misc respiratory medications Flashcards
What are bronchodilators demonstrated effects in the neonatal population?
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
What is albuterol/ salbutamol?
a selective beta-adrenergic agonist
What are the effects of albuterol on respiratory system?
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
What are the concerns regarding long term use of albuterol?
impaired healing of lung tissue in the developing neonate, development of tolerance to med; only used in ACUTE situations and for SHORT TERM therapy
What are the systemic effects of albuterol?
inc HR, arrythmias, tremors, hypoK and irritable behavior
When is the peak effects of albuterol noted and what is the duration?
peak: w/i 30 min
duration: sustained for 3 hours
What are the effects of aminophylline administration?
less potent and shorter acting than theophylline; improves diaphragmatic and inspiratory muscle control
Studies show that preterm infants with chronic lung disease are more prone to experience what respiratory outcomes?
significant pulmonary fx abnormalities, moderate air trapping and obstruction
the benefits of albuterol inhalation are most easily observed in what indices?
significant improvement in both resistance and compliance
What is the recommended dosing for albuterol?
100mg administered via metered dose inhaler with spacer device; remaining patients in study who did not demonstrate improvement req’d dosing at 200 mg
What receptors does racemic epinephrine stimulate?
both alpha and beta adrenergic receptor
What is the narrowest part of the neonatal airway?
subglottis
What is the cumulative effect of intubation on the neonatal airway?
the presence of a foreign object (intubation) produces edema in the subglottic region and can result in further narrowing of an already small airway
When is racemic epi indicated?
to treat patients with postextubation stridor, may be used adjunct to tx pulmonary hemorrhage; no evidence to support prophylactic use
what is the mechanism of action of racemic epi?
acts on vascular smooth muscle to produce vasoconstriction which decreases blood flow at the capillary level thereby shrinking upper airway edema and reduces edema
What are the s/e of racemic epi inhalation?
tachycardia, arythmias, HTN, peripheral vasoconstriction, hyperglycemia, metabolic acidosis and leukocytosis
When can ipatropium bromide recommended to be administered with albuterol?
for the management and treatment of patients with chronic lung disease; b/c of presence of functional muscarinic receptors in preterm infants
what is the intended effect of IPB inhalation?
aids in bronchodilation and decreases respiratory resistance; given together achieves the greatest decrease in resp system resistance and in in compliance in vent pts
What conclusions has the field of research drawn concerning the use of inhaled steroids?
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
what is the intended effect of iNO?
a direct pulmonary vasodilator; iNO is a potent selective sustained pulmonary vasodilation, dec pulmonary vascular resistance and improving oxygenation
what is the usual starting dose of iNO?
20ppm
in what conditions is iNO not an appropriate therapy?
patients with PPHN with debris in the airway; PPHN responds better than > PPHN + MAS
What is the effect of iNO on the neonatal PPHN patient?
~ 30-40% of patients with PPHN will respond to this intervention and avoid escalation (i.e. ECMO)
What is the onset of action of iNO?
arterial oxygenation improves rapidly (even at 1-2ppm); pts should respond quickly
What is the intended duration of iNO therapy?
< 5 days
Why is it important to not use iNO excessively for long periods of time?
it exposes patients to high ventilator pressures, prolonged LOS, inc risk of BPD and is a/w inc incidence of neurological injury
