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Pharmacology > Chap 18 & 20 > Flashcards

Chap 18 & 20 Flashcards

1
Q

The accidental inhalation of food particles, fluids, or gastric contents into the lungs

A

Aspiration

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2
Q

One of the basic functional units of the nervous system that is specialized to transmit electrical nerve impulses and carry information from one part of the body to another; it consists of a cell body, axons, and dendrites

A

Neuron (Nerve cell)

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3
Q

Pneumonia that is acquired in a health care setting

A

Noscomial pneumonia

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4
Q

A chemical that is released from a nerve ending to transmit an impulse from a nerve cell to another nerve, muscle, organ, or other tissue

A

Neurotransmitter

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5
Q

Characteristics of a substance or drug with the ability to cause total or partial loss of memory

A

Amnestic properties

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6
Q

Involuntary contractions or twitching of groups of muscle fibers

A

fasciculation

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7
Q

an enzyme that breaks down the neurotransmitter acetylcholine at the synaptic cleft, so that the next nerve impulse an be transmitted across the synaptic gap

A

Acetylcholinesterace (AchE)

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8
Q

The production of a restful state of mind, particularly by the use of drugs that have a calming effect, relieving anxiety and tension

A

Sedation

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9
Q

An autoimmune neuromuscular disorder characterized by chronic fatigue and exhaustion of muscles

A

Myasthenia gravis

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10
Q

A person having at least 30 minutes of continuous seizure activity without full recovery between seizures

A

Status Epilepticus

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11
Q

A substance that interferes with the neural transmission between motor neurons and skeletal muscles

A

Neuromuscular blocking agents (NMBAs)

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12
Q

An attack of asthma lasting for more than 24 hours

A

Status asthmaticus

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13
Q

A molecular structure inside or outside the cell that binds to a specific substance to elicit a physiologic response

A

Receptor

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14
Q

Is a part of the nervous system that controls muscles that are under voluntary control

A

Somatic motor neurons

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15
Q

Name the only depolarizing drug currently available

A

Succinylcholine (Anectine)

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16
Q

List eight clinical uses of NMBAs

A
  1. Facilitate ET intubation
  2. Muscle relaxation during surgery
  3. Enhance PT-Ventilation Synchrony
  4. Reduce intracranial pressure in intubated pts
  5. Reduce O2 consumption
  6. Terminate convulsive status epilepticus and tetanus
  7. Facilitate procedures or diagnostic studies
  8. Paralyze selected pts who must remain immobile (trauma pts)
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17
Q

The most common pathologic condition requiring a pt to be placed on mechanical ventilation and require muscle relaxation is

A

severe asthma

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18
Q

Somatic motor nervous system, or skeletal muscle system controls

A

Voluntary movement

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19
Q

The autonomic nervous system controls

A

involuntary movement

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20
Q

The transmission of nerve conduction in skeletal muscle is chemically mediated by the neurotransmitter

A

Ach

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21
Q

Acetylcholine is then broken down and inactivated by the enzyme ___, allowing ?

A

AchE (acetylcholinesterase), allowing the muscle fiber to repolarize

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22
Q

Based on neuromuscular physiology, describe two ways muscle contraction may be blocked

A

A. Competitive inhibition (-Binding and blocking of Ach receptors without depolarization-Nondepolarization-Restimulated)
B. Prolonged occupation and persistent binding of the Ach receptors (-Depolarization of the neuromuscular juction- depolarizing agents - contraction of muscle)

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23
Q

Nondepolarizing agents cause muscle paralysis by affecting the postsynaptic cholinergic receptors at the

A

neuromuscular junction

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24
Q

___is an example of a cholinesterase inhibitor that can reverse nondepolarizing agents

A

Neostigmine

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25
Q

Nondepolarizing agents have a longer duration of action than the depolarizing agents

A

Succinylcholine (which has no reversal agents)

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26
Q

___has the greatest potential to cause cardiovascular side effects, especially tachycardia and hypERtension

A

Pancuronium

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27
Q

What are two concerns RT when administering nondepolarizing agents

A
  • Maintain a patent airway

- Maintain appropriate ventilation

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28
Q

Which reversal agent is used to treat myasthenia gravis

A

pyridostigmine

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29
Q

Hoffman Degradation related to elimination of atracurium and cistracurium

A

Partly inactivated by spontaneous degradation by pH and temp (nonenzymatic breakdown)

