Question Answer
Clarks Rule Weight of child(lbs) X normal adult dose / 150
To solve for mg mg = mL x (% x 10)
To solve for mL mL = mg x (% x 10)
Three categories of bronchodilators Front door, back door, side door
Define SABA Short acting beta2 agonists
Define LABA Long acting beta2 agonists
SABA Drugs Albuterol, levalbuterol, metaproterenol, terbutaline, pirbuterol
LABA Drugs Salmeterol, Formoterol
Parasympatholytics (anticholinergics) work against bronchoconstriction caused by the parasympathetic nervous system
Anticholinergics Atropine sulfate, Ipratropium bromide, tiotropium bromide(spiriva), oxitropium bromide(oxivent)
Methylxanthines (side door bronchodilators) Theophylline (aminophylline), theobromine, caffeine
Caffine levels for apnea of prematurity are kept at 5-10 mcg/mL
Side effects of methylxanthines tachycardia, palpitations, jitters, irritability, and diuresis.
When does toxicity occur with methylxanthines When serum levels exceed 20 mcg/mL
Signs of toxicity from methylxanthines nausea, vomiting, headaches and seizures
Leukotriene modifiers non-steroid drugs that have been approved for mild to moderate asthma
When are leukotriene modifiers not appropriate for use During an acute asthma attack
Leukotriene modifiers examples Zarfirlukast (accolate) Zileton (Zyflo) Montelukast (singulair)
How do leukotriene modifiers work? Act by blocking leukotriene at their receptor sites
IgE blocker Omalizumab (Xolair)
IgE blockers are used to treat what Allergic asthma (pts 12 yrs and older)
Wetting agents used to thin secretions, best is good hydration, aersol can also be used (USN, mist tents, jet nebulizers)
When are mucolytics recommended when secretions are so thick and tenacious (inspissated) that they can not be easily removed
Primary hazard for mucolytics bronchospasm, always given with a bronchodilator
Pulmozyme is also known as Recombinant human DNAse (dornase alpha)
How does pulmozyme work reduces mucus viscosity by cutting DNA in sputum
Anti-Asthmatic Drugs are also known as Mast cell stabilizers
How do anti-asthmatics work? They help prevent an asthmatic attack by inhibiting the degranulation of mast cells and preventing the release of histamine
Cromolyn sodium is also known as Intal, Aarane
Cromolyn sodium dosage 20mg Q4
Nedocromil sodium also known as Tilade
Corticosteroids have what effect? Anti-inflammatory, immunosuppressive agents with direct and indirect bronchodilating effects
What are steroids indicated for? asthma and BPD
IV corticosteroids Prednisone, methylprednisolone, solumedrol,
Dexamethazone (Decadrone) Can be IV or inhaled
Decongestants (alpha adrenergic) Reduce swelling (mucosal edema)
Indications for decongestants upper airway conditions such as croup and post extubation swelling where mild/moderate stridor is present
Antiviral agents Ribavirin (Virazole), Respigam, Palivizumab (synagis)
Antiviral agents must be given via SPAG, scavenger system
Exogenous surfactants are used for what to prevent and treat IRDS/HMD
What two ways can surfactant be administered prophylactic and rescue
Adverse effects of surfactants pneumothorax, bradycardia, hypotension, hemorrhage, apnea
Topical anesthetics indication to reduce coughing reflex during bronchoscopy or in patients with persistent coughing
Examples of topical anesthetics Lidocaine, benzocaine, cetacaine, novocaine
Neuromuscular blocking agents indication for patients receiving mechanical ventilation in order to: Reduce spontaneous breathing, prevent movement that can dislodge airways, reduce oxygen consumption, improve patient synchrony with ventilator
Depolarizing neuromuscular blocking agents Example: succinylcholine (Anectine)
Nondepolarizing neuromuscular blocking agents Pancuronium(Pavulon), Vecuronium (norcuron), Atracurium(Tracrium), Cisatracurium(Nimbex)
Sedatives action decrease anxiety and promote relaxation
Indications for sedatives Manage fear and anxiety, increase comfort while receiving mechanical ventilation, induce sleep
Most common class of sedatives Benzodiazepines
Examples of benzos Alprazolam, diazepam, midazolam, lorazepam
Reversal agent for benzos Romazicon (flumazenil)
Ideal level of sedation on the Ramsay scale Level 3: Responds to verbal commands
Anesthetics action reduces patients ability to perceive sensations
IV anesthetics Propofol (Diprivan), Ketamine (Ketalar)
Analgesics action reduce sensation of pain
Opiods Most common class of analgesics (narcotics)
Examples of opiods (narcotics) Morphine, hydromorphone, fentaynl, codeine, hydrocodone, oxycodone, meperedine
Diuretics Furosemide (Lasix), mannitol (osmitrol), CAI– acetazolamide (diamox)
Question Answer
Action an RT should take to the hearing of a sputtering sound origination from a nebulizer during a treatment Terminate treatment at the time
Reason pass-over humidifiers are preferred over pneumatic nebulizer humidifiers Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers
Most important consideration when using a LVN to provide oxygen and humidification to an infant in an incubator Preventing a large noise level from developing
Most efficacious device to deliver bronchodilator to pediatric patient with an inspiratory flow of 20LPM. SVN
Functions served by spacer and holding chambers in conjunction with pMDIs Reduction in oropharyngeal deposition of drug, elimimation of the “cold Freon effect”, and Improvement in lower respiratory tract deposition
Types of patients for whom DPI is contraindicated A 4-year-old child, an 85-year- old patient with COPD, and a teenager with altered mental status
Medication with synergistic effect with beta-2 during asthma exacerbations Ipratropium bromide (atrovent)
Possible condition present if acute asthma episode does not respond favorably to Beta-2 administration Aspiration of a foreign object
Aerosol delivery devices to select in order to avoid increasing a patient’s delivered tidal volume during the administration of bronchodilator to a mechanically ventilated patient pMDI, vibrating mesh nebulizer, and ultrasonic nebulizer
Likely adverse effects of nonselective beta-adrenergic agonists Tremor, tachycardia, and headaches
The brand name of Pirbuterol Maxair
A long beta-agonist Formoterol
Medication most suited for tx of postextubation edema Racemic epinephrine
One of best Rx suited to relieve revresible airflow obstruction occurring in COPD patients Ipratropium bromide
Proper dose of theophylline pediatric patient should take if theophylline was received within past 24 hours 2.5 mg/kg
Medication that works to maintain integrity of mast cell Cromolyn sodium
Reason DPIs are not recommended for children under the age of 5 They cannot generate enough respiratory flow
Medication that is a recombinat humanized monoclona anti-IgE antibody Omalizumab
Drug of choice for a 10 year old asthmatic who presents to ER with acute, extrinsically induced bronchospasm Cromolyn sodium
Medication commonly used to increase mucociliary clearance in patients with cystic fibrosis and bronchiolitis 3% hypertonic saline
Action to take if varying FiO2 is read for a neonate receiving oxygen by an oxyhood Increase the oxygen flow