Title: Anti-Infective Agents Cholinergics Surface Tension Reducing Agents Nicotine Replacement Therapy
1Anti-Infective AgentsCholinergicsSurface
Tension Reducing AgentsNicotine Replacement
Therapy
2Topics for Discussion
- Anti-infective agents
- Antibacterial
- Antitubercular
- Antiviral
- Antifungal
- Antiprotozoal
- Parasympathomimetics (cholinergics)
- Surfactant Agents
- Nicotine Replacement Therapy
3Terminology
- Antibiotic Substance that kills microorganism
growth. - Pathogen Disease causing microorganism.
- Empiric Therapy that is started based upon on
experience and precedent in the observation and
treatment of disease. - Normal flora Organisms found in various parts of
the body living symbiotically. - Aerobic Requires oxygen to survive.
- Anaerobic Does not require oxygen to survive.
4Terminology
- Gram Stain Laboratory test used to determine if
an organism is gram-positive or gram-negative. - C S Culture and sensitivity. Determines the
organism present in the culture and the
antibiotic to which it is sensitive (susceptible
to). - Bacteriostatic Inhibits replication of
microorganisms and prevents growth. Does not
kill bacteria. - Bacteriocidal Kills the bacteria.
- Broad spectrum vs. Narrow spectrum
5Classes of Anti-infective Agents
6Classes of Antibiotics
7Antibiotics
- Beta Lactams
- penicillins
- cephalosporins (4 generations)
- Broader coverage with each generation.
- Aminoglycosides
- tobramycin
- Vancomycin
- MRSA
- Protein Synthesis Inhibitors
- macrolides
- tetracyclines
- Folate Inhibitors
- metronidazole
8tobramycin
- Antibiotic used to treat pneumonias associated
with cystic fibrosis (p. 286). - Pseudomonas aeruginosa
- Trade Name is Tobi
- Dosage
- 300 mg/5 mL unit dose vial
- Give one vial BID
- 28 days on, 28 days off
- Very viscous solution
- Administer a bronchodilator prior to giving Tobi.
- Bronchospasm common side-effect.
9Pari LC Plus Nebulizer
- Tobi needs to be delivered with Pari LC Plus
nebulizer - Flowrates should be set at 10 12 L/min
10colistimethate
- Brand Name Colymycin, Colistin
- Alterative to Tobi in drug-resistant strains of
Pseudomonas. - From a group of antibiotics known as polymyxins
and is similar to polymyxin B. - Supplied as a powder that needs to be
reconstituted. - Has been identified to produce bronchospasm in
some patients. - May require pre-treatment with a bronchodilator.
- Dose
- Children less than 2 years of age 1 MU twice
daily. - Children older than 2 years of age adults 2 MU
twice daily
11Antibiotics and Pneumonias
Page 281
12Anti-Viral Agents
- A virus is an obligate parasite.
- Kill the organism, risk killing the host.
- RNA Viruses
- Influenza
- Polio
- HIV
- Rabies
- Encephalitis
- DNA
- Adenovirus Respiratory Disease
- Papilloma warts
- Herpes Simplex
- Epstein-Barr Mononucleosis
13Anti-Viral Agents
- Anti-Prototozoal Agents
- pentamidine
- Used to treat Pneumocystis carinii pneumonia
(PCP) Organism may be a virus, may be a
protozoa. - Anti-viral Agents
- ribavirin
- Used to treat Respiratory Syncytial Virus
14ribavirin
- Trade Name Virazole
- Antiviral Drug given with SPAG nebulizer
- Used to treat Respiratory Syncytial Virus (RSV),
influenza A and B and herpes simplex - Bronchiolitis and pneumonia.
- RSV virus affects all children by age 3.
- Use of ribavirin has decreased dramatically over
the past 5 years.
15(No Transcript)
16Environmental Exposure
- In animal studies, ribavirin has been found to be
- Mutagenic
- Carcinogenic
- Teratogenic
- Embryocidal
- Pregnant women or women thinking of becoming
pregnant should avoid exposure
17ribavirin
- American Academy of Pediatrics recommends
ribavirin to ONLY be given for children with RSV
and - Congenital Heart Disease
- Bronchopulmonary Dysplasia
- Immunodeficient patients (cancers, AIDS,
malnutrition) - Infants requiring mechanical ventilation
- Premature infants or infants less than 6 weeks
18RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN
INTRAVENOUS RSV-IGIV (1996)
- Trade Name RespiGam
- Indications
- Indicated for the prevention of serious lower
respiratory tract infection with RSV in children
under 24 months of age. - RSV-IGIV is a sterile liquid formulation of
immunoglobulin G (IgG) containing antibody to RSV
- Administration is by IV
19RSV Virus
- Supportive Care
- Hydration
- Oxygen
- Bronchodilators
- Most Commonly seen in Winter Months
- November March
- Handwashing is the most effective way to
interrupt the spread of RSV
20Anti-Fungal Infections
- Fungi include mushrooms, yeasts molds.
- Fungal infections occur in immunocompromised
patients. - Common examples include athlete's foot, ringworm.
