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Questions and Answers
What is the primary rationale for administering pentamidine via aerosol rather than systemically?
What is the primary rationale for administering pentamidine via aerosol rather than systemically?
- Aerosol administration provides targeted drug delivery to the lungs, minimizing systemic side effects. (correct)
- Aerosol administration is less expensive than systemic administration.
- Systemic administration causes lung damage.
- Aerosol administration ensures the drug reaches all organs equally.
A patient with HIV and a CD4+ count of 190/mm3 is prescribed aerosolized pentamidine. What is the main goal of this therapy?
A patient with HIV and a CD4+ count of 190/mm3 is prescribed aerosolized pentamidine. What is the main goal of this therapy?
- Preventing _Pneumocystis jiroveci_ pneumonia (PCP). (correct)
- Reducing the patient's viral load.
- Treating an existing bacterial pneumonia.
- Treating an existing _Pneumocystis jiroveci_ pneumonia (PCP).
What is the recommended dosage and frequency for pentamidine administration?
What is the recommended dosage and frequency for pentamidine administration?
- 300 mg once every 4 weeks (correct)
- 150 mg every 2 weeks
- 300 mg daily
- 600 mg every week
Why is sterile water, rather than saline, used to reconstitute dry powder pentamidine?
Why is sterile water, rather than saline, used to reconstitute dry powder pentamidine?
Which nebulizer is recommended for the administration of aerosolized pentamidine?
Which nebulizer is recommended for the administration of aerosolized pentamidine?
During pentamidine administration, which measure helps to reduce the exposure of healthcare workers to the drug?
During pentamidine administration, which measure helps to reduce the exposure of healthcare workers to the drug?
What is a common local side effect observed during aerosolized pentamidine administration?
What is a common local side effect observed during aerosolized pentamidine administration?
Which of the following side effects is least likely to be associated with aerosolized pentamidine administration?
Which of the following side effects is least likely to be associated with aerosolized pentamidine administration?
Why is environmental contamination a concern with nebulized pentamidine?
Why is environmental contamination a concern with nebulized pentamidine?
A pregnant healthcare worker is potentially exposed to aerosolized ribavirin. What is the primary concern regarding this exposure?
A pregnant healthcare worker is potentially exposed to aerosolized ribavirin. What is the primary concern regarding this exposure?
What is the primary clinical indication for aerosolized ribavirin?
What is the primary clinical indication for aerosolized ribavirin?
Ribavirin is described as a virostatic agent. What does this mean?
Ribavirin is described as a virostatic agent. What does this mean?
Ribavirin is administered using a SPAG-2 nebulizer. What is the typical duration of a ribavirin treatment?
Ribavirin is administered using a SPAG-2 nebulizer. What is the typical duration of a ribavirin treatment?
During ribavirin administration, a respiratory therapist notices a patient's pulmonary function is deteriorating. What immediate action should the therapist consider?
During ribavirin administration, a respiratory therapist notices a patient's pulmonary function is deteriorating. What immediate action should the therapist consider?
What is a potential cardiovascular side effect associated with ribavirin administration?
What is a potential cardiovascular side effect associated with ribavirin administration?
What is a hematological effect that has been reported with aerosolized ribavirin use?
What is a hematological effect that has been reported with aerosolized ribavirin use?
What is the primary indication for palivizumab (Synagis)?
What is the primary indication for palivizumab (Synagis)?
Which population has established safety and efficacy for Synagis?
Which population has established safety and efficacy for Synagis?
A 2-month-old infant is at high risk for RSV. Which medication is most appropriate for preventing serious complications from this virus?
A 2-month-old infant is at high risk for RSV. Which medication is most appropriate for preventing serious complications from this virus?
What is the mechanism of action of ribavirin against viruses?
What is the mechanism of action of ribavirin against viruses?
During the process of viral infection, when does the virus 'recode' the host cell's DNA?
During the process of viral infection, when does the virus 'recode' the host cell's DNA?
What flow rate range is recommended when administering aerosolized pentamidine using the Respirgard II nebulizer?
What flow rate range is recommended when administering aerosolized pentamidine using the Respirgard II nebulizer?
What is the approximate mass median diameter (MMD) of the particles produced by the Respirgard II nebulizer when administering pentamidine?
What is the approximate mass median diameter (MMD) of the particles produced by the Respirgard II nebulizer when administering pentamidine?
Why is it important to diagnose viral infections, like RSV, through virus isolation or antibody titer increase?
Why is it important to diagnose viral infections, like RSV, through virus isolation or antibody titer increase?
If a vial of ribavirin contains 6 g of powder, what is the resulting concentration when it is reconstituted with sterile water to a total volume of 300 mL?
If a vial of ribavirin contains 6 g of powder, what is the resulting concentration when it is reconstituted with sterile water to a total volume of 300 mL?
Flashcards
Aerosolized Pentamidine Indications
Aerosolized Pentamidine Indications
Prevention of Pneumocystis pneumonia (PCP) in HIV-infected patients with a history of one or more episodes of PCP or peripheral CD4+ lymphocyte count of 200/mm3 or less.
Rationale for Aerosol Administration
Rationale for Aerosol Administration
Local targeted lung delivery with fewer systemic side effects compared to systemic administration.
