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Pharmacology
Respiratory Care Pharmacology
Question | Answer |
---|---|
What are the indications for Catecholamine | 1. Relief of acute reversible airflow obstruction- relaxation of smooth muscle 2. Increased ciliary motility |
Side Effects for sympathomimetic bronchodilators | 1. Hypersensitivity to the drug 2. Tremors 3. Increase HR, BP, Blood sugar & insulin 4. Tolerance 5. Headache 6. Nervousness 7. Anxiety 8. Insomnia 9. Decrease K+ by increasing the action of the Na+/K+ pump 10. Shift K+ to intracellular |
Mechanism of Action for Cathocholamine | Stimulates both Alpha and Beta receptors |
What is the Frequency of cathocholamine: | Onset 1-3 min, Peak 15-20 min, Short duration 1 hr |
Name four drugs that are used for cathocholamine (generic and trade names) | Epinephrine (adrenalin) Racemic Epinephrine (Vaponephrine, Micronephrine) Isoproterenol (Isuprel) Isoetharine (Bronkosol) |
What is the mechanism of action for racemic epinephrine (Vaponephrine, micronephrine) | Stimulates Alpha receptor |
Indications for Vaponephrine? | Racemic Epinephrine (Vaponephrine, Micronephrine) Indications: Vasoconstriction- helps reduce swelling after extubation & relieve stridor |
What is the dosage for Racemic epinphrine | SVN: .25-.5 |
How is racemic epinephrine given | SVN |
Name two SABA for the class Resorcinols? | Metaproternol (Alupent, Metaprel) Terbutaline (Breathaire |
What is the frequency and dosage for metaproternol | Dosage: SVN: .2-.3 ml QID MDI: 2-3 Puffs QID Frequency: Onset 5 min, Peak 30-60 min, Duration 4-6 hr –not broken down by COMT |
What is the mechanism of action for resorcinols | dilation of smooth muscle, bronchodilation |
What are the four drugs in the class Saligenins? (Generic and trade name) | Albuterol-ventolin, proventil) Levalbuterol (xopenex) Salemeterol (Serevent) Formoterol (Foradil) |
Which two Saligenis are LABA? | Salmeterol-serevent Formoterol- foradil |
Which two of the Saligenis are SABA? | Albuterol-ventolin, proventil) Levalbuterol (xopenex) |
What are the indications for Parasympatholytics: LABA? | Indications: 1. Maintenance treatment of COPD when a second bronchodilator is needed 2. Severe asthma not responding well to a beta agonist |
What are the contraindications for Parasympatholytics: LABA? | • Drug Hypersensitivity • Caution for: • Glaucoma • Prostatic Hypertrophy • Bladder neck obstruction • Not for use in acute attack (PDR 2003) • Contains soy derivative which may trigger peanut allergies • Pregnancy B |
What are some side effects for Parasympatholytics: LABA? | • Blurred vision • Dry mouth • Tachycardia • Headache • Bronchitis • Dyspnea • Coughing • Upper respiratory infection • Nausea |
What is the mechanism of action for Parasympatholytics: LABA? | Block bronchoconstriction being help by the parasympathetic system/ Muscarinic Receptors on smooth muscle, cardiac muscle, and glands |
What are the three common drugs used in the class (generic and trade names) | Drugs: Ipratropium Bromide (Atrovent) Tiotropium Bromide (Spiriva) Atropine-not used anymore |
What is the dosage/frequency for Ipratropium Bromide (Atrovent)> | Dosage: SVN: .5 QID o MDI: 2 Puff QID Frequency: 15-30 Min, Peak 1-2 Hr, Duration 4-5 hr |
What is the dosage/frequency for Tiotropium Bromide (Spiriva)? | Dosage : DPI 1 capsule DQ Frequency: Onset 30 minutes, Peak 3 hrs, Duration 24 hr |
What are some side effects for bronchodilation? | 1. Hypersensitivity to the drug 2. Tremors 3. Increase HR, BP, Blood sugar & insulin 4. Tolerance 5. Headache 6. Nervousness 7. Anxiety 8. Insomnia 9. Decrease K+ by increasing the action of the Na+/K+ pump 10. Shift K+ to intracellular |
What are the Parasympatholytic Combination Drugs? | Duoneb: Albuterol/Ipratropium Combivent: Albuterol/Ipratropium |
Indications for inhaled Corticosteroids: | Inhaled: Maintenance therapy for chronic inflammation in mild-moderate persistent asthma and COPD; not a rescue drug Nasal Rhinitis |
Indications for Systemic: | used for exacerbation of COPD or home maintenance if needed |
