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KETTERING PHARM
| Question | Answer |
|---|---|
| Beta 2 Adrenergic bronchodilators (front door bronchodilators): | SABA, LABA |
| SABA (SHORT ACTING BETA 2 AGONISTS): | RESCUE/ QUICK RELIEF MEDS -indicated for tx of acute episodes of bronchospasm -ALBUTEROL (VELTOLIN or PROVENTIL) -LEVALBUTEROL (XOPENEX) |
| ALBUTEROL DOSE: | 2.5 mg in 3mL Q1-Q6H |
| LABA (long acting beta 2 agonists): | maintenance/ long term meds: -indicated for tx of long term control of bronchospasm in pt's w/ COPD & asthma -taken twice daily to control symptoms -should not be used for acute episodes of bronchospasm |
| Examples of LABA's: | 1. Salmeterol (severent) 2. Formoterol (foradil) 3. Arformoterol (brovana) - ends in "met/moterol" |
| Side effects/hazards of Beta 2 Adrenergic bronchodilators: | tremors, shakes, quivering (most common), tachycardia, palpitations, hyper/hypotn, headache, paradoxical hypoxemia, tachyphylaxis, nausea/vomiting -IF ANY OCCUR STOP TX NOTIFY RN/MD -IF BRONCHOSPAM/WHEEZING PERSISTS, 1ST INCREASE DOSAGE TO MAX THEN FREQ |
| Anticholinergic (Parasympatholytics); Back door bronchodilators: | These drugs work against BRONCHOCONSTRICTION caused by the parasympathetic nervous system (decrease cyclic GMP) -Act by blocking cholinergic parasympathetic receptors |
| Examples of Anticholinergic (Parasympatholytics): | 1. Ipratropium bromide (ATROVENT) 2. Tiotropium Bromide (SPIRIVA) 3. Oxitropium BROMIDE (Oxivent) "Bromide Brothers" -these can be given w/ SABA's for persistent bronchospasms |
| Methylxanthines (phosphodiesterase inhibitors): side door bronchodilators: | safe therapeutic blood level= 10-20 mcg/mL to optimize bronchodilation. -also given to increase diaphragmatic contractility & stimulate the CNS in Apnea of prematurity NEONATES= 5-10 -BLOOD LEVELS ARE IMPORTANT TO MONITOR IN PT'S RECEIVING THESE MEDS |
| EXAMPLES OF Methylxanthines: | 1. Theophylline (Aminophylline) 2. Theo-Dur 3. Oxtriphylline (Choledyl) 4. Theolair 5. caffeine |
| Side effects of Theophylline include: | tachycardia, palpitations, jitters, irritability, and diuresis |
| Theophylline toxicity is serious & occurs when it comes when serum levels exceed ____ mcg/mL: -Signs include | Theophylline toxicity is serious & occurs when it comes when serum levels exceed __20__ mcg/mL: -tremors, nausea/vomiting, nervousness, seizures, tachycardia & other arrhythmias that may lead to cardiac arrest |
| Corticosteroids: | -anti-inflammatory agents w/ direct & indirect Broncho dilating effects -steroids are indicated for patients w/ Asthma & COPD |
| Examples of Corticosteroids: | 1. Fluticasone (Flovent) 2. Beclomethasone (Beclovent, Vanceril, QVAR) 3. Budesonide (Pulmicort) 4. Flunisolide (AeroBid) 5. Triamcinolone (Azmacort) 6. Prednisone 7. Methylprednisolone (SOLU-medrol) |
| SIDE EFFECTS OF CORTICOSTEROIDS: | MAY BE SEVERE: INCLUDE: ADRENAL SUPPRESSION, CUSHINGS SYNDROME, HYPERTENSION, & ORAL CANDIDIASIS (THRUSH) FOR INHALED AEROSOLS -THRUSH INFECTIONS CAN BE TREATED W/ ANTIFUNGAL AGENT: NYSTATIN |
| COMBO MEDS: (adrenergic + anticholinergic) | ipratropium bromide + albuterol (Combivent, DuoNeb) -bronchodilation -more control of bronchospasm for pt's w/ COPD & asthma -reduced drug dosages -avoidance of steroids |
