11-17-25 kopp

Respiratory Drugs and Therapies Notes

Overview of Smoking and Inhalation Therapies

  • A discussion about smoking habits, where one individual has not smoked for approximately nine years.
  • Mention of Advair, an asthma medication, introduced in 2002.
  • Description of Advair's delivery device:
    • Purple Diskus used to administer dry powder inhalers (DPIs).
    • No spacer required; patients should breathe in the powder.

Nitric Oxide (NO)

  • Definition: Nitric oxide (NO) is a gas naturally present in the atmosphere.
  • Clinical use involves delivery in small concentrations (parts per million; starting dose is 20 ppm).
  • Historical context:
    • Initially provided exclusively by the company INOMAX using large tanks and delivery units.
  • Mechanism of action:
    • Induces pulmonary artery vasodilation, selectively affecting only the pulmonary artery,
    • Helps in cases of neonatal Persistent Pulmonary Hypertension (PPHN) and adult right ventricular failure.
  • Administrations in adults:
    • Useful for those experiencing right ventricular failure, often secondary to chronic diseases causing low oxygen levels (e.g., chronic bronchitis).
  • FDA approval: Granted for neonatal PPHN and right ventricular failure only.
  • Mention of cases during the COVID-19 pandemic where it was used off-label for ARDS, but no definitive evidence supports its effectiveness in that condition.
  • Shift from INOMAX monopoly due to patent expiration leading to competition (e.g., Vero Biotech).
  • Vero Biotech's delivery system:
    • Utilizes a cartridge-based method for nitric oxide concentration from atmospheric air.
  • Safety Concerns:
    • Nitric oxide is corrosive; it requires an evacuation line to prevent degradation of equipment.
    • Potential effects on tubing due to its corrosiveness.

Comparison with Heliox

  • Heliox is a mixture of helium and oxygen used primarily in upper airway obstruction cases:
    • Characteristics: Lighter than air, improving ease of breathing.
    • Dilution factors include:
    • Concentrations: 80/20, 70/30, 60/40 (heavier mixes yield less effectiveness).
  • Medical application details:
    • Administration through rebreather masks or specific ventilators capable of integrating Heliox.
  • Discussion of potential complications and dosages in therapeutic settings.

Key Clinical Questions

  • The importance of asking about the availability of specific therapeutic gases (e.g., Heliox) in various hospitals.
  • Safety measures regarding storage and handling of oxygen tanks.

Drugs for Respiratory Therapy

  • Racemic Epinephrine (Vaponephrine):
    • Primarily used for:
    • Post-extubation airway edema;
    • Stridor and upper airway obstruction, especially in pediatric patients.
    • Mechanism: Alpha-adrenergic effects leading to vasoconstriction and reduced mucosal swelling.
    • Side effects include tachycardia, possible rebound effects, and prolonged airway assessment post-treatment.

Emergency Medication Administration via Endotracheal Tube

  • NAval (Narcan, Atropine, Vasopressin, Epinephrine, Lidocaine): Types of medications administered through an endotracheal tube when IV access is not available.
    • Narcan (Naloxone): Opioid antagonist for cases of opioid overdose. Can be administered via ET tube if IV access fails.
    • Atropine: Anticholinergic agent for bradycardia, raises heart rate by blocking parasympathetic activity.
    • Epinephrine: Main resuscitation drug during cardiac arrest administered through ET tube.
    • Lidocaine: An antiarrhythmic, also used in bronchospastic patients to numb airways.

Sedation Agents List for Intubation

  • Etomidate: Quick-acting sedative used in pre-intubation phases.
  • Ketamine: Sedative with dissociative properties.
  • Propofol (Diprovan): Commonly used sedative for intubated patients, suppressing respiratory drive but metabolized quickly.
    • Risks associated with overdose during sedation.
  • Versed (Lorazepam): An amnesic that reduces anxiety pre-procedure.
  • Prasinex (Dexmedetomidine): Another sedative affecting respiratory function, used in agitated patients, also a potential respiratory suppressor.

Intubation Protocols

  • Importance of maintaining oxygenation prior to intubation with high-flow systems or bag-mask ventilation.
  • Objective to maximize oxygen availability before administering paralytics necessary for intubation.
  • Additional insights on managing patients throughout their intubation journey based on specific drugs and their pharmacodynamics.

Conclusion and Implications

  • Overview of major and minor respiratory drugs along with specific protocols for emergency scenarios and sedation practices.
  • Highlighting the necessity of proper administration routes and meticulous safety measures in respiratory therapy settings.