Pulmonary Medications

Metered Dose Inhalers (not a med)

-Small/Hand held

- Inhale prior to administering

-Measured dose with each puff

- Hand coordination required

- 10% reaches lung

- 80% hits oropharynx

Dry powder inhalers

- Dry powder into lungs

- no hand lung coordination

- 20% gets into lungs

Spacers (not a med)

- increases drug delivery to lungs

- used with corticosteroids

Nebulizers

- converts liquid into mist

- face mask used

- delivered over several minutes

Beclamethosone (Vancenase)

Bedesonide (Pulmicort)

Fluticasone (Flovent) Flonase

Solumerdrol

Solucortef

Mometasone (Nasonex)

Triamcinolone (Nasocort)

Glucocorticoids

Beclamethosone (Vancenase) Inhale

Bedesonide (Pulmicort) Inhale

Fluticasone (Flovent) Flonase- Inhale

Solumerdrol (IV)

Solucortef (IV)

Mometasone (Nasonex) -Nasal

Triamcinolone (Nasocort) -Nasal

Use:

- Antiasthma

- 1st line of use for asthma

- Given prophylactically

Indication

- Asthma, COPD
-Emphysema

Patho

- Decreases edema and mucus production

- Given prophylactically

Side Effects

*only applicable for chronic use

adrenal suppression, bone loss, hoarseness, difficulty speaking, hyperglycemia, dry nasal mucosa, sore throat, epistaxis

*Provide bronchodilator before inhaled corticosteroid

Results

2-8 days/4-6 weeks

Zileuton (Zyflo)

Montelukast (Singuliar)

Leukotriene Modifiers- modifies compounds that promote bronchoconstriction, inflammation, mucous production, and edema

Zyflo

- blocks leukotriene synthesis

- hepatotoxic

- Increases Warfarin levels

-Monitor ALT
blocks leukotriene synthesis; used for adults and children >12 yrs; hepatotoxic, monitor ALT, competes with theophylline, coumadin (increases drug levels)*

Singuliar

- Blocks leukotriene receptor

- use prophylactically and for maintenance

- prevention of exercise induced bronchospasm

- relief of allergic rhinitis

- Not toxic

Beta 2 Adrenergic Agonist

Short Acting:

Albuterol

Xopenex

Long Acting:

Servant

- Provides symptomatic relief but does not address underlying cause

Uses

- acute bronchospasm

Patho

- Causes broncho dilation in smooth muscle of lungs

- Suppresses histamine release

Short Term

- aborts an acute attack

- Available as inhalers/nebs

-Allbuterol causes tachycardia

- Xopenex use with tachycardia pts.

Long Term

- inhalation q12

- often used with steroid

SE:

-angina

-Tremor

Ipratropium (Atrovent)

Tiotropium (Spiriva)

Anticholinergic

- Block muscarinic receptors in bronchi causing dilation

Uses

- COPD, Asthma

Atrovent (Inhale)

- onset 30 sec

- causes dry mouth, irritation of pharynx

- 10% have anaphylaxis

- Can combine with albuterol for duoNeb

Spiriva (DPI)

- long acting

- take 1x daily

- causes dry mouth

- greatest benefits when used with Beta 2

Chlorpheniramine (Chlor-Trimeton)

Diphenhydramine (Benedryl)

Clemastine (Tavist)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

Lordatadine (Claritin)

Oral Antihistamines

- Relieves runny nose, sneezing, and itching

- Take of regular basis

1st Gen Side effects

- sedation, dry mouth, urinary hesitancy, constipation

2nd generation

- No sedation

- Minimal side effects

Oral Antihistamines

1st generation

Chlorpheniramine (Chlor-Trimeton)

Diphenhydramine (Benedryl)

Clemastine (Tavist)

- Relieves runny nose, sneezing, and itching

- Take of regular basis

1st Gen Side effects

- sedation, dry mouth, urinary hesitancy, constipation

Oral Antihistamines

2nd Generation

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

Lordatadine (Claritin)