| COMBO MEDS: (anti-inflammatory + long acting bronchodilator) | 1. Advair: Fluticasone & salmeterol 2. Symbicort: Budesonide & formoterol -Indicated for patients w/ Asthma !!12 yrs & older!! & COPD -should be taken BID -NOT rec. for tx of ACUTE bronchospasm |
| COMBO MEDS: if patient is receiving multiple inhaled meds administer in THIS SEQUENCE: | A. bronchodilator and/or anticholinergic (albuterol and/or ipratropium bromide) B. Corticosteroid (Fluticasone) C. Antibiotics (TOBI) |
| Mucolytics/ Proteolytic: | may be recommended when secretions are thick & tenacious (inspissated) and cannot be easily removed 1. Aceylcysteine (Mucomyst) 2. recombinant human DNAse (Pulmozyme) |
| Mucomyst (acetylcysteine): | dissolves disulfide bonds -Indications: to thin secretions -to treat acetaminophen overdose |
| most common side effect of Mucomyst (acetylcysteine): | bronchospasm: patients should receive bronchodilator prior to acetylcysteine |
| This med is indicated for patients with Cystic Fibrosis: | recombinant human DNAse (Pulmozyme); side effects: voice alteration, pharyngitis, laryngitis, rash, chest pain, conjunctivitis |
| Pulmonary Vasodilators: | Specifically DILATE the PULMONARY blood vessels |
| Indications of Pulmonary Vasodilators: | -Pulmon. HTN -ARDS -Cor Pulmonale (right heart failure) |
| Examples of Pulmonary Vasodilators: | -Prostacyclins: Epoprostenol (Flolan) -Lloprost: (Ventavis) - Sildenafil (Viagra, revatio) |
| Wetting Agents: | the main uses of these are to LIQUEFY secretions & as DILUENT for meds: -HYPOTONIC saline 0.45% -ISOTONIC/ NORMAL saline 0.9%% -HYPERTONIC saline 1.8-15% |
| hypotonic saline 0.45% | for liquifying secretions & humidifying the a/W -may be irritating & can cause swelling of dried retained secretions or bronchospasm |
| isotonic/ normal saline 0.9% | commonly used to liquefy secretions, to humidify the a/W & as a diluent for meds |
| hypertonic saline 1.8-15%: | commonly used to induce sputum specimens can irritate the a/W & cause bronchospasms or secretion obstruction |
| Leukotriene modifiers: | Non steroid drugs that have been approved for patients w/ mild to mod persistent asthma -NOT to be used for tx of ACUTE asthma attacks - improve lung function, reduce symptoms, & the need for beta agonist drugs |
| Examples of leukotriene modifiers: | 1. montelukast (singulair) 2. Zafirlukast (accolate) 3. Zileon (Zyflo) |
| Asthma med recommended for patients with exercised induced asthma (EIA) or exercise induced bronchospasm (EIB): | -Mast cell Stabilizers -These drugs are NOT effective once the asthma attack has begun (Pt will continue to have wheezing) 1. cromolyn sodium (Intal, Aarene) 2. nedocromil sodium (Tilade) |
| Mucosal Vasocontrictors/ Decongestants: Indications: include upper a/W conditions such as CROUP 7 Post extubation swelling where mild/moderate stridor is present. | aerosolized racemic epinephrine (vaponefrin) |
| Cardiovascular Drugs: | - Inotropic Agents - Anti-Arrhythmic Agents - Antianginal Agents - Vasodilator Drugs - Vasoconstrictor/ Vasopressor Drugs |
| Inotropic Agents: increase strength of myocardial contraction Indications: side Effects: examples: | Indications: CHF, atrial tachycardia, Afib side Effects: nausea, vomiting, headache, arrhythmias examples: digitalis (crsytodigin), digoxin (Lanoxin) |
