“The Supporting Players….”

RC 195

Anti-foaming agent: ETOH

Aerosolized ETOH used to decrease the foam and froth in pulmonary edema Decreases surface tension so that bubbles liquefy

Dose: 3-5 ml of 30-50% ETOH Side effects: Intoxication, bronchospasm, decreased surfactant Not a primary treatment now

Aerosolized Antibiotics

Ideal Properties: Potent topical effect Less toxicity/side effects

Indications: Systemic administration is ineffective Toxicity/side effects from systemic administration

Limitations: V/Q abnormalities and “hiding” microbes Variable dosing when aerosolized

Aminoglycosides

Used against gram – rod respiratory infections Pseudomonas Klebsiella Proteus E-coli

Side effects/Toxicity: Nephrotoxicity, ototoxicity, neurotoxicity

May cause temporary paralysis and hence apnea when given as an IV bolus

Aminoglycoside Examples

Stretpomycin Gentamycin (Garamycin) Tobramycin (Nebcin) Kanamycin (Kantrex) Neomycin (Neosporin)

Penicillins

Some are very broad spectrum so can be used for gram+ and gram- infections Methicillin (Staphcillin) – staphylococcus Ampicillin (Omnipen, Polycillin) – H.flu, Streptococcus Carbenicillin (Geopen) – pseudomonas Nafcillin (Unipen) – staphylococcus Pen G – strep Also : Amoxicillin ( Polymox) and amoxicillin with

potassium clavulanate (Augmentin) The penicillins can be very allergenic!

Other Antibiotics

Cephalosporins – gram+ and gram-; e.g. Keflex Fluoroquinolones –very broad spectrum

Ciprofloxacin (Cipro), Moxifloxacin (Avelox) Macrolides – very broad spectrum and used in place of

penicillin Erythromycin, Clarithromycin (Biaxin), Azithromycin (Zithromax)

Polymixins –Colistin (Promixin) -75-150mg BID via aerosol for H.Flu, Klebsiella, Acinetobacter, and Pseudomonas

Vancomycin (Vancocin) – last choice drug! Used for MRSA or other infections that are not responding to

penicillins or cephalosporins

Antifungal Drugs

Amphotericin B (Fungizone) – Big gun! Can be very toxic Has been aerosolized Is light sensitive Histoplasmosis, Valley Fever

Nystatin (Mycostatin) – topically applied for yeast-like infections, eg Thrush

Antifungal Drugs (cont.)

Pentamidine (NebuPent) Aerosolized for PCP/PJP infections in HIV

patients Pneumocystis Carinii Pneumonia now known

as Pneumocystis Jiroveci Pneumonia Can be very toxic

RCP administering must use barrier precautions

Antituberculosis Drugs

Isoniazid (INH) Usually given orally for 9 months

Rifampin – also oral for 9 months Patients may also need Streptomycin,

Ethambutol, or Pyrazinamide Patient compliance is a real problem! These drugs can also be damaging to the

liver

Respiratory Depressants Usually used to “control” respiration in mechanically

ventilated patients CNS Depressants – Narcotics (Morphine, Heroin) and

Barbiturates (Seconal, Nebutal) Paralyzing agents

Succinylcholine (Anectine) – short acting: usually used for intubations

D-Tubocurare (Curare): long lasting but may cause hypotension and histamine release (reversed by Neostigmine)

Pancuronium Bromide (Pavulon) – no histamine release Vecuronium Bromide (Norcuron) – like Pavulon

Respiratory Stimulants

Usually used for drug overdose and/or post-op anesthesia depression May also be tried short term with COPD

Doxapram (Dopram) Naloxone (Narcan) – narcotic antagonist Progesterone – female hormone that

stimulates respiration but may have a lot of side effects

Antiviral Drugs

Ribavirin (Virazole) Used for RSV (Respiratory Syncytial Virus) Aerosolized via SPAG

HIV Drugs: Zidovudine (AZT), Didanosine (DDI)

Nitric Oxide – A Magic Bullet?

Also known as EDRF – Endothelium derived relaxing factor, a naturally-occurring vasodilator

When inhaled, it quickly dilates pulmonary arteries without causing systemic vasodilation Improves V/Q Very precise dosing: 4-25 PPM

Iloprost

Brand: Ventavis Aerosolized for Pulmonary Hypertension

in adults Is a stable analogue of PGI2 (a natural

prostaglandin that is a vasodilator) Unit does for aerosol: 20mcq/2ml Duration: 1-2 hours