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

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