Phramocolgy

Refers to decrease in the diameter of the airways

• Bronchospasms
• Airway edema
• secretion

Is the actual spasm or contraction of the smooth muscle in the bronchial wall

Occurs when insult or injury to the mucous membranes causes dilation of the blood vessels and accumulation of fluids in the tissues

Administration of steriods to block the inflammatory response

• Sympathomimetrics (B-adrenergics)
• Anticholinergics (Parasympatholytics)
• Methylxanthines

Increasing Cyclic AMP

• A substance that causes bronchial smooth muscle relation by inactivationg an enzyme that initiates the interaction of actin and myosin
• Also decreases the amount of intracellular calcium and causes relation because calcium is needed for contraction
• Also inhibits mast cell chemical mediator release

decreasing cyclic GMP

Causes bronchial smooth constriction

stimulation causes bronchodilation and vasoconstriction in the pulmonary system

• Alpha 1
• Beta 1
• Beta 2

Stimulation results in vasoconstriction, which reduces blood flow and swelling

Stimulation will increase heart rate and contraction

Stimulation results in bronchial smooth muscle relation, inhibits the inflammatory response, and increased mucous clearance

Phoophodiesterase

• Catecholamines
• Resorcinols
• Saligenins

The longer the side chain, the more beta 2 specific

A catechol nucleus and an amine chain

• oldest grouip of bronchodilators
• The have rapid onset, but short duration of action, so the requrie frequent dosing
• May turn pink in color due to inactivation when exposed to heat, light and air

The COMT and MAO

• Epinephrine
• Norepinephrine
• Racemic epinephrine
• dopamine
• Isoproterenol
• Isoetharine
• Bitolterol
• Only isoetharine and bitolterol are aerolized as bronchodialtors because others have lots of cardiac side effects

• Has alpha and beta effects
• Used mostly for vasoconstrictor for treatment of airway edema associated with croup and laryngeal edema

• Modified catechol nucleus to be resistance to breakdown by COMT, thus its longer acting
• Can be taken orally
• First true maintence drug

• Metraproterenol
• Terbutaline

• Onset of action 5-15 min
• Peak effect 30 to 60 minutes, but its duration is 4-6 hours
• longer side chain makes it more beta 2 specific
• Many cardiac side effects

• Onset 5-15 min
• Peak 30-60 min
• Duration 4-6 hours
• Beta 2 selective with few cardiac side effects

• Modified catechol nucleus to be more beta 2 specific
• Rapid onset and a duration of 4-6 hours

• Albuterol (Ventolin)
• Levalbuterol (Xopenex)
• Sameterol (Serevent)

• Onset 15 min
• Peak 30 - 60 min
• duration 4-6 hours
• Very beta 2 specific, few side effects, long chain

• Onset 15 min
• Peak 30 - 60 min
• Duration 3-8 hours
• R isomer only
• More potent bronchodilator with less side effects

• Very long side chain with a 12 hour duration
• Maintence drug (prevention of bronshospasms)

Decreased response to a drug shortly after administration

Catecholamines, rescue

Resorcinols, rescue

Albuterol and bitolterol, rescue

Salmeterol and Formoterol, maintenance

• Weak beonchodilator
• Theophylline
• Aminophylline
• Theobromine
• Caffeine Citrate
• Given orally or IV

• Atropine sulfate
• Ipratropium Bromide (Atrovent)
• Tiotropium Bromide (Spiriva)

• Drying of secretion
• Increased heart rate
• Bronchodilation

• Increased heart rate
• GI effect are dry mouth and decrease gut mortility
• At small doses
• Restleness
• Irritability
• Fatigue
• drowsiness
• At high doses
• Hallucinations
• Coma
• Psychotic reactions

• onset in minutes
• Peak 1 - 2 hours
• Bronchodilator

• Little effect on heart rate, Blood pressure, or the GI tract
• Little or no effect on the mucous clearance
• Blocks M1, M2, and M3 receptors

• Long acting broncodilator, maintence for COPD
• Onset in 30 minutes
• Peak 3 hours
• Duration is 24 hours

• Dry mouth is the most common side effects
• only block M1 and M3 receptors
• Urinary retention, constipation, glaucoma, blurred vision
• Increased heart rate

• Increase strength and endurance of respiratory muscle contraction
• A diuretic
• Slow onset, long duration
• Can be affected by other meds
• metabolized differently by all people, thus toxicity can result

5 - 15 mcg/ml

Produce small amout of mucus in the airways

Produce less viscous mucus, which makes up the sol layer of the mucus

The role is not completely clear but are known  to have a high degee of metabolic activity and to contain a lot of enzymes

• Do not affect the mucus molecule directly, dilutes mucus by altering water content
• Irritates the airway which increases production of thin mucus and stimulates coughing

• SVN
• LVN
• Ultrasonic

• sterile water is free of microorganisms, but does not contain additives to make it bacteriostatic
• Distilled water is sterile and free of additives
• Distilled is more irritating to the airway
• Sterile water is hypotonic so it may thin mucus better than saline

It is less irritating than water

• Very irritating to the airway
• Mostly used for sputum induction or in CF
• More likely to cause bronchospasms thatn others, may need to pre treat with a bronchodilator

