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Respiratory Pharmacology

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Simple Face Mask 6-12 liters per minute. 40% to 60% FiO2 ... MUST SNOW UNDER FIRST using valium, versed, fentanyl, MS etc. Ken ... – PowerPoint PPT presentation

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Title: 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
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