phamacology final exam review. inhaled drugs bronchodilators beta agonists anticholinergic xanthines...
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Phamacology Final Exam Review
Inhaled DrugsBronchodilators
Beta agonistsanticholinergic
XanthinesMucolyticsCorticosteroidsTB drugs
Beta Agonist BronchodilatorsBeta 2 agonistsBeta agonistsAdrenergicBeta adrenergicSympathomimetic
Some of the several names this type of bronchodilator goes by
Beta Agonist Bronchodilators
Effects Stimulates the
sympathetic system
Bronchodilation
Side effects 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 Blocks the
parasympathetic system
Bronchodilation
Side effects 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
XanthinesNon-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)
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 Bronchospasm Must give with
bronchodilator Irritating to
mucosal lining
Pulmozyme Nothing serious
CorticosteroidsAdrenal CorticosteroidsSteroids
Come from adrenal cortexHave a circadian rhythm
up and down over 24 hourspeak in the morningtaper off in evening so can sleep
Corticosteroids
Effects Reduce
inflammation Blocks
prostaglandin release
Increases response to beta agonists
Side Effects Suppresses
adrenal cortex Fluid retention Hypertension Diabetes Many many more
Corticosteroids Inhaled for lung inflammation
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 = 1mg3ml 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 = 1mg3ml Xml
2.5X = 3
Dose calculations and divide
2.5mg = 1mg3ml Xml
2.5X = 3
X = 3 X = 1.2 ml 2.5
Aerosol Devices Three main goals of our drugs given via
aerosol1. Bronchodilation2. Mucociliary clearance3. 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