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Pharmacology > Chap 5, 6, and 7 > Flashcards

Chap 5, 6, and 7 Flashcards

1
Q

The nervous system has two major control systems, what are they?

A 
The Nervous System
Central Nervous System
Brain
Spinal Cord
Peripheral Nervous System
Somatic Neurons
Autonomic Neurons
Endocrine System
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2
Q

The Central Nervous System consists of what?

A

The brain and spinal cord

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3
Q

The Peripheral Nervous System consists of what?

A

The Somatic Nervous System

The Peripheral Nervous System

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4
Q

In the Peripheral Nervous System:
The Somatic Nervous System is considered the _____controls. The Autonomic Nervous System is considered the ______controls.

A

Voluntary, Involuntary.

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5
Q

The Autonomic Nervous System is further divided into two categories. What are they?

A

Sympathetic and Parasympathetic.

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6
Q

In the Autonomic Nervous System:
The Sympathetic side is considered as “____ or _____” response.
The Parasympathetic side is considered as the “ ______ and ____.”

A

Fight or Flight

Rest and Digest

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7
Q

Parasympathetic fibers arise from?

A

The cranial/sacral portions of the spinal cord.

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8
Q

Sympathetic fibers are located where?

A

They leave the spinal cord primarily from the thoracic/lumbar regions.

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9
Q

The Parasympathetic controls day-to-day bodily functions:
“Rest and Repair” or “Rest and Digest”
Overstimulation = SLUD syndrome
Salivation, Lacrimation, Urination, Defecation
Sympathethic reacts as a general alarm system
Not essential to life, but allows coping with violent
stress.

A

True

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10
Q

What are the neurotransmitters for the Sympathetic side?

A

Nor-epinephrine

Epinephrine

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11
Q

What are the neurotransmitter(s) for the Parasympathetic side?

A

Acetylcholine.

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12
Q

The neurotransmitters from the Sympathetic side bind to what receptors?

A

Alpha receptors

Beta receptors

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13
Q

The neurotransmitters from the Parasympathetic side bind to what receptors?

A

Muscarinic receptors

Nicotinic receptors

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14
Q

Parasympathomimetic means:

Which system dominates?

A

…agent causing stimulation of the parasympathetic nervous system.
Parasympathetic system dominates

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15
Q

Parasympatholytic means:

Which system dominates?

A

..agent blocking the effects of the parasympathetic nervous system.
Sympathetic system dominates

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16
Q

Sympathomimetic means:

Which system dominates?

A

…agent causing stimulation of the sympathetic nervous system.
Sympathetic system dominates

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17
Q

Sympatholytic means:

Which system dominates?

A

..agent blocking the effects of the sympathetic nervous system.
Parasympathetic system dominates

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18
Q

Cholinergic means:

What system dominates?

A

..refers to a drug causing stimulation of a receptor for acteylcholine.
Parasympathetic system dominates

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19
Q

Anticholinergic means:

What system dominates?

A

…refers to a drug blocking a receptor for acteylcholine.

Sympathetic system dominates

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20
Q

Adrenergic means:

What system dominates?

A

..refers to a drug stimulating a receptor for nor-epinephrine or epinephrine.
Sympathetic system dominates

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21
Q

Anti-adrenergic means:

What system dominates?

A

…refers to a drug blocking a receptor for nor-epinephrine or epinephrine.
Parasympathetic system dominates

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22
Q

What are the effects of the Parasympathetic System?

A

Decreased HR, BP

Bronchial Smooth Muscle Constriction

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23
Q

What are the effects of the Sympathetic System?

A

Increased HR, BP

Bronchial Smooth Muscle Dilation

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24
Q

What are the neurotransmitters for the Sympathetic System?

A

Alpa -1 (blood vessels)
Beta -1 (cardiac muscle)
Beta -2 (bronchial, skeletal, and vascular muscle)

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25
Q

Parasympathetic - SLUD

A

S aliviation
L acrimation (crying)
U rination
D efication

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26
Q

Efferent nerve fibers

A

from the brain to the neuroeffector site

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27
Q

Afferent nerve fibers

A

from the periphery to the spinal cord

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28
Q

Five sub types of muscarinic

A

M1, M2 (heart), M3, M4, M5 (123 airway smooth muscle)

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29
Q

two types of cholinergic agents

A
  1. direct acting

2. indirect acting

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30
Q

direct acting cholinergic agent

A

mimics acetylcholine

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31
Q

indirect acting cholinergic agent

A

prevents cholinesterase from deactivating Ach

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32
Q

what do anticholinergic agents do

A

they block Ach receptor sites

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33
Q

sympathetic branch receptors

A
  1. Alpha receptors (alpha1, alpha2)

