Respiratory Medications

Question 1

albuterol sulfate (Proventil)

Answer 1

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

Question 2

albuterol sulfate (Proventil) Indications

Answer 2

Asthma, bronchitis with bronchospasm, and COPD.
Known or suspected hyperkalemia with EKG changes such as peaked T waves and QRS widening.

Question 3

albuterol sulfate (Proventil) Contraindications

Answer 3

Sensitivity to albuterol or levalbuterol.
Severe tachycardia (relative)

Question 4

albuterol sulfate (Proventil) Adverse Effects

Answer 4

Tachycardia, palpitations, and dysrhythmias.

Question 5

albuterol sulfate (Proventil) Drug Interactions

Answer 5

Sympathomimetics may exacerbate adverse cardiovascular effects. Beta Blockers may antagonize albuterol.

Question 6

albuterol sulfate (Proventil) Dosage and Administration

Answer 6

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

Question 7

albuterol sulfate (Proventil) Special Considerations

Answer 7

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.

Question 8

epinephrine (Adrenalin)

Answer 8

An INOTROPIC ADRENERGIC catecholamine alpha, beta1 and beta2 adrenergic receptor agonist.

Question 9

epinephrine (Adrenalin) Indications

Answer 9

Pulseless Arrest
Anaphylaxis
ASTHMA
Bradycardia with poor perfusion

Question 10

epinephrine (Adrenalin) Adverse Reactions

Answer 10

Tachycardia and tachydysrhythmia
Hypertension
Anxiety
May precipitate angina pectoris

Question 11

epinephrine (Adrenalin) Dosage for Asthma

Answer 11

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.

Question 12

ipratropium bromide (Atrovent)

Answer 12

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

Question 13

ipratropium bromide (Atrovent) Indications

Answer 13

Bronchospasm

Question 14

ipratropium bromide (Atrovent) Contraindications

Answer 14

Children under the age of 2
Soy or peanut allergy (MDI)

Question 15

ipratropium bromide (Atrovent) Adverse Reactions

Answer 15

Palpitations
Tremors
Dry Mouth

Question 16

ipratropium bromide (Atrovent) Dosage and Administration

Answer 16

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.

Question 17

magnesium sulfate

Answer 17

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.

Question 18

magnesium sulfate Indications

Answer 18

Severe bronchospasm unresponsive to continuous albuterol, ipratropium, and IM epinephrine.

Question 19

magnesium sulfate Precautions and Adverse Reactions

Answer 19

Bradycardia
Hypotension
Respiratory depression

Question 20

magnesium sulfate Dosage and Administration

Answer 20

2 g IV bolus

Not indicated for pediatrics

Question 21

methylprednisolone (Solu-Medrol)

Answer 21

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.

Question 22

methylprednisolone (Solu-Medrol) Indications

Answer 22

Anaphylaxis
Severe Asthma
COPD
Suspected Addisonian crisis (cardiovascular collapse in patient at risk for adrenal insufficiency)

Question 23

methylprednisolone (Solu-Medrol) Contraindications

Answer 23

Evidence of GI bleed

Question 24

methylprednisolone (Solu-Medrol) Adverse Reactions

Answer 24

Gastrointestinal bleeding
Hypertension
Hyperglycemia
(all typically results of long-term therapy)

Question 25

methylprednisolone (Solu-Medrol) Dosage and Administraton

Answer 25

125 mg IV bolus, slowly over 2 minutes Pediatric: 2 mg/kg IV bolus, slowly over 2 minutes, max of 125 mg.

Question 26

methylprednisolone (Solu-Medrol) Special Considerations

Answer 26

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.

Question 27

nitroglycerin

Answer 27

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

Question 28

nitroglycerin Indications

Answer 28

Pain or discomfort due to suspected acute coronary syndrome. Pulmonary Edema due to congestive heart failure.

Question 29

nitroglycerin Contraindications

Answer 29

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

Question 30

nitorglycerin Adverse Reactions

Answer 30

Hypotension Headache Syncope

Question 31

nitroglycerin Dosage and Administration

Answer 31

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.

Question 32

racepinephrine

Answer 32

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

Question 33

racepinephrine Indications

Answer 33

Stridor at rest

Question 34

racepinephrine Side Effects

Answer 34

Tachycardia Palpitations Muscle Tremors

Question 35

racepinephrine Dosage and Administration

Answer 35

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.

Question 36

racepinephrine Special Considerations

Answer 36

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. .