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“The Supporting Players….”
RC 195
Anti-foaming agent: ETOH
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Aerosolized ETOH used to decrease the foam and froth
in pulmonary edema
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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
Aerosolized Antibiotics
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Ideal Properties:
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Indications:
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Potent topical effect
Less toxicity/side effects
Systemic administration is ineffective
Toxicity/side effects from systemic administration
Limitations:
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V/Q abnormalities and “hiding” microbes
Variable dosing when aerosolized
Aminoglycosides
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Used against gram – rod respiratory infections
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Pseudomonas
Klebsiella
Proteus
E-coli
Side effects/Toxicity:
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Nephrotoxicity, ototoxicity, neurotoxicity
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May cause temporary paralysis and hence apnea when
given as an IV bolus
Aminoglycoside Examples
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Stretpomycin
Gentamycin (Garamycin)
Tobramycin (Nebcin)
Kanamycin (Kantrex)
Neomycin (Neosporin)
Penicillins
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Some are very broad spectrum so can be used
for gram+ and gram- infections
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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!
Other Antibiotics
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Cephalosporins – gram+ and gram-; e.g. Keflex
Fluoroquinolones –very broad spectrum
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Macrolides – very broad spectrum and used in
place of penicillin
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Ciprofloxacin (Cipro), Moxifloxacin (Avelox)
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!
Antifungal Drugs
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Amphotericin B (Fungizone) – Big gun!
Can be very toxic
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Has been aerosolized
Is light sensitive
Histoplasmosis, Valley Fever
Nystatin (Mycostatin) – topically applied
for yeast-like infections, eg Thrush
Antifungal Drugs (cont.)
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Pentamidine (NebuPent)
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Aerosolized for PCP/PJP infections in HIV
patients
Pneumocystis Carinii Pneumonia now known
as Pneumocystis Jiroveci Pneumonia
Can be very toxic
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RCP administering must use barrier precautions
Antituberculosis Drugs
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Isoniazid (INH)
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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
Respiratory Depressants
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Usually used to “control” respiration in
mechanically ventilated patients
CNS Depressants – Narcotics (Morphine,
Heroin) and Barbiturates (Seconal, Nebutal)
Paralyzing agents
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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
Respiratory Stimulants
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Usually used for drug overdose and/or
post-op anesthesia depression
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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
Antiviral Drugs
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Ribavirin (Virazole)
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Used for RSV (Respiratory Syncytial Virus)
Aerosolized via SPAG
HIV Drugs: Zidovudine (AZT), Didanosine
(DDI)
Nitric Oxide – A Magic Bullet?
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Also known as EDRF – Endothelium
derived relaxing factor, a naturallyoccurring vasodilator
When inhaled, it quickly dilates pulmonary
arteries without causing systemic
vasodilation
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Improves V/Q
Very precise dosing: 4-25 PPM
Iloprost
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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