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pharmacology 4

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4 Effects of disease on mucus
Change in volume, change in color, change in odor, change in viscosity
Clinical indication of Active agents
Treatment pf pulmonary Edema and IRDS
2 layers of the Mucociliary Blanket
Sol layer, Gel layer
2 Aerosolized steroids side effects
Canida Albicans, Thrush
Flunisolide is Longer acting than which drug
Azmacort
Form of Theophylline used for maintenance in asthma
Oral
What are Exogenous surfactants
Surfactants produced outside of patient's body
Why must a bronchodilator be administered with Acetylcysteine
Acetylcysteine causes severe bronchospasms
Define Lysis of mucus
Break down of mucus
Goblet cells function
Split open and discharge mucus or secretions
Dosage of Exosurf
5ml/kg in 2 divided doses of 2.5ml/kg
Function of an Expectorant
Stimulate to cough
Cilia length
2-5 microns
When should serum Theophylline levels be monitored
At the time of peak absorption , 1-2 hours after administration for immediate release
Side effects of Dornase Alfa
Pharyngitis, Laryngitis, rash, chest pain, conjunctivitis in eye
Dosage of Survanta
100mg/kg
What does advair not replace
Fast acting bronchodilators in asthma attacks
what are Corticosteroids
Group of chemicals secreted by the adrenal cortex
Indication for Acetylcysteine
Thick retained mucoid secretions, Acetaminophen overdose
Representative drug of natural surfactant
Survanta
Range of serum Theophylline is the therapeutic range
10-20ug/ml
What must be administered with Acetylcysteine
Bronchodilator
Trade name for beclamethasone
Vanceril, beclovent
What improvements should be seen after use of Systemic steroids
Less SOB less Inflamation
List 6 Aerosolized Corticosteroids
Dexamethasone (decadron), Beclamethasone (Meclovent, Vanceril), Triamcinolone (Azmacort), Flunisolide (aerobid), Fluticasone (flovent), Advair Diskus (Flovent &serevent)
Synthetic surfactant
Artificial Surfactant
3 negative aspects of natural surfactant
expensive, time consuming, not readily available
Physiologic effects of Xanthine
CNS stimulation, skeletal muscle stimulation, bronchodialation, pulmonary & coronary vasodialation, cardiac stimulation , diuresis
Indication for Ethyl Alchol
Acute Pulmonary Edema
How Exosurf is stored
As a powder
Function of the Mucociliary Escalator
Keep airway clean and lubricated
A true mucolyic
Liquefying expectorant
What must you monitor closely when using Theophylline
Serum level
Rrange of serum Theophylline has no effect?
< 5ug/ml
5 characteristics of Asthma
Inflamation in the lungs, stimuli releases chemical mediators from the mast cells, inflammatory response, increase in eosinophils and neutrophils, goblet cell hyperplasia
Form of Theophylline used for acute episodes of asthma
IV
List 3 systemic steroids
hydrocortisone, prednisone, cortisone
Acetylcysteine is incompatible with which 4 drugs
Ampicillin, Amphotericin B, Erythromycin, Tetracycline
What are surfactant also known as
Surface active Agent
Why proteolysis is no longer used
It not only breaks down the protein of mucus but also the protein of the lungs which is damaging
How Exosurf is reconstituted
with 8ml of sterile water
Mechanism of action of Corticosteroid
Anti-inflammaotory effect due to the ability to inhibit the activity of inflammatory cells and mediators of inflammation.
Trade name for Acetylcysteine
Mucomyst
Survanta is what type of agent
natural surfactant
What is the goal of Systemic steroids
Optimal pulmonary treatment with lowest possible dose
Cause of viscosity of mucus
Dehydration
Make up of Synthetic Surfactant
mixture of DPPC, Cetyl Alcohol, Tyloxapol
Range of serum Theophylline causes cardiac arrhythmias
>30ug/ml
What should you not do to survanta bottle
shake it
Dosage for Theophylline Anhydrous5
100% (100mg)
A classic Xanthine derivative
Theophylline
Dosage for Triamcinolone Acetonide
high inital doses100mcg/puff 12-16 inhalations per day
7 Complications of surfactant therapy
Airway occlision, bradycardia, desaturation, hyperoxia, hypocarbia, apnea, pulmonary hemorrhage
Dyphylline is a derivative of what drug?
