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QuestionAnswer
What are the Diuretic Drugs?Lasix, Mannitol, and Diamox
LasixDiuretic, Fast onset, Loss of Potassium resulting in excretion of hydrogen ions which results in a metabolic ALKALOSIS
MannitolOsmotic diuretic, slow, gentle, spares electrolytes, tx of head trauma to reduce intracranial pressure
DiamoxDiuretic promotes Metabolic ACIDOSIS by the loss of HCO3(BiCarb)
Sedative/Hypnotic/Narcotic drugsAtivan, Diprivan, Narcan, Haldol, Demerol, Dilantin, Compazine, Morphine Sulfate, Versed, Valium
HaldolTx of Dt’s & highly agitated states
DilantinPrevent seizures, makes pt sleepy
CompazineTx of nausea
VersedShort acting sedative/hypnotic, used during short-term procedures.
DiprivanSedative/hypnotic, dose dependent, fast onset, quick recovery, IV drip for continuous sedation.
AtivanAnti-anxiety, pre-op med
ValiumTx of occurring seizure
Morphine SulfateNarcotic analgesic, reduces drive to breathe by lowering sensitivity to CO2, relaxes smooth muscle surrounding blood vessels which drops preload & may drop BP, reduces work of heart.
DemerolNarcotic analgesic
NarcanAntidote for narcotic & barbiturate overdose.
ASA(Asprin)Non-narcotic analgesic, avoid w/viral symptoms (fever, side aches) may worsen asthma by dropping PGE levels & promoting airway spasms.
COX2 InhibitorsNon-narcotic analgesic, given for pain
Atrovent(Ipratopium Bromide)Anticholinergic, Neb dose is 0.5mg, MDI not for those with soy or peanut allergy.
Spiriva(Tiotropium Bromide)Anticholinergic, DPI, long-lasting anticholinergic 24-36hrs
AnticholinergicsPromote bronchodilation in the LARGER airways. Prevent parasympathetic response (bronchoconstriction) by antagonist action of M3 receptor. Avoid mask therapy due to eye problems caused by dilation of pupils.
Combo MedsAdvair DPI, DuoNeb, Combivent
Advair DPISlow onset, mtce med, sympathomimetic w/ steroid
DuoNebAnticholinergic Atrovent(Ipratropium Bromide) w/ sympathomimetic Albuterol Sulfate, dilates upper & lower airways.
CombiventMDI, anticholinergic ipratropium bromide & sympathomimetic albuterol sulfate, NOT for those with soy/peanut allergies.
GlucocorticoidsStops all inflammation, takes hours for onset. Enhances and promotes Beta response. Problems: promotes metabolic ALKALOSIS, mood swings, fat deposits, hair growth, atrophy of adrenal glands.
Leukotrienes (LT) InhibitorsReduce/prevent inflammation response associated with asthma.
Anticholinesterase MedsAct by promoting acetylcholine by inhibiting acetylcholinesterase which is the enzyme that breaks down acetylcholine.
Sympathomimetic Side-EffectsB1(cardiac): ^HR & contraction strength, B2(lungs): Tremors/Nausea
SympathomimeticsAdrenergic bronchodilators that stim B2 receptor & promote dilation in smaller airways, inhibit prod of inflammatory mediators.
Racemic EpinephrineFast catecholamine, A1, B1 & 2 agonist. Dose 0.5ml, for tx of upper airway edema.
Albuterol Sulfate (Ventolin, Proventil)5mg/ml – onset up to 15 min.
XopenexRacemic albuterol, pure R isomer, 2 strengths, lower B1 activity which means lower incidence of tachycardia & less B2 effects which means a lower occurrence of tremors.
Brovana (arformoterol)Long lasting 12hr sympathomimetic
Foradil(formoterol)DPI, long-lasting sympathomimetic, 12hrs.
Mucomyst(n-acetylcysteine)Mucolytic, disrupts mucus viscosity & elasticity, airway irritant, re-eval every 3-5 days, toss after 96hrs of opening.
