Airway Pharmacology & Aerosol Delivery

Drugs!

100

the three phases of drug action?

what is:

Drug administration 

Pharmacokinetic Phase 

Pharmacodynamic Phase

200

the phases of drug action that:

-How the drug is made available to the body 

-Aerosol, IV, IM, patch 

what is:

-Drug administration

300

the phase of drug action that:

-What the body does to the drug 

-Absorption, distribution, metabolism, and elimination 

-Fully ionized have little to no systemic effects (Atrovent) 

what is:

Pharmacokinetic Phase

400

the drug action phase that:

-What does the drug do to the body 

-The combination of a drug with a matching receptor causes drug effects 

what is:

Pharmacodynamic Phase

500

the most common devices used for aerosol delivery

 

what is:

MDI, SVN, DPI

600

 the largest group of drugs RTs aerosolized(beta#,brand names are Albuterol or Xopenex)

what is:

Adrenergic bronchodilators ( most common beta 2 agonists)

700

the most common drug-aerosol delivery systems for pulmonary patient(3 part)

what is a:

-DPI,

-inhaler MDI,

-& Nebulizer (SVN)

800

the 2 things that should be asked before administrating the medicine to the patient 

what is:

name & DOB

inhale & their receptors

100

the following are the benefits of what:

-Smaller doses than systemic administration 

-The quick onset of drug 

-Delivers to the targeted organ 

-Systemic side effects minimal 

what is:

using inhaled aerosol for respiratory issues

200

the type of medication would you use to limit the systemic effects

 

what is:

Fully ionized – Ipratropium Bromide 

300

 the folllowing are parts of what term

-Lung availability/total systemic availability 

-Higher the number the better the lung deposition (greater efficiency) 

what is:

L/T ratio

400

the receptors for pharmacologic control located(3 parts)

what is:

Smooth muscle, secretory cells, and blood vessels (in bronchioles)

500

the neurotransmitter and receptor for parasympathetic system

 

what is:

PSNS – Acetylcholine (cholinergic)

600

 the neurotransmitter and receptor for the sympathetic system 

what is:

SNS – Norepinephrine (Adrenergic) 

700

the problems that may occur after administering MDI and who would struggle to use this device(adding a spacer would help)

what is:

thrush

if the patient is in distress, infants and young children, the elderly finger pain

Markers

100

the type of effects occurs when this receptors are stimulated

 vasoconstriction

what is:

Alpha 1 

200

the type of effects occurs when this receptors are stimulated

increased heart rate & contractility

what is:

Beta 1

300

the type of effects occurs when this receptors are stimulated

what is:

Beta 2

400

the type of effect occurs when this receptor is stimulated

-Bronchoconstriction, increased mucus production

 

what is:

Muscarinic 3(M3)

500

the quick-acting “rescue” treatment (Albuterol)

 

what is:

Short acting beta agonist (SABA) 

600

the treatment that takes time and aids with“controlling” (Serevent) 

what is:

-Long-acting beta agonist (LABA)

700

the decrease in heart rate & strength of contraction 

what is:

Chronotropic & inotropic

treatment

100

the indication of the following event should be treated with:

-the breakup of mucus (thinning out) aids mucus ciliary escalator

 

what is:

Mucolytic

200

the indication of the following event should be treated with:

Inflammation

what is:

steroids

300

the indication of the following event should be treated with:

 -Upper airway edema or during bronchoscopy to stop bleeding

 

what is:

Ultra-Short-acting catecholamine

400

the indication of the following event should be treated with:

-Reversible airflow obstruction

 

what is:

Adrenergic bronchodilator

500

the following are the side effects of what:

Tachycardia, nervousness, palpitations, V/Q mismatch (in pneumonia), and hypokalemia

 

what is:

adrenergic bronchodilators

600

the treatment of acetylcysteine for RTs is breaking up thick secretions, what is another indication when acetylcysteine should be used

 

what is:

Tylenol (acetaminophen) overdose

700

the hazards of aerosol therapy and the primary one:

what is:

- a primary adverse reaction to medication

Others: infection, airway reactivity, pulmonary and systemic effects of bland aerosols, drug concentration changes during nebulizer, eye irritations.

800

the following are what type of aerosol treatment

Pentamidine(NebuPent), Ribavirin(Virazole), Tobramycin(TOBI)

what is:

an aerosol anti-infective Agents

mucous & inhalation

100

 the muco-active agent that is specifically for 

 CF (cystic fibrosis); helps reduce recurrent infection

 

what is:

Dornase Alfa

200

the muco-agents that specifically treat

viscous mucus; breaks the disulfide bond into a sulfhydryl bond.

