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Phamacology

Phamacology. Final Exam Review. Inhaled Drugs. Bronchodilators Beta agonists anticholinergic Xanthines Mucolytics C orticosteroids TB drugs. Beta Agonist Bronchodilators. Beta 2 agonists Beta agonists Adrenergic Beta adrenergic Sympathomimetic

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Phamacology

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  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 Tachycardia Tremors Shakiness Nausea • Stimulates the sympathetic system • Bronchodilation

  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 Dry mouth Dries secretions Don’t use on patients with peanut allergies • Blocks the parasympathetic system • Bronchodilation

  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) • 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 Nothing serious • Bronchospasm • Must give with bronchodilator • Irritating to mucosal lining

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

  15. Corticosteroids • Inhaled for lung inflammation • 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 = 3 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

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