Question

OP, a 55-year-old patient, was recently diagnosed with bronchial asthma. In the past year, OP has had three asthma attacks that have been treated with prednisone and an albuterol inhaler.

• Explain the purpose for the use of prednisone during an asthma attack. Explain why the dosage is tapered over days.
• Can cromolyn sodium be substituted for prednisone during an asthmatic attack?
• What effect does albuterol have on controlling asthma?
• What instruction should the patient be given concerning use of the inhaler?
• What type of drug is aminophylline? Why should the nurse ask if the patient smokes?
• What are the side effects, adverse reactions, and drug interactions related to aminophylline?
• Which are rescue medications and which are preventive medications?

Answer 1

purpose for the use of prednisone during an asthma attack

Chronic inflammatiom is a primary component of asthma. Corticosteroids( prednisone) that reduce bronchial hyperresponsiveness, block the late-phase response, and inhibit migration of inflammatory cells.

Why dosage is tapered over days?

Initial dose: 5 to 60 mg orally per day
Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.Sometimes systemic steroids like prednisone are taken in high doses for a few days. This is called a steroid burst. They may also be given in a low dose daily or every other day for long-term asthma control. After introduction of inhaled steroids, the need for oral steroids such as prednisone may decrease.

Can cromolyn sodium be substituted for prednisone during an asthmatic attack?

Cromolyn has been the non-corticosteroid treatment of choice in the treatment of asthma, for which it has largely been replaced by corticosteroid because of their convenience (and perceived safety). Drugrequires administration four times daily, and does not provide additive benefit in combination with inhaled corticosteroids.

What effect does albuterol have on controlling asthma?

​​​​​Albuterol are short acting beta-adrenergic agonist (SABA) helps to relieve bronchospasam precipated by exercise and other stimuli because they prevent the release of inflammatory mediators from mast cells. They do not inhibit the late phase response of asthma or have antiinflammatory effects. This drug not used for long-term control of asthma and used as quick relief. Long term use may mask asthma severity and may lead to drug effetiveness. Sideeffects are tremors, anxiety, tachycardia and palpitation.

what instruction should the patient be given concerning use of the inhaler?

Dry Powder Inhaler

1. Remove the cap.
2. For a single-use device, load a capsule.
3. Breathe out slowly (not into the mouthpiece).
4. Put the mouthpiece between your front teeth and close your lips around it.
5. Breathe in through your mouth deeply for 2-3 seconds.
6. Remove the inhaler.
7. Breathe out slowly.

Metered dose inhaler

Using an MDI with a valved holding chamber

1. Remove the cap from the MDI and chamber. Shake well.
2. Insert the MDI into the open end of the chamber (opposite the mouthpiece).
3. Place the mouthpiece of the chamber between your teeth and seal your lips tightly around it.
4. Breathe out completely.
5. Press the canister once.
6. Breathe in slowly and completely through your mouth. If you hear a "horn-like" sound, you are breathing too quickly and need to slow down.
7. Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung.
8. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute in between puffs.
9. Replace the cap on your MDI when finished.
10. If you are using a corticosteroid MDI, rinse your mouth and gargle using water or mouthwash after each use. You should always use a chamber with a steroid MDI.

Using an MDI without a chamber

1. Remove the cap from the MDI and shake well.
2. Breathe out all the way.
3. Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it.
4. As you start to breathe in slowly, press down on the canister one time.
5. Keep breathing in as slowly and deeply as you can. (It should take about 5 seconds for you to completely breathe in.)
6. Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung.
7. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute between puffs.
8. Replace the cap on the MDI when finished.
9. If you are using a corticosteroid MDI, you should use a valved holding chamber as described above.

Caring of inhaler

For most MDIs, remove the canister and rinse the plastic holder with warm running water once a week to prevent the holes from getting clogged. Shake well and let air dry. There are some medications in which the inhaler cannot be removed from the holder. These usually need to be cleaned by wiping the mouthpiece with a cloth or cleaning with a dry cotton swab.

Clean the chamber about once a week. Remove the soft ring at the end of the chamber. Soak the spacer in warm water with a mild detergent. Carefully clean and, rinse, and shake off excess water. Do not hand dry. Allow to completely air dry. Do not store the chamber in a plastic bag.

Checking inhaler

It is important that you know how much medication is left in your inhaler. The number of puffs contained in your MDI is printed on the side of the canister. After you have used that number of puffs, you must discard your inhaler even if it continues to spray. Keep track of how many puffs you have used. You also must include priming puffs in this total.

If you use an MDI every day for control of symptoms, you can determine how long it will last by dividing the total number of puffs in the MDI by the total puffs you use every day. For example: 2 puffs x 2 times per day = 4 total puffs per day. At 120 puffs, the MDI will last 30 days.

If you use an inhaler only when you need to, you must keep track of how many times you spray the inhaler. Some of the newer MDIs have counting devices built in.

If your MDI does not have a dose counter, you can obtain a device that attaches to the MDI and counts down the number of puffs each time you press the inhaler. Ask your healthcare professional for more information about these devices, as well as how to best keep track of your medicine without an add-on device.

What type of drug is aminophylline? Why should the nurse ask if the patient smokes?

Aminophylline is a bronchodilator with mild antiinflammatory effects. They are used only as an alternative therapy for mild persistent asthma. Nurse enquires about smoking habits because smoking causing intensifying adverse effects. The main problem with aminophylline are the relatively high incidence of interaction with other drugs and the side effects, which include nausea, headache, insomnia, gastrointestinal distress, tachycardia, dysrhythmias and seizures.

Aminophylline drug interactions,

• Acetylsalicylic Acid (aspirin)
• Activated Charcoal (charcoal)
• adenosine
• Adrenalin (epinephrine)
• albuterol
• allopurinol
• Bactrim (sulfamethoxazole / trimethoprim)
• Benadryl (diphenhydramine)
• caffeine
• Cipro (ciprofloxacin)
• Combivent (albuterol / ipratropium)
• Digox (digoxin)
• dopamine
• furosemide
• halothane
• Lasix (furosemide)
• Lexiscan (regadenoson)
• lithium
• Metoprolol Tartrate (metoprolol)
• neomycin
• Paracetamol (acetaminophen)
• Phenergan (promethazine)
• propranolol
• theophylline
• Valproate Sodium (valproic acid)
• Vitamin B12 (cyanocobalamin)
• Vitamin B6 (pyridoxine)
• Vitamin C (ascorbic acid)
• Vitamin D3 (cholecalciferol)
• Vitamin K (phytonadione)
• Vitamin K1 (phytonadione)
• Zantac (ranitidine)

​Which are rescue medications and which are preventive medications?

Rescue medications:

​​​​​​​​​1.Bronchodilators : Shirt-acting Beta-adrenergic agonists

( albuterol), Antichilinergics(inhaled-ipratropium)

2.Antiinflammatory drugs:corticosteroids (systemic-prednisone)

preventive medications:

1.Bronchodilators : Long-acting inhaled Beta- adrenergic agonists (salmeterol), Long-acting oral Beta-adrenergic agonists (albuterol), Methylxanthines (theophylline).

2.Antiinflammatory Drugs :corticosteroid - oral (prednisone)

Inhaled (fluticasone), Leukotriene modifiers ( montelukast), Anti-IgE (omalizumab).