 

what is:

Mucomyst (acetylcysteine)

 

300

the following reduce oropharyngeal impact and helps with hand & breath coordination, what are they used with

1. Reservoir devices 

2. One-way spacers 

3. Valved holding chambers 

what is:

-a MDI

400

the mocu-active agents used specifically for sputum induction

what is:

Hypertonic saline

500

the following are the advantages of what drug

-smaller dose than for systemic administration

-onset of drug action is rapid 

-delivery targeted to organs requiring treatment

-systemic side effects minimal

what is:

advantages of inhalation aerosols

600

the following are the disadvantages of what drug 

-unable to ascertain the exact dosage 

-lack of adequate knowledge of device performance

what is:

inhalation of aerosols

700

the following are what types of drugs and what do they treat 

1. Mast cell stabilizers – cromolyn sodium (Intal) 

2. Antileukotrines – zileuton, montelukast (singular) 

3. Anti-IgE - Xolair

4.  
   
   
   
   
   
   

what is:

 nonsteroidal anti-asthma drugs

aerosol delivery

100

the folllowing treats what

 Pentamadine (Nebupent); uses Respiragard II 

what is:

Pneumocystis jiroveci 

200

the following treats what:

- Ribavirin (Virazole); uses SPAG

 

what is:

Respiratory Synovial Virus 

300

the term defined by suspension of solid or liquid particles in gas

 

what is:

aerosol

400

the following effect:

Size of particles, physical characteristics of the airways, shape, and motion of the particles

 

what is:

deposition of aerosol

500

the actions to prevent yeast or infection associated with MDI steroids 

what is:

Rinse your mouth and/or use a spacer

600

the following are actions that should take place before, during, and after what treatment

Vital signs, peak flow, breath sounds, and patient’s response

 

what is an:

aerosol treatment

700

what do we do if the heart rate increases by more than 20BPM during treatment was 80BPM at the start and is now 110BPM (4 parts)

what is:

- stopping treatment

-remain with patient till heart rate comes down

- inform the doctor of the reaction

-MAKE SURE YOU CHART ADVERSE EFFECTS

 

dose

100

the equation to find dose(mg)

what is:

dose(mg)= vol(mL) x conc (mg/mL)

200

the equation for volume(mL)

what is:

Volume(mL)= dose (mg) /(divide by) conc (mg/mL)

300

the following are procedures for what device

-shake device

-release one or more sprays in the air, will mix the drug propellant

-attach spacer/ holding chamber

- spray inhale slowly, and continue to inhale

-hold your breath for 5-10 seconds

-after have the patient rinse their mouth (steroids cause thrush)

what is:

a MDI

400

the following is the procedure for which the device

- assemble the apparatus

-load dose(should come already loaded) sometime extra dosage counted but just for practice/clearing

-exhale slowly to the functional residual capacity

-seal lips around

-inhale deeply and forcefully(fast must be at least 40-60Lpm)

-hold your breath and repeat if needed for dosage 

-monitor adverse reactions

-assess beneficial effects overtime

what is a:

DPI(dry powder inhaler)

500

the following is the proper procedure for giving what treatment

-assess the patient for needs (clinical signs, breath sounds, peak flow)

-select a mask or mouthpiece for delivery

-use a conserving system (thumb port, breath actuator, or reservoir) if indicated

-place the drug in the nebulizer(if using multidose vial, add saline to the approved dose volume per label

-set gas flow  to nebulizer at 6-10L/min 

-patient is upright or mask added to keep the nebulizer upright

-coach the patient to breathe slowly through the mouth at normal V_T 

-continue until the nebulizer begins to sputter 

-rinse with sterile water or discard

-monitor patients for adverse response

-assess outcome (change in peak flow)

what is a:

SVN

600

the common side effect of Atrovent

what is:

Dry mouth and cough

700

the patient is not improving with SVN what should you ask the doctor to consider doing

what is:

to up the dosage and recommend continuous nebulizer

800

the following are needed for what:

patient name, drug name, dose, frequency, route of administration, doctor signature

what is: a prescription

Phase & terms

100

the phase that describes the time course and distribution of the drug in our body is based on:

"what the body does to the drug"

-absorption

- distribution

-metabolism

-& elimination(primary source is kidney)

what is the:

pharmacokinetic phase (receptor)

200

the aerosol drug has little or no side effects, and does not absorb across lipid membranes, so is not absorbed in the bloodstream, having little to no effects on the parasympathetic system (what term is this) 

-RTs use this to limit systemic distribution transformation(stays in lungs)

what is:

fully ionized aerosol (most common Ipratropium Bromide aka Atrovent) 

