we've got a really effective medication.

08:03 Okay. now let's look at the inflammatory meds.

08:06 We're gonna inhale glucocorticoids like beclomethasone dipropionate.

08:11 You've got, look at this one ends in: Budesonide and you've got Ciclesonide.

08:16 So start to look for a common theme in these medications.

08:20 They end in S-O-N-E or N-I-D-E.

08:24 Those are the inhaled glucocorticoids.

08:29 Now anti-leukotriene modifiers.

08:32 You can take these by mouth.

08:34 Remember the role of why we want to block leukotrienes? because they're the one, that nastiness in that inflammatory response.

08:44 So these medications are antagonists, they will block the action of leukotrienes in your body.

08:50 So you see the names there, they end in, first two end in -lukast.

08:54 The third one doesn't so, those are a little trickier to remember but that is the role.

08:59 They block leukotrienes.

09:01 Now the mast cells stabilizers, are like probably the oldest drug out there: Cromolyn.

09:07 This one I'll tell you now, I just want you to write a quick note by this one.

09:10 Mast cell stabilizer like Cromolyn is an old school drug.

09:14 You inhale it, but this is pretty good because it's really safe.

09:18 So make sure you put the word "safe' down there, has minimal adverse effects and it's really good for exercise-induced asthma.

09:27 If a patient, like if they go to run, they get an asthma attack when they run, if they will take Cromolyn 15-20 mins before they go and do their exercise, they will likely have less of a response from that exercise-induced asthma.

09:40 So if a patient is going to do something that exacerbates or kicks in their asthma, if they medicate before that time, we're gonna helpfully minimize that reaction.