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108 Cards in this Set
- Front
- Back
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Name the uses of xanthines? |
asthma, COPD, Apnea of prematurity in neonates |
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Name the use of xanthines: asthma? |
-use in asthma |
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What is theophylline? |
Maintenance therapy (step 2 or alternative step 3 with ICS) of mild, persistent asthma. Classified as a bronchodilator but has a relatively weak bronchodilating effect compared with beta2 agonists. |
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The side effects of use of xanthines? |
Patients older than 5 years of age. Side effects and narrow therapeutic index may make it a poor choice vs. other agents. Not used in acute asthma exacerbation. |
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What are xanthines? |
A nitrogenous compound found in many organs and in blood and urine |
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What are use of Xanthines? |
Use in apnea of prematurity, first line treatment as a respiratory stimulant, theophylline most extensively used in the past but caffeine citrate may be a better choice |
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What do COPD patients use? |
Use of Xanthines, Theophylline recommended by GOLD as alternative to B2- agonist and anticholinergics. Not used in acute COPD exacerbation due to the potential toxicity. |
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What to use in apnea for prematurity? |
The Xanthines are the first line treatment as a respiratory stimulant. Theophylline most extensively used in the past, but caffeine citrate may be a better choice ( safer, higher therapeutic index) |
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What to use in apnea for prematurity? |
The Xanthines are the first line treatment as a respiratory stimulant. Theophylline most extensively used in the past, but caffeine citrate may be a better choice ( safer, higher therapeutic index) |
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Xanthine agents are also known as what? |
Methylxanthines |
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What to use in apnea for prematurity? |
The Xanthines are the first line treatment as a respiratory stimulant. Theophylline most extensively used in the past, but caffeine citrate may be a better choice ( safer, higher therapeutic index) |
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Xanthine agents are also known as what? |
Methylxanthines |
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Specific Xanthine agents are found as what? |
Found as alkaloids in plant species |
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What to use in apnea for prematurity? |
The Xanthines are the first line treatment as a respiratory stimulant. Theophylline most extensively used in the past, but caffeine citrate may be a better choice ( safer, higher therapeutic index) |
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Xanthine agents are also known as what? |
Methylxanthines |
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Specific Xanthine agents are found as what? |
Found as alkaloids in plant species |
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Name three specific xanthine agents and what they are made from? |
Theophylline: tea leaves Theobromine: cocoa seeds or beans Caffeine: coffee beans and kola nuts, cocoa seeds or beans, and tea leaves |
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Name xanthine derivatives? |
Theophylline (Theo- 24), Caffeine, Dyphylline (Lufyllin), Oxtriphylline, Aminophylline |
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Name xanthine derivatives? |
Theophylline (Theo- 24), Caffeine, Dyphylline (Lufyllin), Oxtriphylline, Aminophylline |
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How do Xanthine derivatives come? |
Come in table, syrup, injection, and suppository |
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Name xanthine derivatives? |
Theophylline (Theo- 24), Caffeine, Dyphylline (Lufyllin), Oxtriphylline, Aminophylline |
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How do Xanthine derivatives come? |
Come in table, syrup, injection, and suppository |
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What is good to know about titrating theophylline doses? |
Individuals metabolize theophylline at different rates, difficult to determine therapeutic doses |
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What are serum levels for theophylline? |
1. < 5 ug/ml : no effects seen 2. 10 to 20 ug/ml: therapeutic range 3. > 20 ug/ ml: nausea 4. > 30 ug/ ml: cardiac arrhythmia 5. 40 to 45 ug/ ml: seizures |
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What are serum levels for theophylline? |
1. < 5 ug/ml : no effects seen 2. 10 to 20 ug/ml: therapeutic range 3. > 20 ug/ ml: nausea 4. > 30 ug/ ml: cardiac arrhythmia 5. 40 to 45 ug/ ml: seizures |
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What is the titrating theophylline dose for asthma? |
5 to 15 ug/ ml |
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What are serum levels for theophylline? |
1. < 5 ug/ml : no effects seen 2. 10 to 20 ug/ml: therapeutic range 3. > 20 ug/ ml: nausea 4. > 30 ug/ ml: cardiac arrhythmia 5. 40 to 45 ug/ ml: seizures |
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What is the titrating theophylline dose for asthma? |
5 to 15 ug/ ml |
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What is the titrating theophylline dose for COPD? |
5 to 10 ug/ml |
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Theophylline side effects: |
