Respiratory Drugs 03/19 Flashcards Preview

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Flashcards in Respiratory Drugs 03/19 Deck (54):
1

Albuterol: MOA

Beta 2 —> promotes sympathetic stimulation of bronchial smooth muscles, reducing interaction between actin and myosin causing smooth muscle relaxation —> bronchodilation.

2

Albuterol: pharmacokinetics

Onset: 5-15 mins
Peak: 1.0-1.5 hours
Duration: 3-6 hours
Half-life: < 3 hours

3

Albuterol: indications/field use

~reversible bronchospasm associated with COPD
~wheezing associated with allergic reaction/anaphylaxis

4

Albuterol: contraindications

~Symptomatic tachycardia
~Hypersensitivity

5

Albuterol: side effects/adverse reactions

Tachycardia, anxiety, headache, palpitations, sweating, dizziness, nervousness, tremor, HTN, dysrhythmias, chest pain, N+V

6

Albuterol: dosage

Small volume nebulizer: adult ~ 2.5mg in 2.5ml NS nebulized with oxygen 8lpm q 5 min

Small volume nebulizer: pedi ~ 2.5mg in 2.5ml NS nebulized with O2 8lpm q 5 min

7

Albuterol: precautions

First three doses of albuterol should be given concurrently with ipratropium bromide. May worsen cardiac asthma (pulmonary edema) and precipitate dysrhythmias

8

Albuterol: drug-drug interactions

Side effects may increase with other sympathetic agonists. Beta blockers may blunt effects of this drug.

9

Levalbuterol (xopenex):drug classification

Sympathomimetric/ sympathetic agonist (beta 2 selective)

10

Albuterol: drug classification

sympathomimetric/ sympathetic agonist (beta 2 selective)

11

Levalbuterol (xopenex): MOA

Beta 2 —> promotes sympathetic stimulation of bronchial smooth muscle cells, reducing interaction between actin and myosin causing smooth muscle relaxation —> bronchodilation

12

Levalbuterol: Pharmacokinetics

Onset: 5-15 mins
Peak: 1-1.5 hours
Duration: 3-6 hours
Half-life: 3.3 hours

13

Levalbuterol (xopenex): indications/field use

~reversible bronchospasm associated with COPD and asthma
~wheezing associated with allergic reaction/anaphylaxis

14

Levalbuterol (Xopenex): Contraindications

~ Symptomatic tachycardia
~ Hypersensitivity

15

Levalbuterol (Xopenex): Side effects/adverse reactions

Palpations, anxiety, headaches, dizziness, nausea, hypertension

16

Levalbuterol (Xopenex): dosages

Small-volume nebulizer: (Adult) 1.25mg in 3 mL NS nebulized with O2 8LPM q 5 min
Small-volume nebulizer: (Adult) 0.31mg in 3 mL NS nebulized with O2 8LPM q 5 min

17

Levalbuterol (Xopenex): Precautions

First three doses of levalbuterol should be given concurrently with ipratropium bromide. Caution in patients with cardia ischemia.

18

Levalbuterol (Xopenex): Drug-Drug interactions

Side effects may increase with other sympathetic agonists.
Beta blockers may blunt effects of this drug.

19

Ipratropium Bromide (Atrovent): Drug Classification

Anticholinergic / Parasympatholytic

20

Ipratropium Bromide (Atrovent): MOA

Muscarinic ACh-R antagonist —> inhibits parasympathetic stimulation in bronchial smooth muscle cells, submucosal glands, and goblet cells —> dries respiratory tract secretions and allows for bronchial dilation.

21

Ipratropium Bromide (Atrovent): Pharmacokinetics

onset: varies
Peak: 1.5-2.0 hours
Duration: 4-6 hours
Half life: 1.5-2.0 hours

22

Ipratropium Bromide (Atrovent): Indications

~ Respiratory distress
~ Reversible bronchospasm associated with COPD/asthma

23

Ipratropium Bromide (Atrovent): Contraindications

Hypersensitivity
Hypersensitivity to atropine

24

Ipratropium Bromide (Atrovent): Side effects/Adverse Reactions

Anxiety, HA, palpitations, dizziness, nervousness, rash, dry mouth, N+V

25

Ipratropium Bromide (Atrovent): Dose

Small volume nebulizer: (Adult) 500 mcg UP TO 3 DOSES
Small volume nebulizer: (Pedi) 500 mcg UP TO 3 DOSES

26

Ipratropium Bromide (Atrovent): Precautions

Ipratropium Bromide should be administered concurrently with albuterol x 3 doses

27

Ipratropium bromide (Atrovent): drug-drug interactions

None EMS

28

Dexamethasone (Decadron): Classification

Corticosteroid / Anti-inflammatory

29

Dexamethasone (Decadron): MOA

Diffuses across the cell membranes of various cells present in all tissues, binds to DNA, regulates gene expression and increases synthesis of proteins and enzymes that inhibit inflammatory agents (cytokines, interleukin, interferon); inhibits synthesis of pro-inflammatory enzymes.
**immunosuppressant**

30

Dexamethasone (Decadron): Pharmacokinetics

Onset: <1 hour
Peak: <1 hour
Duration: Varies IV
Half-life: 3-4 hours

31

Dexamethasone (Decadron): Indications

~Allergic Reaction/anaphylaxis
~Asthma, COPD
~ adrenal insufficiency

32

Dexamethasone (Decadron): Contraindications

~ Hypersensitivity

33

Dexamethasone (Decadron): Side Effects/Adverse Reactions

Fluid retention, CHF, HTN, abdominal distinction, vertigo, HA, nausea, malaise, hiccups, psychosis.

