Respiratory Meds Flashcards
T/F: They used to think that preemies had too little bronchiolar smooth muscle to experience a bronchospasm.
True, they used to think that but it’s a myth.
What do Bronchodilators do?
Decrease Airway resistance
Increase Compliance
In what age do Bronchodliators work?
- NB’s as young as 28 wks GA w/BPD
- Other infants as young as 2 DOL w/RDS
What is the concern over long-term use of Bronchodilators?
Healing ability of lung tissue
Tolerance to the medication
What do most practitioners advocate with Bronchodilator use?
Acute Situation for Short Period of Time
What is the most common Bronchodliator we use in NICU?
Albuterol (Salbutamol)
Albuterol is a selective _____-________ agonist.
It relaxes _______ ________.
Causes _______________.
It drives ___ into the cell.
Beta-Adrenergic
Smooth Muscle
Bronchodilation
K+ (remember, can be used in acute Hyperkalemic events :-)
Albuterol promotes the production of intracellular ______, which enhances intracellular binding of ____ to the cell membrane—>decreased ___ ________within the cell—>relaxation of smooth muscle and bronchodilation
cAMP (cyclic AMP)
Ca++
Ca++ concentration
Peak response to Albuterol is:
Sustained response is:
30 minutes
3 hours
Name the systemic effects of Albuterol
Increased HR Arrhythmias Tremor Hyperkalemia Irritability
What is the narrowest portion of the neonatal airway
Subglottis
What does the presence of a foreign body (ETT) lead to?
Edema in the subglottic region–>further narrowing an already small airway w/extubation
Is there evidence to support Racemic Epi use in PREVENTATIVE post-extubation stridor?
No.
Racemic Epi is considered adjunct therapy in what condition?
Pulmonary Hemorrhage
Racemic Epinephrine stimulates both ___ & ____-_______ receptors
Alpha & Beta
Racemic Epi acts on _________ smooth muscle to produce ____________–> decreases blood flow at the __________ _____–>shrinking upper respiratory mucosa and reduces edema.
Vascular
Vasoconstriction
Capillary level
What is Racemic Epi useful for?
Post-extubation stridor
What are side effects of Racemic Epi?
Tachycardia Arrhythmias HTN Peripheral vasoconstriction Hyperglycemia Hyperkalemia Metabolic acidosis Leukocytosis
What is the brand name of IPB, Ipratropium Bromide?
Atrovent
Can IPB be used in conjunction w/Albuterol?
Yes, to manage CLD
What is the rationale for using IPB in neonates w/CLD
The presence of functional muscarinic receptors in premature infants
IPB aids in _______ & decreases _____ _______
Bronchodilation (in infant’s w/BPD)
Respiratory resistance
The combination of IPB and Albuerol achieved the greatest decrease in Respriatory system resistance and increases in compliance in _________ pts w/BPD
Ventilated
What class of medication is Pulmicort?
Inhaled corticosteroid
Is Inhaled steroid use evidence based?
No
Why do we use inhaled steroids if they aren’t evidence based?
Because the use of systemic corticosteroids increased survival in infants w/BPD—so it seems logical that local steroids delivered to the lungs might provide benefits without systemic complications.
Have studies shown inhaled steroids to provide local effects without systemic complications?
No, the few studies done have not shown this.
May be due to difficulty getting small air particles into small airways.
Does Meta-analysis support prophylactic or treatment use of inhaled steroids to decrease the incidence of BPD?
No
What is the direct effect of iNO?
Direct pulmonary vasodilator
-Potent, selective, sustained pulmonary vasodilation, decreasing the pulmonary vascular resistance and improving oxygenation
What is the usual starting dose of iNO?
20 PPM
iNO is given via _______ circuit
seperate
iNO is most effective in _______ syndromes w/little debris in the airway
PPHN
What type of PPHN responds less well?
MAS
____-____% of infants w/PPHN will respond to iNO therapy & ECMO may be avoided.
30-40%
With iNO use, ______ _________ appears to improve rapidly-even in concentrations as low as 1-2 PPM
Arterial oxygenation
What is the typical duration of iNO therapy?
< 5 days
T/F: It is important NOT to use iNO to avoid ECMO therapy
Why?
True
May increase exposure to increased vent pressures, Prolong LOS, Increase risk of BPD, Increase risk of Neurologic injury
An infant should respond _______ to iNO therapy or what?
Quickly or be referred to an ECMO center.
