Theo-filling My Lungs
What is the therapeutic range of serum theophylline for asthma control?
5–15 µg/mL.
How is surfactant delivered to newborns/prematures with RDS?
Direct instillation into the trachea via an endotracheal tube (ETT).
*Surfactant is delivered directly into the lungs to reduce surface tension, improve alveolar stability, and increase compliance. Beractant should stand at room temperature for ~20 minutes before use.
What is the brand name for dornase alfa? What does it target?
Pulmozyme
DNA in CF pts
Chronic systemic corticosteroid use can suppress which body axis?
HPA (hypothalamic-pituitary-adrenal) axis.
Name two antileukotriene agents.
Montelukast (Singulair), Zafirlukast (Accolate)
Which methylxanthine is preferred for treating apnea of prematurity? Why?
Caffeine citrate. Longer half-life, safer therapeutic window, and less toxicity than theophylline.
What are lamellar bodies, and why are they significant in surfactant production?
Lamellar bodies are organelles in Type II alveolar cells that store and secrete surfactant.
*They are critical for producing and releasing the surfactant mixture of ~90% lipids and ~10% proteins into the alveolar space.
Whos Law revolves around surface tensions of the alveoli? Smaller alveoli with the same surface tension require _____ (greater/less) pressure to stay open.
La Place’s Law.
Smaller alveoli with the same surface tension require greater pressure to stay open.
Name 1 systemic risk of prolonged corticosteroid use.
Osteoporosis, cataracts, hyperglycemia/diabetes, and growth suppression in children.
Which nonsteroidal antiasthma agent is given subcutaneously? What does it bind to?
Omalizumab (Xolair) for moderate to severe allergic asthma not controlled by standard therapy.
A monoclonal antibody binds IgE, preventing allergic inflammation.
Which of the following is a long-acting muscarinic antagonist (LAMA)? Give its standard dose and frequency.
A) Ipratropium
B) Tiotropium
C) Albuterol
D) Levalbuterol
B Tiotropium. Once daily. 2 puffs, 18mcg
A premature infant on pressure-controlled ventilation receives surfactant. You notice tidal volume increases while inspiratory pressure remains constant. What does this indicate?
Lung compliance has improved.
*Higher compliance means the lungs can expand more easily with the same pressure. Surfactant reduces surface tension, so less pressure is needed to achieve target volumes.
How does beta-adrenergic (sympathetic) stimulation improve mucociliary clearance?
It increases ciliary activity and widens the airways, making mucus easier to move.
*Beta-agonists (like albuterol) help clear mucus not by reducing its production but by enhancing the mechanical processes that move it along the airway, unlike cholinergic stimulation which increases mucus production and airway constriction.
A patient using fluticasone MDI complains of oral thrush and hoarseness. How can you reduce these side effects without stopping the medication?
Use a spacer/holding chamber, rinse mouth and spit after inhalation, brush teeth if possible.
* Proper inhaler technique reduces oropharyngeal deposition, preventing local side effects while maintaining therapy.
What is pentamidine used for, and how is it administered?
Prevention of Pneumocystis pneumonia (PCP) in HIV (immunosuppressed) patients, via Respirgard 2 nebulizer with flow 5–7 LPM.
What does the acronym SLUD stand for in cholinergic stimulation?
Salivation, Lacrimation, Urination, Defecation.
*These parasympathetic effects are what anticholinergics aim to block.
After surfactant administration, a neonate’s PaO₂ rises significantly. What adjustment should be considered?
Decrease FiO₂.
*To avoid oxygen toxicity, FiO₂ should be reduced once oxygenation improves post-surfactant.
You have a patient who is taking nebulized Mucomyst (ONLY). The patient complains that their chest is tight and they are coughing. What would you explain to the patient? (Hint. RT made a mistake)
Acetylcysteine is typically given with a bronchodilator such as albuterol because nebulized acetylcysteine can cause bronchospasm, which the patient is experiencing. After all, the RT forgot to administer albuterol as well.
What two drugs make up Breo Ellipta?
Vilanterol (LABA) and Fluticasone furoate (ICS).
What is a major precaution RTs must take when administering pentamidine?
Administer in a negative-pressure room with six air changes per hour and use an N95 mask/contact precautions. Limit female RT due to risks for birth defects in pregnant women.
*Reduces exposure risk and prevents nosocomial infections; pentamidine aerosol can cause bronchospasm and systemic effects.
You have a chronic COPD patient who is experiencing chronic chest pain and needs to be placed on a drug for maintenance treatment of bronchospasm. What drug would you give them, and why would this drug be considered safer than albuterol in cardiac patients?
Ipratropium bromide. It has minimal systemic beta-adrenergic effects.
* It does not significantly raise HR or myocardial oxygen demand.
Name at least three hazards associated with surfactant therapy.
Airway complications (bradycardia, plugging ETT, apnea), pulmonary complications (pneumothorax, over/under inflation, pulmonary hemorrhage), infection risk.
What is the standard aerosolized dose of dornase alfa for what type of patient?
2.5 mg diluted in 2.5 mL via SVN once daily. CF patients.
Why are corticosteroids not first-line therapy for acute bronchospasm?
They act slowly and do not provide immediate bronchodilation.
*Rapid-acting agents like albuterol (SABA) are preferred for immediate relief; corticosteroids are for long-term inflammation control.
A CF patient on TOBI, albuterol, and hypertonic saline presents with voice changes. Which drug is the most likely cause?
TOBI, can cause dysphonia.