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