2. Beta receptor (Beta1 - heart, Beta2 - lungs)

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34
Q

adrenergic nerve transmission steps

A
  1. dopamine is converted into norepinephrine
  2. norepinephrine can go back into autoreceptor
  3. norepinephrine can diffuse and metabolize
  4. norepinephrine can go back into pre-membrane for uptake; or post membrane for uptake`
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35
Q

epinephrine stimulates

A

both alpha and beta receptors

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36
Q

norepinephrine stimulates

A

primarily alpha receptors

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37
Q

Acetylcholine (Ach)

A

a chemical produced by the body that is used by the transmission of nerve impulses. It is destroyed by the enzyme cholinesterase.

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38
Q

Adrenergic (adrenomimetic)

A

refers to a drug stimulating a receptor for norepinephrine or epinephrine.

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39
Q

Autonomic Nervous System

A

is the involuntary, unconscious control mechanism of the body, sometimes said to control vegetative or visceral functions.

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40
Q

Neuro effector Site

A

the end of the nerve fiber, terminal nerve site (e.g., a gland or smooth muscle).

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41
Q

Muscarinic

A

stimulates acetylcholine (cholinergic) receptors at the parasympathetic terminal sites: exocrine glands (lacrimal, salivary, and bronchial mucous glands), cardiac muscle, and smooth muscle(gastrointestinal tract).

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42
Q

Nicotine

A

a substance in tobacco products, stimulates acetylcholine (cholinergic) receptos at autonomic ganglia (both parasympathetic and sympathetic) and at skeletal muscle sites.

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43
Q

α Receptors

A

generally Excite, with the exception of the intestine and central nervous system receptors, where inhibition or relaxation occurs.

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44
Q

β Receptors

A

generally inhibit or relax, with the exception of the heart, where stimulation occurs.

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45
Q

β1 Receptors

A

increases the rate and force of cardiac contraction.

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46
Q

β2 Receptors

A

relaxes bronchial smooth muscle and vascular beds of skeletal muscle.

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47
Q

The part of the nervous system that includes the brain and spinal cord, controlling voluntary and involuntary acts, is called

A

Central Nervous System

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48
Q

The portion of the nervous system that is outside the central nervous system and includes the sensory, sympathetic and parasympathetic nerve is known as

A

peripheral nervous system

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49
Q

Nervous System

A

Central (brain, spinal cord) , Peripheral (sensory, motor)

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50
Q

Sensory

A

afferent

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51
Q

Motor (skeletal)

A

Somatic. Acetylcholine at neuro-effector sites

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52
Q

Autonomic consists of

A

Parasympathetic and Sympathetic

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53
Q

Parasympathetic

A

Acetylcholine at ganglion and neuro-effector sites, Chominesterase removes acetycholine

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54
Q

Sympathetic

A

Acetycholine at ganglion, Norepinephrine at neuro-effector sites, Reabsorbs norepinephrine and COMT and MAO metabolize

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55
Q

Parasympathetic Stimulation

A

Heart slows rate, Bronchial smooth muscle constricts, Exocrine glands increase secretions

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56
Q

Sympathetic

A

Increase heart rate, Dilates (beta 2) bronchial muscles, Relax (beta) coronary and skeletal blood vessels, Contract (alpha)/ Dilate (beta) pulmonary and cerebral blood vessels, Constrict (alpha) peripheral blood vessels, increased sweat glands, arises from the thoracolumbar portion of the spinal cord

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57
Q

Alpha generally (1 abd 2)

A

Excite, Alpha 1- vasoconstriction, alpha 2- lowers blood pressure

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58
Q

Beta generally (1 and 2)

A

Generally inhibit or relax. Beta 1- Stimulates the heart, increases force and rate, beta 2- relax bronchial smooth muscle and vascular beds

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59
Q

Parasympathomimetic (agonist) Cholinergic

A

Agent causing stimulation of the parasympathetic nervous system

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60
Q

Parasympathomimetic direct

A

acts like ACH ex, methacholine to induce bronchospasm to test for asthma

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61
Q

Parasympathomimetic Indirect

A

blocks cholinesterase ex, Tensilon to test for nerve activation in Myasthenia gravis

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62
Q

Parasympatholytic (antagonisht)/ Anti-cholinergic

A

agent blocking or inhibiting the effects of the parasympathetic nervous system.
-Blocks ACH receptors ex, atropine, used to raise HR and bronchodilate

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63
Q

Sympathomimetic (agonist)/ Adrenergic (alpha, beta)

A

Agent stimulation of the sympathetic nervous system.

