Respiratory Meds

Question 1

T/F: They used to think that preemies had too little bronchiolar smooth muscle to experience a bronchospasm.

Answer 1

True, they used to think that but it’s a myth.

Question 2

What do Bronchodilators do?

Answer 2

Decrease Airway resistance

Increase Compliance

Question 3

In what age do Bronchodliators work?

Answer 3

• NB’s as young as 28 wks GA w/BPD

- Other infants as young as 2 DOL w/RDS

Question 4

What is the concern over long-term use of Bronchodilators?

Answer 4

Healing ability of lung tissue

Tolerance to the medication

Question 5

What do most practitioners advocate with Bronchodilator use?

Answer 5

Acute Situation for Short Period of Time

Question 6

What is the most common Bronchodliator we use in NICU?

Answer 6

Albuterol (Salbutamol)

Question 7

Albuterol is a selective _____-________ agonist.

It relaxes _______ ________.

Causes _______________.

It drives ___ into the cell.

Answer 7

Beta-Adrenergic

Smooth Muscle

Bronchodilation

K+ (remember, can be used in acute Hyperkalemic events :-)

Question 8

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

Answer 8

cAMP (cyclic AMP)
Ca++
Ca++ concentration

Question 9

Peak response to Albuterol is:

Sustained response is:

Answer 9

30 minutes

3 hours

Question 10

Name the systemic effects of Albuterol

Answer 10

Increased HR
Arrhythmias
Tremor
Hyperkalemia
Irritability

Question 11

What is the narrowest portion of the neonatal airway

Answer 11

Subglottis

Question 12

What does the presence of a foreign body (ETT) lead to?

Answer 12

Edema in the subglottic region–>further narrowing an already small airway w/extubation

Question 13

Is there evidence to support Racemic Epi use in PREVENTATIVE post-extubation stridor?

Answer 13

No.

Question 14

Racemic Epi is considered adjunct therapy in what condition?

Answer 14

Pulmonary Hemorrhage

Question 15

Racemic Epinephrine stimulates both ___ & ____-_______ receptors

Answer 15

Alpha & Beta

Question 16

Racemic Epi acts on _________ smooth muscle to produce ____________–> decreases blood flow at the __________ _____–>shrinking upper respiratory mucosa and reduces edema.

Answer 16

Vascular
Vasoconstriction
Capillary level

Question 17

What is Racemic Epi useful for?

Answer 17

Post-extubation stridor

Question 18

What are side effects of Racemic Epi?

Answer 18

Tachycardia
Arrhythmias
HTN
Peripheral vasoconstriction
Hyperglycemia
Hyperkalemia
Metabolic acidosis
Leukocytosis

Question 19

What is the brand name of IPB, Ipratropium Bromide?

Answer 19

Atrovent

Question 20

Can IPB be used in conjunction w/Albuterol?

Answer 20

Yes, to manage CLD

Question 21

What is the rationale for using IPB in neonates w/CLD

Answer 21

The presence of functional muscarinic receptors in premature infants

Question 22

IPB aids in _______ & decreases _____ _______

Answer 22

Bronchodilation (in infant’s w/BPD)

Respiratory resistance

Question 23

The combination of IPB and Albuerol achieved the greatest decrease in Respriatory system resistance and increases in compliance in _________ pts w/BPD

Answer 23

Ventilated

Question 24

What class of medication is Pulmicort?

Answer 24

Inhaled corticosteroid

Question 25

Is Inhaled steroid use evidence based?

Answer 25

No

Question 26

Why do we use inhaled steroids if they aren't evidence based?

Answer 26

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.

Question 27

Have studies shown inhaled steroids to provide local effects without systemic complications?

Answer 27

No, the few studies done have not shown this. | May be due to difficulty getting small air particles into small airways.

Question 28

Does Meta-analysis support prophylactic or treatment use of inhaled steroids to decrease the incidence of BPD?

Answer 28

No

Question 29

What is the direct effect of iNO?

Answer 29

Direct pulmonary vasodilator -Potent, selective, sustained pulmonary vasodilation, decreasing the pulmonary vascular resistance and improving oxygenation

Question 30

What is the usual starting dose of iNO?

Answer 30

20 PPM

Question 31

iNO is given via _______ circuit

Answer 31

seperate

Question 32

iNO is most effective in _______ syndromes w/little debris in the airway

Answer 32

PPHN

Question 33

What type of PPHN responds less well?

Answer 33

MAS

Question 34

____-____% of infants w/PPHN will respond to iNO therapy & ECMO may be avoided.

Answer 34

30-40%

Question 35

With iNO use, ______ _________ appears to improve rapidly-even in concentrations as low as 1-2 PPM

Answer 35

Arterial oxygenation

Question 36

What is the typical duration of iNO therapy?

Answer 36

< 5 days

Question 37

T/F: It is important NOT to use iNO to avoid ECMO therapy Why?

Answer 37

True May increase exposure to increased vent pressures, Prolong LOS, Increase risk of BPD, Increase risk of Neurologic injury

Question 38

An infant should respond _______ to iNO therapy or what?

Answer 38

Quickly or be referred to an ECMO center.