300

the drug is lipid soluble, diffuses across the cell membrane, and into bloodstream, causing systemic side effects

what is:

nonionized aerosol 

400

the phase that describes the mechanisms of drug action by which a drug molecule causes its effects in the body 

"what the drug does to the body"

what is:

-the Pharmacodynamic phase (purpose)

500

the phase that is the method by which the drug is made available to the body

what is:

Drug administration phase(elements: MDI,SVN,DPI)

600

the key that opens the door to neurotransmitters 

"stimulates agents"

what is:

an agonists

-would want this for the sympathetic system to cause relaxation of the bronchi which is dilation making it easier to breathe

700

the term associated with blocking the door to neurotransmitters that acts on receptors

what is:

Anatogonist

Generic & brand

100

the brand name for this drug is Proventil & Ventolin

Drug Class: Beta-Adrenergic, SABA(short-acting beta agonist)

receptors: Very mild Beta 1, Beta 2(beta 2 agonist most active part)

Dosage: SVN 2.5mg & MDI 90ug/puff, 2-4 puffs

frequency: TID or QID

Use for reversible airway obstruction 

side effects: tremors(most common), headaches,tachycardia, worsening of V/Q ratio, insomnia, nervousness

what is:

Albuterol Sulfate

200

the aerosol medicine that matches the following:

brand name: xopenex

drug class: Beta-Adrenergic, Noncatecholamine

Receptors: less beta 1, more Beta 2

patient type: cardiac patient

Dosage: SVN: 0.63mg/ 1.25 mg & MDI: 45ug/puff, 2 puffs Q4-6hours

what is:

Levalbuterol

300

the aerosol medicine that matches the following:

Brand name: Serevent

Drug Class: Beta-Adrenergic, LABA, Noncatecholamines

Receptor: Primarily Beta 2

Uses: Maintenance therapy; nocturnal asthma

-not a rescue inhaler

Dosage strength: MDI 25ug/puff (micrograms/ BID 2 puffs), DPI 50ug/puff

duration: 12 hours (BID)

side effects: mild tremors, headache, insomnia, nervousness, nausea

what is:

Salmeterol

400

the aerosol medicine that matches the following:

brand name: Foradil

drug class: Beta-Adrenergic, LABA, Noncatecholamines

Effects: more rapid & similar to albuterol but long-acting

Uses: maintenance therapy only

-not a rescue inhaler

Dosage: DPI 12 ug per puff Duration: 12 hours (BID)

what is:

Formoterol

500

the aerosol medicine that matches the following:

Brand name: Atrovent(type of atropine)

Drug class: Anticholinergic 

enhances: sympathetic effects

Effects: blocks cholinergic induced bronchospasm(fully ionized)

-often used with Albuterol(enhances bronchodilation)

Dosage: 0.5 mg SVN, MDI 17mcg/puff

frequency: Q4-6 hours or 2 puffs QID

Side effects: cough and dry mouth, pupil dilation

Ipratropium Bromide

600

the subgroups of adrenergic bronchodilators

what is:

Ultra-short acting catecholamine agents(race epinephrine)

short-acting non-catecholamine agents (albuterol, levalbuterol) duration 4-6hrs, rescue inhaler

long-acting adrenergic bronchodilators (salmeterol- serevent, formoterol- Foradil, arformoterol- Brovana) duration of action is about 12 hours, controller inhaler- maintenance

700

the aerosol medicine that matches the following:

Brand name: Vaponephrin, MicroNefrin

Drug class: Adrenergic Catecholamine

Receptors: Alpha, Beta 1, Beta 2 (catecholamine)

concentration: 2.25%

volume: 0.25-0.50 mL (given with NS)

routes: aerosol or ETT

frequency: 2-4 hours

Indications: to reduce airway swelling after extubation or with acute upper airway inflammation from croup, epiglottis, or bronchiolitis

what is:

Racemic Epinephrine

800

the aerosol medicine that matches the following: 

Brand name: Spiriva (long-acting)

Drug class: Anticholinergic

Usage: maintenance management of COPD

Dosage: 18ug/ inhalation

Frequency: once daily

what is:

Tiotropium bromide

more names

100

the combined anticholinergic bronchodilator and beta-agonist bronchodilators

Brand names combined: Proventil, Ventilin, Atrovent

usage: patients for COPD receiving regular treatment who require 

names for this combined in MDI & SVN

frequency 2 puffs Q4 or QID

what is:

MDI-Combivent & SVN-Duoneb

Dosage: 

combivent- MDI= albuterol 90mcg/ atrovent 17mcg

DouNeb- SVN= albuterol 2.5 mg/ Atrovent 0.5mg

200

the term found in caffeine causes bronchodilation

what is: 

methyl-xanthines

300

the aerosol that affects respiratory secretions

-Acetylcysteine(Mucomyst)