| Anti-Arrhythmic Agents: treat these cardiac issues-> | 1. Ventricular Arrhythmias 2. Bradycardia |
| Inotropic Agents for BRADYCARDIA | a. atropine b. epinephrine |
| Inotropic Agents for VENTRICULAR ARRHYTHMIAS: | a. Amiodarone b. Procainamide c. Verapamil d. Lidocaine |
| Treats Pulseless vtach & vfib that has not responded to defibrillation: | Amiodarone (cordarone, nexterone) |
| treatment of Ventricular eptopic beats, vtach, & atrial arrhythmias | Procainamide (Pronestyl) |
| used to control ventricular rates in narrow complex SVT | verapamil |
| control of PVC, stable vtach | Lidocaine |
| Antianginal agents: relief of pain (angina pectoris) is almost immediate: | Nitroglycerin Isodil |
| Drugs that lower blood pressure | vasodilator drugs: Nitroprusside (Nipride) Milrinone (primacor) |
| drugs that increase blood pressure: | vasoconstriction/ vasopressor drugs: epinephrine norepinephrine (levophed) dopamine dobutamine (dobutrex) |
| Diuretics: | Furosomide (Lasix) Mannitol (Osmitrol) Acetazolamide (Diamox) |
| Diuretics: Furosemide (lasix) uses: adverse reactions: | uses: Pulmonary Edema, Liver/ Kidney disease, CHF adverse reactions: hypokalemia, hypochloremia, metabolic alkalosis |
| Diuretics: Mannitol (osmitrol) uses: adverse reactions: | uses: cerebral edema, drug toxicity & drug OD adverse reactions: increased cardiac workload due to increased plasma volumes |
| Diuretics: Acetazolamide (diamox) uses: adverse reactions: | uses: cerebral edema, perioheral edema, altitude sickness adverse reactions: metabolic acidosis- contraindicated in renal failure or respiratory failure because it causes excretion of bicarbonate ions |
| Depolarizing blocking drugs: NMBA -rapid onset of action (1-1.5 minutes) -short duration of action (7-12 min.); no need for reversal -PRIMARILY USED FOR ENDOTRACHEAL INTUNATION -cause of total muscle contraction followed by COMPLETE MUSCLE PARALYSIS | SUCCINYLCHOLINE (Anectine) |
| Non- depolarizing blocking drugs: NMBA -rapid onset of action (3-5 minutes) -Longer duration of action (35-120 min) RECOMMENDED WHEN PARALYSIS IS INDIACTED FOR LONGER PERIOD OF TIME | EXAMPLES: end in "IUM" - Pancuronium (Pavulon) - Vecuronium (Norcuron) - Atracurium (Tracrium) - Cisatracurium (Nimbex) - Rocuronium ( Tensilon) |
| drugs to reverse the effects of NMBA: | can be reversed with anticholinesterase inhibitors if desired: - neostigmine (Prostigmin) - pyridostigmine (mestinon) - Edrophonium (Zemuron) |
| NMBA do not affect pain perception or consciousness, so patient should also receive: | sedation and analgesia (pain control) |
| Indications for NMBA: | -cause of paralysis skeletal muscle -reduce of spont. breathing -prevent movement that can dislodge a/W's, catheters, chest tubes, etc. -reduce O2 consumption in pt's w/ poor cardiopulmonary status -improve pt/vent synchrony |
| Indications for sedatives/hypnotics: | -Decrease anxiety & promote relaxation - Indications: manage fear & anxiety, increase comfort while receiving mechanical ventilation, induce sleep |
| Examples of Benzo's (SEDATIVES/HYPOTICS): ends in "AM" | ALPRAZOLAM (XANAX) DIAZEPAM (VALIUM) MIDAZOLAM (VERSED) LORAZEPAM (ATIVAN) |
| LEVEL OF SEDATION (RAMSAY SCALE) LEVEL: 1 | agitated, anxious, restless |
| LEVEL OF SEDATION (RAMSAY SCALE) LEVEL: 2 | calm, cooperative, oriented, tranquil |
