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 11,000

• 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 11,000

• 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
• DosageINHALATION 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
• IndicationsSevere anaphylaxis, Asthma, COPD
• ContraindicationsNone 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
• ActionsSkeletal muscle relaxant, paralyzes
  muscles including respiratory muscles
• IndicationsTo 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.

28
?