-
Identify from a list catecholamines
The chemical structure of a catecholamine consists of a benzene ring, 2 hydroxy groups & 1 amine side chain. dopamine, epinephrine, norepinephrine, and isoproterenol.
Examples of catecholamines are dopamine, epinephrine, norepinephrine, and isoproterenol. The first three occur naturally in the body.
-
What are catecholamines inactivated by?
COMT (Catechol O-Methyltransferase)
unsuitable for oral admin because it is inactivated in the gut and liver by conjugation with sulfate or glucuronide at the carbon 4 site
Also inactivated by adrenochromes by heat, light or air
-
Are all catecholamines bronchodilators?
yes but not all bronchodilators are catecholamines (anticholinergics which are parasympathetic)
-
Which drugs are sympatholytics?
Phentolamine, prazosin, labetalol, metoprolol, propranolol, timolol, esmolol.
-
If your patient is diagnosed with persistent asthma, which type of drug would you recommend for maintenance/rescue bronchodilation?
- LONG ACTING ADRENERGIC AGENT
- Short-Acting β Agonist (SABA) <- this adrenergic will be more useful for an acute asthma attack.
- LABA for maintenance of bronchodilation (salmeterol, formoterol, arformoterol,indacaterol, olodaterol, and vilanterol) and control of bronchospasms and nocturnal symptoms in asthma or COPD
- Recommend drug for maintenance such as a long acting adrenergic bronchodilator combined with anti-inflammatory medication for control of airway inflammation and bronchospasms
-
What is the main indication for continuous nebulization of inhaled β agonists?
SEVERE ASTHMA
The Guidelines for the Diagnosis and Management of Asthma released by NAEPP EPR 3 recommends, 2.5 to 5 mg of albuterol by nebulizer every 20 minutes in three doses and 10 to 15 mg/hr by continuous nebulization.
Useful in managing severe asthma to avoid respiratory failure, intubation, or mechanical ventilation.
-
Albuterol is available in which formulations?
Syrup, nebulizer solution, MDI, oral tablets, DPI
inhalation and by subcutaneous injection
-
If a patient with glottic edema is in mild distress, what medication/s would be of benefit in this situation?
Racemic epinephrine
-
What is the main difference between salmeterol and formoterol?
Formoterol has a quicker onser and peak effect than salmeterol
The onset of Formoterol is quicker (2-3min) than Salmeterol (15min)
Salmeterol is metabolized by hydroxylation and eliminated in the feces
-
You enter the room of a 2-year-old patient who presents with the characteristic “barking cough” found with croup. Once the diagnosis is confirmed, you may recommend which medication to help provide relief from subglottic swelling?
Racemic epinephrine
-
What is the rationale for using the single-isomer agent levalbuterol instead of racemic albuterol?
- THE S – ISOMER IS THOUGHT TO PROMOTE BRONCHOCONSTRICTION
- The racemic albuterol containing (R)- and (S)-isomers antagonizes the bronchodilating effects of the single isomer levalbuterol (R) -isomer.
- The (S)-isomer in racemic albuterol is more slowly metabolized
- Less side effects (ie, tremor and heart rate changes) with single-isomer formulation
- The (S)-isomer is thought to promote bronchoconstriction when the goal is bronchodilation
-
You receive an order to administer 5 ml of albuterol by small volume nebulizer (SVN). You would:
- Call the physician to confirm the medication dose
- Call the provider because listed on table 6-1 the dosage is 0.5mL being the max
-
Your patient is receiving her third continuous nebulizer of albuterol (15 mg/hr). Which potential complications should you be on the lookout for?
Kypokalemia, cardiac arrhythmias, hyperglacemia, PVCs, and tremor
Muscle tremors, hyperglycemia, hypokalemia, cardiac arrhythmias, PVCs
Close monitoring is necessary and includes observation and cardiac and electrolyte monitoring
-
What are short-acting β2 agonists indicated for:
Relief of acute reversible airflow obstruction
indicated for relief of acute reversible airflow obstruction in asthma or other obstructive airway diseases such as COPD.
Ex, albuterol, levalbuterol or metaproterenol
-
You are ordered to extubate a mechanically ventilated patient who has recently undergone open- heart surgery. On postextubation assessment you note that the patient has stridor with mild retractions. Pharmacologically, you would recommend:
ALPHA ADRENERGIC: (racemic epi)
-
What is the relationship between intracellular cAMP and bronchodilators?
Increase cAMP lead to smooth muscle relaxation & mast cell stabilization
Beta receptors increase the synthesis of cAMP, which leads to muscle relaxation. The Beta agonist forms bonds with the transmembrane loops. When the beta agonist stimulates it, the receptor undergoes a conformational change that reduces the affinity of a subunit of the G protein for GDP. The GDP is replaced by GTP, and the alpha subunit dissociates from the receptor and the beta-gamma portion of the G protein links with the effector (Adenyl cyclase). Therefore, the increase of cAMP which helps in the smooth muscle relaxation.
More CAMP equals more bronchodilation
-
A 7-year-old boy has been given multiple aerosolized albuterol treatments over the last several You enter the room and his father tells you that every time a therapist administers a treatment, a few minutes later the saturation falls. You explain to the father:
- That this is normal because of incr perfusion to poorly ventilated areas
- It is normal because of increased perfusion (ie, blood flow) to poor ventilated portions of the lung. It is known that regional alveolar hypoxia produces regional pulmonary vasoconstriction in an effort to shunt perfusion to the areas of the lung with higher oxygen tension.
- Administration of inhaled beta-agonists may reverse hypoxic pulmonary vasoconstriction by beta-2 stimulation, which increases perfusion to under ventilated lung regions.
-
You are administering an aerosolized bronchodilator to your patient. Her pretreatment pulse was 85 beats/min. You would stop the treatment if her pulse reached:
- 110
- 102 or higher. If the pulse rate has increased by greater than 20% relative to the pretreatment pulse. 20% of 85bpm is 17bpm, and 85bpm+17bpm = 102bpm, anything at that dose or higher, the treatment should be stopped.
-
Is it appropriate to use formoterol as a rescue β-agonist bronchodilator?
No, because it’s a controller up to 12 hours
No. Use albuterol=rescue (emailed restrepo and he mentioned this was the correct answer)
Formoterol is considered a maintenance treatment (for COPD)
-
What side effects should be monitored in your patient when using a sympathomimetic aerosol?
Insomnia, muscle tremor, tachycardia
-
The dosage recommended by NAEPP EPR 2 for continuous nebulization of adrenergic agents is:
- 10-15 mg/hr
- 2.5-5 mg of albuterol by nebulizer every 20 minutes in three dosages and 10-15 mg/hr. by continuous nebulization.
-
Which procedure would tell you that a patient has reversible airway obstruction?
Pre and postpulmonary function tests
-
If a physician has granted your request to change a patient from an SVN to an MDI for administration of albuterol. What would be the equivalent dose via MDI to administer to your patient if XX mg of albuterol is ordered?
- SVN; 05% sol, 0.5 mL (2.5mg), 0.63 mg, ….
- MDI 90 mcg/puff, 2 puffs tid, qid
**LOOK on pg 92 table 6.1 for dosage**
|
|