| LEVEL OF SEDATION (RAMSAY SCALE) LEVEL: 3 | responds to verbal commands (conscious sedation) |
| LEVEL OF SEDATION (RAMSAY SCALE) LEVEL: 4 | brisk response to light touch |
| LEVEL OF SEDATION (RAMSAY SCALE) LEVEL: 5 | unable to be assessed (paralyzed) |
| Sedation should be adjusted to achieve level: | level 3 on the Ramsay Sedation Scale (responds to verbal commands) |
| What drug can reverse the effects of sedatives (Benzo's): | Flumazenil (Romazicon) |
| Anesthetics: reduce patients ability to PERCEIVE sedation examples: | 1. Propofol (diprivan) 2. Ketamine (Ketalar) |
| Propofol: short acting used for: | anesthesia & sedation of ventilated patients |
| Analgesics reduce _____ of pain & can cause _____ at higher doses. | sensation; respiratory depression |
| Examples of Analgesics: | 1. morphine 2. codeine 3. Meperidine (Demerol) 4. fentanyl (Sublimaze) 5. hydromorphone (dilaudid) 6. oxycodone (oxycontin) 7. hydrocodone |
| Analgesics can be revered with _____: | naloxone (Narcan) |
| Surfactant Replacement Therapy: uses: administration techniques: adverse effects: | uses: to prevent & treat IRDS/HMD administration techniques: Prophylactic /Rescue adverse effects: pneumothorax, bradycardia, hypotension, hypoxemia, hemorrhage, apnea route of administration: |
| route of administration for SURFACTANT: | instilled directly into the trachea. infant is positioned to allow gravity to aid in distributing the surfactant throughout the lung |
| Examples of surfactant: | 1. calfactant (infasurf)- Bovine 2. beractant (survanta)- Bovine 3. poractant alfa (curosurf)- Porcine |
| Examples of Antibiotics: | - Penicillins - Cephalosporins - Aminoglycosides - Protein Synthesis Inhibitors - Antitubercular Agents - Vancomycin |
| - Penicillins: | end in "CILLIN" |
| - Cephalosporins | start with "CEF" |
| - Aminoglycosides | end in "CIN" 1. Amikacin 2. Gentamicin 3. Tobramycin |
| - Protein Synthesis Inhibitors | end in "OMYCIN" 1. Erythromycin 2. Azithromycin |
| - Antitubercular Agents | 1. isoniazid (INH) 2. Rifampin 3. ethambutol 4. Streptomycin (NOT protein synthesis inhibitor) 5. Cycloserine 6. Ethionamide |
| - Vancomycin | for infections caused by methicillin resistant staphylococcus aureus (MRSA) |
| ANTIVIRAL agent Ribaviran (Virazole) may be used to treat ____: and how is it given? | RSV (respiratory synical virus); given via small particle aerosol generator (SPAG) for 12-24 hours for 3-5 days or more. |
| ANTIPNEUMOCYSTIS agent: used to treat ____ infections commonly seen in ______. example of med: administered how: Most common adverse effects: | Pneumocystis Jiroveci (carinii); Patients with AIDS. =PENTAMIDINE (NebuPent) - administered w/ special neb (RESPIGARD II) -adverse effect is bronchospasm, pretreat the patient with a bronchodilator |
| Immunization against INFLUENZA & staphylococcus pnuemoniae (Pneumovax) is recommended for individuals over ____ years of age, those with _____ or _____ disorders, & the _____ workers. | 60 yrs old; chronic respiratory; cardiac disorders; healthcare workers. |
| Children @ risk for RSV should be immunized annually: | a. RSV Immune Globulin Intravenous (RespiGam) b. Palivizumab (Synagis) |
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tumi6472
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