Class 9 Deck 1 Flashcards
Atropine antagonizes ACh effects on __________ via the ___________ receptors in large and medium airways that respond to __________ stimulation
- Airway smooth muscle
- Muscarinic
- Vagal
Atropine ___________ airway resistance and _______ dead space.
- Decreases
- Increases
What is the most common anticholinergic used for aerosol administration?
-Ipratropium
Ipratropium is most effective in treating _______ due to _______ .
- Bronchospasms
- Beta antagonists
How does ipratropium compare to beta agonists in treating asthma?
- Slower onset
- Less effective
How does ipratropium compare to beta agonists in treating bronchitis / emphysema?
-More effective due to M3 receptors
Ipratropium may cause paradoxical bronchospasm due to what?
-M2 blockade
what is Tiotropium (Spiriva)? and what does it treat?
- Long acting anticholinergic bronchodilator
- Bronchospasms associated with COPD, bronchitis, emphysema
Tiotropium (Spiriva) blocks what 2 receptors and what do they do?
- M1 = Bronchodilation
- M3 = reduce mucus
How does ephedrine treat bronchial asthma?
-Bronchodilating effect from beta 2 activation
What is isoproterenol? How does it effect the lungs?
- beta sympathomimetic
- Bronchodilator, ↑HR, ↓ PVR in pulmonary HTN
What makes Beta 2 selective sympathomimietics (albuterol) work?
- Relax bronchial and uterine smooth muscle (Beta 2)
- No beta 1 stimulating effects on heart
- COMT resistant (sustained duration)
What are the uses of Beta 2 selective sympathomimietics?
- Acute asthma
- Prevent exercise induced asthma
- Improve airflow in COPD
- Tocolytic (stop uterine contractions)
What are the 2 classes of Beta 2 selective sympathomimietics?
- Intermediate acting (3-6 hours)
- Long acting (>12)
What are the side effects of Beta 2 adrenergic agonists?
- Tremor
- Tachycardia
- Metabolic (Hyperglycemia, Hypokalemia, Hypomag)
What is the preferred beta 2 agonist for bronchospasm? and how long will it last? And what are the side effects?
- Albuterol
- 4 hours (relief up to 8)
- Tachy & HypoK
How does albuterol effect volatile anesthetics?
-Additive effects
What is the (R)-enantiomer of racemic albuterol. How is it different than albuterol?
- Levoalbuterol (Xopenex):
- Little or no clinically significant difference
What kind of drug is terbutaline? and when is it used?
- Beta 2 selective agonist
- Ashtma and tocolytic
What kind of drug is salmeterol? and what is it frequently administered with?
- Long acting Beta 2 agonist (>12 hours)
- Steroid (advair) prophylaxis of asthma
What is the most common membrane stabilizer?
-Cromolyn Sodium (Intal)
What does cromolyn do?
- Stabilizes mast cell membrane to prevent release of histamine.
- Suppresses secretory response
Does cromolyn treat established bronchoconstriction?
No, it is a prophylatic treatment
Name the 3 methylxanthines
- Theophylline
- Caffeine
- Theobromine
What 4 things does methylxanthines do?
- Stimulate CNS
- Diuresis
- Increase myocardial contractility
- Relax airway smooth muscle
methylxanthines are what kind of drugs?
-Non-selective PDE inhibitors
methylxanthines do what to adenosine receptors?
-Competitive antagonist
What are the uses of theophylline?
- Bronchospasms due to acute asthma
- CNS stimulant (apnea in premies)
What are caffeine’s effects?
- CNS stimulant
- Cerebral vasoconstrictor
- gastric acid secretion
What are caffeine’s uses?
- Apnea of prematurity
- PDPH
- Offset sedation of cold remedies
Which beta 2 agonist is the most frequently used tocolytic? How does it work?
- Ritodrine
- Stimulates Beta 2 and activate adenyl cyclase
When can ritrodine be safely used?
- PO until fetus has matured
- No teratogenic effects after 20 weeks
What are the side effects of ritodrine?
- Increased HR, CO, Renin
- Decreased Na, H+, K, BP, H2O secretion
- Pulmonary edema
- Hyperglycemia in mom, hypoglycemia in fetus
How do Histamine receptor antagonists work?
- Prevent response mediated by histamine
- Does not inhibit release of histamine
what are the 2 generations of H1 receptor antagonists?
- 1st gen = sedating (benadryl)
- 2nd gen = non-sedating (zyrtec, claritin, allegra)
When is benadryl used?
- Sedative, antiprurtic, antemetic,
- Type 1 allergic reactions (Uticaria, angioedema)
- Anaphylactoid reactions (IV contrast)
What type of drug is benadryl?
-H1 histamine receptor antagonist
What type of drug is dramamine? and when is it used?
- -H1 histamine receptor antagonist
- Motion sickness and PONV
What is the major benefit of H2 blockers?
- keep histamine from binding to gastric parietal cells
- ↓ H+ ion secretion
Which H2 blocker is the least potent and which is the most potent?
- Cimetidine = Least potent & shortest acting
- Famotidine = most potent
When are H2 blockers used?
- Duodenal ulcers
- GERD / PUD
- Decrease risk of pneumonitis by increasing gastric PH
- Preop prophylaxis for likely allergic reactions
- Drug induced histamine release
What are the most common side effects of H2 blockers? Most severe?
- Diarrhea, headache, fatigue, muscle pain
- Mental confusion (high dose cimetidine), cardiac dysrhythmias
What 2 H2 blockers inhibits CYP450? what drugs are prolonged?
- Cimetidine and ranitidine
- (diazepam, propranolol, meperidine, lidocaine)
H2 blockers may also alter ________ of some drugs due to ________ gastric fluid ________.
- Absorption
- Increasing
- PH
Which drugs are the most effective at controlling gastric acidity and volume?
-PPI’s
PPI’s are used to treat what?
- GERD
- PUD
- Hypersecretory disorders
What drug combination can be given 1 hours prior to surgery to decrease gastric fluid and raise PH?
-Pantoprazole (potent and fast acting) w/ ranitidine
What type of drug is metoclopramide? and how does it work?
- Prokinetic (motility modulating)
- Cholinergic stimulation of GI tract
What 3 things does metoclopramide do?
- Increase LES tone
- Enhance perastalsis (not opioid induced)
- Accelerate gastric emptying
Metoclopramide is a __________ antagonist that is structurally similar to _________ but lacks local anesthetic activity.
- Dopamine
- Procainemide
What drug may result in extrapyramidal effects
-Metoclopramaide
How is metoclopramide cleared?
- Hepatic metabolism (first pass)
- Renal elimination
- Crosses BBB and placenta
- Excreted in breast milk
What are the clinical uses of metoclopramide?
- Preop decrease of gastric fluid
- Antiemitic (dopamine antagonism CTZ)
- Gastroperesis
- GERD
What are the side effects of metoclopramide?
- Abd cramps
- Akathesia
- Extrapyramidal
Metoclopramide drug interactions?
- Inhibit plasma cholinesterase (prolong succs)
- Increase sedative effects of CNS depressants
Avoid giving metoclopramide to what patients?
- Seizures
- Mechanical gastric outlet obstruction
- Intestinal anastamosis (delay healing)
