Ipratropium bromide
Atrovent-brand name
Keep out of the face because it can cause pupil dilation
Ask if patient has a soy or peanut allergy
What does Atropine sulfate do?
Relaxes bronchial smooth muscles
Inhibits mucus production
Tiotropium Bromide
Spiriva- brand name
Maintenance drug for COPD
Not indicated for use during acute exacerbations
Dry mouth is the most common side effect
Tudorza
aclidinium bromide- trade name
LAMA
Not a rescue drug
12hr drug
Combivent is what 2 drugs combined?
Ipratropium bromide (Atrovent) & albuterol
Given by a pMDI or Respimat inhaler
DuoNeb is what 2 drugs?
Ipratropium bromide & albuterol
Given by SVN
Respimat inhaler technique
- Assemble
- Prime-
Twist 1/2 turn with cap closed
Open cap push spray button
Repeat until a spray is visible
Repeat 3X there should be 120 sprays available.
If not used >3 days prime 1X
If not used >21 days prime until spay is visible and then 3 more times
3.twist
4.ensure cap is off & no obstructions - Exhale slow & complete toward RV
6.place in mouth don’t obstruct vents on the side of the mouth piece
7.inhale, slowly, deeply toward TLC - Press spray button
- Continue to inhale deeply
- Hold breath (glottis open)
- If another dose is to be given wait 2 minutes
- Discard after 120 sprays (see counter on side) or after 3 months
- Clean with damp cloth weekly
When should you not use sterile water?
For inhalation
Collecting sputum
Hypertonic saline
Can cause bronchospasm
Used for sputum collection & induction
May need Beta 2 before or with solution.
Sodium retention when in large dose
What are mucolytics?
Alter the structure of mucous( causing them to be thinner & more liquid)
n-acetylchsteine, NAC
Mucomyst & Mucosol
Breaks disulfide bonds in mucous
Common to use with a bronchodilator
After opened discard after 96 hours
Giving the bronchodilator then the Mucomust may be a better method
Smells like rotten eggs. (Mix with cola)
dornase alfa
Pulmozyme
Breaks down DNA in mucous making it thinner
Take very day
Keep refrigerated and shield from light
What can also be used as an antidote to protect the liver from acetaminophen (Tylenol) overdose?
Mucomyst
Ivacaftor
Kalydeco
Targets the genetic defect that causes a protein to malfunction of CF
Sodium bicarbonate
Weekends the polysaccharide chain in mucus
Give every 4-8 hrs
Expectorants
Guaifenesin & hypertonic saline are the most common drugs
Increase production and expectoration of mucus by increasing the amount of fluid in the respiratory tract in stimulating a cough
Antitussive/ cough suppressant
It’s a cough suppressant
Codine- narcotic
Dextromethorphan- non-narcotic
Ethanol
Ethyl alcohol
Decrease surface tension of the froth causes the bubbles to rupture.
This is thought to improve oxygenation (maybe)
respiratory bronchioles are composed of?
Alveolar ducts
Alveoli
Pulmonary capillaries
Alveolar macrophages
Phagocytic cells destroy digest bacteria and other material
Produced in bone marrow and transported throughout the body via the bloodstream
Hey how are the surface tension?
Greater the force to contract
Law of LaPlace
The smaller the sphere the greater the forces are to continue it to decrease in size
Surfactant administration
Ensure the drug is at room temperature
Pre and post oxygenate
Swirl the vial to mix prior to use DO NOT shake because shaking will cause it to foam
Infant is turned onto one side to administer half the dose followed by manual ventilation and assessing for hypoxemia
The infant is then turned onto the other side to administer the other half dose followed by more manual ventilations
This encourages the surfactant to move it to each lung. However there is a little data that this improves the effectiveness of the drug
If effective PIP will drop rapidly VC or volume will increase rapidly PC. The infant and ventilator must be monitored closely and adjusted as needed.