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30
Q

Two NMBAs would not be recommended for a pt with high bp and tachycardia

A

Atracurium and pancuronium

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31
Q

List two side effects of reversing agents

A

Severe bradycardia and salivation

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32
Q

Succinylcholine

A

Depolarizing agent, IV dose 1-1.5mg/kg, Total muscle paralysis= 60-90 sec, clinical duration= 10-15 minutes

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33
Q

During brief periods of paralysis, two simple measures of voluntary muscular function include subjective assessments such as

A

handgrip strength or lift head off bed for 5 seconds

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34
Q

Which of the following indications for administration of NMBA

  1. ET extubation
  2. Muscle paralysis during surgery
  3. to facilitate mechanical ventilation
  4. ET intubation
A
  1. Muscle paralysis during surgery
  2. Facilitate mechanical ventilation
  3. ET Intubation

2,3,4

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35
Q

If a mechanically ventilated pt is receiving vecuronium, the pt should also receive which of the following?

A

Sedation and Analgesics

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36
Q

Vecuronium metabolized by___ and excreted by___

A

Liver, Kidney

Watch for renal failure

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37
Q

NMBA

A

Drugs that paralyze muscles and prevent movement

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38
Q

Muscle paralysis caused by nondepolarizing blocking agents can be reversed using what

A

Cholinesterase inhibitors or anticholinesterase (Neostigmine)

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39
Q

The transmission of nerve conduction in skeletal muscle is chemically mediated by which neurotransmitter

A

Acetylcholine

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40
Q

The neuromuscular drug of choice to assist in ET intubation is

A

Succinylcholine

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41
Q

What is the simplest means of monitoring the adequacy of neuromuscular blockade

A

Direct observation of muscle activity

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42
Q

The brain and spinal cord make up the functional components of this system; together these provide for all conscious and subconscious functions of the body

A

Central Nervous System (CNS)

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43
Q

These drugs can alter levels of certain neurotransmitters, in particular norepinephrine and serotonin within the brain

A

Antidepressants

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44
Q

These drugs depress the nervous system, they can be divided into two categories, local and general. Their use results in the absence of pain perception

A

Anesthetics

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45
Q

These drugs are used primarily to treat bipolar disorders

A

Mood stabilizers

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46
Q

These drugs provide pain relief; they can be subdivided into narcatic and nonnarcotic medications

A

Analgesics

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47
Q

These drugs are used to treat psychotic disorders, such as schizophrenia, and they affect primarily the neurotransmitter dopamine

A

Antipsychotics

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48
Q

This is a method used during certain invasive procedures; the goal of this method are to decrease the level of consciousness and relieve anxiety and pain, while allowing the pt to follow verbal commands

A

Conscious sedation

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49
Q

These drugs can cause increased activity of the brain

A

Stimulants

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50
Q

These drugs are known as minor tranquilizers; they treat several conditons, including anxiety disorders and insomnia

A

Anxiolytics

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51
Q

These drugs block the activity of cholinisterase, an enzyme that inactivates the neurotransmitter acetylcholine

A

Cholinesterase Inhibitors

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52
Q

This is a chemical substance that allows neurons to transmit electrical impulses throughout the CNS and peripheral nervous system

A

Neurotransmitter

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53
Q

Give a brief description of the following areas of the brain..

a. Cortex
b. Midbrain
c. Brainstem or medulla

A

A. Location of thought, memory, self awareness, and personality, perception of sensation and control of body movement(speech)
B. Relay station for info traveling to and from cortex- Integrates and modulates autonomic function
C. Control area for autonomic functions, such as breathing and cardiovascular control, and the area responsible for alertness-the reticular activating system

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54
Q

The clinical effects of CNS drugs depend on what factor

A

localization of specific neurotransmitters in specific brain areas

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55
Q

Do CNS drugs increase or decrease individual neuronal activity

A

both increases or decreases
-Balance of activity of different types of neurons seems to affect brain function and mood
Goal- restoration of balance and treat mood disorders