Pulmozyme(Dornase Alpha)Proteolytic, tx of infectious mucus(pneumonia), noted by purulent secretions, refrigerate after opening, toss if cloudy or discolored, HCW should avoid breathing this med, often used with CF pts.
MethylxanthinesInhibits bronchoconstriction, reduces PVR/dilates pulmonary blood vessels, enhances diaphragm contraction & endurance. Side-effects: improvement of resp drive, anxiety, irritability, insomnia, twitching, tremors, seizure.
LidocaineUsed during bronchoscopy to prevent spasm, tx PVC(cardia arrythmia), admin as an IV drip.
Dobutrex+INO, improves stroke volume by B1 stimulation
Digitalis+INO, improves stroke volume by promoting free Ca+ for contraction.
NitratesVasodilators reduce pre & after loads while improving coronary perfusion by dilation of coronary arteries.
DopamineHigh dose: vasopressor for tx low BP(shock) Moderate dose: B1 effects, Low dose: dilates renal vessels which promotes urine output = diuretic.
OxygenNon-flammable, non-explosive, promotes rapid combustion, will reduce PVR when it is secondary to low PAO2.
SSKI (Potassium Iodide)Reduces mucus elasticity.
Calcium Channel BlockersTx of atrial arrythmias.
Singulair(Montelukast)LT receptor agonist.
TensilonDx & Tx of Myasthenia Gravis.
AminophyllineA methylxanthine
Lidocaine overdoseCauses methemoglobin which darkens the arterial blood which changes skin color to gray/dusky appearance due to the low O2 content, may also cause seizure.
QuestionAnswer
What are the Diuretic Drugs?Lasix, Mannitol, and Diamox
LasixDiurectic, Fast onset, Loss Potassium, Loss hydrogen ions = promotes Metabolic ALKALOSIS
MannitolOsmotic diuretic, slow, spares electrolytes, tx of head trauma
DiamoxDiuretic promote Metbolic ACIDOSIS
Sedative/Hypnotic/Narcotic drugsHaldol, Dilantin, Campazine, Versed, Diprivan, Ativan, Morphine Sulfate, Demerol, Narcan
Haldolgood for DTs, and highly agitated states
Dilantinanti-epileptic, good to prevent seizures
Compazineantiemetic = tx of nausea
Versedshort acting sedative/hypnotic, excellent for short term memory block
Dipravansedative/hypnotic, dose dependent, Used as drip for continuous sedation, Fast onset, quick recovery
Ativananti-anxiety, PREOP
Valiumanticonvusant to tx occuring seizure
Morphine SulfateNarcotic analgesic. Relax Smooth Muscles surrounding Bl. Vessels which drops preload and may drop BP. Can result in bronchospasm by releasing histamine. Constipation. Reduce drive to breath by lowering sensitivity to CO2
Demerolnarcotic analgesic, 50 mg standard dose
Narcanantidote for narcotic and barbiturate overdose
Non-narcotic Analgesic DrugsASA(Asprin), COX 2
ASA(Asprin)avoid w/viral symptoms(fever, side aches, may worsen Asthma by dropping PGE levels)
COX 2 inhibitorsFor Pain – analgesic
Anticholinergic DrugsAtrovent(Ipratropium Bromide), and Spiriva(Tiotropium Bromide)
Atrovent(Ipratropium Bromide)as a solution the dose is 0.5mg and available as MDI. Not w/soy or peanut allergy
Spiriva(Tiotropium Bromide)DPI, long lasting, 24-36 hrs. QDay
What do Anticholinergics do?Promotes bronchodilation in the LARGER airways by preventing parasympathetic response(bronchoconstriction)because it is an antagonist action on the M3 receptor. Avoid Mask w/all anticholinergics due to eye problems due to dilation of pupils
Combo MedsAdvair DPI, DuoNeb, Combivent
Advair DPIslow onset, maintenence med, slow onset sympathomimetic with steroid
DuoNebsolution is anticholinergic Atrovent(Ipratropium Bromide)w/ sympathomimetic Albuterol Sulfate