Narrow therapeutic margin, distressing side effects may occur at therapeutic levels ( some may skip nausea side effects and enter the seizure phase). Common side effects are gastric upset ( not recommended in patients with peptic ulcer), headache, anxiety, diuresis |
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What are conditions that increase theophylline levels? |
Viral hepatitis, alcohol, and left ventricular failure |
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What are conditions that decrease theophylline levels? |
Smoking |
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What causes an additive effect with theophylline activity? |
B- agonists |
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When to use theophylline in asthma? |
Use is debated, only after other relievers and controllers have failed |
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When to use theophylline in asthma? |
Use is debated, only after other relievers and controllers have failed |
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When to use theophylline with COPD? |
If ipratropium bromide and B2 - agonist fail to provide control |
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What are nonbronchodilating effects of theophylline ? |
Increase in force of respiratory muscle contractility, increase in respiratory muscle endurance, increase in ventilators drive, cardiovascular effects (increased cardiac output), anti inflammatory effects |
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What are nonbronchodilating effects of theophylline ? |
Increase in force of respiratory muscle contractility, increase in respiratory muscle endurance, increase in ventilators drive, cardiovascular effects (increased cardiac output), anti inflammatory effects |
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What is the first line choice for apnea in prematurity? |
Xanthines are the first- line choice when nonpharmacological methods are unsuccessful. Caffeine citrate is preferred over theophylline. The loading dose of caffeine citrate is 20mg/kg. The daily maintenance dose is 5 mg/kg. Remember: caffeine citrate is preferred over theophylline. |
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The mode of action of theophylline is ? |
Unclear |
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What are properties and functions of mucus? |
Protective, lubricating, waterproofing, and entraps microorganisms. |
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What may failure of mucus system result in? |
Failure of this system may result in mechanical obstruction of the airway |
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Why would you use mucus controlling drug therapy? |
To reduce accumulation of airway secretions, improve pulmonary function and gas exchange, and prevent repeated infection and airway damage |
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What diseases would mucus controlling drugs have clinical use for? |
Cystic fibrosis, chronic bronchitis, pneumonia, diffuse panbronchiolitis (DPB), primary ciliary dyskinesia, asthma, bronchiectasis |
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What areas is mucus found? |
Mucus found in airways, GI tract, genital tract |
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What areas is mucus found? |
Mucus found in airways, GI tract, genital tract |
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What can the normal barrier entrap? |
In normal mucus barrier can entrap microorganisms preventing biofilm formation, and chronic bacterial infection, protects against inflammatory changes. |
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When should mucus- controlling drug therapy be considered? |
Consider after: Therapy to decrease infection/inflammation, removal of irritants (including tobacco smoke) |
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When should mucus- controlling drug therapy be considered? |
Consider after: Therapy to decrease infection/inflammation, removal of irritants (including tobacco smoke) |
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What should be added when giving mucomyst? |
Whenever giving mucomyst add Albuterol (short acting bronchodilator agent) |
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When should mucus- controlling drug therapy be considered? |
Consider after: Therapy to decrease infection/inflammation, removal of irritants (including tobacco smoke) |
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What should be added when giving mucomyst? |
Whenever giving mucomyst add Albuterol (short acting bronchodilator agent) |
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What is pulmozyme used for? |
Used to break infection DNA used for cystic fibrosis |
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Mucomyst is also called what and what is the % and dosage? |
Mucomyst is also called N- Acetylcysteine. The % is 10% and 20%. The dosage is 600 mg and 1000 mg. |
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Mucomyst is also called what and what is the % and dosage? |
Mucomyst is also called N- Acetylcysteine. The % is 10% and 20%. The dosage is 600 mg and 1000 mg. |
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Pulmozyme is also called what and what is the dosage? |
Pulmozyme is also called dornase alfa. The dosage is 2.5 mg/ ampule. |
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Mucomyst is also called what and what is the % and dosage? |
Mucomyst is also called N- Acetylcysteine. The % is 10% and 20%. The dosage is 600 mg and 1000 mg. |
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Pulmozyme is also called what and what is the dosage? |
