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MODULE 9 - Respiratory System > PHARMACOLOGY - Respiratory Pharmacology and General Anaesthetics > Flashcards

PHARMACOLOGY - Respiratory Pharmacology and General Anaesthetics Flashcards

1
Q

How can the lungs be used as a route of drug administration?

A

The lungs can be used as a route of drug administration through the inhalation of gaseous or vaporised drugs

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2
Q

Which pharmacokinetic properties of an inhaled drug would achieve systemic distribution?

A

An inhaled drug that is uncharged (highly lipid soluble) will be able to diffuse through lipid membranes into the bloodstream

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3
Q

What pharmacokinetic properties of an inhaled drug would achieve localised distribution?

A

An inhaled drug that is charged (limited lipid solubility) will not be able to diffuse though lipid membranes and thus remain in the lungs

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4
Q

Which type of drug, administered through inhalation, undergos systemic distribution?

A

General anaesthetics

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5
Q

Which types of drug, administered through inhalation, require localised distribution?

A

Bronchodilators
Corticosteroids

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6
Q

What is a premedicant (pre-med)?

A

A premedicant is a drug that is given prior to general anaesthetics

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7
Q

What is an induction drug?

A

An induction drug is a drug that achieves the transition from consciousness to unconsciousness

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8
Q

What is a maintenance drug?

A

A maintenance drug is a drug that maintains the anaesthetic state

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9
Q

(T/F) General anaesthetics have a large therapeutic index

A

FALSE. General anaesthetics have a narrow therapeutic index

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10
Q

What is the oil:gas partition coefficient?

A

The oil:gas partition coefficient is a measure of the distribution of a general anaesthetic between lipid and gas

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11
Q

What is indicated by a high oil:gas partition coefficient (explain why)?

A

A high oil:gas partition coefficient indicates that a general anaesthetic has a higher lipid solubility and thus a higher potency (lower quantity of drug is required to achieve the desired effect)

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12
Q

What is the blood:gas partition coefficient?

A

The blood:gas partition coefficient is a measure of the distribution of a general anaesthetic between blood and gas

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13
Q

What is indicated by a low blood:gas partition coefficient?

A

A low blood:gas partition coefficient indicates that a general anaesthetic has a more rapid induction and recovery

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14
Q

Which organ metabolises inhalational general anaesthetics?

A

Liver

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15
Q

How are inhalational general anaesthetics eliminated?

A

Expiration

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16
Q

What is the risk of more highly metabolised general anaesthetics?

A

General anaesthetics can be metabolised into toxic metabolites which can be eliminated through expiration and thus pose a risk to the staff in the operating theatre

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17
Q

What is the minimum alveolar concentration (MAC)?

A

The concentration of the drug required so 50% of patients will not respond to a particular stimulus

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18
Q

What is indicated by a low minimum alveolar concentration (MAC)?

A

A low minimum alveolar concentration (MAC) indicates that the general anaesthetic has a higher potency as a lower concentration is required to produce the desired effect

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19
Q

Which five factors can affect the minimum alveolar concentration (MAC)?

A

Species
Age
Pregnancy
Hypothermia
Other drugs (such as opioids)

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20
Q

What are inhalational general anaesthetics usually used for?

A

Inhalational general anaesthetics are typically used as maintenance drugs

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21
Q

What is the main advantage of using inhalational general anaesthetics as maintenance drugs?

A

Allows for rapid adjustment of anaesthetic depth

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22
Q

What are the two disadvantages of using inhalational general anaesthetics as maintenance drugs?

