Respiratory Pharmacology

1. Respiratory Pharmacology Ken Corn, NREMT-P

2. Treatment Aimed at Relief of Symptoms Gases Beta Agonists Xanthines Anticholinergics Corticosteroids Neuromuscular Blockers

3. Gases Oxygen - O2 Decreases hypoxia Reduces the volume of respiration needed Reduces myocardial oxygen demand NO CONTRA-INDICATIONS

4. Oxygen Nasal Cannula 1-6 liters per minute 24% to 44% FiO2 Simple Face Mask 6-12 liters per minute 40% to 60% FiO2 Nonrebreather Mask 8-12 liters per minute 80% to 100% FiO2 Venturi Mask adjustable FiO2 concentrations

5. Beta Stimulants Epinephrine Albuterol Isoethraine Metaproterenol Trebutaline Racemic Epinephrine

6. Epinephrine 1:1,000 Class: Sympathomimetic Actions: Alpha, Beta 1 & Beta 2 Indications: Asthma and reversible bronchospasm in allergic reactions Contraindications: Should be used with caution in cardiac patients or tachycardias

7. Epinephrine 1:1,000 Precautions: Protect from light Side Effects: Palpitations, anxiety, tremors, nausea and vomiting Dosage: 0.3-0.5 mg SubQ All that wheezes is not asthma and all asthma does not wheeze!!

8. Albuterol, Proventil, Ventolin Class: Sympathomimetic Actions: Beta 2 selective Indications: Asthma and reversible bronchospasm in COPD Contraindications: Should be used with caution in cardiac patients or tachycardias

9. Albuterol, Proventil, Ventolin Precautions: Pulse, EKG and BP must be monitored Side Effects: Palpitations, anxiety, dizziness, tremors, sweating, headache Dosage: 1-2 metered sprays (90mcg each) 2.5 mg in 2.5 ml NS over 15-20 minutes nebulized

10. Isoetharine, Bronkosol Class: Sympathomimetic Actions: Beta 2 selective, increases heart rate Indications: Asthma and reversible bronchospasm in COPD Contraindications: Should be used with caution in cardiac patients or tachycardiac rhythms

11. Isoetharine, Bronkosol Precautions: Pulse, EKG and BP must be monitored Side Effects: Palpitations, anxiety, dizziness, tremors, sweating, headache Dosage: 0.25-0.5ml in 4ml NS over 15 minutes nebulized

12. Metaproterenol, Alupent Class: Sympathomimetic Actions: Beta 2 selective, increases heart rate Indications: Asthma and reversible bronchospasm in COPD Contraindications: Tachycardiac rhythms or significant cardiac history

13. Metaproterenol, Alupent Precautions: Pulse, EKG and BP must be monitored Side Effects: Palpitations, anxiety, dizziness, tremors, sweating, headache Dosage: 0.05-0.3ml in 4ml NS over 15 minutes nebulized

14. Terbutaline, Brethine Class: Sympathomimetic Actions: Bronchodilation, increases heart rate, stops pre-term labor Indications: Asthma and reversible bronchospasm in COPD, pre-term labor Contraindications: Tachycardiac rhythms or significant cardiac history

15. Terbutaline, Brethine Precautions: Pulse, EKG and BP must be monitored Side Effects: Palpitations, anxiety, dizziness, tremors, sweating, headache Dosage: 2 Inhalations, 1 min apart, 0.25 mg SubQ, IV for pre-term labor

16. Racemic Epinephrine Class: Sympathomimetic Actions: Bronchodilation, increases heart rate Indications: Croup, asthma Contraindications: Epiglottitis Precautions: Pulse, EKG and BP must be monitored, used only once pre-hospital, REBOUND worsening, not shelf stable

17. Racemic Epinephrine Side Effects: Palpitations, anxiety, dizziness, tremors, sweating, headache Dosage:INHALATION ONLY!!!!!! 0.25-0.75 ml 2.25% solution in 2 ml NS, nebulized DO NOT INJECT CAUSES SEVERE TACHYCARDIA AND DEATH

18. Aminophylline Class: Xanthine bronchodilator Actions: Bronchodilation, smooth muscle relaxant, mild diuretic, increases heart rate Indications: Asthma and reversible bronchospasm in COPD, CHF, Pulmonary eduma Contraindications: Hypotension, peptic ulcer disease

19. Aminophylline Precautions: Pulse, EKG and BP must be monitored, do not administer to patients taking Theophylline without blood levels Side Effects: Palpitations, anxiety, dizziness, tremors, seizures, tachycardia and PVCs Dosage: 6mg/kg in 100 ml NS over 20 minutes

20. Atrovent Class: Anticholinergic Actions: Blocks acetycholine receptors, increases heart rate Indications: Bronchospasm in emphysema and bronchitis, may help acute asthma Contraindications: Allergies to soya lecithin, peanuts or related foods

21. Atrovent Precautions: Avoid eyes, prostate hypertrophy Side Effects: Exacerbation of symptoms, cough, anxiety, dizziness, GI upset, palpatations, headache, rash Dosage: 2.5 ml vial in NS or with Alupent, nebulized over 10 minutes

22. Methlprednisolone, Solu-Medrol Class: Steroid Actions: Anti-inflammatory, suppresses immune response in allergies Indications:Severe anaphylaxis, Asthma, COPD Contraindications:None in the emergency setting

23. Methlprednisolone, Solu-Medrol Precautions: Must be reconstitued for use, may take 2-6 hours for onset of action Side Effects: GI bleeding, prolonged wound healing, suppression of natural steroids, bad for diabetics Dosage: 125 mg IV push

24. Neuromuscular Blockers Used for RSI Succinylcholine Vecuronium Pancuronium MUST SNOW UNDER FIRST

25. Neuromuscular Blockers Class: Neuromuscular blocking agents Actions:Skeletal muscle relaxant, paralyzes muscles including respiratory muscles Indications:To achieve paralysis for intubation Contraindications: None in the emergency setting, known hypersenitivity

26. Neuromuscular Blockers Precautions: May not be given if intubation is not possible, paralysis occurs in minutes and lasts from 6-60 minutes depending on drug used Side Effects: Prolonged paralysis, Hypotension, bradycardia

27. Neuromuscular Blockers Succinylcholine 1-1.5 mg/kg lasts 8 minutes Vecuronium 0.08-0.1 mg/kg lasts 30 minutes Pancuronium 0.04-0.1 mg/kg lasts 20-40 minutes MUST SNOW UNDER FIRST using valium, versed, fentanyl, MS etc.

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