Less irritating than water or hypertonic saline and not likely to cause sodium retention as normal saline

Works by altering the structure of the mucus molecule, breaks down the molecular strand to thin the mucus

Antidote for acetaminophen overdose and it would be given orally

• Used to treat rapid onset pelmonary edema associated with sever acute CHF
• Reduces ciliary function and bronchospasms

• Type II pneumocytes make it
• Consist of 80% phospholipids, 10% neutral lipids and 10% surface proteins
• Surface protein B and C are important for surfactant function

• Prevents alveolar collaspe
• Enables lungs to expand easily
• Prevents leakage of fluid from the alveolar capillary membranes

Are mixtures of synthetic componets and produced in a lab which means that the drug is free of infection and foreign proteins

Synthetic surfactant

A natural/Modified surfactant comprised of natural bovine (cow) lung extract

• Prevent or treat RDS in pre term infants
• Type II pneumocytes are immature in these infants
• Type II pneumocytes can be damanged by hypoxemia

• A clone of the natural enzyme that digest extracellular DNA
• Used commonly with CF patients
• It is a proteolytic enzyme which breaks down the DNA to decrease muscus viscosity and restoring its ability to flow
• It is a maintenance drug

• 5 ml/kg given 4 - 6 hours apart
• usually 2 or 3 doses sependind on the response
• instilled threw the side port of the adaptor, ventilation is not interupted
• Haf dose is given, turn baby 45 degrees to one side, return to supine, other half dose is given, turn baby 45 degrees to other side

• Can change lung compliance rapidly, must be ready to change vent settings
• During adminstration: reflux of solution, transient decrease in oxygenation, bradycardia,hypotension
• After adminstration: hyperoxygenation, hypoventilation
• Uncommon side effects are apnea, pulmonary hemorrahage and bronchospasms

• MAS
• Term infant with RDS
• Pulmonary hemmorrhage
• CDH
• Severe pneumonia
• Pulmonary infections
• Any condition with surfactant and low lung lung volumes

• Most common
• 80% of total immunoglobins in plasma
• Protect against childhood disease

10% of total Immunoglobins, numbers increase in chronic infections

• Hypersensitivity reactions
• Allergic rhinitis, allergic asthma
• Bound to mast cell

• Mucous membranes in respiratory tract
• salivary and bronchial secretions
• transfer immunity to the child

Role unknown, may B cell maturation

Adrenal or HPA supression can occur, causing the adrenal glands to atrophy because thaty no longer have to work to produce these hormones

• Appetite stimulation
• Stomach irritation
• Headache
• Mood changes
• Acne exacerbation
• Hypokalemia
• hyperglycemia
• leukocytosis

• osteoporosis
• Immunosuppression
• Skeletal muscle myopathy
• Cushing syndrome

Arachidonic Acid

they are mediators of inflammation which lead to airways smooth muscle contriction, vasodilation, increased vascular permeability and mucus secretions and decreased mucus clearance

• Block the arachidonic acid cascade
• remove circulatory lymphocytes, monocytes, eosinophils, and basophils
• Inhibit macrophage and leukocyte processing of antigens
• Decrease production of eosinophils, basophils, and monocytes
• Enhance Beta 2 receptor responsiveness by increasing the responsiveness of adenyl cyclase in airway of smooth muscle

• Prevent the inflammatory process by preventing mast cell rupture
• Not a bronchodilator or dont inhibit action of mediators which are already released
• Prevents the Ca+ influx so it a mast cell stabilizer
• Prevents the early and late phase asthmatic reaction to antigens and inhibits the degranulation caused by immunologic and nonimmunologic mechanisms

• Used to prevent allergic and nonallergic asthma
• to prevent allergic rhinitis and excercise induced bronchospasms

• Can decrease Beta agonist use and increase morning FEV1in children
• Can increase FEV1 in adults
• Can decrease the dose of inhaled steriods when used in combo with steriods

• Antagonize histamine 1 receptors and are mainly used to treat allergic rhinitis
• Blocks the action of histamine at histamine 1 receptor

• reaction of organism when stained with dye
• determines basic characteristics of the pathogen

• stain purple
• single layer cell wall

• stain pink
• multi layer cell wall
• harder to treat

• Bacteria has become resistance to therapy due to use of antibiotics to treat viral infections
• bacteria adapt to become resistance to some antibiotics

• Acyclovir
• Famciclovir
• Valcyclovir
• Interferes with DNA to inhibit viral replication

• Zanamivir (Relenza)
• Oseltamivir (Tamiflu)
• Reduce duration of flu by 1 - 3 days
• Treats influenza A and B
• Most effictive if started within 30 hours of exposure or symptoms

• RSV causes bronchiolitis and pneumonia in children
• Ribavin
• Very teratogenic

• Nucleoside reverse transcriptase inhibitors
• Non nucleoside reverse transcriptase inhibitors
• Protease inhibitors

• Broad spectrum antibiotics
• Produced by soil organisms and are bacteriostatic
• Cannot be taken by children under 9 or pregnant women due to tooth discoloration

• work by preventing the making of ergosterol
• Often develope in people with impaired immunity or after antibiotic therapy

Bacterium needs oxygen

• bacterium doesn't need oxygen
• More serious infection with fewer antibiotics