  • Increase norepinephrine
  • block COMT or MAO release
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64
Q

Sympatholytic (antagonist)/ Anti-adrenergic

A

agent blocking or inhibiting the effect of the sympathetic nervous system
-block adrenergic effects

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65
Q

Beta adrenergic activates

A

adenyle cyclase (in the cell membrane) and that catalyzes the conversion of intracellular adenosine triphosphate (ATP) to cyclic adenosine 3’, 5’ monophosphate (cyclic AMP)

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66
Q

Cyclic AMP causes

A

broncho relaxation, inhibits mast cell degranulation

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67
Q

Mast cell degranulation releases

A

histamine and causes bronchial constriction and swelling

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68
Q

Cyclic-AMP is deactivated by

A

Phosphodesterase

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69
Q

Guanosine monophosphate-

A

Cyclic-GMP, _contracts smooth muscle - enhances mast cell release of histamine

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70
Q

Parasympathetic/ Sympathetic stimulation lease to

A

increase c-GMP/ c-AMP

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71
Q

“metic”

A

stimulate

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72
Q

“Lytic”

A

blocker

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73
Q

Muscarinic Receptor subtypes (parasympathetic)

A

M1, M2, M3

74
Q

M1

A

Parasympathetic ganglia, nasa submucosal glands.

75
Q

M2

A

Heart, postganglionic parasympathetic nerves

76
Q

M3

A

Airway smooth muscle, submucosal glands

77
Q

Adrenergic Receptor Subtypes

A

A1, A2, B1, B2, B3

78
Q

A1

A

Peripheral blood vessels (vasoconstriction)

79
Q

A2

A

(vasodilator) presynaptic sympathetic neurons (autoreceptors), CNS

80
Q

B1

A

Heart

81
Q

B2

A

Smooth muscle (including bronchial), cardiac muscle (albuterol-relaxation)

82
Q

B3

A

Lipocytes

83
Q

Inhibitory Nerves

A

When stimulated cause bronchodilation, May lead to a new class of bronchodilators

84
Q

Excitatory Nerves

A

Afferent fibers that when stimulated lead to parasympathetic stimulation causing bronchoconstriction. May be significant in asthma

85
Q

Linergic

A

Blocker

86
Q

Indication for anticholinergic bronchodilators

A

Bronchodilators for maintenance treatment in COPD, including chronic bronchitis and emphysema. given with beta agonist

87
Q

Anticholinergic drugs given by

A

inhaled aerosol can block cholinergic- induced airway constriction

88
Q

Nasal Spray

A

Allergic and nonallergic perennial rhinitis and common cold.

89
Q

Ipratotropium Bromide (ATROVENT)

A
  • Nonselective antagonist of muscarinic receptors in smooth muscle
  • Approved specially for the maintenance of airway obstruction in COPD
90
Q

Hours to ipratotropium bromide (ATROVENT)/ Vitals

A

96 hours and its the #1 side effect is dry mouth, no tolerance effect. Doesnt cause change in HR, BP or EKG

91
Q

2 delivery routes of Atrovent

A

MDI, Nasal Spray, Neb

92
Q

Solution dose of Aerosol in ATROVENT

A

0.02% solution in 2.5cc unit dose ( ADULT DOSE= 0.5 mg)

93
Q

MDI Dose of ATROVENT

A

17ug/puff

94
Q

Aerosol of Atrovent info (onset, peak effect, duration)

A

onset is in minutes, peak effect is 1-2 hours, in COPD, duration in 1-2 hours longer then beta agonist

95
Q

Albuterol and Atrovent: 2 forms ->

A

Synergistic effect. DUONEB and COMBIVENT

96
Q

Duoneb

A

unit dose neb solution (SVN)

97
Q

Combivent

A

HFA Meterdose inhaled (MDI and RESPIMAT)

98
Q

Tiotropium Bromide (SPIRIVA) (tolerance, gonist?, delivery route, in copd)

A

no tolerence effect.

