Pharmacology of Asthma Medications and Clinical Reasoning in Care

This report provides a comprehensive overview of the pharmacology of asthma medications, including bronchodilators (ᵦ2 agonists, anticholinergics, methylxanthines) and anti-inflammatory drugs (glucocorticosteroids, leukotriene receptor antagonists, cromolyns). It discusses routes of administration, advantages of inhaled drugs, and the importance of combined drug therapy for managing airway inflammation. The report also highlights the clinical reasoning cycle in the context of a patient case (Zancy), emphasizing the need for careful evaluation and decision-making in asthma treatment, prioritizing bronchodilation and cough management. The conclusion underscores the role of various medications in reducing bronchospasm and inflammatory responses, noting positive outcomes in the patient case and the significance of clinical reasoning in nursing care. Desklib offers a wealth of solved assignments and past papers for students seeking to deepen their understanding of healthcare topics.

Part B
Introduction:
Pharmacology of the asthma medication
The pharmacology of any medication is the how the medication improve the condition and how
the body reacts to this drug. In the pharmacology of asthma medication, there will be discussion
of the different types of the drugs that are used and how they improve the abnormal condition.
As from the pathphysiology, it has been cleared that it occurs due to bronchoconstriction,
inflammation and due to the immune response to particular allergens (Divekar, Ameredes &
Calhoun, 2013). Thus the drugs used may include bronchodilators, steroids, and
immunosuppressant and so on.
Due to increase in asthma prevalence, there is huge research on the asthma medication that has
lesser side effects and more selective treatment. Bronchodilators are the drugs that act by
reversing the bronchospasm that relax airways of smooth muscle
ᵦ2 agonists-salbutamol (Gelaw & Gelaw, 2014)
Anticholinergics- ipratropium bromide
Methylxanthines-aminophylline, theophylline
Airways inflammation reduction drugs
Glucocorticosteroids (Gelaw & Gelaw, 2014)
Leukotriene receptor antagonists-Montelukast

Cromolyns-sodium cromoglycate (Barnes, 2009)
Miscellaneous
Allergen extracts that are used for the allergic desensitization therapy
Air that is oxygen-rich
Routes of the administration
The medication for the asthma are mostly administrated through the inhalation but there are
some exceptions
Methylxanthines is the drug that is not affected through inhalation and thus, given orally
Leukotriene receptor antagonists are administrated orally (Barnes, 2009)
Salbutamol is also sometimes administrated orally in very young or in elderly people in which
administration through inhalation is much difficult
A glucocorticosteroids oral course is administrated in much severe asthma for controlling
symptoms
ᵦ2 agonists-salbutamol and hydrocortisone are administrated through injection in the acute or
severe asthma that includes the IV infusion through in ICU a central venous line
Two pathways for the inhaled drugs (Barnes, 2009)
Systemic absorption that is absorption into the bloodstream and then passed to target site such as
sodium cromoglycate

Localised absorption that is absorbed to a localized area, when only there is a requirement of the
local drug
Inhaled drug advantage
Rapid onset of the drug action
In most of the cases, very much small concentration of the drug is effective as compared to the
same drug administration through systemically that is because as the drug delivered directly to
target site and have a local effect that leads to lesser side effects and lower drugs costs.
Short-acting b2 agonists, salbutamol these MDI have a speedy onset of action and that last for
about 4 hours
Long-acting b2 agonists such as salmeterol contain prolonged effect duration so the two doses
daily are adequate for the symptoms control
Glucocorticosteroids MDIs have known preventers.
Asthma’s combined drug therapy
There has been rising recognition of the ongoing inflammatory procedure in the airway wall of
asthmatic patients
Inadequate recovery of the airway obstruction between the exacerbations of the asthma
In the airway remodeling, slow and progressive that are irreversible changes that is the result of
the chronic damage from the ill-treated airway inflammation. This lead to the changes in the
asthmatic pharmacological management that’s why now, there is lessens reliance on the use of
the bronchodilators as the main treatment. There is greater emphasis on airways’ inflammation

control with continuous inhaled glucocorticosteroids or another anti-inflammatory drug for
example Montelukast
Classification of the drugs for the asthma
Bronchodilators are the drugs that act chemically by contracting smooth muscle cells airways
for the relaxation and thereby reduction of the airway obstruction if there is the presence of the
bronchospasm.
There are mainly three types of the bronchodilators:
ᵦ2 sympathomimetics which stimulate ᵦ2 adrenergic receptors on the airway of smooth muscle
cells (Antoniu, 2012)
Inhaled anticholinergics which inhibit muscarinic cholinergic receptors on the airway of smooth
muscle cells (Antoniu, 2012)
Methylxanthine alkaloids are the drugs that are taken orally or through intravenous injection.
These drugs are toxic and have a lesser therapeutic index and are not used widely in Australia
but still marketed in the North America (Antoniu, 2012).
The ᵦ2 agonists are chemically associated with the adrenaline receptor same as the adrenaline it
binds to the adrenergic receptors and stimulates the adrenergic receptors on the airway of the
smooth muscle cells. As adrenaline hormone stimulates all α1, ᵦ1, ᵦ2 and all the receptors but the
ᵦ2 agonists is selective for the ᵦ2 receptor only so they remarkably reverse the bronchospasm
These are further of two types’ short acting and long acting ᵦ2 agonists

