Respiratory Medications Flashcards
albuterol sulfate (Proventil)
a BRONCHODILATOR BETA AGONIST that binds and stimulates beta2 receptors, resulting in the relaxation of bronchial smooth muscle.
Onset - 5-15 minutes after inhalation
Duration - 3-4 hours after inhalation
albuterol sulfate (Proventil) Indications
Asthma, bronchitis with bronchospasm, and COPD.
Known or suspected hyperkalemia with EKG changes such as peaked T waves and QRS widening.
albuterol sulfate (Proventil) Contraindications
Sensitivity to albuterol or levalbuterol.
Severe tachycardia (relative)
albuterol sulfate (Proventil) Adverse Effects
Tachycardia, palpitations, and dysrhythmias.
albuterol sulfate (Proventil) Drug Interactions
Sympathomimetics may exacerbate adverse cardiovascular effects. Beta Blockers may antagonize albuterol.
albuterol sulfate (Proventil) Dosage and Administration
Single Neb:
One 2.5 mg/3 mL dose at a flow rate of 6-8 liters per minute was delivered over 5 to 15 minutes. May be repeated 2 times for a total of 3 administrations.
Continuous Neb:
3 2.5 mg/3 mL bullets for a total of 7.5 mg/9 mL at a flow rate of 6-8 liters per minute
albuterol sulfate (Proventil) Special Considerations
Use with caution in lactating patients, patients with cardiac dysrhythmias, suspected or known coronary disease, diabetes, hyperthyroidism, prostatic hypertrophy, or seizure disorders.
May precipitate angina and dysrhythmias.
Wheezing associated with anaphylaxis should first be treated with epinephrine IM.
Consider inline nebs for patients requiring endotracheal intubation or CPAP.
Pregnancy Class C.
epinephrine (Adrenalin)
An INOTROPIC ADRENERGIC catecholamine alpha, beta1 and beta2 adrenergic receptor agonist.
epinephrine (Adrenalin) Indications
Pulseless Arrest
Anaphylaxis
ASTHMA
Bradycardia with poor perfusion
epinephrine (Adrenalin) Adverse Reactions
Tachycardia and tachydysrhythmia
Hypertension
Anxiety
May precipitate angina pectoris
epinephrine (Adrenalin) Dosage for Asthma
Adult: 0.3 mg (0.3 mL of 1:1000) IM. May repeat dose 1 time.
Pediatric: 1 to 12 years old - 0.01 mg/kg (0.01 mL/kg of 1:1000) IM. May repeat dose one time after 5 minutes.
ipratropium bromide (Atrovent)
An ANTICHOLINERGIC BRONCHODILATOR that is chemically related to atropine, meaning it competes with acetylcholine at the site of the muscarinic receptor.
Onset - 5-15 minutes
Duration - 6-8 hours
ipratropium bromide (Atrovent) Indications
Bronchospasm
ipratropium bromide (Atrovent) Contraindications
Children under the age of 2
Soy or peanut allergy (MDI)
ipratropium bromide (Atrovent) Adverse Reactions
Palpitations
Tremors
Dry Mouth
ipratropium bromide (Atrovent) Dosage and Administration
Adult: 0.5 mg/2.5 mL along with albuterol in a nebulizer.
Pediatric: 2-12 years old - 0.5 mg/2.5 mL along with albuterol.
1-2 years - 0.25 mg with albuterol in a nebulizer.
Not indicated for repetitive dose or continuous neb use.
Pregnancy Class B.
magnesium sulfate
An ELECTROLYTE that reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. It may act as a bronchodilator in acute bronchospasm due to asthma or other bronchospastic diseases.
magnesium sulfate Indications
Severe bronchospasm unresponsive to continuous albuterol, ipratropium, and IM epinephrine.
magnesium sulfate Precautions and Adverse Reactions
Bradycardia
Hypotension
Respiratory depression
magnesium sulfate Dosage and Administration
2 g IV bolus
Not indicated for pediatrics
methylprednisolone (Solu-Medrol)
A CORTICOSTEROID that suppresses acute and chronic inflammation and may alter the immune response. It potentiates vascular smooth muscle relaxation by beta-adrenergic agonists and may alter airway hyperactivity.
methylprednisolone (Solu-Medrol) Indications
Anaphylaxis
Severe Asthma
COPD
Suspected Addisonian crisis (cardiovascular collapse in patient at risk for adrenal insufficiency)
methylprednisolone (Solu-Medrol) Contraindications
Evidence of GI bleed
methylprednisolone (Solu-Medrol) Adverse Reactions
Gastrointestinal bleeding
Hypertension
Hyperglycemia
(all typically results of long-term therapy)
methylprednisolone (Solu-Medrol) Dosage and Administraton
125 mg IV bolus, slowly over 2 minutes
Pediatric: 2 mg/kg IV bolus, slowly over 2 minutes, max of 125 mg.
methylprednisolone (Solu-Medrol) Special Considerations
Must be reconstituted and used immediately.
The effect is generally delayed for several hours.
Not considered a first-line drug. Be sure to attend to the patient’s primary treatment priority.
Do not delay transport to administer this drug. Administer during transport if there is time.
nitroglycerin
An ANTIAGINAL that relaxes vascular smooth muscle, dilating peripheral arteries and veins causing pooling of venus blood and decreased venous return to the heart which decreases preload. Reduces left ventricular systolic wall tension which decreases afterload.
Onset - 1-3 minutes
Duration - 20-30 minutes
nitroglycerin Indications
Pain or discomfort due to suspected acute coronary syndrome.
Pulmonary Edema due to congestive heart failure.
nitroglycerin Contraindications
Suspected right ventricular ST-segment elevation MI (Inferior STEMI pattern plus ST elevation in right-sided precordial leads).
Hypotension, systolic less than 100
Recent use of erectile dysfunction medications
nitorglycerin Adverse Reactions
Hypotension
Headache
Syncope
nitroglycerin Dosage and Administration
Pulmonary Edema: 0.4 mg sublingually or spray every 5 minutes as needed, titrated to symptoms and blood pressure…or
1 inch of Nitropaste on the patient’s left anterior chest.
Pregnancy Class C.
racepinephrine
An ADRENERGIC BRONCHODILATOR that stimulates both alpha and beta receptors, causing vasoconstriction, reduced mucosal edema, and bronchodilation.
Onset - 1-5 minutes
Duration - 1-3 hours
racepinephrine Indications
Stridor at rest
racepinephrine Side Effects
Tachycardia
Palpitations
Muscle Tremors
racepinephrine Dosage and Administration
0.5 mL racemic epinephrine (acceptable dose for all ages) mixed in 3 mL saline, via nebulizer at 6-8 liters per minute over 15 minutes.
racepinephrine Special Considerations
Heat and photosensitive.
Stable at room temperature until the expiration date set on the package.
Do not confuse the side effects with respiratory failure or imminent respiratory arrest.
If no racemic epinephrine is available, consider 5 mL of 1:1000 epinephrine via nebulizer at 6-8 liters per minute over 15 minutes.
.