Pulmozyme is also called dornase alfa. The dosage is 2.5 mg/ ampule. |
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Name aqueous aerosols? |
Water, saline 0.9%, hypotonic saline (< 0.9%), hypertonic saline ( > 0.9%) |
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Mucomyst is also called what and what is the % and dosage? |
Mucomyst is also called N- Acetylcysteine. The % is 10% and 20%. The dosage is 600 mg and 1000 mg. |
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Pulmozyme is also called what and what is the dosage? |
Pulmozyme is also called dornase alfa. The dosage is 2.5 mg/ ampule. |
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Name aqueous aerosols? |
Water, saline 0.9%, hypotonic saline (< 0.9%), hypertonic saline ( > 0.9%) |
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Physiology of the mucociliary system? |
- source of airway secretions gel layer (0.5 -20 um) - Pericilliary layer (sol layer) (7um) - Clara cells in distal airway - surface goblet cells - pseudostratified columnar epithelium -submucosal glands With serous and mucous cells |
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What is mucoactive? |
Agent that has effect on mucus secretions |
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Mucomyst is also called what and what is the % and dosage? |
Mucomyst is also called N- Acetylcysteine. The % is 10% and 20%. The dosage is 600 mg and 1000 mg. |
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Pulmozyme is also called what and what is the dosage? |
Pulmozyme is also called dornase alfa. The dosage is 2.5 mg/ ampule. |
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Name aqueous aerosols? |
Water, saline 0.9%, hypotonic saline (< 0.9%), hypertonic saline ( > 0.9%) |
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Physiology of the mucociliary system? |
- source of airway secretions gel layer (0.5 -20 um) - Pericilliary layer (sol layer) (7um) - Clara cells in distal airway - surface goblet cells - pseudostratified columnar epithelium -submucosal glands With serous and mucous cells |
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What is mucoactive? |
Agent that has effect on mucus secretions |
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What is mucokinetic agent? |
Drug that increase ciliary clearance of respiratory mucus secretions |
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Name factors that slow mucociliary transport rate ? |
Chronic obstructive pulmonary disease, Cystic Fibrosis, Airway drying, narcotics, endotracheal suctioning |
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Name more factors that affect mucociliary transport? |
Airway trauma, tracheotomy, cigarette smoking, atmospheric pollutants, hyperoxia and hypoxia |
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Drinking dairy milk increases production of mucus and congestion in the respiratory tract? Fact or myth |
Myth |
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Most mucus secretion is absorbed where? |
In the bronchial mucosa |
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What is the composition of mucus? |
95% water and 3% musins (salts, proteins, etc.) |
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What is the composition of mucus? |
95% water and 3% musins (salts, proteins, etc.) |
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Name mucus in disease states? |
Chronic bronchitis, asthma, bronchorrhea, plastic bronchitis, CF |
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What is the composition of mucus? |
95% water and 3% musins (salts, proteins, etc.) |
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Name mucus in disease states? |
Chronic bronchitis, asthma, bronchorrhea, plastic bronchitis, CF |
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Hypersecretion causes what predisposition to a patient? |
Bacterial infection |
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What can bronchiole obstruction cause? |
Will increase airflow resistance and lead to complete airway destruction and atelectasis. |
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What do mucolytic agents do? |
Decrease elasticity and viscosity of mucus because the gel structure is broken down |
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What do mucolytic agents do? |
Decrease elasticity and viscosity of mucus because the gel structure is broken down |
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Mucoactive agents do what ? |
Remove causative factors- treat infections, stop smoking, avoid pollution and allergens Optimize tracheobronchial clearance- use bronchodilator, bronchial hygiene ( CPT, Vest, Acapella, Aerobika) exercise Use mucoactive agents when indicated |
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Postural drainage may benefit when incorporated into what? |
Conventional Chest Physiotherapy (CPT) |
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Postural drainage may benefit when incorporated into what? |
Conventional Chest Physiotherapy (CPT) |
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Mode of action for N-Acetyl-L-cysteine? |
Acts by disrupting the disulfide bond bridge between mucoprotein strands in mucus |
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Hazards with N-Acetyl- L- cysteine? |
Bronchospasm, irritates airway coughing, ALWAYS used with bronchodilator, mechanical obstruction of airway |
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Disadvantages of N-Acetyl- L-cysteine? |
Odor (smells like rotten eggs), incompatibility with antibiotics in mixture. Antibiotics should not be mixed in same nebulizer because it can inactivate the antibiotics. Used for acetaminophen overdose.
