Mast cell stabilizers - Inhaled: Nursing pharmacology

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. When done, instruct them to turn off the machine and wash the medicine cup and mouthpiece with water, then set them out to air dry until the next treatment.

Stress the importance of rinsing their mouth and gargling after administration to minimize bitter taste, dry mouth, throat irritation, and hoarseness.Be sure your client understands that the medication is used as maintenance therapy to prevent symptoms, and should never be used for quick relief from an asthma attack.

Teach them to take the medication as prescribed and avoid stopping abruptly, as this can lead to an asthma exacerbation.

Explain that it can take 1 to 2 weeks to see an improvement in symptoms; if symptoms don’t improve after 4 weeks of use, encourage your client to consult with their health care provider.

If cromolyn is ordered intranasally, instruct the client to blow their nose beforehand to clear the nasal passages. Then, ask them to place the tip into one nostril, aiming slightly away from the nasal septum; then ask them to sniff the mist in while gently pressing the nozzle, and then breath out through their mouth.

After repeating the entire process in the other nostril, instruct them to wipe the spray nozzle with a clean tissue and replace the cap.

If your client is prescribed cromolyn eye drops, show them how to gently pull the bottom eyelid down and place the ordered amount of medication into the center of the lower conjunctiva.

Explain the importance of not touching the medication dropper to the eye, their fingers, or any other surface. If your client wears soft contact lenses, instruct them to avoid wearing them while being treated with this medication.

As you care for your client, continue to monitor their symptoms and the effectiveness of the medication therapy.Alright, as a quick recap… Mast cell stabilizers are a class of medications that help reduce inflammation in allergic conjunctivitis, allergic rhinitis, and asthma.

Cromolyn is the only type of mast cell stabilizer that is currently used in clinical practice. Nurses are responsible for safely administering cromolyn, educating clients on how to self-administer the medication and what