Mod Iv Pharm- Aerosol Anti Infectives

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Pentamidine Isothionate
NebuPent

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anti-protozoal agent
treats pneumocystis carinii
aerosol or parental (no oral)

used to prevent the colonization of the pneumocystis organism

SE:Aerosol route: Cough and bronchial irritation, SOB, Bitter taste or burning.
Bronchospasm & wheezing, spontaneous pneumothoraces.

Administer a bronchodilator before pentamidine administration to prevent this.

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what happens when you inhale Pentamidine Isothionate?

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The inhaled drug binds to lung tissue, though it is slowly absorbed into the circulation and is distributed to body tissues.

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Pentamidine Isothionate (Nebupent) MOA

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blocks the synthesis of RNA & DNA, inhibits phosphorylation

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Pentamidine Isothionate (Nebupent) dosage

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300 mg by inhalation once every 4 wks

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Pneumocystis Carinii Pneumonia

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PCP produces a foamy intra-alveolar exudate that contains cysts of P. carinii
there is a mild to moderate interstitial infiltrate of lymphocytes. And macrophages are present in the alveoli.
CXR shows diffuse bilateral interstitial or alveolar infiltrates.

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Pentamidine Isothionate precautions:

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Risk of infection with TB ( is associated with AIDS patient’s)
Limit exposure
Use a neb system with a 1-way valve. &
An Expiratory Filter.
Stop the neb if the pt. Takes the mouth piece out of his mouth.

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Pentamidine Isothionate administration

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special SVN fitted with a series of 1-way valves and an expiratory filter.

flow rate of 5 - 7 LPM.

No less than a 22 - 25 PSI source should be used.

1-2 microns

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RIBAVIRIN - Virazole

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anti-viral agent
treats: bronchiolitis and pneumonia caused by RSV in the youngin's

RSV,INFLUENA, The Herps

Virucidal

it inhibits both DNA & RNA

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RIBAVIRIN - Virazole
side effects: pulmonary

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Pulmonary
Deterioration of PFT’s
Worsening of RAD or COPD
PNX
Apnea
Bacterial pneumonia

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RIBAVIRIN - Virazole
side effects: Cardiovascular

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Instability
Hypotension
Cardiac Arrest
Digitalis Toxicity

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RIBAVIRIN - Virazole
dosage??

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DOSAGE
given in a 20 mg/ml solution

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ribavirin precautions with babies on vents??

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use caution when aerosolizing this on infants requiring mechanical ventilation as the drug may form a precipitate and clog the expiratory valves and or sensors of the ventilator.

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potential SE for RCP administrator??

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mutagenic and carcinogenic effects, and is teratogenic or embryocidal in animal species.
Limit or avoid exposure to the drug when possible.

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Antibiotics with Poor oral availability for lung tissue

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Aminoglycosides
Penicillin derivatives
Cephalosporins
Consequently the IV or inhaled route is preferred

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Cystic Fibrosis patient’s are chronically infected with organisms such as:

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Pseudomonas aeruginosa, and cepacia
Hemophilus influenzae
Staphylococcus aureus

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Nebulizing Anti-Infectives what do I need to know???

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b/c of antibiotic viscosity flow rate 10-12 LPM

Use Expiratory filters with 1 - way valves and a thumb port to avoid exposure