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What is the use for dornase alfa (Pulmozyme) ? |
Indications and use in CF. For clearance of purulent (pus) secretions. To reduce frequency of respiratory infections requiring parenteral antibiotics. To improve or preserve pulmonary function in these subjects. |
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Mode of action for dornase alfa (pulmozyme) ? |
When given by aerosol reduces viscosity and adhesivity by breaking down DNA |
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Mode of action for dornase alfa (pulmozyme) ? |
When given by aerosol reduces viscosity and adhesivity by breaking down DNA |
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Dose administration for dornase alfa (pulmozyme) ? |
Available as single- use ampule, should be refrigerated and protected from light. |
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Mode of action for dornase alfa (pulmozyme) ? |
When given by aerosol reduces viscosity and adhesivity by breaking down DNA |
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Dose administration for dornase alfa (pulmozyme) ? |
Available as single- use ampule, should be refrigerated and protected from light. |
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How is dornase alfa (pulmozyme) delivered? |
Delivered by one of these tested and approved nebulizers: Hudson RCI UP- Draft II OPTI- NEB, Acorn II nebulizer, PARÍ LC PLUS nebulizer |
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What should you know about the mucoactive agent hyperosmolar saline (7%)? |
May increase FEV1 in patients, alternate effect is an acute decrease in FEV1, unpleasant taste, coughing may make it unsuitable for long-term use |
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What should you know about expectorant sodium bicarbonate? |
Inflammation caused by bicarbonate is thought to draw water into secretions, has not been clinically demonstrated to improve airway mucus clearance, cannot recommend its use |
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What should you know about expectorant Guaifenesin? |
Generally considered an expectorant, can be ciliotoxic when applied directly to respiratory tract, thought that expectorant action is mediated by stimulation of the GI tract |
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What is insuflalation- exsufflation? |
Inflated lungs with positive pressure followed by negative pressure to stimulate cough |
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What does exercise do? |
Cause increased sputum production compared with rest |
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What does positive pressure techniques do? |
Can be effective alternatives to chest physical therapy in expanding lungs and mobilizing secretions |
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What does positive pressure techniques do? |
Can be effective alternatives to chest physical therapy in expanding lungs and mobilizing secretions |
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Name examples of oscillation of airway? |
The flutter, the percussionator (IPV) |
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What should you know about chest wall compression? |
The vest reported to be effective for secretion clearance in patients with CF |
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Respiratory Care Assessment of Mucoactive Drug Therapy short term? |
Correct use of equipment, assess therapy, mucus production, respiratory rate and pattern, subjective response, adverse reactions |
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Respiratory Care Assessment of Mucoactive Drug Therapy short term? |
Correct use of equipment, assess therapy, mucus production, respiratory rate and pattern, subjective response, adverse reactions |
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Respiratory Care Assessment of Mucoactive drug therapy long term? |
Number and severity of infections, ER visits, Hospitalizations, Need for antibiotics, pulmonary function testing |
