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Neonatal Pharmacology > Respiratory Meds > Flashcards

Flashcards in Respiratory Meds Deck (38):
1

T/F: They used to think that preemies had too little bronchiolar smooth muscle to experience a bronchospasm.

True, they used to think that but it's a myth.

2

What do Bronchodilators do?

Decrease Airway resistance
Increase Compliance

3

In what age do Bronchodliators work?

-NB's as young as 28 wks GA w/BPD
-Other infants as young as 2 DOL w/RDS

4

What is the concern over long-term use of Bronchodilators?

Healing ability of lung tissue
Tolerance to the medication

5

What do most practitioners advocate with Bronchodilator use?

Acute Situation for Short Period of Time

6

What is the most common Bronchodliator we use in NICU?

Albuterol (Salbutamol)

7

Albuterol is a selective _____-________ agonist.

It relaxes _______ ________.

Causes _______________.

It drives ___ into the cell.

Beta-Adrenergic


Smooth Muscle

Bronchodilation

K+ (remember, can be used in acute Hyperkalemic events :-)

8

Albuterol promotes the production of intracellular ______, which enhances intracellular binding of ____ to the cell membrane--->decreased ___ ________within the cell--->relaxation of smooth muscle and bronchodilation

cAMP (cyclic AMP)
Ca++
Ca++ concentration

9

Peak response to Albuterol is:

Sustained response is:

30 minutes

3 hours

10

Name the systemic effects of Albuterol

Increased HR
Arrhythmias
Tremor
Hyperkalemia
Irritability

11

What is the narrowest portion of the neonatal airway

Subglottis

12

What does the presence of a foreign body (ETT) lead to?

Edema in the subglottic region-->further narrowing an already small airway w/extubation

13

Is there evidence to support Racemic Epi use in PREVENTATIVE post-extubation stridor?

No.

14

Racemic Epi is considered adjunct therapy in what condition?

Pulmonary Hemorrhage

15

Racemic Epinephrine stimulates both ___ & ____-_______ receptors

Alpha & Beta

16

Racemic Epi acts on _________ smooth muscle to produce ____________--> decreases blood flow at the __________ _____-->shrinking upper respiratory mucosa and reduces edema.

Vascular
Vasoconstriction
Capillary level

17

What is Racemic Epi useful for?

Post-extubation stridor

18

What are side effects of Racemic Epi?

Tachycardia
Arrhythmias
HTN
Peripheral vasoconstriction
Hyperglycemia
Hyperkalemia
Metabolic acidosis
Leukocytosis

19

What is the brand name of IPB, Ipratropium Bromide?

Atrovent

20

Can IPB be used in conjunction w/Albuterol?

Yes, to manage CLD

21

What is the rationale for using IPB in neonates w/CLD

The presence of functional muscarinic receptors in premature infants

22

IPB aids in _______ & decreases _____ _______

Bronchodilation (in infant's w/BPD)
Respiratory resistance

23

The combination of IPB and Albuerol achieved the greatest decrease in Respriatory system resistance and increases in compliance in _________ pts w/BPD

Ventilated

24

What class of medication is Pulmicort?

Inhaled corticosteroid

25

Is Inhaled steroid use evidence based?

No

26

Why do we use inhaled steroids if they aren't evidence based?

Because the use of systemic corticosteroids increased survival in infants w/BPD---so it seems logical that local steroids delivered to the lungs might provide benefits without systemic complications.

27

Have studies shown inhaled steroids to provide local effects without systemic complications?

No, the few studies done have not shown this.
May be due to difficulty getting small air particles into small airways.

28

Does Meta-analysis support prophylactic or treatment use of inhaled steroids to decrease the incidence of BPD?

No

29

What is the direct effect of iNO?

Direct pulmonary vasodilator
-Potent, selective, sustained pulmonary vasodilation, decreasing the pulmonary vascular resistance and improving oxygenation

30

What is the usual starting dose of iNO?

20 PPM

31

iNO is given via _______ circuit

seperate

32

iNO is most effective in _______ syndromes w/little debris in the airway

PPHN

33

What type of PPHN responds less well?

MAS

34

____-____% of infants w/PPHN will respond to iNO therapy & ECMO may be avoided.

30-40%

35

With iNO use, ______ _________ appears to improve rapidly-even in concentrations as low as 1-2 PPM

Arterial oxygenation

36

What is the typical duration of iNO therapy?

< 5 days

37

T/F: It is important NOT to use iNO to avoid ECMO therapy

Why?

True

May increase exposure to increased vent pressures, Prolong LOS, Increase risk of BPD, Increase risk of Neurologic injury

38

An infant should respond _______ to iNO therapy or what?

Quickly or be referred to an ECMO center.