Theophylline
2 mucus controlling agents
Liquefying expectorant, stimulant expectorant
Representative drug of Synthetic surfactant
Exosurf
Action of Ethyl Alchol
Lowers the surface tension
2 parts of the adrenal cortex
Adrenal medulla and Cortex
Exosurf is what type of agent
synthetic surfactant
How is Exosurf administered
instilled dirctly into trachea on inspiration
Indication of exogenous surfactant
ARDS-stiff lungs
List the 4 wetting agents
Sterile water, Normal Saline, Hypotonic saline, Hypertonic saline
Trade name for Triamcinolone Acetonide
Azmacort
clinical application of surfactant
Prevention of IRDS in LBW infants and preemies, rescue treatment of infants with IRDS
Action of Dornase Alfa
Decrease viscosity by breaking down extracellular DNA
What are wetting agents
Dilutents
Dosage of beclamethasone
12-16 inhalations per day
What are Synthetic Natural Surfactants
Genetically engineered surfactants
Beclamethasone is stronger topically than which drug
dexamethasone
Mediator Antagonists
Nonsteroid Antiasthma Agents
Range of serum Theophylline causes Nausea
>20ug/ml
Action of Acetylcysteine
Lysis of disulfide bonds
3 types of lysis of mucus
Proteolysis, Ph adjustment, disulfide disruption
Dosage for Acetylcysteine
10% 6-10ml, 20% 3 -5ml
Dosage of Dornase Alfa
1 Ampule (2.5mg in 2.5ml solution) every day
Range of serum Theophylline causes seizures
>40-45ug/ml
Have Synthetic Natural Surfactants been FDA approved
NO
Make up of Synthetic Natural Surfactants
combination of natural and artificial agents
Indication of Dornase Alfa
Cystic Fibrosis
Drug Name for Decadron Respihaler
Dexamthasone
Are Alevaire and Tergemist still used
NO
The Pharmacological class of Theophylline
Third class of bronchodilators
What action must be taken after use of airosolized steroids(MDI)
rinse mouth and gargle
Corticosteroids are referred to as
Adrenal cortical hormones
Cause of change in color of mucus
Infection
2 Clinical uses of Theophylline
Management of asthma and COPD, Treat Apnea in premature newborns
Primary use of corticosteroids
Prevent or reduce inflammation, severe asthma
Define proteolysis
Breaks down protein in mucus
Surface Active Agents
Detergents,Ethyl Alcohol
HPA pathway
Stimulate hypothalmus--release of CRF--pituitary gland--releases ACTH--stimulates Adrenal Cortex--release of Corticosteroid in the body
What doesn't the wetting agents do when it comes to mucus
does not control mucus
how Survanta is administered
divide dose in 1/4, give through french catheter in E-T tube.
What color is Exosurf drug
white milky substance
8 Therapeutic use of steroids
Asthma, adrenal insufficiency, suppression of immune response in organ transplant, arthritis, rheumatic carditis, osteoarthritis, acute inflammatory disease, bronchitis
Beat per minute cilia move
1200-1300 bpm
First available MDI
Decadron Respihaler
2 Representative drugs of Detergents
Alevaire, Tergemist
How natural surfactants are obtained
humans and animals- cow lung
Diurnal Steroid cycle
Rhythmic circadian cycle
Mucus is made up of what percentage water and mucin
95%H2O, 5%mucin
what does HPA stand for
Hypothalmus Pituitary Adrenal Axis
Why should you not shake survanta bottles
it will be useless
4 Xanthine derivatives
Theophylline, Oxtriphylline, Aminophylline, Dyphylline
What does the Diurnal Steroid Cylce prepare the body for
Stress
Make up of Survanta
mixture of natural bovine and DPPC
Trade name for Dornase Alfa
Pulmozyme
How exogenous surfactants obtained
Obtained from other humans, animals, or lab synthesis
3 Clinical applications of Corticosteroids
Control of asthma, treat bronchospasm, control allergic responses
6 Side effects of corticosteroids
Cushings disease, hypertension, aggravation of diabetes mellitus, aggravation of peptic ulcer, psychotic manifestations, adrenal atrophy
Dosage of Oxtriphylline
64%(156mg)
Optimum serum level of Theophylline that must be achieved for maximum therapeutic bronchodilation
10-20ug/ml
What is Triamcinolone Acetonide used in
built-in spacer device
Principle of surfactant
LaPlace's Law-greater the radius the lower the surface tension
Trade Name for Flunisolide
Aerobid
position of infant recieving Exosurf
in midline position then rotated to the right after first half of dose. then rotated to the left after second half of dose
what the diurnal steroid cycle mimic
Normal fall and rise in body so not comatose
Side effects of Acetylcysteine
Bronchospasm, excessive liquification, stomatitis, nausea
Advair diskus make up
Combined inhaled corticosteroid and inhaled long-acting bronchodilator
Dose of Theophylline for chronic therapy
16mg/kg per 24 hours
The 3 different types of steroids produced by adrenal cortex
Glucocorticoid (cortisol), Mineralocoricoid (aldosterone), Androgenic Corticosteroid (testosterone)
Decadron Respihaler anti-inflammatory activity
30 times greater that hydrocortisone
Initial oral dose of Theophylline
5mg/kg
First line drug for therapy of Asthma
Theophylline
Secretory structures of mucus
Surface epithelial cells, subepithelial cells, submucosal glands.
Dosage for Aminophylline?
79%(127mg)
2 representative drugs of Exogenous surfactants
Exosurf and survanta
4 Mucociliary properties
Cohesive force, adhesive force, viscosity, elasticity
Approximately how many cilia per cell are there
200
Action of Detergents
Alter surface Tension

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