  • Long acting antacholinergic
  • muscarinic receptor antagonist
  • IN COPD, GIVES BRONCHODILATING EFFECT FOR UP TO 24 HOURS (only one)
  • 1 delivery route- dry powder inhaler (DPI)
  • COPD maintenance
99
Q

Atropine (parent drug)

A

blocks parasympathetic neuro receptors

100
Q

Umeclindinium Bromide (incruse Elipta) is a

A
  • Bronchodilator; Synthetic quaternary ammonium antimuscarinic agent
  • Long term maintenance treatment of reversible bronchospasm associated with COPD, Including chronic bronchitis and or emphysema
101
Q

Umeclindinium Bromide not indicated for

A

treatment of acute bronchospasm and treatment of asthma, saefety and efficacy in asthma not established

102
Q

Administer umeclidinium by oral inhalation only

A

oral inhalation only using a specific oral inhalation device (Incruse Ellipta) that delivers powdered drug from foil wrapped blisters

103
Q

Administer umeclidinium in fixed combination with

A

vilanterol by oral inhalation only using a specific preloader (anoro ellipta) that delivers powder umeclidinium in fixed combination with vilanterol from foil-wrapped blisters

104
Q

Administer umeclindinum alone or in fixed combination with

A

vilanterol once daily at the same time every day

105
Q

Umeclidinium is a

A

long acting muscarinic antagonist (LAMA) used as maintenance treatment for symptoms of COPD. it is available as a once daily inhalation monotherapy or as a fixed dose combination product with the long acting beta 2 agonist VILANTEROL

106
Q

COPD blocks which one of the muscarinic receptors

A

M3 which is highly expressed in airway smooth muscle of the lungs

107
Q

Methacholine (provocholine) (agent type, use, test)

A
  • Parasympathomimetic agent
  • Use in PFT bronchial provacation testing
  • Used for confirming or identify hyperactive airway disease (asthma)
  • Positive test is indicated by a >20% reduction in baseline FEV1 following inhaled of methocholine
108
Q

Quaternary Ammonium Compounds

A

Respiratory effect, CNS, Eye effect, Cardiac Effect, GI Effect, GU effect

109
Q

Respiratory effect

A

minimal effect on mucociliary clearance, cause bronchodilation effect by blocking cholinergic contractile action

110
Q

CNS to quaternary ammonium compounds

A

No side effects

111
Q

Eye effect

A

Cause with patients with glaucoma (PROTECT THE EYES)

112
Q

Cardiac Effect in quarternary ammonium compounds

A

Minimal effect on HR or BP

113
Q

GI Effect

A

little effect on gastrointestinal motility

114
Q

GU Effect

A

no effect in urinary ability

115
Q

Parasympathetic nerves enter the lung at the

A

hila, deriving from the vagus, and travels along the airways-

116
Q

Parasympathetic postganglionic fibers terminate

A

on or near the airway epithelium, submucosal mucous glands, smooth muscles, and probably mast cells

117
Q

Parasympathetic innervations and muscarinic receptors are concentrated in

A

the large airways, but they are present from the trachea to the respiratory bronchioles

118
Q

In normal airways, a basal level of bronchomotor tone is caused by

A

parasympathic activity

119
Q

Anticholnergic agents competively block the

A

action of acetycholine at the parasympathetic postganglionic effector cell receptors. because of this action, anticholinergic agents block cholinergic-induced bronchoconstriction

120
Q

Vagal Mediated Reflex Bronchoconstriction

A

A portion of bronchoconstriction seen in COPD may be due to a mechanism of vagally mediated reflex innervations of airway smooth muscle

121
Q

Sensory C fiber nerves respond

A

to various stimuli, such as irritant aerosols, smoking, mediators of inflammation such as histiamine

122
Q

When Vagal mediated reflex is stimulated

A

they produce an afferent nerve impulse to the CNS, which results in a reflex cholinergic efferent impulse to cause constriction of airway smooth muscle and release of secretion for mucous glands, as well as cough

123
Q

Adverse Side Effects by drugs

A

Most common side effect is- dry mouth, and eyes should be protected from drug exposure during SVN tx

124
Q

Anticholinergic agents vs. Beta Agonist in bronchitis/ emphysema

A

Anticholinergic agents have been found to be more potent bronchodilators then Beta Agonist in bronchitis/ emphysema

125
Q

FDA approved Atrovent specifically for use in the treatment of

A

COPD, but can be used in asthma if Beta Agonist unable to provide adequate bronchodilation alone

126
Q

Lung function in maintained at a higher level throughout the day with

A

Spiriva

127
Q

Prolonged effect may also be useful in controlling nocturnal asthma because of

A

increased airway tone

128
Q

Combined anticholinergic and Beta-agonist therapy may give

A

additive bronchodilating results in COPD and in severe asthma

129
Q

Complementary sites of action with anticholinergic effect/ adrenergic effect seen more in

