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PHARM > anticholinergic > Flashcards

anticholinergic Flashcards

1
Q

Anticholinergic AKA

A

Parasympatholytic

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2
Q

Anticholinergic Agents

A

Atropine
Atrovent
Spiriva

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3
Q

What do these drugs block?

A

(Ach) Cholinergic-induced bronchoconstriction

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4
Q

When are these drugs effective?

A

If bronchoconstriction is due to cholinergic activity

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5
Q

What disease are anticholinergic drugs approved for?

A

COPD ONLY

used a bronchodilator for maintenance treatment for copd including chronic bronchitis and emphysema.

May be used for severe asthma in addition to beta agonist- especially if patient does not respond well to beta agonist therapy.

BUT ONLY APPROVED FOR COPD!!!!

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6
Q

Specific anticholinergic agents

A

Atropine
Ipratropium bromide
Combination Ipratropium Bromide/Albuterol
Tiotropium bromide

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7
Q

How would you administer Atropine?

A

Injection

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8
Q

Why wouldn’t you use Atropine?

A

Because of the systemic side effects

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9
Q

What kind of membranes do Atropine cross over?

A

Lipid Membranes

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10
Q

When does the onset begin for Ipratropium Bromide begin?

A

in several minutes

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11
Q

When does Ipratropium bromide peak?

A

1-2 hours

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12
Q

When can B2 agonist peak?

A

20-30 minutes

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13
Q

In asthma patients how long will the Ipratropium Bromide’s duration last?

A

about the same length of time as the B2 agonist drugs.

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14
Q

In COPD patients how long will the Ipratropium Bromide’s duration last?

A

1-2 hours longer

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15
Q

What would you use for symptomatic relief of allergic/non-allergic perennial rhinitis AND the common cold?

A

Anticholinergic Nasal Spray

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16
Q

What kind of effect do you get when mixing Albuterol and Ipratropium Bromide?

A

Synergistic Effect

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17
Q

What are the trade names for Albuterol and Ipratropium Bromide mixed?

A

Combivent

Duo-Neb

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18
Q

What is the long acting anti-cholinergic?

A

Tiotropium Bromide

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19
Q

What is the Trade name for Tiotropium Bromide

A

Spiriva

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20
Q

How is Spiriva given?

A

DPI

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21
Q

When does Spiriva Peak?

A

1-3 hours (says the book)

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22
Q

Easily absorbed in the blood stream?

A

Tertiary

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23
Q

Poorly absorbed into the bloodstream

A

Quaternary

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24
Q

Why is Quaternary poorly absorbed into the bloodstream?

A

Low lipid solubility

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25
Q

Crosses the Blood brain barrier?

A

Tertiary

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26
Q

CNS

A

Teritary

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27
Q

Does not cross into the Blood brain barrier?

A

Quaternary

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28
Q

What kind of compound is Quaternary?

A

Ipratropium Bromide

Atrovent
Spiriva

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29
Q

Effects of Tertiary (Atropine)

A 
Bronchodilation
Decreased Mucus Clearance 
Block Hypersecretion 
Altered CNS
Heart rate (increases or decreases) 
dry mouth
dysphagia 
dysphonia 
Urinary retention
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30
Q

Effects of Quarternary (Ipa)

A

Bronchodilation
Dry mouth
Blocks hypersecretion

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31
Q

(MOA) How does it enter the lung?

A

Vagus Nerve

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32
Q

(MOA) Where is it found

A

Epithelium
Submucosal Glands
Smooth Muscle
Mast Cells

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33
Q

(MOA) Automapping on what sized airways?

A

Large to Midsized (3-8mm)

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34
Q

(MOA) Are there receptors in the smaller proximal airways or bronchioles?

A

NO!

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35
Q

(MOA) Basal level of bronchomotor tone is caused by what kind of activity?

A

Parasympathetic

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36
Q

(MOA) Metacholine stimulates what?

A

constriction

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37
Q

(MOA) the effects of anticholinergic agents depend upon the degree of tone present that can be?

A

Blocked

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38
Q

(MOA) In health subjects, there is minimal airway dilation with an anticholinergic agent because there is only what kind of tone being blocked

A

basal or resting

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39
Q

IF THERE IS NO PARASYMPATHETIC ACTIVITY what kind of effect will the drug have?

A

MINIMAL!!!!

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40
Q

Bronchoconstriction in COPD may be due in part by what kind of reflex innervation of airway smooth muscle.

A

Vagally Mediated Relex

41
Q

What kind of irritants can cause the sensory C-fibers to respond

A 
Aerosols 
cold air
high flows
cigarette smoke
histamine
42
Q

When C-fibers are activated they produce what kind of impulse to the CNS?

A

Afferent Nerve

43
Q

When C-fibers are activated they produce an afferent impulse to the CNS that results in an ______ impulse to cause _______ of muscle?

A

Efferent; Constriction

44
Q

When C-fibers are activated they produce an afferent impulse to the CNS that results in an efferent impulse to cause constriction of muscle, _____ and _______?

A

Mucus secretion; Cough

45
Q

When C-fibers are activated they produce an afferent impulse to the CNS that results in an efferent impulse to cause constriction of muscle, mucus secretion and cough. What is this doing?