34

Dexamethasone (Decadron): Dose

Asthma/Anaphylaxis (Adult): 10mg slow IV, IO
Asthma/Anaphylaxis (Pedi): 0.6mg/kg slow IV, IO, max dose 10 mg

35

Dexamethasone (Decadron): Precautions

Give one dose prehospitally, long term steroid use can cause GI bleeding, prolonged wound healing, and suppression of adrenocortical steroids.

36

Dexamethasone (Decadron): Drug-Drug Interactions

NONE

37

Magnesium Sulfate: Drug Classification

Electrolyte / Antidysrhythmic

38

Magnesium Sulfate: MOA

*SMC* Ca2+ channel blocker —> inhibits calcium entry and the subsequent interaction between actin and myosin in smooth muscle cells —> smooth muscle relaxation and dilation of blood vessels and bronchial tree.
**Cardiac** Ca2+ channel blocker —> negative chronotropy, inotropy, dromotrophy.

39

Magnesium Sulfate: Indications/Field use

~Severe Asthma/Bronchospasm
~Severe refractory VF or pulseless VT w/ hypoMg2+; Torsades de pointes
~Eclampsia

40

Magnesium Sulfate: Contraindications

3 degree heart block, hypotension

41

Magnesium Sulfate: Side effects/ Adverse RXN

Flushing, sweating, bradycardia, drowsiness, respiratory depression, dysrhythmias, hypotension, itching, rash

42

Magnesium Sulfate: Pharmacokinetics

Onset: immediate IV; 1 hour IM
Peak: Varies
Duration of Effect: 1 hour
Half life: N/A

43

Magnesium Sulfate: Dose

Asthma (ADULT): 2g in 100ccs NS IV, IO infusion over 10 mins
VT, VF, Torsades-nopulse (ADULT): 2g IV, IO over 1-2 mins
VT/Torsades + pulse (ADULT): 1-2g in 50-100cc NS, IV, IO over 5-60 mins
Eclampsia (ADULT): 4g in 20ml IV, IO over 5 min
Asthma (PEDI): 25-50mg/kg IV, IO infusion over 15-30 min, max dose 2g
VT/Torsades-no pulse (PEDI): 25-50mg/kg IV, IO, max dose 2g
VT/Torsades + pulse (PEDI): 25-50mg/kg IV, IO over 10-20 mins, max dose 2g

44

Magnesium Sulfate: Precautions

~No benefit with COPD
~Caution with Renal impaired PT
~Watch for respiratory depression

45

Magnesium Sulfate: Drug-Drug interactions

Cardiac conduction abnormalities if given with digitalis

46

Methylprednisolone (Solu-medrol): Classification

Corticosteroid / Anti-inflammatory

47

Methylprednisolone (Solu-medrol): MOA

Diffuses across the cell membrane of various cells present in all tissues, binds to DNA, regulates gene expression and increases synthesis of proteins and enzymes that inhibit inflammatory agents (cytokines, interleukin, interferon); inhibits synthesis of pro-inflammatory enzymes.
**is an immunosuppressant**

48

Methylprednisolone (solu-medrol): Pharmacokinetics

Onset: 2-6 hours
Peak: 4-8 days
Duration: 1-5 weeks
Half-life: 3.5 hours

49

Methylprednisolone (Solu-medrol): Indications

~Allergic RXN/anaphylaxis
~Asthma, COPD
~Adrenal insufficiency

50

Methylprednisolone (solu-medrol): Contraindications

Hypersensitivity

51

Methylprednisolone (Solu-Medrol): Side Effects

Fluid retention, CHF, HTN, abdominal distinction, vertigo, HA, nausea, malaise, hiccups, psychosis.

52

Methylprednisolone (Solu-medrol): Dose

Asthma/Anaphylaxis (ADULT): 125mg slow IV, IO
Asthma/Anaphylaxis (PEDI): 2mg/kg slow IV, IO max dose 125mg

53

Methylprednisolone (Solu-medrol): Precautions

Give only one dose prehospitally, long term steroid use can cause GI bleeding, prolonged wound healing, and suppression of adrenocortical steroids.

54

Methylprednisolone (Solu-Medrol): Drug-Drug interactions

Lasix and thiazide diuretics increase potassium excretion.
Decreased effect with phenytoin, phenobarbital, and rifampin due to increased metabolism of steroids.