Mechanism of Action of Corticosteroids: | Regulates anti-inflammatory responses after binding to the cell’s DNA Enhances the body’s inflammatory inhibitors Inhibits migration of inflammatory cells (eosinophil and lymphocytes) Inhibits mast cells Constricts microvasculature at inflammatory sit |
Side Effects Systemic steroids | Immunosuppression, Cushing Syndrome (Moon Face), Increased Blood sugar,Adrenal Suppression , Osteoporosis, Fluid Retention, HTN |
Side effects for Local/Topical steroids | Candida Infection (thrush), Dysphonia (Hoariness),Bronchoconstriction |
Name the Corticosteroids used for inhaled or topical purposes? | Drugs: Local/Topical: Anti-inflammatory •Beclomethasone HFA (QVAR, Beclovent, Vanceril) • Flunisolide (Aerobid) • Triamcinolone (Azamcort) • Fluticasone (Flovent) • Budesonide (pulmicort) |
What is the dosage/Frequency of Albuterol (Proventil & Ventolin) | SVN: .63-1.25 mg TID MDI: 2 Puffs QID |
What is the dosage/frequency of levalbuterol (Xopenex) | SVN:.63-1.25 mg TID MDI: 2 Puffs QID |
What is the dosage/frequency of Salmeterol (serevent) | MDI- 2 Puffs BID DPI- 1 inhaled BID |
What is the dosage/frequency of Formoterol (Foradil) | DPI (aerolizer) 1 inhaled BID |
What is the dosage/frequency of Budensonide (Pulmicort) | DPI 1-2 inhaled BID SVN: 1 cap .25-.5 BID |
What is the dosage/frequency of Mometasone (nasonex, elecon, asmanex) | 220 mcg once daily increased dose after 2 weeks. Maximum dose 440 mcg daily |
What is the dosage/frequency of Fluticasone (Flovent) | MDI 44-110-220 mcg 2 puffs BID DPI Diskus 50-100-250 mcg |
What is the dosage/frequency of Belcomethasone (QVAR) | MDI- 40&80 mcg 1-2 Puffs BID |
What is the dosage/frequency of Acetlycysteine (Acetadote) | Mucolytic: SVN: 3-5 ml 10-20% mucomyst |
What is the dosage/frequency of Dornase Alpha (Pulmozyme) | SVN: 2.5 mg/ampoule QD |
What is the dosage/frequency of Cormolyn (NasalCrom, Gastrocrom, Crolom) | SVN: 20mg 4x a day at intervals MDI: 2 Puffs QID at intervals |
What are the indications NON-steroidal Antiasthma Agents? | Prevention of mild persistent asthma Alternative to steroids especially in small children/infants Used to prevent allergic rhinitis (nasal spray) Prevention of EIB |
What are some Contraindications of NON-steroidal Antiasthma Agents? | Ineffective if already in bronchospasm |
Mechanism of action for NON-steroidal Antiasthma Agents? | Inhibits degranulation of mast cells in allergic and non-allergic stimuli Does not bronchodilate |
Side Effects/hazards HHN for NON-steroidal Antiasthma Agents: | Sneezing Stinging or burning Nasal Irritation Bad Taste |
Common Side Effects of NON-steroidal Antiasthma Agents? | Dizziness Cough Headache Nausea |
What are the indications for Antileukotrienes | Indications: Used prophylactically for control of asthma |
What is the Mechanism of Action for Antileukotrienes: | Normally leukotrienes act like histamines only stronger inhibits action of leukotrienes (SRS-A) |
What are the Drugs in the class Antileukotrienes: | Zarfilucast (Accolate) 12 yrs and up, Zileuton (Zyflo) Hard on liver, Monteleukast (Singulair) 2yrs and up, |
What is the dosage/frequency for Zarfilucast (Accolate) 12 yrs and up | Dosage: 10-20 mg tablet BIQ |
What is the dosage/frequency for Zileuton (Zyflo) Hard on liver | Dosage: 600 mg tablets QID or BID if extended release, |
What is the dosage/frequency for Monteleukast (Singulair) 2yrs and up | Dosage: 4-10 mg tablet QD |
What are the indications for Xanthines: | Indications:Management of mild persistent asthma and COPD, Sometimes used as a respiratory ventilatory stimulant in premises for apnea, Used only for maintenance |
What are the Contraindications for the xanthines: | Any condition that effects liver or kidney function affects Theophylline level |
What is the Mechanism of action for Xanthines: | CNS Stimulation and ventilatory drive Cardiac muscle stimulation Increase in respiratory muscle strength and endurance Diuresis Bronchial uterine, vascular smooth muscle relaxation, Peripheral and coronary vasodilation, Cerebral vasoconstriction |
