1. Phamacology
Final Exam Review

2. Inhaled Drugs
Bronchodilators Beta agonists anticholinergic Xanthines Mucolytics Corticosteroids TB drugs

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

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

5. 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

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

7. 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

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

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

10. 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

11. 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

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

13. 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

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

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

16. Corticosteroids Oral: Prednisone IV: Solumedrol
Indicates level of severity

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

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

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

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

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

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

23. Depolarizing agents Depolarizing for short term paralysis
Succinylcholine
intubation

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

25. Indications
Intubation
Surgery
Mechanical ventilation
Reduce ICP

26. Ribaviron
Used to treat RSV
Uses SPAG nebulizer

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

28. 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?

29. 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?

30. 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?

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

32. 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

33. 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

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

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

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

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

38. 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

39. 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

40. 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