Exam number 2 Review for Pharm

When should mucolytic agents be given in relation to the other aerosolized medications that the patients are on such as albuterol?

Give the bronchodilator first then give the mucolytic agent.

What should you follow up with after giving a mucolytic agent?

CPT/ACT (Chest Physical Therapy/Airway Clearance Therapy)

Acetylcistine (Mucomyst) comes in what percent?

10% and 20%

How often do we give Dornase Alfa

Q day (once a day)

What are the four components of mucus?

viscosity, elasticity, cohesivity, adhesivity

In a healthy patient, if the viscosity is low then the elasticity is what?

High, and those are inversely related. If the patient is sick, then it may be different.

What mucolytic drug is given to patients with CF (Cystic Fibrosis)

Dornase Alfa (Pulmozyme)

What is the over-the-counter drug that can be purchased for stuffy nose, allergies, etc. and is it a mucolytic or expectorant?

Muscinex, it is an expectorant

What does ACT stand for?

Airway Clearance Therapy

If the patient is getting mucolytics, should they also be getting ACT?

Yes

What are some Airway Clearance Therapies?

Exercise

manual percussion

flutter device

vest therapy

cough

insufflation/exsufflation (manual cough; positive pressure in, negative pressure out)

After giving medication like a mucolytic, beta-2 agonist, anticholinergic to a patient should they be instructed to cough afterwards?

Yes, and if they refuse to cough/can't cough let them know suctioning is needed.

What is cough assist, and what does it use?

Insufflation and exsufflation, it uses positive and negative pressure to simulate a cough.

When doing airway clearance therapy and mucolytic agent therapy, is it helpful to do PFT testing afterwards?

No, you won't get much change afterwards and it makes the patient work harder.

What part of the body makes steroids?

adrenal cortex

What area of the adrenal gland makes epinepherine?

adrenal medulla

Where are your corticosteroids produced in the body?

outer zone of the cortex

How can you give flovent?

MDI and DPI (not aerosolized)

What way do glucocorticoids affect the body?

They aid in Anti-inflammatory towards allergies, asthma, etc.

What is the stress hormone called?

cortisol

What rhythm does cortisol follow?

circadian rhythm

When is cortisol highest?

8 in the morning

What are some side effects of inhaled steroids?

Thrush

can cause major eye problems (eyes should be covered)

hypertension

increased appetite

mood changes

If steroids are given via MDI what can be done to decrease side effects but increase the effects?

use a holding chamber and have a good breath hold

In regard to treating asthma steroids are what type?

Primary treatment towards asthma

What is a prophylactic drug that we use for asthma?

cromolyn sodium

If a patient has reactive airway disease to outside allergens such as pollen what kind of asthma would that be called?

Extrinsic Asthma (external)

What is the dose of cromolyn sodium?

20 mg inhaled 4 times daily (SVN)

5.2 mg per actuation (spray) over-the-counter

What is a very common antileukotrienes?

montelukast (brand name: singular)

What is the dose of montelukast (singulair)?

10 mg tablet daily

What would we use to treat severe asthma?

monoclonal antibody

Pentamidine isethionate (NebuPent) is what kind of agent?

Anti-fungal

What is the dose of pentamidine isethionate (NebuPent)?

300 mg of powder in 6 mg of sterile water; 300 mg is given once every 4 weeks

What is pentamidine isethionate (NebuPent) used to treat?

PCP prophylaxis/ HIV/ AIDS

Is Ribavirin ( Virazole) expensive?

Yes

What kind of stain is in CF patients and what is the specific bacteria called?

Gram-Negative stain, the bacteria is called Pseudomonas

What is the dose of Ribavirin (virazole) given in the SPAG?

20 mg/mL solution that is administered 12-18 hours a day for at least 3 days.

What is SPAG?

Small Particle Aerosolized Generator (a special type of nebulizer)

If a patient is bradycardic, what type of drug would you recommend?

A sympathomimetic agent

What does the somatic portion of the nervous system control?

Motor neurons/ voluntary motor functions

What are drugs that block acetylcholine receptors called?

anticholinergics

Adrenergic Bronchodilators mimic what receptors?

Beta-2 receptors

What are some examples of adrenergic bronchodilaotrs

SABA: Albuterol (ProAir HFA), Levalbuterol (Xopenex)

LABA: salmeterol (Serevent Diskus), formoterol (Perforomist), arformoterol (Brovana), Olodaterol (Stiverdi Respimat)

Racemic Epinephrine (Asthmanerfrin) comes in what solution?

2.25% Solution (SVN)

What do we give Racemic epinephrin for?

Stridor

Where do you hear stridor?

in the neck

What is a side effect of Anticholinergics?

Dry mouth