- Relieves runny nose, sneezing, and itching

- Take of regular basis

2nd generation

- No sedation

- Minimal side effects

Phenylephrine (Neosynephrine)

Pseudoephedrine (Sudafed)

Oxymetazoline (Dristan)

Decongestants - decrease nasal congestion by vasoconstricting swollen membranes

Uses

- allergic rhinitis to relieve stuffiness, decrease congestion

Side Effects

- rebound congestion, CNS excitation, restlessness, anxiety, systemic vasoconstriction

*Watch <3 patients INCREASES BP

- may need to use with steroid

Sudafed

- can be converted to methamphetamine; no more than 9g/month

Codeine

Dextromethorphan

Antitussive

** used with nonproductive cough in the absense of wheezing**

Codeine

- decreases frequency and intensity of cough

- potential for abuse

Dextromethorphan

- non opiod

- can cause euphoria in high doses

-can be abused

Guaifenesin (Mucinex)

Expectorants and Mucolytics

- stimulates flow of secretion and breaks up mucous

- often combined with pseudoephedrine

(Mucinex D)

Term: bactericidal

kills bacteria

Term: bacteriostatic

slows bacterial growth; allows body to mount immune response

Prevention of Resistance

1. Vaccinate

2. D/C invasion lines

3. Culture + Sensitivity

4. Infectious Disease

5. Antimicrobial control

6. Treat bacteria NOT colonization

7. Stop treatment when infection cured

Penicillins

Penicillin G

Piperacillin (Pipracil)

Piperacillin/tazobactam (Zosyn)

Amoxicillin/clavilante (Augumentin)

- bactericidal

- bind to receptor cite on bacterial cell and tears down cell wall

Penicillin G

- active against gram +

- Given IM/IV

- Can produce severe reaction

Piperacillin (Pipracil)

- Broad spectrum

- IV

- decrease dose of impaired renal function

Zosyn

- similar to beta lactamase inhibitor

- prevents enzyme from breaking down Abx

Augmentin

- Contains beta lactamase inhibitor

- given PO

- Can cause rash and diarrhea

*Watch out of PCN allergy

*MRSA resistant to PCN

Cephalosporins

Cefazolin

Cefprozil (Cefzil)

Cefuroxime (Ceftin)

Cefriaxone (Rocephin)

Cefepime (Maxipime)

*1st/2nd gen often used prophylactically

1st) Cefazolin

- given Im/IV

2nd) Cefprozil (Cefzil) / Cefuroxime (Ceftin)

- given PO

3rd) Cefriaxone (Rocephin)

- given IM/IV

- do NOT mix with calcium

4rd) Cefepime (Maxipime)

- given IM/IV

Side Effects

- Hypersensitivity

- Rash, risk of bleeding (interferes with vit K), thrombophlebitis

*Watch for cross sensitivity with PCN

Imipenem (Cilastatin)

Meropenem (Merrem)

Carapenems

- last resort

- Beta lactamase Abx

- able to penetrate gram (-) outer membrane

Pharm

- penetrates CSF, elimination by renal

Side Effects

- diarrhea, hypersensitivity, N/V

Imipenem/Cilastatin:  Cilastatin inhibits destruction of imipenem by renal enzymes

Vancomycin

- reserved for serious infections

- inhibits cell wall synthesis

- dos NOT interact with PCN binding proteins

- given IV

- resistance to VRE

- - monitor troughs/peaks

Side Effects

- nephrotoxic

-ototoxic

- red man syndrome, flushing, tachycardia, hypo, rash --- slow down infusion to avoid

Tetracyclines

Tetracycline (Sumycin)

Doxycycline (Vibramycin)

- suppresses bacterial growth by inhibiting protein synthesis

Uses

- Chlamydia

-Lymes disease

- H.plylori

**do not give with calcium products or iron bc with discolor teeth

Tetracycline (Sumycin)

