Ch. 14: Respiratory Medications Flashcards
Drugs that break down the sputum chemically for more effective expectoration.
Mucolytics
You are having difficulty intubating a combative patient in the emergency department. The respiratory therapist should recommend the delivery of which drug to facilitate intubation?
Succinylcholine
Diluents
Normal saline solution (0.9% NaCl) INDICATION
Used to dilute bronchodilating agents.
May be instilled through endotracheal (ET)
tubes and tracheostomy tubes, 3 to 5 mL at a
time to clear mucus plug within the tube.
Diluents
Hypotonic saline solution (0.4% NaCl) INDICATION
Used in ultrasonic nebulizers because smaller particles are produced as a result of lower concentration.
More stable than sterile water.
Diluents
Hypertonic saline solution (1.8% NaCl) INDICATION
Used to stimulate coughing and induce sputum because it is irritating to the airway.
Larger aerosol particles are produced because of the higher concentration of the solution.
Diluents
Sterile distilled water INDICATION
- Used to dilute other medications.
- Used to hydrate secretions, thereby decreasing the viscosity for easier expectoration.
- Used to humidify dry gases.
What is the drug class?
Acetylcysteine (Mucomyst)
Mucolytic
Acetylcysteine (Mucomyst) is available in what two concetrations?
- 10%
- 20%
________ breaks the disulfide bonds in the sputum, thus decreasing the sputum’s viscosity.
Acetylcysteine (Mucomyst)
Acetylcysteine (Mucomyst) is often coupled with what type of medication and why?
Used with bronchodilating agents because a common side effect of acetylcysteine is bronchospasm.
With which of the following lung disorders would acetylcysteine (Mucomyst) be indicated?
- CF
- Bronchiectasis
Dornase alfa (Pulmozyme, rhDNase) is used commonly for what patient population?
Used most commonly in patients with cystic fibrosis or other lung conditions in which thick, tenacious sputum is present.
MUCOLYTIC
May be nebulized (1 to 3 mL, three to four times daily) or instilled directly into the trachea.
Acetylcysteine (Mucomyst)
How should dornase alfa be stored?
Must be kept refrigerated and protected from light.
Which mucolytic should NOT be nebulized in combination with other drugs?
Dornase alfa (Pulmozyme, rhDNase)
Administering a bronchodilator before dornase alfa may help increase the deposition of the drug.
What medication works by increases the pH of the sputum, thereby
decreasing its viscosity?
Sodium bicarbonate (2% NaHCO3)
May be used to improve the mucolytic actions
of acetylcysteine
What is the indication for Mannitol (Bronchitol)?
CF patients
Not approved by the FDA yet, but soon. Administered by DPI (bronchodilator prior to mannitol is indicated for children who may experience bronchospasm from the powdered drug).
Sympathomimetic Bronchodilators
Epinephrine hydrochloride (Adrenalin Chloride, Sus-Phrine) stimulates which adrenergic receptors?
All three
Epinephrine hydrochloride (Adrenalin Chloride, Sus-Phrine)
Indication
Used to stimulate the heart;
What is the indication for Racemic epinephrine (Micronefrin, Vaponefrin)?
Used to decrease mucosal edema and inflammation after extubation or in pediatric patients with croup
Indication for Metaproterenol (Alupent, Metaprel)
Used to decrease airway resistance
Indication for Albuterol
Used to decrease airway resistance (Wheezing, bronchospasm)
What is the first line drug for patients with COPD or
asthma?
Levalbuterol (Xopenex)
It’s a SABA
Indication for Salmeterol (Serevent) - LAMA
Used to decrease airway resistance
Same for Formoterol
An anticholinergic bronchodilator that acts topically in the lung instead of systemically.
- Ipratropium bromide (Atrovent)
- Tiotropium bromide (Spiriva)
According to CLIA standards, quality control must be performed for blood gas analyzers every ____ hours.
8
While counseling a patient during a smoking cessation session, the patient expresses concern about weight gain. A respiratory therapist should address the patient’s concern by explaining that this is partially the result of what?
