Review: Asthma Medications (Nursing)

00:00 So that's why we call these rescue inhalers. They are quick relief medications, they are taken at the first sign or symptoms to get immediate relief. So they kick in very very quickly. Now our first choice is a short-acting beta-2 agonist, so short acting and inhaled. Why would we want inhaled? Because that's going to get the medication directly to the spot where we're having the problem which is in the lungs. So a short-acting beta-2 adrenergic agonist, sometimes we shorten that to SABA. So I would write that in in your notes, SABA. That is short-acting B is for beta-2 and it's an agonist. This is a rescue inhaler. So while the patient is going and it's something that looks like an asthma attack, a bronchospasm, this is what I want to get, something that's quick acting and will get directly there. We can also use an anti-cholinergic medication. So, this kind of drugs, a short acting, a SABA is an agonist so it will go to those beta-2 receptors on the lungs and activate them. Beta-2 receptors in the lungs cause bronchodilation. Another type of medication we can use is an anti-cholinergic.

01:20 Anti-cholinergic will block what those cholinergic receptors do in the lungs. What they do is cause bronchoconstriction and mucus production. So the one group, the SABAs, will bronchodilate because they activate a receptor, the anti-cholinergics will block that response so you have less bronchoconstriction and mucus production. Both are what we're looking for. Now when you talk about adrenergic receptors, that's a SABA. Right? We're talking about short-acting adrenergic receptor agonist. So, these receptors, adrenergic receptors, beta-2 is an example.

01:59 So they're activated by norepinephrine and epinephrine. So, beta-2 receptors, what are they activated by? Right, norepinephrine and epinephrine. Now beta-2 receptors in the lungs are considered adrenergic receptors because adrenergic receptors are hit by things or activated by things like norepinephrine and epinephrine. Cholinergic receptors are activated by, right, acetylcholine. So the beta-2 receptors are adrenergic receptors, meaning they're activated by norepinephrine and epinephrine. Beta-2 receptors in the lungs are adrenergic and they cause bronchodilation when they're hit by epinephrine. So we give an inhaled medication, it's going to go down and act as an agonist or an activator for beta-2 receptors. Now we have short acting ones and we have long acting ones. So first of all, very important that you know the difference and next you need to educate your patients so they know when in an emergency they don't reach for a long-acting beta-2, they ask for short-acting beta-2. So depending on your patient's level of understanding, you may want to help them with some stickers and some things to label "ey this is the one that I use in an emergency." Because beta-2 agonist medications are drugs that may act just like epinephrine or norepinephrine in the body. So, we took something that normally happens in your body, we made the medications you get extra of it when you need it, because beta-2 adrenergic agonist can be short acting or long acting.

03:43 Now I introduced you to that concept but I want to make sure you really understand that because this can be a huge factor if someone's in an attack. The short acting ones, remember we nicknamed those SABAs. That stands for S for short, A for acting, B for beta-2, and A for agonist. Remember an agonist activates a receptor. So that's why we call them SABAs. So it works fast, they relax the muscles of the airways and prevent them from getting too tight.

04:15 Now example of a medication that we would use is called albuterol. So albuterol is an example of one type of medication that is a short acting beta-2 agonist or activator. So albuterol is a rescue inhaler. Why? Because it's short-acting. So if I have a patient who is in trouble, who's starting to have respiratory distress, this would be a good choice for them to take. Now on the other end of the time spectrum, we've got the long-acting inhaled beta-2 agonist. So LABAs, long-acting B for beta-2 agonist. These are drugs that will activate the beta-2 receptors but not as quick as a short-acting one so you don't want to use these guys by themselves for long-term control. Okay, we're going to use them with something else. Monotherapy means one. So you don't really use LABAs for monotherapy, just by themselves. We use it with other things. So we knew those are patients who need a little more than this alone. We wanted to reduce asthma attacks and the need for short-acting beta-2 adrenergic agonist but we use it in conjunction with other medications. So let's do some examples of some long-acting inhaled beta-2 agonist or LABAs. Remember, patients in a crisis, these are not the drugs I grab but some example drugs would be like salmeterol, formoterol, those would be or you may say sal-me-te-rol or for-mo-te-rol, however you prefer to pronounce it but those are some examples of the drugs. Now we've got some combination drugs down there. So you've got some options where we can put these types of drugs together and we give them combination meds. Now why do we combine meds? Well sometimes they potentiate each other but usually it's for convenience. And the fewer times a patient has to administer a medication, the better shot we have of them being compliant. So sometimes we put drugs together for the patient's convenience. Now let's talk about inhaled corticosteroids. Do you think an inhaled corticosteroid would bronchodilate quickly? No. Okay. Now these are the most effective medications for a long-term control of asthma that's persistent. They're not what we use as a rescue inhaler.

06:32 Now inhaling the corticosteroids, that's the best. Right? We would rather do that because it's inhaled, goes right to the site that we want it to and it's going to help reduce the inflammation but it is not a rescue inhaler. A corticosteroid in order for it to be effective, you want to make sure that the patient uses that everyday. Now we prefer that it be inhaled because that's going to limit the type of systemic side effect someone has from corticosteroids.

07:01 Remember, corticosteroids are mimicking what normally comes from your adrenal cortex, that's why they're called corticosteroids. If we give it to you as an inhaler, it's directly to the site that we want it to. Also, we minimize the side effects of corticosteroids; moon face, facial hair, mood swings, buffalo hump, hard on my skin, hard on my bones. Those systemic side effects are most often experienced by the patient who's taking oral doses or IV doses.

07:32 So, we want to control asthma, that inflammatory response, by consistently taking steroids and inhaled is the route of preference. Why? Because we minimize those systemic effects and we deliver the medication right to the site that we need it, right to the site that's inflamed in asthma. It won't rescue a patient but if they take it consistently on a daily basis as needed, that's going to minimize the inflammatory response and help us deal with exacerbations of asthma. Now one example of a drug, you've got it listed there in a metered dose inhaler. So usually drugs that end in sone, s-o-n-e, that's an example of a corticosteroid.