Side Effects of Xanthines: | CNS, GI, Respiratory, Cardiovascular, Renal |
What are the Drugs used in this class: | Theophylline (theo-Dur,Slo-phyllin, etc…)Aminophylline |
What is the dosage/frequency for Theophylline (theo-dur, slo-phyllin) | Dosage: Serum Levels <5ug/ml- no effect 10-20 ug/ml-theraperatic level >20ug/ml- nausea >30 ug/ml- arrhythmias 40-45 ug/ml- seizures |
What are some indications for Mucolytics: | Indications:Degrades or breaks down mucus,To aid in the removal of thick secretions |
What are some different Types of Mucolytics: | Mucolytic:breaks down mucus.(Mucomyst, Pulmozyme)Mucokinetic-increases mucociliary escalator or cough efficiency(Bronchodilators improve cough flow,surfactants decrease mucus adhesiveness) Mucoregulatory:decreases mucus production Expectorant:increases |
What are some Contraindications for mucolytics: | Hypersensitivity to the drug Caution: Wheezing |
What are some Drugs that are mucolytics: | Acetylecystine (Mucomyst) Dornase Alpha (rhDNAse)Pulmozyme NaHCO3 Saline (hypertonic saline and isotonic saline) Expectorant |
What is the mechanism of action for Acetylecystine (Mucomyst)- | breaks disulfide bonds of the mucus amino acid that holds sputum together Decreases Viscosity |
What is the Dosage/Frequency for Acetylecystine (Mucomyst: | SVN: 3-5 ml 10-20% mucomyst, HHN: Onset 1 min, Peak 5-10 min, |
Side Effects for Acetylecystine (Mucomyst: | Bronchospasm (always give with or after a Beta 2 agonist) Hemoptysis Nausea Rhinorrhea |
What are some Other Uses for Acetylecystine (Mucomyst: | Acetaminophen OD Protection of kidneys from cardiac dyes (angiogram) Experimental for prevention of lung injury in ARDS or lung cancer |
What is the mechanism of action for Dornase Alpha (rhDNAse)-Pulmozyme | Breaks down mucus DNA strands |
What is the dosage for Dosage/Frequency Dornase Alpha (rhDNAse)-Pulmozyme: | SVN: 2.5 mg/ampoule QD |
What are some Side Effects for Dornase Alpha (rhDNAse)-Pulmozyme: | Voice alterations Pharyngitis Laryngitis |
Miscellaneous uses for Dornase Alpha (rhDNAse)-Pulmozyme: | Drug of choice for CF patients Not as irritations as Acetylcystein Dont Give alone in HHN Discard if cloudy or discolored |
What is the mechanism of action NaHCO3 | Increases pH of mucus Weakens accharide chains Very little evidence of effectiveness |
what is the Dosage NAHCO3: | 2-5ml of 2% |
Side Effects for NAHCO3 | Hypernatremia Bronchial Irritation |
What are some indications/mechanism of action Saline (hypertonic saline and isotonic saline) Expectorant | Used to induce sputum Hypertonic pulls water into the airway Isotonic: Induces cough and makes mucus move easier Can be nebulized or instilled into ETT |
What is the Dosage for Saline: | 3-10% solution |
What are some indications for antiinfectives | Indications:For gram negative infections: Joint & bone skin & soft tissue respiratory infection sepsis abdominal infection UTIs Poor GI absorptions-given parenteral 400 mg (1.6ml) HHN- dose per local practice |
What are the drugs that fall within this class (antiinfectives) | Tobramycin (TOBI) Aminoglycoside Pentamidine (NebuPent) Ribavirin (Virazole) |
Indications for Tobramycin (TOBI) Aminoglycoside: | Pseudonmonas aeruginosa in CF, Staph and E-coli infections |
Dosage for Tobramycin (TOBI) Aminoglycoside: | 300 mg/5ml, 28 course of 80mg or more |
Indications for Pentamidine (NebuPent): | PCP Prophylaxis,Antiprotozoal for treatment and prevention of opportunistic pneumonia, Given if history of P carinii and/or low CD4 count <200 |
Dosage for Pentamidine (NebuPent): | 300 mg of powder in 6 ml of sterile water once every 4 wk |
Misc facts about Pentamidine (NebuPent) | Don’t mix with another drug in HHN Don’t administer if pregnant Give in a ventilator booth if possible Give once a month |
Indications for Ribavirin (Virazole): | RSV |
Dosage for Ribavirin (Virazole): | 6mg of power in 300 ml of sterile water x 12-18/day for 3-7 days Used by SPAG Neb Wear goggles and respirator |
Side Effects of Ribavirin (Virazole): | Bronchospasm Cardiac Arrhythmias Conjunctives |