A

PROTECTING

46
Q

These agents also ______ exercise induced asthma, psychogenic bronchoconstriction, and bronchoconstriction caused by beta blockade and cholinergic agents

A

Inhibit

47
Q

These agents also inhibit ___________, psychogenic bronchoconstriction, and bronchoconstriction caused by beta blockade and cholinergic agents

A

exercise induced asthma

48
Q

These agents also inhibit exercise induced asthma, ____________, and bronchoconstriction caused by beta blockade and cholinergic agents

A

psychogenic bronchoconstriction

49
Q

These agents also inhibit exercise induced asthma, psychogenic bronchoconstriction, and ___________ caused by beta blockade and cholinergic agents

A

bronchoconstriction

50
Q

These agents also inhibit exercise induced asthma, psychogenic bronchoconstriction, and bronchoconstriction caused by ________and ________

A

beta blockade and cholinergic agents

51
Q

What else inhibits reflex bronchoconstriction by blocking irritant receptors?

A

Aerosolized Lidocaine

52
Q

Changes in airway may also make cough mechanism more _____?

A

sensitive

53
Q

Airways are hypersensitive to deep breaths that result in a cough or increase in

A

bronchomotor tone

54
Q

At least a portion of the obstruction in COPD may be due to?

A

VAGALLY MEDIATED REFLEX BRONCHOCONSTRICITON

55
Q

Stimuation by afferent ______, trigger reflex efferent vagal nerve activity and constriction

A

C-Fibers

56
Q

Anticholinergic agents are ______ antagonists for acetylcholine at muscarinic receptors on airway smooth muscle and M1 receptors at the parasympathetic ganglia

A

competitive

57
Q

Anticholinergic agents are competitive antagonists for ______ at muscarinic receptors on airway smooth muscle and M1 receptors at the parasympathetic ganglia

A

acetylcholine

58
Q

Anticholinergic agents are competitive antagonists for acetylcholine at ______ receptors on airway smooth muscle and M1 receptors at the parasympathetic ganglia

A

muscarinic

59
Q

Anticholinergic agents are competitive antagonists for acetylcholine at muscarinic receptors on ___________ and M1 receptors at the parasympathetic ganglia

A

airway smooth muscle

60
Q

Anticholinergic agents are competitive antagonists for acetylcholine at muscarinic receptors on airway smooth muscle and ____ receptors at the parasympathetic ganglia

A

M1

61
Q

Anticholinergic agents are competitive antagonists for acetylcholine at muscarinic receptors on airway smooth muscle and M1 receptors at the _____________?

A

parasympathetic ganglia

62
Q

They block the action of ________ at the M3 receptor in the airway reversing bronchoconstriction due to cholinergic activity.

A

acetylcholine

63
Q

They block the action of acetylcholine at the ____ receptor in the airway reversing bronchoconstriction due to cholinergic activity.

A

M3

64
Q

They block the action of acetylcholine at the M3 receptor in the airway ________ bronchoconstriction due to cholinergic activity.

A

reversing

65
Q

They block the action of acetylcholine at the M3 receptor in the airway reversing _______ due to cholinergic activity.

A

bronchoconstriction

66
Q

They block the action of acetylcholine at the M3 receptor in the airway reversing bronchoconstriction due to ________

A

cholinergic activity

67
Q

Atrovent blocks

A

m1, m2, and m3

68
Q

Spiriva blocks

A

M1, M2, and M3

69
Q

Spriva blocks more slowly from

A

M1 and M3

70
Q

Spiriva last for how many hours

A

24 Hours, because it blocks M1 and M3 more slowly

71
Q

Ipratropium Bromide trade name?

A

Atrovent

72
Q

Ipratropium Bromide routes?

A

MDI

SVN

73
Q

Dosages for MDI Atrovent

A

18ug/2puffs

74
Q

Dosages for SVN Atrovent

A

0.5mg, 0.02%

75
Q

Frequency of Ipratropium Bromide?

A

QID

76
Q

Duration of Atrovent

A

4-6 hours

77
Q

Tiotropium Bromide trade name?

A

Spiriva

78
Q

Route for Spiriva?

A

DPI

79
Q

Dosage for Spiriva

A

18ug/1 puff

80
Q

Frequency for Spiriva

A

Once a day

81
Q

Duration of Spriva

A

24 hours

82
Q

Oxtropium bromide trade name?

A

Oxivent

83
Q

Oxivent route?

A

MDI

84
Q

Dosage for Oxivent

A

100ug/2 puff

85
Q

Frequency for Oxivent

A

BID

86
Q

Duration of Oxivent

A

8 hours

87
Q

Common Side Effects of Atrovent MDI and SVN

A

Dry mouth

Cough

88
Q

Occasional Side effects of MDI atrovent?

A 
Nervousness
Irritation
Dizziness
Headache
Palpitation 
Rash
89
Q

Occasional side effects of SVN atrovent

A 
pharyngitis
dyspnea 
flulike symptoms
bronchitis 
upper respiratory infection
nausea 
eye pain
bronchoconstriction 
urinary retention
90
Q

Use with caution in patients with?

A

prostatic hypertrophy
urinary retention
glaucoma

91
Q

For what disease is proper use of MDI and SVN essential. Use of mouthpiece and reservoir?

A

Glaucoma

92
Q

LEARN THE COMPARISON OF

A

Anticholinergic and Beta Agonist

93
Q

(receptor types) Airway smooth muscle. Ipratropium and tiotropium block.

A

M3

94
Q

(receptor types) ganglionic synapse. Enhance cholinergic nerve transmission. Ipratropium and Tiotropium block?

A

M1

95
Q

(receptor types) auto-receptor, inhibition further release of acetycholine so that blocade can increase ach release and may offset the bronchodilating effect of ipratropium

A

M2

96
Q

What percent strength is Ipratropium Bromide SVN?

A

0.02%. 2.5ml vial

97
Q

parasympatholytic aka

A

antimuscaranic

98
Q

What are C-fibers?

A

Nerves that respond to various stimuli

99
Q

Sub mucosal gland

A

M3 receptor

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