Asthma: Prevention and Control Medications (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Okay, welcome back. First of all, good job. I know that was a lot of questions to throw at you but this can make this can make this next section much easier. So if you disciplined yourself to do the work, that's cool, because you're studying as you go. Because nobody has got time for all excess stuff or do it later. So, hang in there, I know it takes discipline to do that but I want to encourage you to keep doing that. Now, let's take a look at Prevention and Control Medications. You answered all those questions I just gave you. Now we're going to talk about Prevention and Control Medications. So these are long-term control medications. That means, you take them everyday to prevent symptoms of an attack. So, if I'm in an acute asthma attack, this is not a type of medication you're going to give me. Right? This is a medication that I need to know to take everyday to make things better. So, let's look at the first bullet point. You got an antileukotriene or a leukotriene modifier. Now, I had a friend, she is brilliant.

    01:02 We're still friends, super smart, I got crazy. ACT, SAT scores, really really sharp. But she was on an antileukotriene. Well, she didn't get educated in the physician's office about when she should take it. So, everytime she had an asthma attack and start having symptoms she would reach for this medication. Took me a little while to figure out why this medication wasn't working because they're usually very effective until, ahha, I asked the right questions of a very smart friend and I figured out she wasn't taking the medication everyday. She just took it when she had symptoms. Well, by that time it was too late. Because leukotrienes are these nasty beasties that are released in an inflammatory response. If you take an antileukotriene, then that medication is on those receptors and so when the leukotrienes come out they can't connect to those receptors and wreak havoc. But, you have to have the medication on the receptor before the leukotrienes are released. So think of it like if you're going to the lake and you're allergic to mold and there's a lot of mold at the lakehouse. If you don't get an antihistamine under those histamine receptors before you go to the lake, it's kind of late after you get there and you start with your inflammatory response. It's kind of late then to take an antihistamine. Same thing with antileukotrienes. You take them everyday to keep that medication on those receptors and you'll have fewer symptoms or asthma attacks. So you can see how even if I had someone who's really bright and sharp, didn't get the right education when they receive the medication, they weren't taking it effectively and they were miserable because where I live allergies can be way out of control. Now another one is cromolyn sodium.

    02:52 That's a muscle stabilizer. That's a great one, it's an old one, really really safe. Patients take it before exercising, it's awesome, works good. But that's because they're not in an asthma attack, they take the cromolyn sodium about 15 minutes before a run let's say, then we'll have those mast cells soothe so they won't release all that nastiness of an inflammatory response.

    03:16 Inhaled corticosteroids, same thing. By taking on a regular basis it's going to suppress that inflammation in the lungs, that's what I'm looking at. Because inflamed airways are small airways. So I want to have the corticosteroids on board so that those airways are not as inflamed. Because corticosteroids mimic what normally comes out of my adrenal cortex, it will suppress inflammation and remember I can have less inflammation in the airways, I have wider more open airway. So I can get more oxygen in and out. Now the long-acting inhaled beta-2 agonist. We have given those LABAs. Right? We gave it that nickname because long-acting inhaled beta-2 adrenergic agonist, this just takes too long to say. So we always give it with another asthma-related drug. Why? Because a LABA is only good for long-term control. It's not a rescue inhaler like a SABA or an anticholinergic medication. Now pause for just a minute and see if you can remind yourself why do we not use a LABA, goes after the beta-2 agonist.

    04:29 Right? That's what it is. Why is the SABA better than a LABA? Okay, good deal. Keep doing the work. Now let's look at long-acting inhaled beta-2 agonist. Remember you always give them with another asthma-related drug. Start looking at methylxanthines or oral corticosteroids or maybe some immunomodulators. What is that? That sounds like some weird kind of robot.