-Dornase alfa(Pulmozyme)

what is:

Mucoactive drug

400

the aerosol treatment that matches the following:

brand name: Mucomyst

Drug Class: Mucolytic(prophylactic)

usage: used to reduce excess viscous section in airway & Tylenol OD must retreat with adrenergic bronchodilator(to reduce the irritation of mucolytic)

side effects: bronchospasm, airway obstruction due to rapid liquefaction of secretions, stinky due to hydrogen sulfide, incompatibility with certain antibiotics

what is: 

Acetylcysteine

500

the aerosol medication that matches the following:

brand name: Pulmozyme

drug class: Mucolytic

indication: for management of cystic fibrosis

action: proteolytic enzyme breaks down DNA material from neutrophils found in purulent secretion (cells)

what is:

Dornase Alfa

600

the aerosol medication that matches the following:

is orally inhaled preparation used for anti-inflammatory maintenance therapy of persistent asthma and severe COPD(chronic inflammation), control allergic and nonallergic rhinitis

mode of action: takes 3 weeks since it modifies cell transcription

instructions: use with spacer & brush your teeth to prevent thrush

what is:

inhaled corticosteroids

700

the following are generic/brand names associated with which aerosol medicine

-beclomethasone dipropionate (QVAR)

-Fluticasone propionate (flovent HFA)

-Budesonide (Pulmicort Flexhaler, Pulmicort Repules)

what is:

inhaled steroids

800

the aerosol medication that matches the following:

Brand name: Flovent (red)

Drug class: Glucocorticoids(inhaled steroids)

primary use: orally inhaled corticosteroid for anti-inflammatory maintenance therapy of persistent asthma and serve COPD

Dosage: MDI- 44,110, 220mcg per puff, DPI- 50, 100, 250 mcg per puff

what is:

Fluticasone

and even more:(

100

the aerosol medication that matches the following: 

Brand name: QVAR

Drug class: inhaled steroid (pink/green)

what is:

Belcomethasone

200

the aerosol medication that matches the following:

Brand name: Pulmicort

Drug Class: inhaled steroid

Dose: SVN 0.25mg and 0.5 mg in 2 mL NS

MDI: 90mcg and 180mcg

administered via Pari-Neb

what is: 

Budesonide

300

the aerosol medication combination that is  mixed with LABAs:

fluticasone propionate/salmeterol (advair diskus/ advair HFA)

Budesonide/formoterol fumarate HFA(Symbicort)

Mometasone furoate/ formoterol fumarate HFA (Dulera)

fluticasone furoate/ vilanterol (breo Ellipta)

what is: 

Combination inhaled corticosteroids and LABAs

400

the aerosol medication that matches the following:

combines Fluticasone and Salmeterol

Brand names: FLovent & Serevent (purple)

Drug class: glucocorticoids (inhaled steroid) & LABA

Effects: steroid reduces inflammation & LABA for bronchodilator

Dosage: flovent DPI 100, 250, 500 mcg

Serevents DPI 50 mcg

Frequency: BID(twice a day)

what is :

Advair Diskus(DPI)

500

the following are actions of what type of aerosol drug:

Mast cell stabilizers(stop breaking down)

Antileukotrienes(modifiers)

Monoclonal antibodies/ anti-IgE agents

includes: anti-viral, anti-protozoal, & antibiotics

Instructions: pre-treat with beta-adrenergic, risk to healthcare workers so proper PPE

Side effects: bronchospasms

what is: Nonsteroidal antiasthma drugs

600

the aerosol medicine that matches the following:

Brand name: NebuPent

Drug class: Anti-protozoal

usage: treatment of opportunistic pneumonia caused by Pneumocystis jiroveci(often seen in AIDS patients)

delivery: via RespirGard nebulizer

what is: Pentamidine

700

the aerosol medication that matches the following:

Brand name: Virazole

usage: severe lower respiratory tract infections caused by RSV(disrupts DNA/RNA of the virus)

administration: requires the use of a small particle aerosol generator (SPAG)

Warning: teratogenic(birth defects), carcinogenic, healthcare worker must use protection, cannot be pregnant while receiving or administrating

adverse effects: skin rash, eyelid erythema, conjunctivitis

what is:

Ribavirin

800

the aerosol medication that matches the following:

Drug class: antibiotic 

Usage: manage chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis

Prevents: lung deterioration due to recurrent infections

benefits: reduces systemic side effects, eliminates organisms colonized in the respiratory tract

what is: inhaled tobramycin (TOBI)