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Overview of Aerosolized Therapeutics for Respiratory Conditions

This document presents a comprehensive overview of various aerosolized treatments utilized in respiratory conditions. It discusses the use of aerosolized ethanol as an anti-foaming agent in pulmonary edema, highlights the effectiveness of aerosolized antibiotics against specific gram-negative infections, and details the use of other classes of medications, including antifungals and antivirals. Key considerations such as side effects, dosing recommendations, and current practices are included. It serves as a valuable resource for healthcare professionals involved in respiratory care.

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Overview of Aerosolized Therapeutics for Respiratory Conditions

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  1. “The Supporting Players….” RC 195

  2. 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

  3. 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

  4. 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

  5. Aminoglycoside Examples • Stretpomycin • Gentamycin (Garamycin) • Tobramycin (Nebcin) • Kanamycin (Kantrex) • Neomycin (Neosporin)

  6. 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!

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

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

  14. 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

  15. 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

  16. The End!

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