Drugs Used to Treat Respiratory Emergencies PDF

Drugs Used to Treat Respiratory Emergencies Module 5  ① quick relief medication short acting( Introduction & beta...

Drugs Used to Treat Respiratory Emergencies Module 5  ① quick relief medication short acting( Introduction & beta agonist anticholinergic ②long acting Respiratory distress is one of the most common patient presentations encountered by prehospital professionals. Acute respiratory distress affects the young and old, male and - female, and people of all ethnicities. - - Although the underlying pathologic condition causing the - -C respiratory distress may be different, with the exception of acute pulmonary edema most of the prehospital care is aimed at treatment of reversible bronchial constriction, or bronchospasm. Advanced life support (ALS) interventions, including respiratory medication administration, have been shown to significantly reduce mortality in patients with respiratory distress.  Oxygen Oxygen is the most commonly used medication in the prehospital setting. As with any drug, oxygen has associated risks, as well as - benefits. - Oxygen is used daily byocbasic and advanced prehospital providers, sometimes with little consideration to its pharmacologic properties. The use of oxygen has become increasingly controversial. In situations such as neonatal resuscitation, chronic obstructive pulmonary disease (COPD) exacerbations, and acute coronary syndrome, oxygen use is now carefully titrated to prescribed oxygen saturation ranges, rather than applied indiscriminately.  Oxygen EMS providers should anticipate additional changes as ongoing research in this area leads to guideline updates and a significant paradigm shift from traditional approaches to oxygen delivery. On occasion, prehospital providers encounter patients with COPD, who require continuous oxygen while at home. Continuous oxygen can require a transtracheal catheter, which is inserted surgically. Transtracheal catheters, like⑳ nasal cannulas, are used for long- term oxygen therapy in patients with chronic lung disease. Some patients find that the long-term use of nasal cannulas is irritating to the nose at night; such patients may receive transtracheal catheters, which are held in place by a necklace.  && condition tient Bronchodilators Da Patients with asthma (an inflammatory disease of the lungs characterized by typically reversible airway obstruction) and COPD have respiratory distress from a functional narrowing of the conducting airways. As a result, these patients report that they feel as though they are breathing through a straw. - & Spasm of the bronchial smooth muscle, also known as bronchospasm, results in a decrease in the airway diameter. - Another factor that contributes to respiratory distress is & edema of the mucosa that lines the respiratory tract. ↑ This inflammatory edema results in a thickening of the mucosal linings and a resultant decrease in airway diameter. -  Bronchodilators Increased secretions also contribute to the distress of these patients. Any reduction of the radius of the airway, from either bronchospasm or mucosal edema, can have a profound effect on the flow of gas. - > specific Recopter Bronchodilators can be divided into selective and - nonselective agents. * itgen impr Selective agents act preferentially on the bronchial smooth muscle and improve the patient’s condition while minimizing (5 Lytic 55) selective side , effects. j activation- Beta2 agonists are sympathomimetic ⑤ medications that target - the beta2 receptors and cause relaxation of bronchial smooth - masig muscle - without stimulating tachycardia or hypertension. -  Bronchodilators Most of these medications are selective for the beta2 receptor; however, paramedics must be cautious because excessive doses can produce the undesirable effects seen with alpha and beta1 stimulation (e.g., tachycardia and hypertension). Use beta2 agonists with caution in patients with a history of heart disease, and always monitor the electrocardiogram during and after treatments. 6599 Jess. & Examples of beta2 agonists include albuterol (Proventil), terbutaline (Brethine), formoterol (Foradil), and pirbuterol & (Maxair). · 3 > oral ↳P is - - N  Bronchodilators Nonselective agents act on alpha, beta1, and beta2 adrenergic receptors. Stimulation of the alpha receptors causes constriction of - peripheral& blood vessels and results in blood pressure ↳ vaso contruction > hypertention - elevation. - Beta1 receptors, which are predominantly located in cardiac - [ tissue, - increase - heart rate and cardiac contractility when - stimulated. - lung > Stimulation of the beta2 receptors results in bronchodilation - by relaxation of bronchial smooth muscle. - & Racemic epinephrine is an example of a nonselective -5 - bronchodilator. Family  - * - - · - & - =>o - - R - - - -  Overview of Asthma Acute asthma attacks can affect patients of all ages. Asthma is caused by a-trigger reaction. Triggers can be either intrinsic (within the body) or extrinsic - (outside the body). - * Examples of intrinsic triggers include exertion, such as an attack triggered by exercise, and anxiety related to stress. & Examples of external triggers are reactions to animal dander, dust, insect droppings, pollen, and cleaning chemicals. 