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OS 216 E2 > Adrenergic Agents in Allergy > Flashcards

Adrenergic Agents in Allergy Flashcards

1
Q

what type of hypersensitivity?

IgE, sting, pollen, drugs
anaphylaxis, urticaria, angioedema

A

I: immediate

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2
Q

what type of hypersensitivity?

complement-dependent
IgG or IgM antibodies

A

II: antibody-dependent cytotoxic

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3
Q

what type of hypersensitivity?

exemplified by serum sickness
IgG
multisystem complement-dependent vasculitis

A

III: complex-mediated

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4
Q

what type of hypersensitivity?

contact derm from topical drugs

A

IV: cell-mediated

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5
Q

immunosuppressive drug

blocks proliferation of IgE-producing clones; inhibits IL-4 production by Th in the IgE response

A

prednisone

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6
Q

reduce release of mediators from mast cells and basophils

produce bronchodilation

A

adrenergic agents (isoprotenerol, epinephrine, theophylline)

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7
Q

histamine effect on

bp, hr
git
lungs
nerves

A

dec bp, inc hr
contract git
constrict lungs
stimulate nerve endings (pain, itching)

also gastric acid secretion

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8
Q

epinephrine (mixed a and b-adrenergic receptor agonist)

bp
git
lungs
eye

why is it the physiologic antidote to H?

A

INC systolic, dec diastolic bp; inc heart rate

relax intestinal sm, contract sphincters

B2-bronchodilation!!!

dec aqueous humor, inc outflow, dilate pupil

BC it activates B2-ADRENERGIC RECEPTORS -> suppress release of mediators from mast cells

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9
Q

why is epinephrine added to local anesthetics? (3)

A

dec systemic absorption
inc duration of action
dec toxicity

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10
Q

epinephrine CI (2)

A

cardiac arrhythmia

angle-closure glaucoma

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11
Q

epinephrine precautions (6)

A 
elderly
DM - glycogenesis
CVS disease
thyroid disease - amplified response
rapid IV infusion - arrhythmia
halothane anesthesia -> heart sensitive to catecholamine; arrhythmia
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12
Q

epineph standard diluent

A

1mg/250ml 0.9 NSS

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13
Q

epinephrine IV compatibility (3)

incompatibility (3)

A

dopamine
dobutamine
diltiazem
(hypotensives)

aminophylline
sodium bicarbonate
other alkaline sol’ns
(deactivates epineph)

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14
Q

epineph ADME

*onset of bronchodilatation
SQ 5-10 min
Inh 1 min

A

Oral - rapid metabolism in GI, liver (not given orally)

Dist - cross placenta, breastmilk

Metab - adrenergic neuron, degraded by MAO and COMT

Elim - no clinical significance

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15
Q

IM dosage epineph

A

0.3-0.5 mg

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16
Q

if px is taking amitriptyline/imipramine/beta blocker

A

give half doses of adrenaline instead of epinephrine

17
Q

IV epinephrine indications (2)

A

hypotensive

in cardiac or respiratory arrest (who failed to respond to IV volume replacement & multiple IM epinephrine)

*infusion = 4ug/ml rate of 1ug/min

18
Q

anaphylaxis != cardiac resuscitation (dosing)

A

anaph 1:1000 (adults and pedia)

cardiac arrest: 1:10000

19
Q

ocular symptoms
itching
sneezing
rhinorrhea

intranasal cs & oral AH
decongestants
intranasal anticholinergics & nasal saline irrigation

A

all

ocular + rhinorrhea (decongestants; a-adrenergic agonist)

rhinorrhea

20
Q

a-adrenergic agonists may damage mucosa due to ischema -> necrosis. what to do?

A

selective for a1 receptors less likely to damage

21
Q

limitation of therapy with nasal decongestants

A

loss of efficacy
“rebound” hyperemia
worsening of symptoms

on chronic use or when drug is stopped

22
Q

ephedrine adverse effect

less potent?

what’s similar to this?

A

CNS

pseudoephedrine -> less tachycardia, inc bp, CNS stimulation

phenylpropanolamine (withdrawn in US due to cardiac effects)

23
Q

nasal decongestants: use with caution in px (3)

A

hypertension

prostatic enlargement

taking MAO inhibitor - addictive; toxicity

24
Q

caveat with topical decongestants even if more selective site of action

how about oral decongestants

A

used excessively by px -> rebound congestion

oral - less likely ang rebound congestion, but more risk of adverse systemic effects

25
Q

phenylephrine drug class and effects (3)

A

a1-agonist

mydriatic (dilate pupil)
topical decongestant
inc bp

  • constriction of nasal mucosa
  • resist COMT
26
Q

ephedrine drug class, effects (3)

A

a/b-agonist

mild stimulant
decongestant
inc bp

  • high bioavailability
  • resist MAO
  • release stored catecholamine
27
Q

xylometazoline, oxymetazoline drug class, effects (2)

A

a2-agonist

topical decongestant
hypotension

  • promote constriction of nasal mucosa
  • congeners of clonidine

OS 216 E2 (6 decks)

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