- take on empty stomach

- eliminated by kidneys

- avoid with renal failure

Doxycycline (Vibramycin)

- can take with food

- eliminated by liver

- Ok to use with renal failure

Clindamycin (Cleocin)

- active against gram + and (-) by inhibiting protein synthesis

- Bacteriostatic

Use

- Group A strep

Side effects

- CDiff

-Abd pain, fever

- leukocytosis

Fluoroquiolones

Ciprofloxacin (Cipro)

Levofloxacin (Levaquin)

Ciprofloxacin (Cipro)

Fluroquiolones

- disrupts DNA replication and cell division

Uses

- respiratory, GI, bone, joints, soft tissue infection

Side Effects:

- tendon rupture

- CNS dizziness/confusion

- Phototoxicity

- Decreases absorption with Al. Mg, Ca, Fe, and dairy products

Levofloxacin (Levaquin)

Fluroquiolones

- disrupts DNA replication and cell division

Uses

- respiratory, GI, bone, joints, soft tissue infection

Side Effects:

- tendon rupture

- CNS dizziness/confusion

- Phototoxicity

- Decreases absorption with Al. Mg, Ca, Fe, and dairy products

Metronidazole (Flagyl)

Antibacterial/protozoal

- breaks down DNA in cells

Uses

- Cdiff, abd sx, vaginal sx, H.Pylori

Side Effects

- Nausea, Headache

- Dry mouth

- Dark urine

*Avoid alcohol

*May need to decrease Warfarin dose

Azoles

Introconazole (Sporomax)

Fluconazole (Diflucan)

Voriconazole (Vfend)

Antifungal

- increases membrane permeability

Uses

- blastomycosis, histoplasmosis, candidiasis

Side Effects

- Cardio suppression, liver injury

*Use cautiously with cardiac and liver pt's

Introconazole (Sporomax)

- take with food

- do NOT take with antacids

Introconazole (Sporomax)

Introconazole (Sporomax)

Antifungal

- increases membrane permeability

Uses

- blastomycosis, histoplasmosis, candidiasis

Side Effects

- Cardio suppression, liver injury

*Use cautiously with cardiac and liver pt's

Introconazole (Sporomax)

- take with food

- do NOT take with antacids

Fluconazole (Diflucan)

Fluconazole (Diflucan)

Antifungal

- increases membrane permeability

Uses

- blastomycosis, histoplasmosis, candidiasis

Side Effects

- Cardio suppression, liver injury

*Use cautiously with cardiac and liver pt's

Voriconazole (Vfend)

Voriconazole (Vfend)

Antifungal

- increases membrane permeability

Uses

- blastomycosis, histoplasmosis, candidiasis

Side Effects

- Cardio suppression, liver injury

*Use cautiously with cardiac and liver pt's

TB Meds

Isoniazid (INH)

Rifapentine (RPT)

Moxifloxacin (MOX)

Pyrazinamide (PZA)

TB Meds

Isoniazid (INH)

Rifapentine (RPT)

Moxifloxacin (MOX)

Pyrazinamide (PZA)

Treatment is at least 6m on all 4 meds

Isoniazid (INH)

- bactericidal for active organisms

- Can cause liver damage, peripheral neuropathy =

take w/ Vitamin B6 to prevent Neuropathy
- excreted by kidneys

Rifapentine (RPT)

- Antibiotic used for active or latent TB

- interacts with birth control, do NOT breast feed

- May cause yellow/brown discoloration of body fluids

Moxifloxacin (MOX)

- antibiotic for active TB

- increased risk of tendonitis or ruptured tendon

- risk of peripheral neuropathy

Pyrazinamide (PZA)

- bactericidal to TB

- Hepatotoxic

- Increases uric acid, inhibits excretion

Acyclovir (Zovirax)

- only active against herpes virus family

- decreases synthesis of viral DNA

Uses

- Chicken pox

- Herpes

-Shingles

IV: phlebitis, nephrotoxic

PO: N/V/D, NOT nephrotoxic