A

the central airways and adrenergic effect in smaller, more peripheral airways

130
Q

Adrenergic component has a ___ onset and anticholingeric components a ___ longer duration (duoneb)

A

Faster, longer

131
Q

Three Sub groups of adrenergic bronchodilators

A

Ultra-short acting, Short-acting Beta Agonist, long-acting beta agonist

132
Q

Ultra-short acting

A
  • duration greater than 3 hours
  • Very fast onset
  • Epinephrine, Racemic Epinephrine, (both stimulate beta and alpha) Isuperil, Bronkosol
133
Q

Short Acting Beta agonist

A
  • Used for relief of acute reversible airflow obstruction, termed “rescue” agents or “relivers”
  • Quick onset and peak, with relatively short duration
  • Duration 4-6 hours
  • Albuterol, Levalbuterol, Metaproternenol, Pirbuterol, Terbutaline
134
Q

Long Acting Beta Agonist

A
  • used for maintenance of bronchodilation
  • Termed “controllers” agents
  • Slower onset and peak, with longer duration
  • Duration 12 hours or greater
  • Salmeterol, formoterol, arformeterol
135
Q

Adrenergic Bronchodilators

A

Sympathomimetic, Beta adrenergic, beta 2 adrenergic, beta agonist, beta 2 agonist

136
Q

Catecholamines (mimics epinephrine)

A

readily inactivated by heat, light, or air. Racemic epinephrine is stored in an amber colored bottle or foil wrap and should be refrigerated

137
Q

Sympathomimetic bronchodilators are all either

A

catecholamines or derivatives of catecholamines

138
Q

Catecholamines are unstable for

A

oral administration because they are inactivated in the gut and liver by conjugation with sulfate or glucuronide

139
Q

If catecholamines has a rust color when drug is put on a white background it is

A

inactivated

140
Q

Epinephrine

A

Stimulates Alpha and Beta receptors

141
Q

Epinephrine cause

A

Tachycardia, elevated BP, Smooth muscle relaxation of bronchioles and skeletal muscle blood vessels, glycogenolysis, skeletal tremor, CNS stimulation

142
Q

Epinephrine is naturally occuring where

A

in adrenal medulla

143
Q

Epinephrine is metabolized by

A

COMT

144
Q

Epinephrine administered either by/ used for

A

Aerosol or SQ injection, used as cardiac stimulant in cardiac arrest, used for anaphylactic reactions

145
Q

Racemic epinephrine (Vaponefrin, MicroNefrin)

A

-Isomer of epinephrine (50:40 R and S isomers)
-Has both alpha and beta stimulation
-used in aerosol treamtment of Croup and upper airway edema
-Metabolized by COMT which shortens duration
_peak 5-30 minutes
-Duration 1.5-3 hours

146
Q

Catecholamines refined to be more

A

beta 2 specific

147
Q

Catecholamines refined to be more beta 2 specific

A

Isoproterenol- no longer neb, Isoetharine - short acting

148
Q

Resorcinol (SABA)

A

drug researchers were able to alter the hydroxyl component of the catecholamine structure, so that it was not readily broken down by COMT. This resulted in a new class of Adrenergic bronchodilators called Resorcinolds

149
Q

Keyhole Theory

A

making a drug more and more specific with less side effects

150
Q

Terbutaline (Breathaire)

A
  • More Beta 2 specific
  • Can be ingested
  • Peak 30-60 minutes
  • Duration 4-6 hours
  • Better maintenance drug
151
Q

Saligenin

A
  • Different modification of the catechol nucleus
  • even more Beta 2 specific
  • TODAYS FRONT LINE SHORT ACTING BRONCHODILATORS
  • Peak effect 30-60 min
  • duration up to 6 hours
152
Q

Albuterol Sulfate (Proair, Ventolin, Proventil, Accuneb)

A
  • Duration up to 6 hours
  • Peak effect 30-60 minutes
  • 2.5 mg standard adult dose via SVNP-> 3cc of 0.83%
  • MDI, Syrup, neb, ER tablets
153
Q

Bitolterol (tornalate)

A
  • PRO DRUG
  • Converted in the body to active ingredient colterol
  • prolonged or sustained release
  • duration up to 8 hours
  • NOT MARKETED IN THE USA
154
Q

Levalbuterol (Xopenex)

