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Neonatal Pharmacology > Respiratory Meds > Flashcards

Respiratory Meds Flashcards

1
Q

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

A

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

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2
Q

What do Bronchodilators do?

A

Decrease Airway resistance

Increase Compliance

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3
Q

In what age do Bronchodliators work?

A
  • NB’s as young as 28 wks GA w/BPD

- Other infants as young as 2 DOL w/RDS

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4
Q

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

A

Healing ability of lung tissue

Tolerance to the medication

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5
Q

What do most practitioners advocate with Bronchodilator use?

A

Acute Situation for Short Period of Time

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6
Q

What is the most common Bronchodliator we use in NICU?

A

Albuterol (Salbutamol)

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7
Q

Albuterol is a selective _____-________ agonist.

It relaxes _______ ________.

Causes _______________.

It drives ___ into the cell.

A

Beta-Adrenergic

Smooth Muscle

Bronchodilation

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

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8
Q

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

A

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

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9
Q

Peak response to Albuterol is:

Sustained response is:

A

30 minutes

3 hours

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10
Q

Name the systemic effects of Albuterol

A 
Increased HR
Arrhythmias
Tremor
Hyperkalemia
Irritability
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11
Q

What is the narrowest portion of the neonatal airway

A

Subglottis

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12
Q

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

A

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

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13
Q

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

A

No.

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14
Q

Racemic Epi is considered adjunct therapy in what condition?

A

Pulmonary Hemorrhage

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15
Q

Racemic Epinephrine stimulates both ___ & ____-_______ receptors

A

Alpha & Beta

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16
Q

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

A

Vascular
Vasoconstriction
Capillary level

17
Q

What is Racemic Epi useful for?

A

Post-extubation stridor

18
Q

What are side effects of Racemic Epi?

A 
Tachycardia
Arrhythmias
HTN
Peripheral vasoconstriction
Hyperglycemia
Hyperkalemia
Metabolic acidosis
Leukocytosis
19
Q

What is the brand name of IPB, Ipratropium Bromide?

A

Atrovent

20
Q

Can IPB be used in conjunction w/Albuterol?

A

Yes, to manage CLD

21
Q

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

A

The presence of functional muscarinic receptors in premature infants

22
Q

IPB aids in _______ & decreases _____ _______

A

Bronchodilation (in infant’s w/BPD)

Respiratory resistance

23
Q

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

A

Ventilated

24
Q

What class of medication is Pulmicort?

A

Inhaled corticosteroid

25
Q

Is Inhaled steroid use evidence based?

A

No

26
Q

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

A

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.

27
Q

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

A

No, the few studies done have not shown this.

May be due to difficulty getting small air particles into small airways.

28
Q

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

A

No

29
Q

What is the direct effect of iNO?

A

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

30
Q

What is the usual starting dose of iNO?

A

20 PPM

31
Q

iNO is given via _______ circuit

A

seperate

32
Q

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

A

PPHN

33
Q

What type of PPHN responds less well?

A

MAS

34
Q

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

A

30-40%

35
Q

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

A

Arterial oxygenation

36
Q

What is the typical duration of iNO therapy?

A

< 5 days

37
Q

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

Why?

A

True

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

38
Q

An infant should respond _______ to iNO therapy or what?

A

Quickly or be referred to an ECMO center.

Neonatal Pharmacology (17 decks)

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