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56
Q

Deficiency of what two neurotransmitters has been linked to depression

A

Serotonin and Norepinephrine

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57
Q

List three etiologies of depressive disorders

A

biologic, psychological, social factors

58
Q

Pharmacologic treatment of bipolar disorder typically begins with

A

mood stabilizers

59
Q

Bipolar disorder involves

A

alternating episodes of depression and mania or hypomania

60
Q

What neurotransmitter does pharmacotherapy for psychosis associated with depression or mania generally aim to increase

A

dopamine in the brain

61
Q

Neurotransmitter associated with cognitive deficits in pts with Alzheimers dementia

A

Decreased acetylcholine levels

62
Q

What type of drug can improve cognition and function in pts with alzheimers disease

A

Cholinesterase inhibitors (Donepezil, Tacrine, Galatamine, and Rivastigmine)

63
Q

Drugs used to treat anxiety and insomnia

A

Xanax and Ativan

64
Q

When given with opiods , what side effects could benzodiazepines augment

A

Used to reduce anxiety - excellent induction agents when providing general anesthesia and useful in preventing unpleasant recall during uncomfortable interventions. May augment the resp depression

65
Q

When choosing sedative drug for your pt , why would you choose a benzodiazepine over a barbiturate

A

they have a widespread depressed effects on neuron activity- high risk of addiction and abuse

66
Q

a common complaint that frequently results in the prescription of a hypnotic is

A

difficulty sleeping

67
Q

What is considered a toxic level of blood alcohol? what side effect from toxic levels would concern you

A

400-600mg/dL BAL

Respiratory arrest, depression of increase cortical behavior control centers

68
Q

What is pain

A

subjective, unpleasant experience, and it is difficult to observe and quantitate objectives

69
Q

Two components of the pain experience

A

a. Sensation of pain as mediated by CNS receiving nociceptive input from peripheral pain receptors
b. Suffering the negative, personal emotional response to the pain experience

70
Q

How do nonsteroidal antiinflammatory drugs (NSAIDs) work

A

Treat moderate pain by affecting the hypothalamus and by inhibiting the production of inflammatory mediators primarily prostaglandins, at the peripheral site of the painful stimulus

71
Q

The most frequently used analgesic, an NSAID that is purchased over the counter is,

A

Aspirin (a salicytate)

72
Q

During conscious sedation pt should remain

A

conscious and able to communicate, protect their own airway, and breathe adequately

73
Q

A disease characterized by resting tremor, rigidity, and postural instability resulting from loss of dopamine containing neurons is

A

parkinsons disease

74
Q

Medical treatment of any degree of bipolar disorders must begin with which medication

A

mood stabalizers

75
Q

An alcohol is broken down and metabolized into CO2 and H2O the byproduct is

A

Acetaldehyde

76
Q

Where do NMBA’s (Neuromuscular blocking agents) effect

A

at the neuromuscular junction by interfering with the action of the acetylcholine

77
Q

Nondepolarizing agents competitively what

A

block the cholinergic nictonic receptor on the postsynaptic muscle fiber, preventing acetylcholine from depolarizing the muscle fiber. Tubocurane is an example

78
Q

Depolarizing agents act by

A

first depolarizing the muscle fiber and then prolonging the depolarized state to prevent repolarization and further stimulation. Succinylcholine is the only agent

79
Q

NMBA’s are given by what and exhibit a dose related to what

A

Given by I.V. and exhibit a dose related response on muscles

80
Q

The peripheral nervous system is divided into two motor neuron groups

A

The somatic motor neurons and the autonomic motor neurons

81
Q

Somatic motor neurons control

A

muscle over which humans have control of voluntary movement

82
Q

autonomic motor neurons control

A

smooth muscle, cardiac muscle, and galnds

83
Q

Nondepolarizing agents

A

Earliest group of NMBAs used clinically. Curare is an example

  • block the acetylcholine receptors without activating them
  • Chemically are either steroid structure agents or benzylisoquinoline esters
  • The difference between them is regarding complications and side effects
84
Q

Nondepolarizing agents- Steroid structure agents

A

Vecuronium, Rocuronium, Pancuronium

85
Q

Nondepolarizing agents- Benzylisoquinolines

A

Atracurium, Mivacurium

86
Q

Nondepolarizing agent mechanism of action

A
  • Compete against endogenous Acetylcholine for receptor occupancy
  • Muscle contraction does not occur if enough sites are blocked by these agents
  • With nondepolarizing agents, depolarization of the postynaptic membrane becomes a function of the amount of drug and the amount of acetylcholine around the receptor
  • They are dose dependent. with larger doses overcoming acetylcholine and block more receptor sites
87
Q