1) oxygen prehospital [ quick Emergencies > - Short 2) medication Management acting 3) C is for the patient to A main focus in management of asthma avoid the triggers that initiate attacks whenever possible and mitigate the effects of these triggers. When EMS is called, these goals have not been achieved and patient management is aimed at the reversal of acute bronchospasm. - Although parenteral medications can be used to treat patients with asthma, the first line of medications is inhaled beta2-specific drugs. If↳ inhaled bronchodilators fail, intravenous② (IV) medications are then administered to reduce bronchospasm and inflammation.  Management Intermedate asthma && Albuterol (Proventil, Ventolin) is by far the most common & inhaled drug used to treat reversible bronchospasm. Albuterol is one of several inhaled bronchodilators that have - been developed to target only the beta2 receptor. -Y Prior beta2 agonists had varying degrees of effect onO - alpha elective non 33 beta1 receptors, and stimulation of these sites may cause 9,s- and & selective unwanted reactions in already compromised patients. For example, stimulation of alpha receptors could cause unwanted vasoconstriction, and stimulation of beta1 - - receptors could cause increased heart rate. - As such, more time between treatments was required to compensate for the unwanted, predominantly beta1, adverse effects.  i Management JS givig V > - & Levalbuterol (Xopenex) is a newer “purified” version of - albuterol, which had been believed to cause fewer adverse effects than albuterol. Both appear to be quite effective in acute treatment of - asthma exacerbations. Gig The - first-generation drugs had significant beta1 effects along betab 18 Iphac ji - & a with beta2 effects.& Second-generation drugs were more beta2 - j - & G betal - - - sigsi specific but would still increase heart rate and could not be : lective rain Per - - - S given close together. L Finally, E third-generation medications predominantly targeted - the beta2 receptors. - - -  Management When given by inhalation and specifically targeting the smooth muscle in the airways, they had little or no systemic effect. Without these systemic effects, multiple and continuous treatments could be given for moderate to severe exacerbations. Ipratropium bromide (Atrovent) is used in more severe - exacerbations of asthma or in cases in which the patient has a - so ii > limited response to treatment with albuterol. - -- sign / Gat]! 05. & Ipratropium bromide is not an adrenergic agent but is considered an anticholinergic. Bronchodilation # ↳ - block y action Aceby => inhibition relaxation => smooth - choline parasympathic muscle stimulation (bronchi)  Management In more severe cases of bronchospasm, additional treatment with ipratropium bromide has provided greater symptomatic relief than albuterol used as a single agent. Adrenergic agents such as albuterol act more centrally in the bronchial tree, whereas cholinergic agents such as ipratropium are more effective in the peripheral airways. - Adrenergic agents are more effective in asthma, whereas the - peripheral action of ipratropium provides greater benefits in patients with COPD. x quick relief medication Mix - - > & Albuterol/ipratropium (Combivent) is a combination product that takes advantage of the different mechanisms of action and anatomic sites of action of albuterol and ipratropium bromide to deliver both medications in a single preparation.  * behaY wis af - - - , i - > es - il abjes S jig. &  & betox ohis al  & il & ver holi · vie an si o jet & · - -  & Mix - prehospitals  Second-Line Therapy for Acute - Long Exacerbation of Asthma acting The clinical picture of a patient having an asthma attack or exacerbation of COPD is that of a patientC gasping for breath, usingCaccessory muscles of respiration, and C wheezing. In asthma and COPD, bronchodilators provide symptomatic therapy but do not directly treat the underlying and initiating Inheald low -> mder- high - > lung condition. - systemic > - oral/Iv In cases in which a prolonged transport time is likely, consider - & corticosteroids to treat the inflammatory processes involved inTboth asthma andG COPD. 7 systimic The most commonly used corticosteroids are methylprednisolone and dexamethasone. Both appear to be equally effective in managing moderate or severe asthma symptoms. -  securit Second-Line Therapy for Acute Exacerbation of Asthma ⑳ If there are concerns regarding patient compliance, providers may choose to administer a - - single dose of dexamethasone over a longer oral course of another corticosteroid. posio eloto Peak expiratory flow rate (PEFR) is an objective assessment & that can guide a provider’s determination of the severity of an exacerbation; the patient’s response to therapy; and the - - S indication for therapy, such as the start of steroids. -. % 10 · When the initial PEFR is less than 50% of predicted, - * & berods & & corticosteroids should be administered after ipratropium corticos - bromide administration. ⑮agees - i Second-Line Therapy for Acute Exacerbation of Asthma Corticosteroids should also be considered when the PEFR does not improve by at least 10% after bronchodilator & therapy or when