Decreased metabolism
While assessing an adult male, receiving invasive, mechanical ventilation, a respiratory therapist notes breath sounds are markedly decreased, the cuff pressure is 5 cmH2O, and airflow is coming from the patient’s mouth during each positive pressure breath. The tube depth remains at 22 cmh2O. Air is added to the cuff, but the cuff pressure is not maintained. What should the RT recommend?
Reintubate using an endotracheal tube exchanger.
The sudden loss of cuff pressure in the air noted coming from the mouth indicates a ruptured cuff and must be addressed immediately. An endotracheal tube exchanger is a safety means to re-intubate successfully.
Stimulates respiratory rate and depth of breathing and produces pulmonary vasodilation and bronchodilation
Theophylline (Theo-Dur)
Theophylline (Theo-Dur) Indication
Used to decrease airway resistance, especially
in patients with asthma
Miscellaneous Respiratory Drugs
Cromolyn sodium INDICATION
Used as preventive therapy for asthma (not effective during an asthma attack)
Not commonly used anymore
Theophylline produces effects that providegreat benefits for patients with COPD
(1) Increased right ventricular output (improves cor pulmonale)
(2) Improves diaphragmatic function
(3) Produces pulmonary vasodilation, reducing pulmonary hypertension that results from chronic hypoxemia
(4) Stimulates breathing by altering the hypoxic response curve when partial PaO2 is elevated above 60 mm Hg
EXAM NOTE
Another mast cell stabilizer similar to cromolyn, but 4 to 10 times stronger, is ________, which is available in MDI aerosol only.
nedocromil sodium (Tilade)
Leukotriene modifiers
What are the indication for Leukotriene modifiers?
Leukotriene modifiers are used to prevent asthma attacks and are for long-term treatment of asthma.
Common drugs: Leukotriene modifiers
- zafirlukast (Accolate)
- montelukast (Singulair)
- zileuton (Zyflo)
Neuromuscular Blocking Agents
Used as a short-term paralyzing agent to facilitate ET intubation.
Succinylcholine
List long-acting paralytic agents.
- Pancuronium bromide (Pavulon) (120-180 mins)
- Vecuronium (60-90 mins)
- Rocuronium (Zemuron) (30-60 mins)
The paralyzing effects of the nondepolarizing agents (pancuronium, vecuronium, and rocuronium) may be reversed with the administration of what drug?
edrophonium (Tensilon) or neostigmine (Prostigmin)
Antibiotics (Aerosolized)
Indication for Gentamicin
CF patients
Effective against Pseudomonas aeruginosa
Antibiotics (Aerosolized)
Indication for Amoxicillin
Bronchiectasis
Reduces the purulence of the sputum
Antibiotics (Aerosolized)
Indication for Tobramycin (TOBI)
- Commonly used in cystic fibrosis patients
- Effective against Pseudomonas aeruginosa and Staphylococcus aureus
Antibiotics (Aerosolized)
Indication for Amphotericin B
Fungal infections
Improvement seen in treatment of pulmonary
aspergillosis and the fungus Candida albicans
Antibiotics (Aerosolized)
Indication for Pentamidine
- Used in the treatment of Pneumocystis carinii pneumonia (commonly seen in AIDS patients)
EXAM NOTE
The primary indication for inhaled steroids is for antiinflammatory maintenance therapy of mild to moderate persistent asthma.
OKAY
List some inhaled steroids
a. Dexamethasone
b. Beclomethasone
c. Budesonide (Pulmicort)
d. Flunisolide
e. Triamcinolone acetonide (Azmacort)
f. Fluticasone propionate (Flovent)
What is the drug of choice to
sedate a ventilator patient for more than 24 hours?
Lorazepam (Ativan)
________ are indicated for rapid sedation of acutely agitated patients because they have a 2- to 5-minute onset of action.
Valium and Versed
Loop diuretics effectively treat what?
hypertension, pulmonary edema, and peripheral edema.
Inhaled pulmonary vasodilators
- Nitric oxide
- Iloprost (Ventavis)
- Treprostinil (Tyvaso)
