misc respiratory medications

Question 1

What are bronchodilators demonstrated effects in the neonatal population?

Answer 1

dec airway resistance and inc compliance in infants as young as 28 wk GA with BPD as well as in other infants as young as dol 2 with RDS

Question 2

What is albuterol/ salbutamol?

Answer 2

a selective beta-adrenergic agonist

Question 3

What are the effects of albuterol on respiratory system?

Answer 3

promotes the production of intracellular c-amp which enhances the binding of intracellular calcium to the cell membrane. This action dec intracellular Ca and results in the relaxation of the smooth muscle and bronchodilation; additionally drives K intracellularly

Question 4

What are the concerns regarding long term use of albuterol?

Answer 4

impaired healing of lung tissue in the developing neonate, development of tolerance to med; only used in ACUTE situations and for SHORT TERM therapy

Question 5

What are the systemic effects of albuterol?

Answer 5

inc HR, arrythmias, tremors, hypoK and irritable behavior

Question 6

When is the peak effects of albuterol noted and what is the duration?

Answer 6

peak: w/i 30 min
duration: sustained for 3 hours

Question 7

What are the effects of aminophylline administration?

Answer 7

less potent and shorter acting than theophylline; improves diaphragmatic and inspiratory muscle control

Question 8

Studies show that preterm infants with chronic lung disease are more prone to experience what respiratory outcomes?

Answer 8

significant pulmonary fx abnormalities, moderate air trapping and obstruction

Question 9

the benefits of albuterol inhalation are most easily observed in what indices?

Answer 9

significant improvement in both resistance and compliance

Question 10

What is the recommended dosing for albuterol?

Answer 10

100mg administered via metered dose inhaler with spacer device; remaining patients in study who did not demonstrate improvement req’d dosing at 200 mg

Question 11

What receptors does racemic epinephrine stimulate?

Answer 11

both alpha and beta adrenergic receptor

Question 12

What is the narrowest part of the neonatal airway?

Answer 12

subglottis

Question 13

What is the cumulative effect of intubation on the neonatal airway?

Answer 13

the presence of a foreign object (intubation) produces edema in the subglottic region and can result in further narrowing of an already small airway

Question 14

When is racemic epi indicated?

Answer 14

to treat patients with postextubation stridor, may be used adjunct to tx pulmonary hemorrhage; no evidence to support prophylactic use

Question 15

what is the mechanism of action of racemic epi?

Answer 15

acts on vascular smooth muscle to produce vasoconstriction which decreases blood flow at the capillary level thereby shrinking upper airway edema and reduces edema

Question 16

What are the s/e of racemic epi inhalation?

Answer 16

tachycardia, arythmias, HTN, peripheral vasoconstriction, hyperglycemia, metabolic acidosis and leukocytosis

Question 17

When can ipatropium bromide recommended to be administered with albuterol?

Answer 17

for the management and treatment of patients with chronic lung disease; b/c of presence of functional muscarinic receptors in preterm infants

Question 18

what is the intended effect of IPB inhalation?

Answer 18

aids in bronchodilation and decreases respiratory resistance; given together achieves the greatest decrease in resp system resistance and in in compliance in vent pts

Question 19

What conclusions has the field of research drawn concerning the use of inhaled steroids?

Answer 19

bc systemis steroids improves survival in infants with BPD, it seems logical to suggest that steroid delivery directly to the site would be advantageous and w/o systemic S/E; research has not supported this; not an EVB; may be r/t difficulty of delivering small aerosolized particles into already small aireays

Question 20

what is the intended effect of iNO?

Answer 20

a direct pulmonary vasodilator; iNO is a potent selective sustained pulmonary vasodilation, dec pulmonary vascular resistance and improving oxygenation

Question 21

what is the usual starting dose of iNO?

Answer 21

20ppm

Question 22

in what conditions is iNO not an appropriate therapy?

Answer 22

patients with PPHN with debris in the airway; PPHN responds better than > PPHN + MAS

Question 23

What is the effect of iNO on the neonatal PPHN patient?

Answer 23

~ 30-40% of patients with PPHN will respond to this intervention and avoid escalation (i.e. ECMO)

Question 24

What is the onset of action of iNO?

Answer 24

arterial oxygenation improves rapidly (even at 1-2ppm); pts should respond quickly

Question 25

What is the intended duration of iNO therapy?

Answer 25

< 5 days

Question 26

Why is it important to not use iNO excessively for long periods of time?

Answer 26

it exposes patients to high ventilator pressures, prolonged LOS, inc risk of BPD and is a/w inc incidence of neurological injury