Bronchitis, Bronchiolitis, Croup Pharm Flashcards
MoA Dextromethorphan
- Decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center through sigma receptor stimulation.
- Structurally related to codeine.
- Decreasing the sensitivity of cough receptors and interrupting cough impulse transmission leads to cough suppression
What is very dangerous side effect of dextromethorphan?
Serotonin syndrome
- can occur if used with other serotonergic drugs
Age dextromethorphan should be used in
> 4 yo
2 Adverse effects of dextromethorphan
- CNS – drowsiness, nausea, constipation
- High dose: confusion, excitement, irritability, nervousness, serotonin syndrome (nausea, vomiting, tachycardia, HTN, increased body temp), metabolic acidosis
Potential for abuse of dextromethorphan
- what dose is abusive
- outcome
- Commonly diverted agent for illicit recreational use
- High dose (>100 mg), hallucinogenic or out of body experiences like Ketamine or PCP
- Abuse can cause death, brain damage, seizure, LOC, irregular heartbeat
Anesthetic products in topical cough products
- Benzocaine
- Dyclonine
Demulcent products in topical cough products
- Pectin (short lived)
- Honey
- Glycerin
Antitussive products in topical cough products
- Dextromethorphan
- camphor
- menthol
What 4 products not recommended for bronchitis
- mucolytics
- inhaled beta2 agonists
- corticosteroids
- abx
Adult dosing recommendation for aspirin
325-650 mg PRN q 4 hrs
Max 4 gm/day
Child dosing recommendation for acetaminophen
10-15 mg/kg q 4-6 hr
max 5 dose in 24 hrs
Adult dosing recommendation for acetaminophen
650-1000 mg q 4-6 hr
max 3 grams daily
Child dosing recommendation for ibuprofen
4-10 mg/kg q 6-8 hr
max 40 mg/kg/day
Adult dosing recommendation for ibuprofen
200-800 mg q 4-6 hrs
max dose 3.2 g daily
3 Alt tx for children with bronchitis
- honey (IF > 1 yo)
- humidifcation
- treat underlying reason for cough (antihistamine for post-nasal drip and GERD treatment)
Two drugs have little evidence to support their use in bronchiolitis
- beta2 agonists
- corticosteroids
MoA Palivizumab (Synagis)
- Humanized monoclonal antibody vs. glycoprotein on RSV cell surface membrane
- Glycoprotein is integral to fusion of RSV to host cell membrane (allows RSV to enter cell)
- Palivizumab’s binding inhibits ability of RSV to fuse with host cell membrane
- Prevents viral replication, infection, RSV sx
Indication to use Palivizumab to prevent RSV
- Infants born ≤28 weeks 6 days AND <12 months at start of RSV season
- Infants <12 months of age with chronic lung disease of prematurity
- Infants ≤12 months of age with hemodynamically significant CHD
- Infants/children <24 months with chronic lung disease of prematurity necessitating medical therapy within 6 months of start of RSV season
dexamethasone dose for croup
0.6 mg/kg once
max dose varies, usually 10-20 mg/dose
what is an alternative to dexamethasone
budesonide nebulized
Difference between epinephrine and racemic epinephrine
epinephrine is just one isomer
Racemic has two isomers of epinephrine
Racemic mixture of epinephrine
- Both isomers
- R-epinephrine: Greatest pressor effect
- S-epinephrine: 1/15 pressor effect but lasts a lot longer!
- Studies show isn’t actually any more effective than plain epinephrine
MoA epinephrine in the tx of croup
Constricts precapillary arterioles in upper airway mucosa → decreases capillary hydrostatic pressure → fluid resorption and reduction of airway edema
State duration of action of epinephrine via nebulization in the tx of croup
<2 hours