CombiventMDI version of DuoNeb, NOT with soy/peanut allergies
Glucocorticoidsstops all inflammation, takes hours for onset. Enhances and promote Beta response. Problems – Promotes Metabolic ALKALOSIS, mood swings, fat deposits, hair growth, atrophy of adrenal gland
Leukotrienes (LT) inhibitorsreduce/prevent inflammation response due to asthma. Singulair(Montelukast)LT receptor antagonist
How do Anticholinesterase Meds workact by promoting AE by inhibiting acetylcholinesterase, the enzyme which breaks down AE. Tensilon to dx Myasthesia Gravis
Sympathetic Nervous SystemA1 = Vasoconstriction, B1= positive INO and CHRONO, B2= relax smooth musc. to dilate airways. c3’5’AMP = smooth muscle relax which causes airway dilation and phosphodiesterase reduces c3’5′ to c5’AMP which stops muscle relax
Sympathomimetic MedsRacemic Epi, Albuterol Sulfate, Xopenex, Brovana, Foradil(formoterol)
Action of Sympathomimetics?Meds work in SMALLER airways by stim of B2 which relaxes Smooth muscles around airways. Solutions should be clear, if not = oxidation and not administered b/c bronchospasm
Racemic Epinephrinefast catacholamine, A1, B1, B2 agonist. Dose = 0.5ml for airway edema
Albuterol Sulfate (Ventolin, Proventil)5mg/ml – onset up to 15 minutes
Xopenexracemic albuterol, pure R isomer, 2 strengths, lower B1 activity = Lower tachycardia and less B2 effects which = lower occurence tremor
Brovanalong lasting 12 hr sympathomimetic
Foradil(formoterol)DPI, long lasting 12 hours
MucolyticsMucomyst(n-acetylcysteine) and Pumozyme(Dornase alpha)
Mucomyst(n-acetylcyteine)disrupts mucus viscosity and elasticity, airway irritant. Re-Eval 3-5 days, 96hrs after opening toss
Pulmozyme(Dornase Alpha)Lysis DNA of infectious mucus(pneumonia), purulent secretions. Refrigerate. Toss if cloudy. HCW do not breathe
MethylxanthinesRelax smooth muscles to prevent bronchoconstriction, improves contraction and endurance of diaphragm. Anti-inflammatory effects beneficial in tx asthma. Cause arrhythmias, nausea, seizure. Aminophylline is methylxanthine
LidocaineGiven w/bronchoscopy cna cause methemoglobinemia, used to tx PVC. IV drip
Dobutrex+ INO, improves stroke V by B1 stim
Digitalis+ INO, improves stroke V by promoting fee Ca+ for contraction
NitratesVasodilators reduce Pre-load and Afterload while improving coronary perfusion by dilation of coronary arteries
DopamineHigh dose = vasopressor for tx low BP(shock)Low dose = diuretic
How do Anticholinesterase Meds workact by promoting AE by inhibiting acetylcholinesterase, the enzyme which breaks down AE. Tensilon to dx Myasthesia Gravis
Sympathetic Nervous SystemA1 = Vasoconstriction, B1= positive INO and CHRONO, B2= relax smooth musc. to dilate airways. c3’5’AMP = smooth muscle relax which causes airway dilation and phosphodiesterase reduces c3’5′ to c5’AMP which stops muscle relax
Sympathomimetic MedsRacemic Epi, Albuterol Sulfate, Xopenex, Brovana, Foradil(formoterol)
Action of Sympathomimetics?Meds work in SMALLER airways by stim of B2 which relaxes Smooth muscles around airways. Solutions should be clear, if not = oxidation and not administered b/c bronchospasm
Racemic Epinephrinefast catacholamine, A1, B1, B2 agonist. Dose = 0.5ml for airway edema
Albuterol Sulfate (Ventolin, Proventil)5mg/ml – onset up to 15 minutes
Xopenexracemic albuterol, pure R isomer, 2 strengths, lower B1 activity = Lower tachycardia and less B2 effects which = lower occurence tremor
