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DRUGS ROUTES OF ADMINISTRATION (5) ✔✔1. Enteral
- Parenteral
- Transdermal
- Inhalation
- Topical What is enteral route? ✔✔ENTERAL - absorbed in GI a. sublingual b. oral c. buccal/ lingual/ sublingual d. rectal What is the Parenteral route? (3) ✔✔Parenteral a. Intravenous ( IV) b. intramuscular (IM) c. subcutaneous (SubQ). What is the transdermal route? ✔✔delivered through the skin into the blood stream What is the inhalation route? (2) ✔✔a. aerosolized
b. airway instillation What is the topical route? ✔✔medication to the body surface for local effects Name the (9) drug classifications ✔✔1. sedatives
- anesthetics
- analgesics
- neuromuscular blocking agents
- bronchodilators
- cardiac drugs
- vasoactive drugs
- renal drugs
- anti- infective agents What are sedatives? ✔✔decrease anxiety and promotes relaxtion What are anesthetics? ✔✔reduce patients ability to perceive sensation What are analgesics? ✔✔reduces the sensation of pain What are neuromuscular blocking agents? ✔✔cause paralysis of skeletal muscles What are bronchodilators? ✔✔open airways
most vasopressors are alpha- stimulating drugs What is the beta 1 response? ✔✔increased rate ( chronotropic) and strength of contraction ( inotropic) of the cardiac muscles most cardiac drugs are beta 1 What is the beta 2 response? ✔✔bronchodilation and a week vasodilation effect most respiratory drugs are beta 2 What response does beta2 agonist / symathomimetic/ adrenergic drugs have? ✔✔bronchodilation What is the parasympathetic branch? ✔✔is a conservation system and innervates smooth muscles What is the primary indication of bronchodilators? ✔✔treat bronchospasm/ wheezing in patients with asthma and COPD What are short acting beta agonists (SABA) used for? Name 2 * ✔✔rescue/ quick relief medications
treats acute episodes of bronchospasm *albuterol and xopenex What are the generic names for albuterol? ✔✔Ventolin or Proventil What are the dose of albuterol when nebulized 0.5% solution? ✔✔0.5 ml- 1.0 ml in 3 ml of NS every 1- 6 hours What is the unit dose vial size of albuterol? ✔✔2.5 mg in 3 ml NS- 1 vial every 1 - 6 hours What is the continuous dose of albuterol? ✔✔ 10 - 15 mg/ hour What is the MDI does of albuterol? ✔✔90mcg/puff- 1 - 2 purrs every 4 - 6 hours What the generic name for levalbuterol? ✔✔xopenex What is the unit dose vial for xopenex? ✔✔0.63 mg in 3 ml NS- 1 vial every 6- 8 hours 1.25 mg in 3ml NS- 1 vial every 6-8 hours What are 8 side effects and hazards of beta adrenergic bronchodilators? ✔✔1. tachypnea
- palpitations ...... feeling heart activity
- hypertension/ hypotension
- Aqueous solution ( Perforomist R) 20 mcg/ 2ml - 1 vial every 12 hrs How is Arformoterol ( Brovana) dispensed? ✔✔Aqueous solution 15 mcg/ 2ml every 12 hours What are anticholingeric bronchodilators? ✔✔block the bronchoconstriction caused by the parasympathetic nervous system decreases cyclic GMP Name 4 anticholinergic bronchodilators? ✔✔1. atropine sulfate
- ipratropium bromide ( atrovent)
- tiotropium bromide (Spiriva)
- Oxitripium bromide ( oxivent) How is atropine sulfate dispensed? ✔✔Aqueous solution nebulized .05 mg/kg in 3 ml NS every 6 - 8 hrs How is ipratropium bromide ( atrovent) dispensed? *2 ✔✔1. unit dose vial ----- 500mcg in 2.5 ml NS 1 vial every 8 hrs
