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Advanced Pharmacology > Lesson 1: Adrenergic Bronchodilators, Anticholinergics & Xanthines > Flashcards

Lesson 1: Adrenergic Bronchodilators, Anticholinergics & Xanthines Flashcards

1
Q

Binds to a receptor and produces a physiological response

A

Agonist

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2
Q

Binds to a receptor and does NOT produce a physiological response

A

Antagonist

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3
Q

What is a adrenergic bronchodialator

A

Drug that stimulates the sympathetic nervous system

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4
Q

What effect does a adrenergic bronchodilator cause

A

Smooth muscle relaxation

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5
Q

Sympathomimetic is another word for….

A

Adrenergic

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6
Q

Indication for use of adrenergic bronchodilators is

A

Reversible airflow obstruction

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7
Q

a- receptor stimulation
-Location
-Action

A

Location: Pulmonary and bronchial blood vessles
Action: Vasoconstriction effect

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8
Q

B1- Receptor stimulation
-Location
-Action

A

Location: Heart
Action: Increased HR and contractile force

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9
Q

B2- Receptor stimulation
-Location
-Action

A

Location: Bronchial smooth muscle, pulmonary and bronchial blood vessles

Action: bronchodilator, vasodialation

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10
Q

Sympathomimetic bronchodilators are this or derivatives of this

A

Catecholamines

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11
Q

Catecholamines mimic what neurotransmitter

A

Epinephrine (fight or flight)

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12
Q

Catecholamine symptoms

A

Tachycardia
Elevated BP
Smooth muscle relaxation
Skeletal muscle tremor
CNS stimulation

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13
Q

Stereoisomers are

A

Non-superimposable molecular mirror images

2 types:
(R)-Isomer (right isomer)
(S)-Isomer (left isomer)

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14
Q

These have similar physical and chemical properties but different physiological effects

A

Stereoisomers

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15
Q

If a drug contains a equal amount of both left and right isomers it is…

A

Racemic

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16
Q

What is the racemic version of levalbuterol

A

Albuterol

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17
Q

What are the ultra short acting B2 bronchodilators

A

Epinephrine and Racemic Epinephrine

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18
Q

What is the duration of a ultra short acting B2 bronchodilators

A

Less than 3 hours

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19
Q

Epinephrine:
-Brand name
-MDI brand name
-Routes of admin

A

Brand name: Adrenaline Chloride
MDI Brand name: Primatene Mist
Routes of Admin: SVN, MDI, IV, IO, IM

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20
Q

When to use epinephrine

A

Cardiac stimulant, anaphylactic reactions, acute asthma

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21
Q

What is the onset of epinephrine

A

Approx. 3 min

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22
Q

Racemic epinephrine
-Brand name
-Route of admin
-Use

A

Brand name: asthmanefrin
Route of admin: SVN
Use: reduce swelling in upper airways (croup and epiglottitis) and tx of bleeding during bronchs

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23
Q

What is the keyhole theory

A

Theory that explains the B2 specificity of sympathomimetic bronchodilators

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24
Q

SABA is used for

A

Relief of reversible acute airway obstructions

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25
Q

LABA is used for

A

Maintenance bronchodilation, nocturnal symptoms for asthma and COPD

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26
Q

SABA duration
LABA duration

A

SABA: 4-6 hrs
LABA: 12-24 hrs

27
Q

What are the 3 types of SABAs

A

Albuterol
Levalbuterol
Metaproterenol

28
Q

What are the 5 types of LABAs

A

Salmeterol : Severent Diskus
Formoterol: Perforomist
Arformeterol: Brovana
Indacaterol: Arcapta Neohaler
Olodaterol: Stiverdi-Respimat

29
Q

Where in the national asthma guidelines is a LABA reccomended?

A

Step 3

30
Q

Stimulation of a and b receptors causes what response?

A

Adrenergic response

31
Q

What types of receptors are types of G protein liked receptors?

A

a and b

32
Q

Increase in cAMP is the goal of ________, through the stimulus of _________, causing __________.

A

Adrenergic bronchodilators, B2 receptors, bronchodilation

33
Q

The difference of how SABAs and LABAs work is due to what?

A

How the drug binds to the G-protein linked receptor

34
Q

When giving high doses of albuterol, what should you monitor?