Brovanalong lasting 12 hr sympathomimetic
Foradil(formoterol)DPI, long lasting 12 hours
MucolyticsMucomyst(n-acetylcysteine) and Pumozyme(Dornase alpha)
Mucomyst(n-acetylcyteine)disrupts mucus viscosity and elasticity, airway irritant. Re-Eval 3-5 days, 96hrs after opening toss
Pulmozyme(Dornase Alpha)Lysis DNA of infectious mucus(pneumonia), purulent secretions. Refrigerate. Toss if cloudy. HCW do not breathe
MethylxanthinesRelax smooth muscles to prevent bronchoconstriction, improves contraction and endurance of diaphragm. Anti-inflammatory effects beneficial in tx asthma. Cause arrhythmias, nausea, seizure. Aminophylline is methylxanthine
LidocaineGiven w/bronchoscopy cna cause methemoglobinemia, used to tx PVC. IV drip
Dobutrex+ INO, improves stroke V by B1 stim
Digitalis+ INO, improves stroke V by promoting fee Ca+ for contraction
NitratesVasodilators reduce Pre-load and Afterload while improving coronary perfusion by dilation of coronary arteries
DopamineHigh dose = vasopressor for tx low BP(shock)Low dose = diuretic
How do Anticholinesterase Meds workact by promoting AE by inhibiting acetylcholinesterase, the enzyme which breaks down AE. Tensilon to dx Myasthesia Gravis
Sympathetic Nervous SystemA1 = Vasoconstriction, B1= positive INO and CHRONO, B2= relax smooth musc. to dilate airways. c3’5’AMP = smooth muscle relax which causes airway dilation and phosphodiesterase reduces c3’5′ to c5’AMP which stops muscle relax
Sympathomimetic MedsRacemic Epi, Albuterol Sulfate, Xopenex, Brovana, Foradil(formoterol)
Action of Sympathomimetics?Meds work in SMALLER airways by stim of B2 which relaxes Smooth muscles around airways. Solutions should be clear, if not = oxidation and not administered b/c bronchospasm
Racemic Epinephrinefast catacholamine, A1, B1, B2 agonist. Dose = 0.5ml for airway edema
Albuterol Sulfate (Ventolin, Proventil)5mg/ml – onset up to 15 minutes
Xopenexracemic albuterol, pure R isomer, 2 strengths, lower B1 activity = Lower tachycardia and less B2 effects which = lower occurence tremor
Brovanalong lasting 12 hr sympathomimetic
Foradil(formoterol)DPI, long lasting 12 hours
MucolyticsMucomyst(n-acetylcysteine) and Pumozyme(Dornase alpha)
Mucomyst(n-acetylcyteine)disrupts mucus viscosity and elasticity, airway irritant. Re-Eval 3-5 days, 96hrs after opening toss
Pulmozyme(Dornase Alpha)Lysis DNA of infectious mucus(pneumonia), purulent secretions. Refrigerate. Toss if cloudy. HCW do not breathe
MethylxanthinesRelax smooth muscles to prevent bronchoconstriction, improves contraction and endurance of diaphragm. Anti-inflammatory effects beneficial in tx asthma. Cause arrhythmias, nausea, seizure. Aminophylline is methylxanthine
LidocaineGiven w/bronchoscopy cna cause methemoglobinemia, used to tx PVC. IV drip
Dobutrex+ INO, improves stroke V by B1 stim
Digitalis+ INO, improves stroke V by promoting fee Ca+ for contraction
NitratesVasodilators reduce Pre-load and Afterload while improving coronary perfusion by dilation of coronary arteries
DopamineHigh dose = vasopressor for tx low BP(shock)Low dose = diuretic
How do Anticholinesterase Meds workact by promoting AE by inhibiting acetylcholinesterase, the enzyme which breaks down AE. Tensilon to dx Myasthesia Gravis
Sympathetic Nervous SystemA1 = Vasoconstriction, B1= positive INO and CHRONO, B2= relax smooth musc. to dilate airways. c3’5’AMP = smooth muscle relax which causes airway dilation and phosphodiesterase reduces c3’5′ to c5’AMP which stops muscle relax