- MDI 18 mcg/ puff 1 - 2 puffs every 4 - 6 hours max 6 puffs/ day How is Tiotropium bromide ( spiriva )dispensed? ✔✔DPI 18 mcg/ inhalation - 1 inhalation per day How is oxitropium bromide ( Oxivent ) dispensed? ✔✔MDI 100 mg/puff- 2 puffs every 8 - 12 hrs what are Methylxanthines? ✔✔Phosphodiesterase inhibitors How does methylxanthines work? ✔✔indirectly increases the amount of cAMP within smooth muscles. The increased amount causes bronchodilation What is the usual route of methylxanthines? *3 ✔✔ 1 - intravenous 2 - injection 3 - tablet what is the safe therapeutic blood levels of theophylline? ✔✔ 10 - 20 mg/ mL to optimize bronchodilation blood level are important for patients receiving methylxanthines Name 5 methylxanthine drugs ✔✔1. Theophylline ( aminophylline)
MDI 2 - 4 times/day How is Budesonide dispensed? ✔✔Pulmicort DPI or unit dose 1 - 2 times/day How is prednisone dispensed? ✔✔oral used for patients with acute exacerbation How is methyprednisone or solu- Medrol dispensed ✔✔IV used for patients admitted with acute exacerbation What are the side effect of inhaled corticosteroids? ✔✔They are severe. Adrenal suppression Cushings syndrome hypertension oral candidiasis ( thrush) How to treat thrush from ICS? ✔✔Nystatin ...... antfungal agent How do you prevent thrush with ICS? ✔✔rinse mouth Combining adrenergic= anticholinergic ✔✔only administer 1 drug from each category eg ipratropium + albuterol ( combivent or duoneb)
Why use duoneb? ✔✔*bronchodilation *more control of bronchospasm seen in COPD and asthma *Reduced drug dosages
- avoidance of steroids What is advair drug combination? ✔✔fluticasone (anti inflammatory) and salmeterol ( long acting bronchodialtory What is symbicort drug combination? ✔✔budesonide ( anti inflammatory) and formoterol ( long acting bronchodilator) Who are anti inflammatory and long acting drugs used for? ✔✔patients with asthma and copd How often should anti inflammatory and long acting drug combination used? ✔✔twice a day When is anti inflammatory and long acting drug combination not recommended? ✔✔treatment of acute bronchospasm What is the sequence multiple inhaled medication should be administered? ✔✔1. bronchodilator and or anticholinergic ( albuterol and atrovent)
How much should be administered? ✔✔bronchodilator 3 - 4 ml of 10 - 20% Who is dornase, alpha DNase ( pulmonzyme) indicated for? ✔✔patients with Cystic Fibrosis What does pulmozyme do? ✔✔* decreases the frequency of respiratory infections in cystic fibrosis patients requiring parenteral antibiotics
- treating viscous secretions in CF What is the recommended dose of pulmozyme and how to administer? ✔✔* 2.5 mg via nebulizer once or twice a day
- requires refrigeration and protection from light What are the side effects of pulmozme? * 6 ✔✔1. voice alteration
- pharyngitis
- laryngitis
- rash
- chest pain
- conjunctivis What are leukotriene modifiers? ✔✔non steroidal drugs approved for use in patient with mild to moderate persistent asthma When you wouldn't use a leukotriene modifier? ✔✔to treat an acute asthma attack What do leukotriene modifiers do? ✔✔improve lung function, reduce symptoms and need for beta agonist drugs Name 3 leukotriene modifiers *3 ✔✔1. montelukast ( singulair)
- zafirlukast ( accolade)
- zileuton ( zyflo) When do you use morphine sulfate nebulized? ✔✔to relieve dyspnea for patients with endstage COPD What is pentamidine ( NebuPent)? ✔✔used to treat pneumocystis jiroveci ( carinii)
- commonly seen in patients with aids or hiv What is the adverse effect of pentamidine ( nebupent)? ✔✔bronchospasm How is pentamidine administered? ✔✔special nebulizer Respiragard II
How does propofol cause hypotension ✔✔negative inotropic effect resulting in decreased stroke volume, cardiac output, SVR Pre- procedure treatment before propofol ✔✔*fluid bolus *vasopressors
