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R36 Respirology
Common Medications Toronto Notes 2019
■ in patients with elevated lactate levels target resuscitation to normalize lactate
■ corticosteroid replacement therapy not indicated if adequate hemodynamic stability achieved with
fluid resuscitation and vasopressor therapy
• infectioncontrol
■ prompt diagnosis of infection
◆ cultures as clinically indicated prior to antibiotic therapy if no significant delay ◆ imaging studies performed promptly to confirm possible infectious source
■ antibiotic therapy
• administereffectiveIVantimicrobialswithinfirsthourofrecognitionofsepsis
■ choice of anti-infective therapy should consider activity against all likely pathogens and penetrance of adequate concentration into tissue presumed to be source of infection
■ antimicrobial regimen should be reassessed daily for potential deescalation
• surgicalsourcecontrolwhenappropriate
• supportiveoxygenationandventilationusinglung-protectiveregimen
• earlynutritionalsupport:enteralrouteisusedtopreservefunctionofintestinalmucosalbarrier
• DVT/PEprophylaxis
• advancedcareplanning,includingthecommunicationoflikelyoutcomeandrealisticgoalsoftreatment
with patients and families
Common Medications
Table 38. Common Medications for Respiratory Diseases
β2-AGONISTS
Short-Acting
Long-Acting
Combination Long-Acting β2- Agonist and Inhaled Corticosteroid
Combination Short-Acting β2- Agonist and Short-Acting Anti-Cholinergic
Combination Long-Acting β2- Agonist and Long-Acting Anti-Cholinergic
ANTICHOLINERGICS
Short-Acting Anti- Cholinergic
Long-Acting Anti-Cholinergic
Drug
salbutamol/albuterol (Ventolin®, Airomir®) (light blue/navy MDI or diskus)
terbutaline (Bricanyl®) (blue turbuhaler)
salmeterol (Serevent®) (green diskus), formoterol (Oxeze®, Foradil®) (blue/green turbuhalor or aerolizer) indacaterol (Onbrez®) (blue/ white breezhaler)
fluticasone and salmeterol (Advair®) (purple MDI or diskus) budesonide and formoterol (Symbicort®) (red turbuhaler) Mometasone and formoterol (Zenhale®) (blue MDI)
ipratropium/salbutamol (Combivent®, Respimat®) (orange respimat)
umeclidinium/vilanterol (Anoro®) (red ellipta)
aclidinium/formoterol (Duaklir®) (yellow genuair) tiotropium/olodaterol (Inspiolto®) (green respimat) indacaterol/glycopyrronium (Ultibro®) (yellow breezhaler)
ipratropium bromide (Atrovent®) (clear/green MDI)
tiotropium bromide (Spiriva®)
(green handihaler or respimat) glycopyrronium bromide (Seebri®) (orange breezhaler), umeclidinium (IncruseTM) (green ellipta), aclidinium (Genuair®, Tudorza®) (green inhaler)
Typical Adult Dose
1-2 puffs q4-6h prn
1-2 puffs bid 1 puff daily
1 puff bid 2 puffs bid
1 puff qid
1 puff daily 1 puff bid 1 puff daily 1 puff daily
2-3 puffs qid
1 puff qam 1 puff daily
Indications
Bronchodilator in acute reversible airway obstruction
Maintenance treatment (prevention of bronchospasm) in COPD, asthma
COPD and asthma
Bronchodilator used in COPD
Bronchodilator used in COPD
Bronchodilator used in asthma and COPD
Bronchodilator used in asthma and COPD
Side Effects
CV (angina, flushing, palpitations, tachycardia, can precipitate atrial fibrillation), CNS (dizziness, H/A, insomnia, anxiety), GI (diarrhea, N/V), rash, hypokalemia, paroxysmal bronchospasm
Common: CNS, H/A, dizziness Resp: URTI, GI (N/V, diarrhea, pain/ discomfort, oral candidiasis)
Palpitations, anxiety, dizziness, fatigue, H/A, N/V, dry mucous membranes, urinary retention, increased toxicity in combination with other anticholinergic drugs
Palpitations, anxiety, dizziness, fatigue, H/A, N/V, dry mucous membranes, urinary retention, increased toxicity in combination with other anticholinergic drugs
Palpitations, anxiety, dizziness, fatigue, H/A, N/V, dry mucous membranes, urinary retention, increased toxicity in combination with other anticholinergic drugs
Palpitations, anxiety, dizziness, fatigue, H/A, N/V, dry mucous membranes, urinary retention, increased toxicity in combination with other anticholinergic drug