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“ The Supporting Players….”

“ The Supporting Players….”. RC 195. Anti-foaming agent: ETOH. Aerosolized ETOH used to decrease the foam and froth in pulmonary edema Decreases surface tension so that bubbles liquefy Dose: 3-5 ml of 30-50% ETOH Side effects: Intoxication, bronchospasm, decreased surfactant

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“ The Supporting Players….”

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  1. “The Supporting Players….” RC 195

  2. Anti-foaming agent: ETOH • Aerosolized ETOH used to decrease the foam and froth in pulmonary edema • Decreases surface tension so that bubbles liquefy • Dose: 3-5 ml of 30-50% ETOH • Side effects: Intoxication, bronchospasm, decreased surfactant • Not a primary treatment now

  3. Aerosolized Antibiotics • Ideal Properties: • Potent topical effect • Less toxicity/side effects • Indications: • Systemic administration is ineffective • Toxicity/side effects from systemic administration • Limitations: • V/Q abnormalities and “hiding” microbes • Variable dosing when aerosolized

  4. Aminoglycosides • Used against gram – rod respiratory infections • Pseudomonas • Klebsiella • Proteus • E-coli • Side effects/Toxicity: • Nephrotoxicity, ototoxicity, neurotoxicity • May cause temporary paralysis and hence apnea when given as an IV bolus

  5. Aminoglycoside Examples • Stretpomycin • Gentamycin (Garamycin) • Tobramycin (Nebcin) • Kanamycin (Kantrex) • Neomycin (Neosporin)

  6. Penicillins • Some are very broad spectrum so can be used for gram+ and gram- infections • Methicillin (Staphcillin) – staphylococcus • Ampicillin (Omnipen, Polycillin) – H.flu, Streptococcus • Carbenicillin (Geopen) – pseudomonas • Nafcillin (Unipen) – staphylococcus • Pen G – strep • Also : Amoxicillin ( Polymox) and amoxicillin with potassium clavulanate (Augmentin) • The penicillins can be very allergenic!

  7. Other Antibiotics • Cephalosporins – gram+ and gram-; e.g. Keflex • Fluoroquinolones –very broad spectrum • Ciprofloxacin (Cipro), Moxifloxacin (Avelox) • Macrolides – very broad spectrum and used in place of penicillin • Erythromycin, Clarithromycin (Biaxin), Azithromycin (Zithromax) • Polymixins –Colistin (Promixin) -75-150mg BID via aerosol for H.Flu, Klebsiella, Acinetobacter, and Pseudomonas • Vancomycin (Vancocin) – last choice drug! • Used for MRSA or other infections that are not responding to penicillins or cephalosporins

  8. Antifungal Drugs • Amphotericin B (Fungizone) – Big gun! Can be very toxic • Has been aerosolized • Is light sensitive • Histoplasmosis, Valley Fever • Nystatin (Mycostatin) – topically applied for yeast-like infections, eg Thrush

  9. Antifungal Drugs (cont.) • Pentamidine (NebuPent) • Aerosolized for PCP/PJP infections in HIV patients • Pneumocystis Carinii Pneumonia now known as Pneumocystis Jiroveci Pneumonia • Can be very toxic • RCP administering must use barrier precautions

  10. Antituberculosis Drugs • Isoniazid (INH) • Usually given orally for 9 months • Rifampin – also oral for 9 months • Patients may also need Streptomycin, Ethambutol, or Pyrazinamide • Patient compliance is a real problem! • These drugs can also be damaging to the liver

  11. Respiratory Depressants • Usually used to “control” respiration in mechanically ventilated patients • CNS Depressants – Narcotics (Morphine, Heroin) and Barbiturates (Seconal, Nebutal) • Paralyzing agents • Succinylcholine (Anectine) – short acting: usually used for intubations • D-Tubocurare (Curare): long lasting but may cause hypotension and histamine release (reversed by Neostigmine) • Pancuronium Bromide (Pavulon) – no histamine release • Vecuronium Bromide (Norcuron) – like Pavulon

  12. Respiratory Stimulants • Usually used for drug overdose and/or post-op anesthesia depression • May also be tried short term with COPD • Doxapram (Dopram) • Naloxone (Narcan) – narcotic antagonist • Progesterone – female hormone that stimulates respiration but may have a lot of side effects

  13. Antiviral Drugs • Ribavirin (Virazole) • Used for RSV (Respiratory Syncytial Virus) • Aerosolized via SPAG • HIV Drugs: Zidovudine (AZT), Didanosine (DDI)

  14. Nitric Oxide – A Magic Bullet? • Also known as EDRF – Endothelium derived relaxing factor, a naturally-occurring vasodilator • When inhaled, it quickly dilates pulmonary arteries without causing systemic vasodilation • Improves V/Q • Very precise dosing: 4-25 PPM

  15. Iloprost • Brand: Ventavis • Aerosolized for Pulmonary Hypertension in adults • Is a stable analogue of PGI2 (a natural prostaglandin that is a vasodilator) • Unit does for aerosol: 20mcq/2ml • Duration: 1-2 hours

  16. The End!

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