1. What are the adverse effects of Ipratropium?

dry mouth and throat, GI, headace, distress, skin rahs and gives, may cause systemic efffects like urinary retention and angle-closure glaucoma

2. What is the dosage order with multiple inhaled drugs?

1. beta agonist (bronchodilator) opens passages -> wait 5 minutes
2. anticholinergic agent -> wait five minutes
3. Cromolyn/nedocromil or corticosteroid

3. How should an inhaler be used

1. hold device upright and shake
2. exhale and tilt head back with the mouth open
3. position inhaler (with spacer, 1-2 inches from mouth or between the lips)
4. release medication while inhaling slowly
5. breathe in for 3-5 seconds, and hold breath for 15
6. wait at least 1 minute between puffs in needed

4. What is a spacer designed to do?

large particles are capable of forming within the inhaled medication, and are eventally swallowed which can cause systemic effects, a spacer tries to decrease this effect by cause the an enriched number of small particles

5. What is the mechanism of action of acetylcystiene?

breaks bonds of mucoproteins, DnA and molecules, redces the thickness of debris and viscosit of secretions which aids in their removal

6. What is the indication for acetylcystiene?

it is the drug of choice for cystic fibrosis ; can be used as an antidote for acetominophen overdose by restoring the glutathione levels in the liver

7. How is acetylcysteine delivered?

inhalation or direct instillation through a catheter in the chest for mucokinesis, they are 10-20% solutions

8. what are the pharmacokinetics of acetlycysteine like

primary effect is local, in about 5-10 minutes after administration, very little abosorbed into the system

9. What are the adverse reactions with acetlycysteine?

n/v, fever, sore mouth irritation of lungs and throat, runny nose, hydrogen sulfide odor

10. What is the mechanism of action of Zafirlukast?

leukotriene receptor antagonist that blocks the SRS-A receptors