java barcode generate code B Quick-Relief Medications in Objective-C

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Short-acting bronchodilators and systemic corticosteroids comprise the important medications in this group of agents (Table 9 5)
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1 -Adrenergic agents Short-acting inhaled -adrenergic agonists are clearly the most effective bronchodilators during exacerbations -adrenergic agonists should be used in all patients to treat acute symptoms These agents relax airway smooth muscle and cause a prompt increase in airflow and reduction of symptoms Administration before exercise effectively prevents exercise-induced bronchoconstriction There is no convincing evidence to support the use of one agent over another 2-selective agents may produce less cardiac stimulation than those with mixed 1 and 2 activities, although clinical trials have not consistently demonstrated this finding Currently available short-acting 2selective adrenergic agonists include albuterol, bitolterol, pirbuterol, and terbutaline Inhaled -adrenergic agonist therapy is as effective as oral or parenteral therapy in relaxing airway smooth muscle and improving acute asthma and offers the advantages of rapid onset of action (< 5 minutes) with fewer systemic side effects Repetitive administration produces incremental bronchodilation Intravenous and subcutaneous routes of administration should be reserved for patients who because of age or mechanical factors are unable to inhale medications One or two inhalations of a short-acting inhaled 2agonist from an MDI are usually sufficient for mild to moderate symptoms Severe exacerbations frequently require higher doses: equivalent bronchodilation can be achieved by high doses (6 12 puffs every 30 60 minutes) of a 2-agonist by MDI with an inhalation chamber or by nebulizer therapy Administration by wet nebulization does not offer more effective delivery than MDIs but it is given in higher doses With most 2agonists, the recommended dose by nebulizer for acute asthma (albuterol, 25 mg) is 25 30 times that delivered by a single activation of the MDI (albuterol, 009 mg) This difference suggests that the standard use of inhalations from an MDI will often be insufficient in the setting of an acute exacerbation Independent of dose, nebulizer therapy may be more effective in patients who are unable to coordinate inhalation of medication from an MDI because of age, agitation, or severity of the exacerbation Scheduled daily use of short-acting 2-agonists is not generally recommended Increased use (more than one canister a month) or lack of expected effect indicates diminished asthma control and dictates the need for additional long-term control therapy 2 Anticholinergics Anticholinergic agents reverse vagally mediated bronchospasm but not allergen- or exerciseinduced bronchospasm They may decrease mucus gland hypersecretion seen in asthma Ipratropium bromide, a quaternary derivative of atropine free of atropine s side effects, reverses acute bronchospasm and is the inhaled alternative for patients with intolerance to 2-agonists Ipratropium bromide may be a useful adjunct to inhaled short-acting 2-agonists and considered in patients with moderate to severe asthma exacerbations High doses of inhaled ipratropium bromide (05 mg) cause additional bronchodilation in some patients with severe airway
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obstruction, but the role in long-term management of asthma has not been clarified It is the drug of choice for bronchospasm due to -blocker medications 3 Phosphodiesterase inhibitors Methylxanthines are not recommended for therapy of asthma exacerbations Aminophylline has clearly been shown to be less effective than 2-agonists when used as single-drug therapy for acute asthma and adds little except toxicity to the acute bronchodilator effects achieved by nebulized metaproterenol alone Patients with exacerbations who are currently taking a theophylline-containing preparation should have their serum theophylline concentration measured to exclude theophylline toxicity 4 Corticosteroids Systemic corticosteroids are effective primary treatment for patients with moderate to severe exacerbations or for patients who do not respond promptly and completely to inhaled 2-agonist therapy Systemic corticosteroids are one of the mainstays of the treatment of patients with severe asthma These medications speed the resolution of airflow obstruction and reduce the rate of relapse Delays in administering corticosteroids may result in delayed benefits from these important agents Therefore, oral corticosteroids should be available for early administration at home in many patients with moderate to severe asthma It may be prudent to administer corticosteroids to critically ill patients via the intravenous route in order to avoid concerns about altered gastrointestinal absorption The minimal effective dose of systemic corticosteroids for asthma patients has not been identified Outpatient prednisone burst therapy is 05 1 mg/kg/d (typically 40 60 mg) as a single or in two divided doses for 3 10 days Severe exacerbations requiring hospitalization typically require 1 mg/kg of prednisone equivalent every 6 12 hours for 48 hours or until the FEV1 (or PEF rate) returns to 50% of predicted (or 50% of baseline) The dose is then decreased to 60 80 mg/d until the PEF reaches 70% of predicted or personal best No clear advantage has been found for higher doses of corticosteroids in severe exacerbations 5 Antimicrobials Empiric antibiotics are not recommended in routine asthma exacerbations, although antibiotics that cover atypical organisms (eg, telithromycin) are an area of ongoing research Antibiotics may be useful if bacterial respiratory tract infections are thought to contribute Thus, patients with fever or purulent sputum and evidence of pneumonia or bacterial sinusitis are reasonable candidates for such therapy
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