A
  • R-isomer of albuterol with less side effects
  • 0.63 mg dose same bronchodilation less side effects as 2.5mg Albuterol
  • 1.25mg dose more bronchodilation with same side effects as 2.5mg Albuterol
  • Essentially no beta 1 affect
  • Expensive
  • Available as MDI and neb
155
Q

4 doses

A
  1. 31mg/ 3ml= 2.5 albuterol
  2. 63 mg/ 3 ml
  3. 25mg/ 3 ml
  4. 25mg/ .5ml concentrate
156
Q

Long acting beta adrenergic agents (LABA)

A
  • sustained release Albuterol tablets -Duration 8-12 hours
  • use in the control of asthma, were inhaled low dose corticosteroids are not enough and in use with COPD that are required daily bronchodilator therapy
157
Q

Long lasting beta adrenergic agents (LABA)

-Salmeterol, Formoterol, and Arformoterol are…

A

are long acting Beta 2 agonist with 12 hours duration resulting in their unique pharmodynamics

158
Q

Over use of LABA can result

A

in accumulation and toxicity

159
Q

FDA now requires LABA be used with a

A

controller medication or typically a inhaled corticosteroid for use in treating asthma - maintenance drugs

160
Q

Formoterol (DPI: Foradil SVN: Performist) MDI

A
  • Can be used for adults and child older than 5
  • Fast onset 12 hours duration
  • Bronchodilation effect 3 min
  • Asthma, COPD and exercise induced bronchospasm
161
Q

Salmeterol (servent)

A
  • Slower peak onset 3-5 hours
  • 12 hour duration
  • Increases anti inflammatory effects
  • Maintenance drug-asthma
  • Still need rescue drugs to go with these
  • Only found in conjuction with a corticosteroid today
  • Mast cell activation
  • COPD daily bronchodilator
162
Q

Arformoterol (brovana)

A
  • Most recent LABA

- Approved by the FDA for treatment of COPD

163
Q

Indacaterol (arcapta neohaler)

A
  • DPI
  • Awaiting FDA approval
  • Could be first 24 duration LABA
  • Likely will be combined with a long acting anticholingeric
164
Q

Alpha receptor (alpha 1)

A

causes vasoconstriction

165
Q

Beta 1

A

in heart only.

  • increases HR
  • Increases contractility of heart
166
Q

Beta 2

A
  • Relaxation of bronchial smooth muscles
  • inhibition of inflammatory mediator release-mast cells
  • Stimulation of mucociliary clearance
167
Q

LABA

A

Chemical added lipophilic tail keeps drug attached so that the hydrophilic head (albuterol) remains on the beta 2 receptor site for appropriate 12 hours

168
Q

Routes of Administration

A

Inhalation, oral route, parenteral route

169
Q

Inhalation preferred why

A

Rapid onset, smaller dose, less side effects, deliver direct to target, painless and safe

170
Q

Continuous nebulization

A

on ventilators for significant bronchospasms

  • Used to treat status asthmaticus
  • Terbutaline or Albuterol
  • Given several ways
  • pt must be on cardiac monitor
171
Q

Ways continuous neb is given

A

Continuous refill of SVN, IV pump fills SVN continuously, Large Volume neb (heart or hope nebs)

172
Q

Status asthmaticus

A

doesnt respond to convential asthma treatment

173
Q

Complications of continuous neb

A
  1. cardiac arrhythmias 2. Hypokalemia 3. Hyperglycemia
174
Q

Hypokalemia

A

can be caused by albuterol-> stimulates Ca+ and K+ pump

175
Q

Oral Route

A
  • Catecholamines can not be taken orally
  • non-catecholamines seem to lose their Beta 2 specificity with oral use
  • Likely due to the affects of first pass
176
Q

Parenteral route

A
  • SQ epinephrine for anaphylactic reaction or severe status asthmaticus
  • seldom used route
177
Q

First pass loss for albuterol is

A

50%

178
Q

Side effects

A

Tremor, Cardiac (tachycardia, HBP), CNS (headache, nausea, nervousness, irritability, anxiety, insomnia), Loss of bronchoprotection, Worsening of V/Q ratio, Tolerance, Metabolic (hyperglycemia, Hypokalemia), Propellant irritation, additive reactions, BAC and EDTA

179
Q

Monitor for what % HR increase

A

increase

180
Q

Assessments

A

Effectiveness of drug, peak flow rates, perform assessment before/after tx, monitor for 20% HR increase, subjective reactions

Pharmacology (10 decks)

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