    04:57 Isn't it? Well, immunomodulators, those are going to be drugs that kind of suppress the inflammatory response. So you're going to use a LABA with one of these other groups or types of medications. Okay, that's it. Now you've got a really good grasp on that and initial overview of prevention and control medications. Not medications that you use in an emergency, not rescue drugs, but these are drugs that we have to be really careful that the patient understands how important it is to take these medications regularly and consistently before they're having symptoms or an attack to hopefully minimize the amount of symptoms or attacks that they have. Because asthma is 2 things, inflammation and bronchoconstriction.

    05:43 Right? So, if I'm going to treat asthma effectively I need medication that will address the inflammation and medication that will address the bronchoconstriction. Now, there are some supercool pictures. Look at there. You got the larynx at the top, the trachea, then it shows you the bronchi going into the right and the left lungs. I love that picture. Everytime you see those, make yourself name the parts that you're looking at that will help reinforce that anatomy in your mind. Look at the airways. Now we're kind of looking at a side view of them instead of looking right down the tunnel. You see with bronchoconstriction. Which one of the airways is normal, the one on the top or the one on the bottom? Right. The one on the bottom.

    06:25 What's the difference between the normal airway and the bronchoconstricted one. Well you see, you know there are smooth muscles in the wall and there are smooth muscle bands wrapped around it. In the bronchoconstriction one, that's clearly on the top. Right? You can see if those bands are tightening and airs are squishing through it. That's to help you recognize that those bands are tightening down as is the wall and you look at that little waterfall of mucus coming out the end. Right? You have bronchoconstriction, you got the extra mucus. So we've got an inflammatory response and bronchoconstriction. So excellent nurses know that a complete asthma plan would involve something that addresses both the inflammation and the bronchoconstriction. Now in an emergency, what am I dealing with first? Correct, bronchoconstriction is what I want to relieve immediately. We're also going to address the inflammation but the biggest bang for my back is dealing with that bronchoconstriction and like a short-acting beta-2-adrenergic agonist or an anticholinergic. So for inflammation, we're going to use an anti-inflammatory; for bronchoconstriction, we're going to use a bronchodilator.

    07:39 Remember the beta-2 agonist are ones that cause bronchodilation, the anticholinergics block bronchoconstriction and that mucus. So there are 2 different types of mechanisms, but they give us the same result. One causes bronchodilation, one blocks bronchoconstriction. Now NIH, the National Institute of Health, these are their goals for asthma treatment. Now I wanted you to know this because it's really important as a professional that you're aware of the standards that we have. So National Institute of Health is pretty standardized. Number 1, we want to reduce impairment. Yeah, that's a good goal for anything. We want to minimize how often the frequency and how intense the symptoms and functional limitations are for the patient that they're experiencing because of asthma. So in real people language, we want to help them feel better, lead more active life. So we want to have fewer asthma attacks and when they do have an asthma attack I don't want them to be as intense. That's goal number 1 in just common language. Now I also want to reduce the risk or the likelihood of future asthma attacks. I don't want their lung function to keep getting worse and worse and worse particularly in our children because we don't want to reduce their lung growth, we want those lungs to grow healthy and we want to minimize medication side effects. So, reducing risk or increasing quality of life or reducing risk for further damage to their lungs from asthma attacks and a progressive decline in lung function. So those are 2 very important goals.

    About the Lecture

    The lecture Asthma: Prevention and Control Medications (Nursing) by Rhonda Lawes, PhD, RN is from the course Obstructive Respiratory Disorders (Nursing).

    Included Quiz Questions

    1. Antileukotrienes
    2. Cromolyn sodium
    3. Inhaled corticosteroids
    4. Albuterol
    5. Ipratropium bromide
    1. Regularly every day
    2. In emergency situations
    3. At the first onset of signs and symptoms of an asthma attack
    4. Before pollen exposure
    1. Because a LABA is not a rescue inhaler
    2. Because a LABA is contraindicated to take alone
    3. Because a SABA is only indicated for lung maintenance
    4. Because a LABA is only indicated as a rescue inhaler
    1. Inflammation
    2. Bronchoconstriction
    3. Excess mucus production
    4. Bronchodilation

    Author of lecture Asthma: Prevention and Control Medications (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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