Beractant
Survanta
From Cow lung
Every 6 hrs up to 4 doses
Calfactant
Infasurf
A natural surfactant
Ever 12 hrs total of 3 doses
Poracant alfa
Curosurf
Naturally occurring surfactant from pig lung
Every 12 hrs up to 3 doses
Cells lining the airway that have cilia on them are responsible for moving mucus towards the pharynx
Ciliated pseudostratified columnar epithelial cells
Cells that secrete mucus into the airways and form the jail later
Goblet cells
Cells that secrete less viscous mucus into the airway that formed the sol layer where the cilia beat
Serous cells
Connective tissue
Lamina propria layer
Produce most of the mucus in the airways. These glands increasing number with chronic pulmonary disease resulting in large quantities of secretion and increasing the risk of mucous plugging the airways?
Bronchial glands
Bronchial glands and goblet cells combined produced about how much mucous per day?
100 ml
About 90 ml is reabsorbed
Cells that release vasoactive substances such as histamine
Mast cells
Catecholamines are either sympathetic or parasympathetic?
Sympathetic
These types of drugs directly cause bronchodilation by increasing Cyclic AMP (cAMP)
Which cause bronchial smooth muscle relaxation
Sympathomimetic, beta-adrenergics
What drug blocks the bronchoconstricting effects of cyclic GMP (cGMP)
A substance produced by the parasympathetic system that causes bronchoconstriction?
Anticholinergics, parasympatholytics
What is thought to cause bronchodilation increasing cAMP I inhibiting phosphodiesterase an enzyme that deactivates cAMP?
Xanthines
Catecholamine benzene ring
Hydroxy your group (OH) at position 3 & 4
Resorcinol benzene ring
Hydroxyl groups at positions 3 & 5
Saligenin benzene ring
Hydroxyl group at position 3 & a hydroxyl H2C at position 5
Catecholamines are deactivated by what?
COMT
MAO
Why can’t catecholamines be given by mouth ( P.O) ?
Because MAO will be deactivated in the gut
Isoproterenol
Isuprel
Isoetharine
Bronkosol, Bronkometer
Inactivated by heat and light
May turn sputum pink
Has a 10 fold decreased broncodilating effect compared to Isoproterenol
Had a 300 fold decreased cardiac stimulating affect compared to isoproterenol
Racemic epinephrine
Vaponefrin, Micronefrin
Has an alpha & beta affect
A synthetic epinephrine
Bitolterol
Tornalate
A “pro-drug” meaning it is administered in and in active form and converted to an active form when metabolized
Muscle tremors are a common side effect
Resorcinol bronchodilators
Longer-lasting then catecholamines
Maybe used as a RESCUE DRUG for an Attack and as maintenance
Examples: Metaproterenol &. Terbutaline
Metaproterenol
Alupent,
Metaprel
Terbutaline
Brethine
Bricanyl
Given as an IV to stop premature labor
Albuterol
Proventil
Ventolin
AccuNeb
Also referred to as racemic albuterol
Pirbuterol
Maxair
Salmeterol
Serevent
Uses the Diskus
LABA- long acting beta agonist
Poor rescue drug
Levalbuterol
Xopenex
It can be used as a rescue drug
Formoterol fumarate
Foradil & Perforomist
NOT a rescue drug
Arformoterol tartrate
Brovana
NOT a rescue drug
Arcapta
Indacarerol maleate
LAMA
NOT a rescue drug it’s a maintenance drug.
Ultra- short acting
2-3 hrs
Isoproterenol
Isoetharine
Short-acting
5-6 hrs
Metaproterenol
Terbutaline
Pirbuterol
Intermediate- acting
Up to 8 hrs
Albuterol
Levalbuterol
Bitolterol
Long-acting
12 hrs
Salmeterol
Formoterol
Arformoterol
Anticholinergic Bronchodilators examples
Atropine
Ipratropium bromide
Tiotropium bromide