Phamacology Final Exam Review

Inhaled Drugs Bronchodilators Beta agonists anticholinergic Xanthines Mucolytics Corticosteroids TB drugs

Beta Agonist Bronchodilators Beta 2 agonists Beta agonists Adrenergic Beta adrenergic Sympathomimetic Some of the several names this type of bronchodilator goes by

Beta Agonist Bronchodilators Effects Side effects Stimulates the sympathetic system Bronchodilation Tachycardia Tremors Shakiness Nausea

Beta Agonist Bronchodilators Most common Albuterol Standard dose 2.5 mg Unit dose 2.5 mg in 3ml NS Levalbuterol (Xopenex) less common Standard doses 1.25 mg, 0.63 mg

Anticholinergic Bronchodilators Effects Side effects Blocks the parasympathetic system Bronchodilation Dry mouth Dries secretions Don’t use on patients with peanut allergies

Anticholinergic Bronchodilators Most common Ipratropium Bromide (Atrovent) Standard dose 0.5 mg Unit dose 0.5 mg in 2.5 ml Less common Tiotropium Bromide (Spiriva) Standard dose dry powder inhaler

Combination beta agonists and anticholinergics Albuterol and Ipratropium Bromide Duoneb for HHN Combivent for MDI

Xanthines Non-bronchodilator effects Increase respiratory muscle strength Increase respiratory muscle endurance Stimulates the drive to breathe Mild bronchodilator

Xanthines Caffeine IV: to treat apnea of prematurity Theophylline: oral for asthma and COPD Aminophylline: IV for asthma and COPD Therapeutic blood level: 10 to 20 Side effects much like coffee up to seizures

Mucolytics Acetylcysteine (Mucomyst) Alpha Dornase (Pulmazyme) Breaks the disulfide bonds Thins secretions Alpha Dornase (Pulmazyme) Breaks up the DNA of white blood cells Thins secretion with infections

Mucolytic side effects Mucomyst Pulmozyme Bronchospasm Must give with bronchodilator Irritating to mucosal lining Nothing serious

Corticosteroids Adrenal Corticosteroids Steroids Come from adrenal cortex Have a circadian rhythm up and down over 24 hours peak in the morning taper off in evening so can sleep

Corticosteroids Effects Side Effects Reduce inflammation Blocks prostaglandin release Increases response to beta agonists Suppresses adrenal cortex Fluid retention Hypertension Diabetes Many many more

Corticosteroids Inhaled for lung inflammation Less side effects COPD Asthma Less side effects Direct application to site

Corticosteroids Oral: Prednisone IV: Solumedrol Indicates level of severity

Corticosteroids Fluticasone (Flovent) MDI Budesonide (Pulmicort) nebulizer Beclomethasone (QVAR) MDI

Combination drugs Fluticasone and Salmeterol: Advair Budesonide and Formoterol: Symbicort

TB drugs Combination of antibiotics Most commonly used drugs Isoniazid Rifampin Pyrazinamide Ethambutol

Anti-Asthmatics Cromolyn Sodium (Intal) Anti-Leukotrienes Primarily used to prevent inflammation, stabilizes the mast cell Preventative, not used for acute asthma

Inhaled Antibiotics Use to treat chronic pulmonary infections Cystic Fibrosis most commonly TOBI(Tobramycin) is the most common inhaled drug in unit dose

Neuromuscular blockers Non-Depolarizing for long term paralyzation Pancuronium (Pavulon) Vecuronium (Norcuron) Mechanical ventilation

Depolarizing agents Depolarizing for short term paralysis Succinylcholine intubation

Neuromuscular blockers Always treat for Pain Anxiety Must be on mechanical ventilation

Indications Intubation Surgery Mechanical ventilation Reduce ICP

Ribaviron Used to treat RSV Uses SPAG nebulizer

Surfactants Premature infants with immature type II alveolar cells Jumps start surfactant production Survanta

Dose calculations Finding the unknown value Start with the known ratio of drug to volume If you have a UD of 2.5 mg in 3 ml solution and you need to give 1 mg, how much solution would be given?

Dose calculations Finding the unknown value Start with the known ratio of drug to volume If you have a UD of 2.5 mg in 3 ml solution and you need to give 1 mg, how much solution would be given?

Dose calculations Finding the unknown value Start with the known ratio of drug to volume If you have a UD of 2.5 mg in 3 ml solution and you need to give 1 mg, how much solution would be given?

Dose calculations You have a 2.5mg/3ml solution 2.5mg 3ml

Dose calculations You have a 2.5mg/3ml solution You need to know how much of the 3ml solution is needed to give 1mg, this is the unknown (X) 2.5mg = 1mg 3ml Xml

Dose calculations Always put the units on the same line, the answer will be the same even if you put the ml on top and the mg on bottom. You just cannot mix them up

Dose calculations Solve for the unknown Cross multiply 2.5mg = 1mg 3ml Xml 2.5X = 3

Dose calculations and divide 2.5mg = 1mg 3ml Xml 2.5X = 3 X = 3 X = 1.2 ml 2.5

Aerosol Devices Three main goals of our drugs given via aerosol Bronchodilation Mucociliary clearance Reduce inflammation

Aerosol Devices HHN, SVN, Aero MDI DPI When do you use which one?

Aerosol Devices MDI Ability to take a slow deep breath Ability to do a breath hold Ability to actuate the device Ability to understand and retain instructions Can be given with a chamber and mask Used commonly inline on ventilators

Aerosol Devices Dry Powder Inhaler Pt needs many of the same qualities as an MDI Slow deep breath Inspiratory flow needs to be fast enough to intake the powder

Aerosol Devices Hand Held Nebulizer If unable to do an adequate MDI can use a mask Uncooperative Unconscious Uncoordinated Etc Doesn’t need a breath hold