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Respiratory:Why to prescribe specific meds, such as corticosteroids. Why. What is the goal. What does it do.Inhaled Corticosteroids: (ASTHMA) Beclomethasone (Beclodisk), budesonide (pulmicort), fluticasone (flovent), flunisolide (aeroBid, Bronalide)Maintenance treatment of asthma and prophylactic treatment in asthmaAnti-inflammatory controller therapiesEducation: rinse mouth after use, monitor for infections – susceptible to oral candidiasis, avoid excessive useSystemic corticosteroids: (ASTHMA)For long term treatment of severe persistent asthma. Short courses or “bursts” effective for establishing control when initiating therapy or during a period of gradual deterioration.Methylprednisolone (Medrol), prednisoneUse caution in patients with TB, hypothyroidism, cirrhosis, ulcerative colitis. May mask infectionMay cause hypokalemia, hypernatremia, glucose intolerance, bone demineralizationCorticosteroids and COPD:The primary role of inhaled glucocorticoids in COPD is as an anti-inflammatory agent. Combination corticosteroid and beta-2 adrenergic agonist inhalers are effective to counteract bronchoconstriction and inflammation. In rare cases, systemic corticosteroids may be used in the management of an acute exacerbation for no more than 10 to 14 days.COPD classificationsStage 1: Mild COPD
oFEV1/FVC < 0.7oFEV1 ≥ 80% predictedStage 2: Moderate COPDoFEV1/FVC <0.7oFEV1 50%–79% predictedStage 3: Severe COPDoFEV1/FVC <0.7oFEV1 30%–49% predictedStage 4: Very severe COPDoFEV1/FVC < 0.7oFEV1 <30% predicted or <50% predicted with chronic respiratory failureGold guidelines for COPDThe diagnostic criterion for COPD is an FEV1/FVC ratio that is less than 70%. The FEV1 is the most useful parameter to assess severity of obstruction. Drugs most commonly used for management of COPD symptoms are beta-2 agonists, anticholinergics, combination short acting beta-2 agonists plus anticholinergics in one inhaler, xanthines, inhaled glucocorticosteroids, and systemic glycocorticosteroids. Antibiotics are warranted in the presence of a prolonged illness, especially with purulent sputum.Inhaled short acting beta 2 agonists are the first line therapy in the Global initiative for Chronic Obstructive Lung disease(GOLD) stage I.oThe major goals of therapy are to prevent bronchospasm with long-acting bronchodilators and to use “rescue” medication to alleviate acute episodes of bronchospasm. oEach episode of acute bronchospasm causes permanent remodeling of the bronchioles; therefore, prevention of these episodes is critical. Gold stage II:oTiotropium is the recommended therapy oWith albuterol as a rescue medication.oFormoterol plus ipratropium, albuterol, or a combination may be used in Stage IIStage III and Stage IV:oAll the above recommendations with the addition of an inhaled corticosteroid.