Adrenergic and anticholinergic bronchodilators
A sympathetic and parasympathetic system has opposing action. Promptness of the sympathetic
nervous system and reticence of the parasympathetic nervous system have similar effect example
for the same is bronchodilating activity of both ipratropium bromide and salbutamol (Soler &
Ramsdell, 2014). .
In Zancy’s case, his medication includes ventolin as it clears the pulmonary pathway and stop
wheezing problem. His medication includes antibiotics and immunosuppressant’s that support
improvement of the inflammation condition and suppression of inflammatory response through
the antibody-antigen reaction. As his mother told that his condition has been improved and they
had stopped taking medication and only when required they use ventolin that improve wheezing
but not coughing. Thus, he required medication for coughing that disturbs his sleep (Soler &
Ramsdell, 2014). .
In Zancy care plan nurse has to follow the clinical reasoning cycle that will the nurse in decision
making that what care is required on the priority for the improvement of the Zancy’s asthmatic
condition. Clinical reasoning is the procedure by which the nurses and clinical gather the cues,
do the handing out of the information, estimate the issues related to the patient, plan the
involvement and put into practice them, assess the interventions outcomes and enlarge their
understanding from the procedure (Soler & Ramsdell, 2014). The procedure of the Clinical
calculation is a recurring process of interlinked medical meetings relatively than a linear process.
The growth of the clinical reasoning model, philosophical strategies concerned are depiction of
the patient situation, information collection related to new patient, relate and reviewed the
information, analysis of the information, recollect the information, intolerance between the

reviewed relevant and irrelevant information, corresponding and predication of the in sequence
analysis for diagnosing and recognition of the difficulty, goal establishment and
evaluation(Matsumura, 2009).
In the case of Zancy’s asthma, his asthma is induced by the long term respiratory infection by the
virus and his breathing is very fast and also it is very hard for him to control his breathing. In
addition to this Zancy produces wheezy sound during breathing and has problem of the
continuous coughing (Girdhar, Menon & Vijayan, 2007). Thus the nurse has to properly do the
evaluation and decision making about his treatment. First priority of the nurse should be
brochodilation that helps in proper breathing and slow breathing and also reduction of his
coughing through the treatment of expectorants as coughing interpreted his sleeping (Anselmo,
2011). If the nurse can do the treatment according then there should be positive results of
Zanchy’s treatment.
Conclusion
The medication used for the asthma includes ᵦ agonist and anticholinergics as they are the
bronchodilators and supports reduction of the bronchospasm and for the treatment of the
inflammation, there is use of the antibiotics. All these drugs help in reduction of bronchospasm
and inflammatory responses (Stockman, 2013). In Zancy’s case, his medication includes
bronchodilator; ventolin, immunosuppressant; flixotide and antibiotics as they all improve his
condition. In the case, the positive results are there as his mother told that he had stopped taking
medication because of improved health. As the asthmatic patients are more prone to allergens
they required immediate relief that is given by the use of inhaler that gives instant relief and
lesser side effect due immediate absorption. In addition to inhalers there are so many drugs that

are given orally and through injections. For the nurse, during first 24 hours of administration, the
decision should be done through following clinical reasoning cycle as it helps in effective
decision making.
References:
Anselmo, M. (2011). Pediatric Asthma Controller Therapy. Pediatric Drugs, 13(1), 11-17.
Antoniu, S. (2012). Nitrix oxide donors in asthma. Drugs Of The Future, 37(8), 571.
Barnes, P. (2009). Drugs for asthma. British Journal Of Pharmacology, 147(S1), S297-S303.
Divekar, R., Ameredes, B., & Calhoun, W. (2013). Symptom-Based Controller Therapy: A New
Paradigm for Asthma Management. Current Allergy And Asthma Reports, 13(5), 427-433.
Gelaw, B., & Gelaw, Y. (2014). Assessment of Adequate Use of Asthma Inhalational Medication
Administration in Children. Journal Of Physiology And Pharmacology Advances, 4(11), 454.
Girdhar, A., Menon, B., & Vijayan, V. (2007). Systemic Inflammation And Its Response To Treatment
In Bronchial Asthma. Chest, 132(4), 511A.
Matsumura, Y. (2009). Inflammation Induces Glucocorticoid Resistance in Patients with Bronchial
Asthma. Anti-Inflammatory & Anti-Allergy Agents In Medicinal Chemistry, 8(4), 377-386.
Soler, X., & Ramsdell, J. (2014). Anticholinergics/Antimuscarinic Drugs in Asthma. Current Allergy
And Asthma Reports, 14(12).