Nondepolarizing agents Pharmacokinetics

A
  • Are poorly lipophilic and do not penetrate fatty tissue
  • Do not cross the blood brain barrier
  • onset of paralysis and duration vaires widely between these agents
  • Tubocurarine last for 35-60 minutes with complete recovery taking hours
  • In general, nondepolarizing agents have a longer duration of action than the depolarizing agents
88
Q

Nondepolarizing agents Metabolism

A
  • Normal conduction can return with still 75% of receptor sites still being blocked
  • most of these agents are metabolized by the liver and excreted by the kidneys
  • important consideration of renal and hepatic function when delivering these agents
  • atracurium and cistracurium spontaneously degraded mechanism is dependent on the pH of the blood and body temp
89
Q

Nondepolarizing agents Adverse effects

A
  • May produce cardiovascular side effects. Tachycardia and hypertension
  • All have a tendency to release histamine from mast cells
  • Histamines can cause hypotension, reflex tachycardia, and bronchospasm
  • Antihistamines may be given as a pretreatment
90
Q

Reversing nondepolarizing agents

A
  • Can be reversed by cholinesterase inhibitors
  • Neostigmine inhibits cholinesterase from breaking down acetylcholine, which then allows more acetylcholine to be available at the neuromuscular juction to complete and displace the NMBA
  • Neostigmine can cause bradycardia, increased salivation, and hyperperistalsis. This can be treated with the administration of ATROPINE
91
Q

Treat neostigmine side effects with what

A

ATROPINE

92
Q

Depolarizing agents

A
  • They are shorter acting
  • There is no agent that reverse their action
  • Succinylcholine is the only agent in this class
  • Given IV it causes total muscle paralysis in 60-90 seconds and lasts for 10-15 minutes
  • It is the ideal agent for intubation
93
Q

Depolarizing Mechanism of action

A
  • Opens sodium channels and depolarizes the postsynaptic muscle
  • Is not effected by cholinesterase
  • Succinylcholine causes fasciculations during initial depolarization
  • You may see the eye lids flickering and other rapid muscle contraction
  • Phase 1 and phase2
  • Phase 2 resembles nondepolarizing tendencies which involves stimulation of the motor neuron is poorly sustained and paralysis is prolonged. This generally occurs with prolonged use and large doses of succinylcholine
94
Q

Phase 2 Depolarizing agents

A

Resembles nondepolarizing tendencies which involves stimulation of the motor neuron is poorly sustained and paralysis is prolonged. This generally occurs with prolonged use and large doses of succinylcholine

95
Q

Metabolism of Depolarizing agents

A
  • Rapidly hydrolyzed by plasma cholinesterase in the blood

- Again, there is no agent available to reverse succinylcholine

96
Q

Adverse effects of depolarizing agents

A
  • Sympathomimetic responses causing tachycardia and hypertension
  • Muscle pain
97
Q

NMBA and Mechanical Ventilation

A
  • Improve ventilator synchrony
  • Improve ventilation and airway pressures
  • Useful in ARDS and asthma ventilator patients
98
Q

Precautions and Risks NMBAs

A
  • Eye care, Eyes dry and prevent corneal abrasions
  • suctioning and secretion retention
  • Nosocomial pneumonia
  • increased risk of aspiration
  • Myopathy
  • Deep vein thrombosis (DVT’s)
99
Q

Use of sedation and Analgesia

A
  • All ventilator pts receiving NMBA must be provided adequate sedation and analgesia
  • Sedatives with amnesic qualities should be used
  • Analgesics should be used to control pain
100
Q

Sedatives with amnesic qualities should be used

A
  1. Propofol (Doprivan)
  2. Ativan (Lorazepam)
  3. Versad (Midazolam)
101
Q

Analgesics should be used to control pain

A
  1. Fentanyl (sublimaze)
  2. Hydromorphone (Dilaudid)
  3. Morphine
102
Q

Titration of drug dose and monitoring of reversal are performed with a

A

Peripheral Nerve Stimulator and train-of-four-stimulation

-4 equal twitches indicates that there is likely less then 75% of the receptor sites still occupied by NMBA

103
Q

Penicilin reaction?