Pneumocystis Pneumonia (PCP)
Pneumocystis Pneumonia (PCP)
An interstitial plasma cell pneumonia caused by the organism Pneumocystis jiroveci, common among patients with lowered immune system response.
Respiratory Syncytial Virus (RSV)
Respiratory Syncytial Virus (RSV)
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Virostatic
Virostatic
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Virucidal
Virucidal
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Virus
Virus
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Pentamidine Dosage
Pentamidine Dosage
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Cystic Fibrosis (CF)
Cystic Fibrosis (CF)
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Side Effects of Aerosol Pentamidine
Side Effects of Aerosol Pentamidine
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Aerosolized Ribavirin Indications
Aerosolized Ribavirin Indications
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Ribavirin Classification
Ribavirin Classification
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Process of Viral Infection
Process of Viral Infection
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Ribavirin Dosage
Ribavirin Dosage
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Side Effects of Ribavirin
Side Effects of Ribavirin
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Environmental Contamination of Ribavirin
Environmental Contamination of Ribavirin
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Palivizumab (Synagis) Indication
Palivizumab (Synagis) Indication
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Study Notes
- This chapter covers antiinfective agents administered as inhaled aerosols. These agents include:
- Pentamidine isethionate (NebuPent)
- Ribavirin (Virazole)
- Tobramycin (TOBI)
- Aztreonam (Cayston)
- Zanamivir (Relenza)
- Other drugs include Palivizumab (Synagis)
Clinical Indications for Pentamidine
- Aerosolized pentamidine is indicated for the prevention of Pneumocystis pneumonia (PCP) in HIV-infected patients. This includes those with a history of PCP episodes or a CD4+ lymphocyte count of 200/mm3 or less.
- The rationale for aerosol administration is local, targeted lung delivery and fewer/less severe side effects.
- PCP is caused by Pneumocystis jiroveci, and mammals are usually infected early in life. The disease often occurs with immune system suppression, like in AIDS.
Dosage: Pentamidine
- The standard dosage is 300 mg via inhalation every 4 weeks, though this can be altered by a physician.
- Pentamidine is a dry powder, supplied as 300 mg/vial.
- It should be reconstituted with 6 mL of sterile water, not saline, to avoid precipitation.
Administration: Pentamidine
- Pentamidine is administered via the Respirgard II nebulizer.
- Requires a flow rate of 5–7 L/min from a 50-psi gas source.
- Escaped particles should be filtered to protect healthcare workers.
- The nebulizer produces a mass median diameter (MMD) of 1–2 μm
Side Effects: Pentamidine
- Common side effects include cough and bronchial irritation (36% of patients).
- Other side effects:
- Shortness of breath
- Bad taste
- Bronchospasm/wheezing (11% of patients)
- Spontaneous pneumothoraces
- Conjunctivitis
- Rash
- Neutropenia
- Pancreatitis
- Renal insufficiency
- Dysglycemia
- Digital necrosis
- Extrapulmonary P. jiroveci infection
Environmental Contamination: Pentamidine
- Nebulized pentamidine can cause environmental contamination due to exhaust aerosol.
- This exposure carries a risk of tuberculosis infection.
- Pentamidine is not known to be teratogenic or mutagenic, and it has minimal carcinogenic potential.
Clinical Indications for Ribavirin
- Aerosolized ribavirin is indicated for the treatment of hospitalized infants with severe lower respiratory tract infections caused by respiratory syncytial virus (RSV).
- Ribavirin is classified as an antiviral drug.
- It's active against RSV, influenza viruses, and herpes simplex virus.
- Ribavirin is a nucleoside analog that is virostatic, inhibiting DNA and RNA viruses, including retroviruses.
Nature of Viral Infection
- Virus adsorbs to cell.
- Virus penetrates cell.
- Virus uncoats itself.
- Virus recodes cell DNA.
- Virus assembles itself.
- Virus sheds from cell
- Viruses are obligate intracellular parasites.
- Diagnosis is based on clinical signs and requires isolating the virus or demonstrating an increase in antibody titer.
Dosage: Ribavirin
- Ribavirin is administered as a 20-mg/mL solution via SPAG-2.
- Treatment duration is 12 to 18 hr/day for a minimum of 3 days, not exceeding 7 days.
- Supplied as 6 g of powder in a 100-mL vial, resulting in a concentration of 6 g/300 mL.
Side Effects: Ribavirin
- Pulmonary side effects:
- Deterioration of pulmonary function
- Worsening of asthma or chronic obstructive disease
- Pneumothorax
- Apnea
- Bacterial pneumonia
- Cardiovascular side effects:
- Cardiovascular instability
- Hypotension
- Cardiac arrest
- Digitalis toxicity
- Hematological side effects:
- Reticulocytosis
- Dermatological/topical side effects:
- Rash
- Eyelid erythema
- Conjunctivitis
Environmental Contamination: Ribavirin
- Aerosolized ribavirin has the potential for mutagenic and carcinogenic effects.
- Its effect on fertility is uncertain (caused testicular lesions in rats).
- It is teratogenic or embryocidal in animal species, raising concerns for pregnant healthcare workers.
RSV Infection—Other Agents: Palivizumab
- Palivizumab (Synagis) is indicated for the prevention of serious lower respiratory tract disease caused by RSV in high-risk children and infants.
- Safety and efficacy are established for infants with bronchopulmonary dysplasia (BPD) and premature infants
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