A

There is a lot of equipment required
Environmental pollution

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23
Q

(T/F) Halogenated drugs are gaseous general anaesthetics

A

FALSE. Halogenated drugs are vaporised anaesthetics

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24
Q

List four halogenated general anaesthetics

A

Halothane
Isofluorane
Sevofluorane
Desfluorane

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25
Why is isofluorane not an appropriate induction drug?
Isofluorane has an unpleasant odour which will cause animals to resist the mask induction
26
Which halogenated general anaesthetic does not produce toxic metabolites?
Sevofluorane
27
Why is sevofluorane an appropriate induction drug?
Sevofluorane has a pleasant odour and causes minimal airway irritation
28
What is vapour pressure (mmHg)?
Vapour pressure is a measure of the ease of vaporisation. The higher the vapour pressure (mmHg) value, the more easily the drug is vaporised
29
Name a gaseous general anaesthetic
Nitrous oxide
30
Why are you unable to use nitrous oxide as a general anaesthetic on its own?
Nitrous oxide has a very high minimum alveolar concentration (MAC) due to its very low oil:gas partition coefficient (i.e. very low lipid solubility)
31
What are intravenous general anaesthetics usually used for?
Intravenous general anaesthetics are generally used as induction drugs
32
What are the three advantages of using intravenous general anaesthetics as induction drugs?
Rapid induction Rapid protection of the airway No environmental pollution
33
What is the main disadvantage of using intravenous general anaesthetics as induction drugs?
Required intravenous access
34
Why are intravenous general anaesthetics mainly used as induction drugs and not maintenance drugs?
Intravenous general anaesthetics are used as induction drugs as they act quickly due to their high lipid solubility, however are not used as maintenance drugs as they are relatively slowly metabolised and eliminated from the body and their short duration of action would require constant infusion to maintain anesthesia
35
Why do intravenous general anaesthetics have such a quick onset but a short duration of action?
Intravenous general anaesthetics are highly lipid soluble and thus quickly travel through the bloodstream to the brain to carry out the desired effects, however, these drugs will redistribute to other blood rich organs and even lipid (fat) stores where the drug will accumulate, resulting in a short duration of action
36
Which organ metabolises intravenous general anaesthetics?
Liver
37
Which organ eliminates intravenous general anaesthetics?
Kidneys
38
What is total intravenous anaesthesia (TIVA)?
Total intravenous anaesthesia (TIVA) is the use of intravenous anaesthetic agents for both induction and maintenance of anaesthesia
39
Which intravenous anaesthetic drugs are appropriate for total intravenous anaesthesia (TIVA)? Why?
Propofol and Alfaxolone are appropriate for total intravenous anaesthesia (TIVA) as they are rapidly metabolised and can thus be continuously infused for maintenance of general anaesthesia without accumulating in lipid (fat) stores
40
Why would hypoproteinaemic patients alter the pharmacological effects of propofol?
Propofol is highly plasma protein bound and thus a hypovolaemic patient will have fewer plasma proteins so there will be more free drug within the bloodstream which will result in an enhanced pharmacological effect
41
Describe how bronchidilation is stimulated
Stimulation of the sympathetic nervous system triggers the release of adrenaline which circulates and binds to β2 adrenergic receptors on bronchial smooth muscle, which stimulates adenylate cyclase and thus increases cAMP which inhibits the smooth muscle contrctile pathway, stimulating bronchodilation
42
Which three drug classifications can be used as bronchodilators?
β-adrenergic agonists Anticholinergic drugs Methylxanthines
43
How do β-adrenergic agonist drugs act as bronchodilators?
The drug will bind to β2 adrenergic receptors on bronchial smooth muscle, stimulating adenylate cyclase which will increase the production of cAMP which will inhibit the smooth muscle contractile pathway and stimulate bronchodilation
44
List two β-adrenergic agonist drugs that can be used as bronchodilators?
Adrenaline β2 specific adrenergic agonists
45
When should you use adrenaline as a bronchodilator?
If there is emergency, life-threatening bronchoconstriction
46
What are two side effects of β2 specific adrenergic agonists?
Tachycardia Tremors
47
Why should β2 specific adrenergic agonists be used intermittently?
β2 specific adrenergic agonists should be used intermittently to avoid tolerance through internalisation of the β2 receptors in response to excessive stimulation
48
List two anticholinergic drugs you could use as bronchodilators
Atropine Ipratroprium bromide
49
What are two side affects of atropine?
Central nervous system (CNS) stimulation Gastrointestinal inhibition
50
What is the main advantage of ipratropium bromide?
Ipratropium bromide is a quaternary derivative of atropine which is permanently charged and thus cannot diffuse out of the lungs and cause any side affects
51
What is the mechanism of action of methylxanthines?
Methylxanthines are phosphodiesterase (PDE) inhibitors. Phosphodiesterases (PDE) are enzymes which catalyse the hydrolysis of cAMP and thus inhibiting this action, there will be increased and prolonged cAMP, stimulating bronchodilation
52
Name an example of a methylxanthine
Theobromine
53
What are the two main functions of corticosteroids?
Immune suppressive Anti-inflammatory
54
What are the two classifications of corticosteroids?
Mineralocorticoids Glucocorticoids
55
Which region of the adrenal cortex produces mineralocorticoids?
Zona glomerulosa
56
Which region of the adrenal cortex produces glucocorticoids?
Zona fasciculata
57
Name the endogenous corticoid essential for normal physiological function
Cortisol
58
Name three examples of synthetic glucocorticoids
Prednisolone Hydrocortisone Dexamethasone
59
What is the mechanism of action of corticosteroids?
Glucocorticoids bind to glucocorticoid receptors to form a steroid-receptor complex which is translocated to the nucleus where this complex will alter gene expression of specific proteins
60
Name three proteins which are upregulated by corticosteroids
Angiotensin converting enzyme β2-adrenoreceptors Lipocortin 1
61
Name two proteins which are inhibited by corticosteroids
Cytokines Cyclooxygenase (COX)
62
What are water-soluble salt formations of corticosteroids useful for?
Water-soluble salt formations of corticosteroids are useful for intravenous (IV) administration, allowing for rapid and systemic delivery throughout the body - useful for immediate treatment
63
What are insoluble ester formations of corticosteroids useful for?
Insoluble ester formations are useful for localised administration with a longer duration of action
64
Why is minimal mineralocorticoid activity preferred when administering corticosteroids?
To minimise the side effects associated with fluid and electrolyte balance
65
Why should you withdraw corticosteroid treatment gradually?
To minimise the risk of an 'addisonian' crisis
66
What is Addisons disease?
Addisons disease is a deficiency in cortisol secretion
67
What should be administered if an animal is suffering from an 'addisonian' crisis?
Intravenous (IV) hydrocortisone sodium succinate
68
What is Cushing's disease?
Cushing's disease is a hypersecretion of cortisol
69
What are the three main tests used to test for Cushing's disease?
ACTH test Low dose dexamethasone test High dose dexamethasone test
70
Which Cushing's disease test is best to use to differentiate between a pituitary and adrenal abnormality?
High dose dexamethasone test

MODULE 9 - Respiratory System (15 decks)

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