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The Supporting Players.

• RC 195

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Anti-foaming agent ETOH

• Aerosolized ETOH used to decrease the foam and
  froth in pulmonary edema
• Decreases surface tension so that bubbles liquefy
• Dose 3-5 ml of 30-50 ETOH
• Side effects Intoxication, bronchospasm,
  decreased surfactant
• Not a primary treatment now

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Aerosolized Antibiotics

• Ideal Properties
• Potent topical effect
• Less toxicity/side effects
• Indications
• Systemic administration is ineffective
• Toxicity/side effects from systemic
  administration
• Limitations
• V/Q abnormalities and hiding microbes
• Variable dosing when aerosolized

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Aminoglycosides

• Used against gram rod respiratory infections
• Pseudomonas
• Klebsiella
• Proteus
• E-coli
• Side effects/Toxicity
• Nephrotoxicity, ototoxicity, neurotoxicity
• May cause temporary paralysis and hence apnea
  when given as an IV bolus

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Aminoglycoside Examples

• Stretpomycin
• Gentamycin (Garamycin)
• Tobramycin (Nebcin)
• Kanamycin (Kantrex)
• Neomycin (Neosporin)

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Penicillins

• Some are very broad spectrum so can be used for
  gram and gram- infections
• Methicillin (Staphcillin) staphylococcus
• Ampicillin (Omnipen, Polycillin) H.flu,
  Streptococcus
• Carbenicillin (Geopen) pseudomonas
• Nafcillin (Unipen) staphylococcus
• Pen G strep
• Also Amoxicillin ( Polymox) and amoxicillin
  with potassium clavulanate (Augmentin)
• The penicillins can be very allergenic!

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Other Antibiotics

• Cephalosporins gram and gram- e.g. Keflex
• Fluoroquinolones very broad spectrum
• Ciprofloxacin (Cipro), Moxifloxacin (Avelox)
• Macrolides very broad spectrum and used in
  place of penicillin
• Erythromycin, Clarithromycin (Biaxin),
  Azithromycin (Zithromax)
• Polymixins Colistin (Promixin) -75-150mg BID via
  aerosol for H.Flu, Klebsiella, Acinetobacter, and
  Pseudomonas
• Vancomycin (Vancocin) last choice drug!
• Used for MRSA or other infections that are not
  responding to penicillins or cephalosporins

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Antifungal Drugs

• Amphotericin B (Fungizone) Big gun! Can be very
  toxic
• Has been aerosolized
• Is light sensitive
• Histoplasmosis, Valley Fever
• Nystatin (Mycostatin) topically applied for
  yeast-like infections, eg Thrush

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Antifungal Drugs (cont.)

• Pentamidine (NebuPent)
• Aerosolized for PCP/PJP infections in HIV
  patients
• Pneumocystis Carinii Pneumonia now known as
  Pneumocystis Jiroveci Pneumonia
• Can be very toxic
• RCP administering must use barrier precautions

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Antituberculosis Drugs

• Isoniazid (INH)
• Usually given orally for 9 months
• Rifampin also oral for 9 months
• Patients may also need Streptomycin, Ethambutol,
  or Pyrazinamide
• Patient compliance is a real problem!
• These drugs can also be damaging to the liver

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Respiratory Depressants

• Usually used to control respiration in
  mechanically ventilated patients
• CNS Depressants Narcotics (Morphine, Heroin)
  and Barbiturates (Seconal, Nebutal)
• Paralyzing agents
• Succinylcholine (Anectine) short acting
  usually used for intubations
• D-Tubocurare (Curare) long lasting but may cause
  hypotension and histamine release (reversed by
  Neostigmine)
• Pancuronium Bromide (Pavulon) no histamine
  release
• Vecuronium Bromide (Norcuron) like Pavulon

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Respiratory Stimulants

• Usually used for drug overdose and/or post-op
  anesthesia depression
• May also be tried short term with COPD
• Doxapram (Dopram)
• Naloxone (Narcan) narcotic antagonist
• Progesterone female hormone that stimulates
  respiration but may have a lot of side effects

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Antiviral Drugs

• Ribavirin (Virazole)
• Used for RSV (Respiratory Syncytial Virus)
• Aerosolized via SPAG
• HIV Drugs Zidovudine (AZT), Didanosine (DDI)

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Nitric Oxide A Magic Bullet?

• Also known as EDRF Endothelium derived relaxing
  factor, a naturally-occurring vasodilator
• When inhaled, it quickly dilates pulmonary
  arteries without causing systemic vasodilation
• Improves V/Q
• Very precise dosing 4-25 PPM

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Iloprost

• Brand Ventavis
• Aerosolized for Pulmonary Hypertension in adults
• Is a stable analogue of PGI2 (a natural
  prostaglandin that is a vasodilator)
• Unit does for aerosol 20mcq/2ml
• Duration 1-2 hours

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The End!