Overview
This lecture covers the main medications used during acute asthma attacks, with a focus on the "BAM" sequence, mechanisms of action, expected side effects, and correct administration techniques.
Acute Asthma Attack Medications (BAM)
- "BAM" stands for Beta-2 agonist, Anticholinergic, and Methylprednisolone.
- Beta-2 agonists (end in -buterol, e.g. albuterol) are used first in asthma attacks as rescue inhalers.
- Anticholinergics (e.g. ipratropium) are administered second.
- Methylprednisolone (a steroid, e.g. Solu-Medrol) is given last due to slower onset.
Beta-2 Agonists (Albuterol)
- Albuterol is the fastest-acting bronchodilator for acute asthma attacks.
- Only use albuterol (not salmeterol/fluticasone) for initial rescue in acute attacks.
- Salmeterol (ends in -terol) is for long-term control, not for acute attacks.
Expected Effects & Patient Education
- Expected side effects of albuterol: tachycardia, tremors, insomnia (the "three T's").
- Teach patients to avoid taking albuterol at bedtime due to insomnia.
- Avoid beta-blockers (end in -lol) and NSAIDs in asthma patients to prevent worsening symptoms.
Administration Guidelines
- During an acute attack: take 2–4 puffs every 20 minutes up to three rounds; notify HCP if symptoms persist after three doses.
- Evaluate effectiveness by decreased respiratory rate and oxygen saturation ≥90%.
- Expected post-treatment effects: increased productive cough, decreased anxiety, mild hand tremors.
Inhaler Use & Cleaning
- Shake inhaler well before use; exhale fully, inhale dose, hold breath, then exhale.
- When using with steroids: take albuterol first, then steroid inhaler second.
- Clean meter-dosed inhaler mouthpiece 1–2 times per week with warm water (not after every use).
- Steroid inhalers should be washed after each use.
Key Terms & Definitions
- Beta-2 agonist — a drug that stimulates beta-2 receptors in the lungs to relax bronchial smooth muscle.
- Rescue inhaler — a fast-acting inhaler used during acute asthma attacks for quick relief.
- Anticholinergic — a drug that blocks acetylcholine in the airways, reducing bronchospasm.
- Methylprednisolone — a corticosteroid used to reduce inflammation, acts slower than bronchodilators.
- Tachycardia — abnormally rapid heart rate.
Action Items / Next Steps
- Review the BAM sequence for asthma attack medication.
- Practice correct inhaler administration steps.
- Memorize side effects and contraindications for asthma medications.