Pulmonary Medications

ipratropium 
Atrovent ®

tiotropium 
Spiriva ®

albuterol 
Proventil ®

Bronchospasm in ICU patients (acute):  Nebulization: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or 10-15 mg/hour continuously.

bitolterol 
Tornalate ®

Supplied [0.8% aerosol.   0.2% (2 mg/ml) inhalation Soln].

metaproterenol 
Alupent ®

Supplied: [12 mcg capsule]

Inhaled Corticosteroids       [TOP]

budesonide 
Pulmicort ®

HOW TO USE - Remove the ASMANEX TWISTHALER from its foil pouch and write the date on the cap label. It’s important to throw away the inhaler 45 days after this date or when the dose counter reads “00,” whichever comes first.
Step 1. Open inhaler - Hold the inhaler straight up with the pink portion (the base) on the bottom. It is important that you remove the cap of the TWISTHALER® while it is in this upright position to make sure that you get the right amount of medicine with each dose. Holding the pink base, twist the cap in a counterclockwise direction to remove it. As you lift off the
cap, the dose counter on the base will count down by one. (If you began with the dose counter reading “30,” this action will cause it to now read “29.”) This action loads the device with the medicine that you are now ready to inhale. IT IS IMPORTANT TO NOTE that the indented arrow (located on the white portion of the TWISTHALER®, directly above the pink base) is pointing to the dose counter.
Step 2. Inhale dose - Exhale fully. Then bring the TWISTHALER®up to your mouth with the mouthpiece facing toward you. Place it in your mouth, holding it in a horizontal position as illustrated. Firmly closing your lips around the mouthpiece, take in a fast, deep breath. Since the medication is a very fine powder, you may not be able to feel or taste it after inhalation.
Remove the TWISTHALER from your mouth and hold your breath for about 10 seconds, or as long as you comfortably can. IMPORTANT: DO NOT BREATHE OUT THROUGH THE INHALER. After you take your medicine, it is important that you wipe the mouthpiece dry, if necessary, and immediately replace the cap firmly closing the TWISTHALER.
This is the only way to be sure that your next dose is properly loaded. Be sure that the arrow is in line with the dose-counter window. The cap needs to be put back on and turned in a clockwise direction, as you gently press down. You’ll hear a distinctive “click” to let you know that the cap is fully closed.

Supplied:  Powder for oral inhalation:  Asmanex® Twisthaler®: 220 mcg (14 units, 30 units, 60 units, 120 units)

Leukotriene inhibitors       [TOP]

Supplied:  10 mg tablet.   4mg, 5mg chewable tablet.

Mast Cell stabilizers       [TOP]

Other       [TOP]

Mucolytic agent. 
Adult (usual): 
Acetaminophen poisoning:   140 mg/kg orally, followed by 17 doses of 70 mg/kg every 4 hours. Repeat dose if emesis occurs within 1 hour of administration. Therapy should continue until all doses are administered even though the acetaminophen plasma level has dropped below the toxic range.  Alternatively: Give Acetadote ®: Loading dose: 150 mg/kg IV over 15 minutes. Maintenance dose: 50 mg/kg infused over 4 hours followed by 100 mg /kg infused over 16 hours. Note: To avoid fluid overload in patients <40 kg and those requiring fluid restriction, decrease volume of D5W proportionally.

Adjuvant therapy in respiratory conditions:  Note: Patients should receive bronchodilator 15 minutes prior to dose.  Inhalation, nebulization: 10% and 20% solution. Dilute 20% solution with sodium chloride or sterile water for inhalation. 10% solution may be used undiluted: 3-5 ml of 20% solution or 6-10 ml of 10% solution until nebulized - given 3-4 times/day. Dosing range: 1-10 ml of 20% solution or 2-20 ml of 10% solution every 2-6 hours.  Into tracheostomy: 1-2 ml of 10% to 20% solution every 1-4 hours.

Decrease risk of contrast-induced nephropathy: (4 doses total): 600 mg (3ml) po BID on the day before the contrast injection, then 600 mg (3ml) in a.m. on the day of the contrast injection (immediately before) and 600 mg (3ml) in the evening. In all cases the patient should be well hydrated. This is particularly important in patients with underlying renal dx or diabetes mellitus. Hydrate patient with saline concurrently.

Supplied: (Mucomyst ® soln): 10% [100 mg/ml] - 4 ml, 10 ml, 30 ml.  20% [200 mg/ml] - 4 ml, 10 ml, 30 ml.  (Acetadote ® injection): 20% [200 mg/ml] (30 ml)