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.