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.