A

Heart rate, glucose, potassium

35
Q

What happens to a patients glucose or potassium with high doses of albuterol?

A

Glucose: levels may increase bc of the fight or flight response that albuterol gives. More energy is needed during FoF, so if the pt isn’t expending that energy it can lead to hyperglycemia

Potassium: levels may decrease bc albuterol stimulates the Na/K/ATPase pump cause of shift of potassium from serum into the intracellular space.

36
Q

What are the two cholinergic receptors?

A

Muscarinic and Nicotinic

37
Q

Stimulation of what receptors cause activation of the parasympathetic system?

A

Muscarinic and Nicotinic

38
Q

What is the neurotransmitter for the parasympathetic system?

A

Acetylcholine

39
Q

3 main muscarinic receptors

A

M1, M2, M3 are found in the lung

40
Q

What are the muscarinic receptors (M1, M2, M3) found

A

M1 receptors: are present at the parasympathetic ganglion on the post junctional membrane

M2 receptors: are localized at the presynaptic membrane of postganglionic parasympathetic nerve endings

M3 receptors: are found on submucosal glands and airway smooth muscle

41
Q

How do anticholingerics cause bronchodilation

A

By blocking the M1 receptors at the parasympathetic ganglia, which facilitates neurotransmission to M3, which cause bronchoconstriction

Bronchodilation will only occur if the bronchoconstriction is due to cholinergic activity

42
Q

Duration of action for anticholinergics

A

Atrovent: 6 hrs

Others: 12 or 24 hrs

43
Q

What common allergen is used in Atrovent HFA and Combivent Respimat (inhaler version of Atrovent)?

A

Soy lecithin

44
Q

Umeclidinium bromide and vilanterol

Brand name and duration

A

Anoro Ellipta

24 hrs

45
Q

Glycopyrrolate bromide and formoterol

Brand name and duration

A

Bevespi Aerosphere

12 hrs

46
Q

Glycopyrrolate bromide and indacaterol

Brand name and duration

A

Utibron neohaler

12 hrs

47
Q

What is atropine used for

A

Anticholinergic used for bradycardia

48
Q

What is the dose of atropine

A

1 mg IV push with epi or vasopressin

49
Q

What is the parasympathomimetic drug we use in the bronchial challenge test

A

Methacholine

50
Q

What is methacholine used to do

A

promote bronchoconstriction to diagnose asthma

51
Q

What is edrophonium

A

Drug used for the Tensilon Test to diagnose Myasthenia Gravis

52
Q

How does edrophonium work

A

Inhibits acetylocholineesterase which is the enzyme that breaks down acetylcholine.

By inhibiting this, ACh will not be broken down, leading to an increase in the amount of ACh available, and greater likelihood of attaching to receptors.

53
Q

What causes cholinergic toxicity

A

Nerve gasses: such as sarin
Organophosphates: insecticides

54
Q

What syndrome does cholinergic toxicity lead to

A

SLUDGE syndrome

55
Q

What does SLUDGE stand for

A

Salivation
Lacrimation
Urination
Defecation
Gastrointestinal cramping
Emesis

56
Q

How do you treat SLUDGE syndrome

A

Atropine (Anticholinergic)

57
Q

What are the two forms of xanthines

A

Theophylline and Caffeine

58
Q

What are effects of xanthines

A

CNS stimulation
Cardiac muscle stimulation
Diuresis
Bronchial, uterine, and vascular smooth muscle relaxation
Peripheral and coronary vasodilation
Cerebral vasoconstriction

59
Q

Theophylline has a _______ therapeutic index so dosage must be titrated to clinical effectiveness

A

small

60
Q

What group of people will need higher doses of theophylline

A

Smokers bc smoking decreases theophylline levels

61
Q

What are the recommended dosages for asthma and COPD with theophylline

A

Asthma: 5-15 μg/mL ( for pts 5 yrs and older)
COPD: 5-10 μg/mL (O and 10 together, to remember)

62
Q

How to treat apnea of prematurity

A

Xanthines are given to stimulate CNS bc preterm infants do not have a fully developed CNS

Theophylline was used in the past, now caffeine is the preferred method bc of the fewer side effects

63
Q

What does of caffeine would you give of AOP

A

Loading dose: 20 mg/kg
Daily maintenance dose: 5 mg/kg

Advanced Pharmacology (5 decks)

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