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Inhaled mast cell stabilizers: Nursing Pharmacology

Notes

Notes

MAST CELL STABILIZERS
DRUG NAME
cromolyn (NasalCrom- intranasal)
CLASS
Mast cell stabilizer
MECHANISM OF ACTION
Anti-inflammatory; inhibits release of inflammatory mediators (e.g., histamine, leukotrienes) from mast cells
INDICATIONS
  • Allergic conjunctivitis
  • Allergic rhinitis (treatment and prophylaxis)
  • Mild asthma (prophylaxis and maintenance therapy)
ROUTE(S) OF ADMINISTRATION
  • Eye drops
  • NAS
  • INH
SIDE EFFECTS
  • Cough
  • Hoarseness
  • Bitter taste
  • Mild burning / stinging upon instillation
CONTRAINDICATIONS AND CAUTIONS
  • Acute asthmatic attack
NURSING CONSIDERATIONS: MAST CELL STABILIZERS
DRUG NAME
cromolyn (NasalCrom- intranasal)
ASSESSMENT AND MONITORING
  • Baseline assessment: current symptoms, vital signs, lung sounds as needed
  • Monitor symptoms and effectiveness of treatment
CLIENT TEACHING
  • Potential side effects
  • Wash hands before self-administering
  • Inhalation
    • Maintenance therapy; do not use medication to stop an acute attack
    • Can take 1–2 weeks or more for symptom relief
    • Proper nebulizer technique
    • Rinse and gargle after administration
    • Clean equipment after use
  • Nasal instillation
    • Blow nose before instillation
    • Proper technique
    • Clean spray nozzle after use
  • Ophthalmic instillation
    • Proper technique
    • Avoid touching dropper to eye, fingers, other surfaces
    • Do not wear soft contact lenses
Transcript

Mast cell stabilizers are a group of medications that help reduce inflammation and are typically used in allergic conjunctivitis, as well as allergic rhinitis and asthma, which is an obstructive lung disease characterized by reversible narrowing of the airways.

Now, these allergic conditions are usually triggered by an environmental factor like air pollutants, cigarette smoke, exercise or stress.

These factors cause a type of immune cells called mast cells, to release various inflammatory chemical mediators like histamine and leukotrienes, triggering an excessive inflammatory response.

Okay, now cromolyn is the only mast cell stabilizer that is used in clinical practice, and depending on the affected area, it can be administered as eye drops for allergic conjunctivitis; by a metered spray pump intranasally for allergic rhinitis; or as a nebulizer solution for asthma.

Alright, so once administered, mast cell stabilizers work by stabilizing the mast cell membrane, preventing the release of inflammatory mediators. This way, mast cell stabilizers produce a mild anti-inflammatory effect at the site of inflammation.

However, compared to other anti-inflammatory medications like inhaled corticosteroids, mast cell stabilizers don’t work fast enough for treatment of acute asthmatic attacks.

In addition, they have a very short duration of action, which is why they’re only used for maintenance therapy in clients with mild asthma, or as prophylaxis right before known exposure to a trigger.

Okay, now generally, mast cell stabilizers are very safe and well-tolerated. Some uncommon side effects when inhaling cromolyn can include cough, hoarseness, and bitter taste. Additionally, clients may also experience mild burning or stinging upon instillation into the eyes and nose.

Before preparing to administer cromolyn for asthma, allergic rhinitis or allergic conjunctivitis, perform a baseline assessment, including current symptoms, vital signs, and lung sounds, as needed.

Teach your client why the medication is given, let them know about any potential side effects, and remind them to wash their hands before they self-administer the medication.

Now, when teaching your client how to use a nebulizer for the first time, demonstrate how to fill the nebulizer cup with the prescribed amount of cromolyn solution and attach the tubing and mouthpiece to the nebulizer cup.

Then show them how to connect the tubing to the aerosol compressor and to the mouthpiece. Next, instruct them to hold the mouthpiece firmly between their lips so that all of the medicine goes into their lungs.

Then show your client how to turn on the nebulizer and check that the mist begins to flow. Instruct them to breathe in through their mouth, holding their breath for 5 to 10 seconds before exhaling, then exhaling passively.

Remind them to continue until all the medicine is used, which usually takes about 10 to 15 minutes.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. " Clinical Nursing Skills and Techniques 8th Edition"  (2014)
  6. "How to use a nebulizer"  (2020)