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Memory map: AIS-BPMA

A — Albuterol (SABA, rescue): Give for acute wheeze/bronchospasm. Hold if HR ≥ 120. Assess lungs, O₂ sat, and heart rate. Can increase blood glucose; caution with digoxin.

I — Ipratropium (anticholinergic): COPD maintenance med. Watch for dry mouth, constipation, urinary retention. Avoid with glaucoma or enlarged prostate.

S — Salmeterol (LABA): Controller only, not rescue. Must always be paired with an inhaled corticosteroid.

B — Budesonide (ICS): Long-term inflammation control. Rinse mouth after each use to prevent thrush. If switching from systemic steroids, taper slowly.

P — Prednisone (systemic steroid): Used short-term for severe flares. Monitor glucose, GI bleeding, infection risk, mood, fluid retention. Never stop abruptly.

M — Montelukast (leukotriene modifier): Prevents asthma symptoms. Black box: mood changes, depression, suicidal thoughts—report immediately.

A — Acetylcysteine (mucolytic/antidote): Breaks up thick mucus; also antidote for acetaminophen toxicity. Give bronchodilator first before nebulizing. Smells like rotten eggs—warn patients.

Administration sequence:
Bronchodilator first → then ICS. Wait 1–2 minutes between meds.

Peak flow zones:

Green (80–100%): Continue usual meds.

Yellow (50–80%): Add rescue inhaler; call provider if persistent.

Red (<50%): Emergency—use rescue inhaler, start oral steroid if ordered, seek care.

Clinical context:

COPD = respiratory acidosis: Clear airway (ipratropium + acetylcysteine).

Asthma attack = respiratory alkalosis: Use albuterol first; monitor HR closely.

Pediatrics:

Use spacer/mask with inhalers.

Monitor growth with long-term ICS use.

Montelukast granules → mix with soft food only.

Prednisone dosing is weight-based.

Pregnancy:

Continue controller meds—budesonide preferred.

Uncontrolled asthma is riskier than medication exposure.

Delegation:

RN: Assessment, judgment, teaching, setting hold parameters.

UAP (if trained): May give neb after RN assessment; RN still responsible.

Quickfire NCLEX Scenarios:

Ipratropium → urinary retention → assess bladder.

Acetylcysteine → new wheeze → stop treatment, give rescue inhaler.

Prednisone taper → glucose 250 → recheck, assess infection, confirm taper.

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