Sympathomimetic MedsRacemic Epi, Albuterol Sulfate, Xopenex, Brovana, Foradil(formoterol)
Action of Sympathomimetics?Meds work in SMALLER airways by stim of B2 which relaxes Smooth muscles around airways. Solutions should be clear, if not = oxidation and not administered b/c bronchospasm
Racemic Epinephrinefast catacholamine, A1, B1, B2 agonist. Dose = 0.5ml for airway edema
Albuterol Sulfate (Ventolin, Proventil)5mg/ml – onset up to 15 minutes
Xopenexracemic albuterol, pure R isomer, 2 strengths, lower B1 activity = Lower tachycardia and less B2 effects which = lower occurence tremor
Brovanalong lasting 12 hr sympathomimetic
Foradil(formoterol)DPI, long lasting 12 hours
MucolyticsMucomyst(n-acetylcysteine) and Pumozyme(Dornase alpha)
Mucomyst(n-acetylcyteine)disrupts mucus viscosity and elasticity, airway irritant. Re-Eval 3-5 days, 96hrs after opening toss
Pulmozyme(Dornase Alpha)Lysis DNA of infectious mucus(pneumonia), purulent secretions. Refrigerate. Toss if cloudy. HCW do not breathe
MethylxanthinesRelax smooth muscles to prevent bronchoconstriction, improves contraction and endurance of diaphragm. Anti-inflammatory effects beneficial in tx asthma. Cause arrhythmias, nausea, seizure. Aminophylline is methylxanthine
LidocaineGiven w/bronchoscopy cna cause methemoglobinemia, used to tx PVC. IV drip
Dobutrex+ INO, improves stroke V by B1 stim
Digitalis+ INO, improves stroke V by promoting fee Ca+ for contraction
NitratesVasodilators reduce Pre-load and Afterload while improving coronary perfusion by dilation of coronary arteries
DopamineHigh dose = vasopressor for tx low BP(shock)Low dose = diuretic
OxygenActs to dilate pulmonary vascular bed lowering PVR and reduce work of R heart
QuestionAnswer
A Pt experiences dizziness and tingling after a bronchodilator treatment, what could be the reason?Probably because of the Pts increased minute ventilation and breathing pattern (aka Respiratory Alkalosis)
Name 2 indications for recommending an MDI spacer?Pt’s reduced tidal volume or Pt’s poor coordination of MDI.
Name the 3 pulmonary reactions to histamine.Brochoconstriction Secretions Mucosal Edema
What is the cardiopulmonary effect of Alpha stimulation?Vasoconstriction
What is the cardiopulmonary effect of Beta 1 stimulation?Tachycardia
What is the cardiopulmonary effect of Beta 2 stimulation?Bronchodilation
What organ is the site of drug metabolism?The liver
Agonist means what pharmacologically?A drug that binds to a receptor site and stimulates a reaction.
Antagonist means what pharmacologically?A drug that prevents or counteracts receptor stimulations (usually blocks by binding to the receptor)
What branch of the CNS is responsible for the “tone” or normal degree of bronchoconstriction?Parasympathetic
What does it mean when an antimicrobial agent ends in “cidal”?Cidal indicates the drug is used to kill the pathogen.
What does it mean when an antimicrobial agent ends in “static”?Static means the drug is used to inhibit the growth or spread of a pathogen.
What is the name given to “Live” vaccines?Attenuated-Uses live but weakened microorganisms
Whit is the name given to “Killed” vaccines?Inactivated-Uses dead organisms and provides less immunity than live
Name 3 bronchodilators used in continuous nebulization for sever bronchospasm?Terbutaline-up to 12mg/hr Albuterol-up to 20mg/hr Xopenex-up to 5mg/hr