- Histoplasmosis capsulatum, Aspergillosis,
Blastomycosis, Candida albicans (oral thrush). - Key agents
- amphotericin B
- nystatin
- IV administration. Given experimentally by
aerosol. - No approval from FDA
21NON-AEROSOLIZED ANTI-INFECTIVE DRUGS
ANTI-TUBERCULOSIS AGENTS
- The standard approach to treating tuberculosis
(TB) today consists of multiple first line drugs
for a period of either 6 or 9 months. - First line drugs are
- Rifapentine
- Isoniazid
- Rifampin
- Ethambutol
- Pyrazinamide
- Streptomycin used to be a front-line drug, but
has been replaced by Rifapentine.
22NON-AEROSOLIZED ANTI-INFECTIVE DRUGS
ANTI-TUBERCULOSIS AGENTS
- 9 Month approach
- Isoniazid and Rifampin are given for 9 months and
in an initial 2 to 8 week period these two drugs
are supplemented with one of the other first line
drugs. - 6 Month approach
- Four drugs are used for 2 months followed by 4
months of Isoniazid and Rifampin. - There is an association of TB and HIV infection.
- Along with the disturbing increase in the number
of TB cases in conjunction with AIDS, there has
been an emergence of drug resistant strains of
TB. The cure rate is poor in this subset.
23lidocaine
- Trade Name Xylocaine
- Effect Anesthetic
- Indications
- Aerosolized prior to bronchoscopy
- Topically as nasal spray/jelly prior to
intubations - Anesthetize area prior to chest tube insertion,
(thoracentesis)
24lidocaine
- Dosage for nebulization Use SVN
- 2 solution 20 mg/mL 3-7 mL total volume
- 4 solution 40 mg/mL 3-7 mL total volume
- Nasal Spray
- 2 solution
- Jelly for lubricating ET tubes
- 2
25Nicotine Replacement Therapy
- What
- Nicotine Replacement Therapy should be used as
part of a comprehensive smoking cessation
program. - Why
- Smoking kills 440,000 Americans each year and
debilitates ½ of all long-term smokers. - Tobacco dependence is a powerful addiction.
- Tobacco relapses are high (5 attempts?).
- Who
- Fagerstrom Test for Nicotine Dependence.
- Figure 13-4, Page 256
- When
- Best time is when they are in the hospital.
26Nicotine Replacement Therapy
- Nicotine Transdermal System
- Habitrol
- Nicoderm
- Nicotrol
- ProStep
- Nicotine Gum
- Nicorette
- Nicotine Nasal Spray
- Nicotrol
- Other (Non-NRT)
- bupropion (Zyban, Wellbutrin)
- Vareniciline (Chantix)
27Nicotine Replacement Therapy
- Nicotine stimulates the cholinergic receptor site
- Nicotinic Receptor Sites
- Autonomic and Somatic Nervous System
- Involuntary and voluntary skeletal muscle systems
- Nicotine directly affects brain cells
- Increases alertness
- Euphoria
- Cognitive performance
28Other Agents
- bupropion (Zyban, Wellbutrin)
- Antidepressant usually used to treat major
depressive disorders and season affective
disorders. - Also decreases urge to smoke mechanism is
unclear. - vareniciline (Chantix)
- Mechanism of action is to partially block the
a4-b2 nicotinic receptor in the brain. - Within 10 to 20 seconds of a single puff from a
cigarette, nicotine attaches to this receptor. - The receptor, in turn, triggers large increases
in dopamine, which rewards the smoker with a
pleasurable sensation.
29Nicotine Replacement Therapy
- Precautions/Instructions
- Replacement formulas DO contain nicotine.
- Side effects can occur if using replacement
formulas with tobacco. - Transference of nicotine dependency can occur.
- Replacement formulas should be gradually
withdrawn and stopped within 3 months. - HCW should avoid handling nicotine products.
- varenicline and bupropion Mood swings even after
drug has been stopped some instances of suicide
ideation have been associated with Chantix. - Questionable whether Chantix had direct influence
or not.
30(No Transcript)
31methacholine
- Trade Name Provocholine
- Used in Pulmonary Function Lab
- Methacholine Challenge Test
- Bronchoprovocation Test
- Used to test for hypersensitive airways
- Parasympathomimetic
- Induces bronchospasm
32methacholine Challenge Test
- Used for patients with normal pulmonary functions
- Chronic cough
- Recurrent respiratory infections
- History of wheezing
- Have crash cart in the room
- Be prepared to administer a fast acting
bronchodilator (metaproterenol)
33Surfactant Agents
- Ethyl Alcohol
- Used in the treatment of pulmonary edema
- Alcohol breaks the bubbles and decreases the
surface tension of the exudate - Lack of approved clinical use
- Efficacy is not well established
- Dosage 30 50 3-5 mL of a 40 solution by
aerosol or direct instillation down ET tube
34Exogenous Surfactants
- Natural Surfactants
- Surfactants from natural sources with addition or
removal of certain molecules - Survanta, Calfactant, Poractant Alfa
- Artificial Surfactants
- Surfaxin (?)
- Synthetic Natural genetic engineering cloning
gene of natural surfactant - None present
35Beractant
- Trade Name Survanta (1991)
- Mixture of bovine (cow) lung extract to which
DPPC (lecithin) has been added - Watch ventilator settings after administration
- O2 can increase, over-ventilation, hypocarbia
- Administered down ET tube
36New Surfactants
- Calfactant (Infasurf)
- Bovine Extract
- Poractant Alfa (Curosurf)
- Porcine Extract