A

Hypersensitivity

104
Q

TB antibiotics

A

Isoniazid.
Rifampin (Rifadin, Rimactane)
Ethambutol (Myambutol)
Pyrazinamide.

105
Q

Assetitive drugs

A

decrease pain tolerance

106
Q

Common cold is a

A

is a viral infectious disease of the upper respiratory tract

107
Q

Bronchodilation by

A

beta 2 receptors

108
Q

Vasoconstriction by

A

Alpha 1 = lungs

Beta= heart

109
Q

Neuromuscular blockers for rapid intubation

A

Succs

110
Q

Ipatropium dose

A

(Atrovent) 0.5 mg

111
Q

Symbicort combination

A

Budesonide/formoterol or pulmicort/ formoterol

112
Q

Acetosystolone=

A

tylenol

113
Q

Alcohol is treated with

A

Benzodiazepines ex. atovan

114
Q

Combination of what drugs seems to be more effective sedative drugs

A

Barbiturates and benzodiazepams in combination with analegesics decreases perceived pain
-Barbiturates and benzodiazepams reduce pain tolerance

115
Q

NSAIDS are used to

A

treat moderate pain levels (OTC)

116
Q

Has no significant anyinflammatory effect

A

Aniline: Acetaminophen (Tylenol)

117
Q

Drugs that decrease to respiratory center and increase in PaCO2

A

Opiods (narcotics). Moderate to severe pain tolerance, develops quick, withdrawal pain, good cough syrup

118
Q

opiods give depresseion of what

A

GI Tract and Constipation. Can cause hypoventilation and not feel the the effect= tube them

119
Q

How do atracurian and cistiacurian get metabolized

A

Liver

120
Q

Anxiolytics Benzodiazepines reversal agent

A

Romazicon can reverse sedative effects

121
Q

Treat overdose of aniline: Acetaminophen (tylenol)

A

with acetylcystein (mucomyst) oral- reduces liver damage

122
Q

Opiod antidote/ reversal

A

narcan

123
Q

Some drugs can cause resp depression such as

A

Barbiturates
opiods
Neuroleptics
Anesthetics

124
Q

Device that needs an insp. >60lpm

A

DPI

125
Q

Why paralyze pt on vent

A

synchronize breathing ventilation

126
Q

Corticosteroid=

A

anti inflam.

127
Q

What depolarizing agents do you need to watch eyelids for twitch and cant reverse

A

succinylcholine

128
Q

Aminoglycodies treat CF

A

TOBI

129
Q

Short Acting Beta Agonist

A

Albuterol?,

Duoneb

130
Q

Long Acting Beta Agonist

A

Umeclindinium,
Brovana,
Foradil (formoterol),
Advair,

131
Q

Short Acting Anticholinergics

A

Ipratropium (atrovent),

Levalbuterol

132
Q

Long Acting Anticholinergics

A

Tiotropium (spiriva),

133
Q

Analgesics

A 
Tylenol (Acetaminophen),
Morphine,
Fentanyl (Sublimaze),
Aspirin (Salicylates),
Advil (ibuprofen),
Dilaudid (hydromorphine),
134
Q

Mucolytic/ Expectorant

A

Acetylcysteine (mycomyst),
Guaifenesin,
Dornase Alfa

135
Q

Corticosteroids

A 
Fluticasone (flovent),
Symbicort (Budesonide and formeterol),
Advair,
Budesonide (pulmocort)
Prednisone
136
Q

Sedatives

A 
Propofol,
Ambien (zolpidem),
Versad (Midazolam),
Alcohol,
Ativan (lorazepam),
137
Q

Antileukotrienes

A

Montelukast (singular),
Zafirlukast,
Zileuton (zyflo)

138
Q

Xanthines

A

Aminophylline,

Theodur,

139
Q

NMBs

A

Succinylcholine,
Vecuronium,
Rocuronium,
Atracurium,

140
Q

Antibacterial/ Antivirals

A

Isoniazid (treats TB),
Relenza (Zanamivir)(treats influenza),
Tobramycin (treat CF),
Cephalosporins

Pharmacology (10 decks)

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