the PEFR is less than 70% after 1 hour of therapy. Aminophylline and other methylxanthines work to reduce the - smooth muscle bronchospasm associated with acute - respiratory distress. These medications were once routinely administered as second-line agents for severe asthma exacerbations. Their role has greatly diminished and they are no longer recommended as routine therapies. & narrowing therapeutic window ↳ high risk toxic blood concentration ↳ sever effect-> cardic arithmia - ↳ seizure -  Sk Second-Line Therapy for Acute aganis beta. improve not b ↑ Exacerbation of Asthma espasm Magnesium sulfate has been demonstrated to decrease - bronchospasm in a subset of asthmatic patients. Patients who do not show an adequate response to beta2 agonist medications can have a favorable response to magnesium sulfate. Magnesium sulfate should not be used in all patients having an asthmatic attack; however, consider using magnesium in patients who do not improve after beta agonist therapy. not select For years, epinephrine administered subcutaneously was the C treatment of choice for- young patients with asthma. adalt/eldug Epinephrine does have strong and desirable beta2 effects; however, it also has strong and undesirable alpha and beta1 O effects.  Second-Line Therapy for Acute Exacerbation of Asthma Rebound bronchospasm can be a secondary problem with the administration of epinephrine in the management of an asthma attack. Although epinephrine is effective when initially administered, its effects are short- lived. If considering epinephrine for use in adults with asthma, do not underestimate beta1-mediated cardiac complications such as tachycardia and hypertension. For these reasons, epinephrine should be used with caution, if at all, in the treatment of the patient with asthma. Epinephrine may still be indicated if an anaphylactic reaction is suspected.  Lasemia Cozone G Lepag · cortignain j's, Nosbar d, Chronic Obstructive Pulmonary out Disease rant a COPD is the classification for diseases that cause obstruction in the pulmonary tree. The two most common diseases are emphysema and chronic bronchitis. Both pathologic conditions cause an increase in sputum production and resultant bronchospasm. As the increase in sputum worsens, so can the irritation and the bronchospasm. Initial treatment of mild to moderate COPD exacerbation is aimed at reducing bronchospasm and mobilizing and clearing Ea the sputum from the airways. · is  Management In severe exacerbations, treatment is first aimed at oxygenation and ventilation of the patient. Oxygenation needs to be provided with care. Patients with a long-standing history of COPD breathe on what is known as a hypoxic respiratory drive. This means that the patient requires a mild degree of hypoxia to continue breathing. If the patient is given too much oxygen, the hypoxic respiratory drive is removed, as well as the patient’s stimulus for spontaneous respirations.  Management Therefore, when monitoring these patients, an SaO2 level in the low 90s as measured by pulse oximetry is considered adequate. Bronchodilators and steroids are used to manage COPD in a similar fashion as for the treatment of asthma.  Anaphylaxis eprition Histamine is a chemical mediator found in almost all body tissues. The concentration is highest in the skin, lungs, and gastrointestinal tract. The body releases histamine when exposed to an antigen, such as pollen or insect stings. This antigen exposure results in increased localized blood flow, increased capillary permeability , and swelling of the tissues , bronchoconstriction, urticaria. The condition described above is called anaphylaxis.  unas ine Antihistamines A There are two types of histamine receptors: H1 receptors (these act mainly on the blood vessels and the bronchioles) stomach > H2 receptors (these act mainly on the GI tract) * Antihistamines have anticholinergic or atropinelike action. This may result in tachycardia, constipation, drowsiness , sedation. --- Examples of antihistamines: dimenhydrinate (Dramamine), diphenhydramine, Chlorphenamine (allerfin)………xxxxxine. Antihistamines sometimes are prescribed to control motion sickness or ⑳ as a sedative or antiemetic.  & Mucokinetic Drugs Mucokinetic drugs are used to move respiratory secretions. These agents work by altering the consistency of these secretions, enabling them to be removed from the body more easily. Mucolytics thin mucus , making it less - thick and- sticky and easier - to cough up, e.g. mucomyst Eig Mucus is a normal secretion produced by the surface cells in the mucous membranes. Sputum is an abnormal viscous secretion. Sputum consists mainly - of mucus. Sputum originates in the lower respiratory tract. sity cort  Cough Suppressants · Cough can be dry - or productive. Examples of antitussive drugs : Codeine, Benzonatate (Tessalon). & &  Direct Respiratory Stimulants (analeptics) Zentral 00 Direct Respiratory Stimulants increase the rate and depth of respirations. neuvng kem Analeptics are used to treat respiratory depression and to counteract drug-induced respiratory depressioncaused by its X anesthetics. agen An example of a direct respiratory stimulant is doxapram ⑭ (Dopram). j' brain * Tem overla abien tion- , Y R al  ⑮ gt The End D