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Anesthesia Pharm > resp agents > Flashcards

resp agents Flashcards

1
Q

what are the 2 major sources of histamine? (MC, B)

A

mast cells, basophils

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2
Q

what are the 4 common H2 antagonists? (CRFN)

A

cimetidine, ranitidine famotidine, nizatadine

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3
Q

what are the 3 primary clinical applications for h1 antagonists? (AR, AC, U)

A

allergic rhinitis, allergic conjunctivitis, urticaria

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4
Q

what are the 2 primary clinical applications of h2 antagonists? (PUD, GERD)

A

peptic ulcer disease, gastroesophageal reflux disease

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5
Q

potential uses of h3 blockers are what body system disorders? (N)

A

neurologic (alzheimer’s, ADHD, schizophrenia, epilepsy

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6
Q

what are 4 systemic reactions to h1 stimulation? (SW, MS, BC, NC)

A

skin wheals, mucous secretions, bronchial constriction, nasal congestion

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7
Q

what 2 drugs stimulate histamine release? (M, A)

A

morphine atracurium

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8
Q

h1 receptors stimulation decreases conduction where and reduces the releaese of what peptide?

A

AV node conduction, atrial natriuretic peptide

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9
Q

h1 receptor stimulation causes blood vessel dilation or constriction?

A

dilation

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10
Q

h1 stimulation decreases or increases capillary permeability?

A

increaes

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11
Q

h1 stimulation causes bronchial SM dilation or constriction?

A

constriuction

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12
Q

h2 stimulation causes bronchial SM dilation or constriction?

A

dilation

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13
Q

what 2 meds can you give for bronchospasms? (A, E)

A

albuterol, epinephrine

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14
Q

what 2 things can you do for laryngospasms? (DVA, P)

A

deepen VA, paralytic

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15
Q

h2 stimulation increases the secretion of what fluid? (G)

A

gastric

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16
Q

does h2 stimulation cause vasoconstriction or vasodilation?

A

vasodilation

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17
Q

h2 stimulation causes vasodilation that is free from what control resulting in maximal dilation of vasculature? (A)

A

autonomic control

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18
Q

does h2 stimulation relax or constrict bronchial SM?

A

relax

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19
Q

does h2 stimulation increase or decrease inotropic and chronotropic response?

A

increase

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20
Q

h2 stimulation causes a more what and what vasodilation compared to h1 stimulation? (S, G)

A

sustained, generalized

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21
Q

is the h2 vasodilation slower or faster onset than h1?

A

slower

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22
Q

antihistamines prevent what 2 things? (E, P)

A

edema, pruritus

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23
Q

do antihistamines prevent bronchospasms?

A

no

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24
Q

what autocoid plays a predominant role in allergic responses like bronchospasms that is not blocked by antihistamines? (L)

A

leukotrienes

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25
Q

is hypotension attenuated or totally blocked by antihistamines?

A

attenuated

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26
Q

first generation h1 antagonists

  1. name 3 drugs (D, C, H)
  2. sedating or non-sedating
  3. selective or non-selective
  4. cross BBB or don’t cross BBB
  5. do they work as an antiemetic?
  6. activate what other 3 receptors? (SAM)
A
  1. diphenhydramine, chlorpheniramine, hydroxyzine
  2. sedating
  3. non-selective
  4. cross BBB
  5. yes
  6. serotonin, alpha, muscarinic
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27
Q

second generation h1 antagonists

  1. name 2 drugs (A, L)
  2. sedating or non-sedating
  3. selective or non-selective
  4. cross BBB or don’t cross BBB
  5. do they work as an antiemetic?
A
  1. astemizole, loratadine
  2. non-sedating
  3. selective
  4. don’t cross BBB
  5. no
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28
Q

h1 antagonists peak within what hour range?

A

2-3 hours

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29
Q

what enzyme metabolizes h1 antagonists in the liver? (MFO)

A

mixed function oxidase

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30
Q

h1 antagonists have potential drug interactions in what 3 pt conditions? (LD, PQTI, MD)

A

liver dysfunction, prolong QT interval, metabolic disorders

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31
Q

h1 antagonists SEs can be of what 3 kinds? (CNS, A, GR)

A

CNS, anticholinergic, gastric related

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32
Q

toxic manifestations of h1 antagonists are related to which one of the 3 kinds of SEs?

A

anticholinergic properties

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33
Q

what are the 3 h1 antagonist AEs on the CNS? (S, DA, SRT)

A

somnolence, decreased alertness, slowed reaction time

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34
Q

what are the 4 h1 antagonists anticholinergic effects? (DM, BV, UR, I)

A

dry mouth, blurred vision, urinary retention, impotence

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35
Q

what 3 reasons is diphenhydramine prescribed for? (S, A, A)

A

sedative, antipruritic, antiemetic

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36
Q

diphenhydramine can treat phenothiazine-related what SEs in early stages of PD? (E)

A

extrapyramidal

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37
Q

name 3 h2 antagonists (R,C,F)

A

ranitidine, cimetidine, famotidine

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38
Q

h2 antagonists reduce gastric acid secretions stimulated by what 3 things? (H, G, A)

A

histamine, gastrin, acetylcholine

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39
Q

h2 antagonists inhibit what 2 forms of gastric secretions? (S, B)

A

stimulated, basal

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40
Q

h2 antagonists what % of first pass effect?

A

50%

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41
Q

because h2 antagonists are so protein bound, they are less effective in what pts? (O)

A

obese

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42
Q

h2 antagonists are metabolized by what in the liver?

A

CYP 450

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43
Q

decrease h2 antagonists dose in what 4 pts? (HD, RD, B, E)

A

hepatic dysfunction, renal dysfunction, burns, eldery

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44
Q

what are 3 clinical uses of h2 antagonists? (PU, APP, HPIA)

A

peptic ulcers, aspiration pna prophylaxis, h. pylori infection adjunct

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45
Q

do h2 antagonists have an influence on pH of current stomach contents?

A

no

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46
Q

do h2 antagonists solely protect against histamine release from IV drugs?

A

no

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47
Q

give cimetidine what range of hours before induction?

A

1.5-2 hours

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48
Q

what group of substances are the most potent endogenous vasodilators after allergic reaction and tissue damage?

A

kinins

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49
Q

bradykinin is a product of what biochemical cascade? (KK)

A

kallikrein-kinin

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50
Q

Kinins modulate what 4 events during inflammation? (V, ICP, H, P)

A

vasodilation, increased cellular permeability, hyperalgesia, pain

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51
Q

bradykinin exists in small amounts in the blood because it circulates as what? (P)

A

prekallikrein

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52
Q

changes in what 2 things convert prekallikrein to bradykinin after tissue damage?

A

pH and temperature

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53
Q

bradykinin is potent for what 2 things? (V, A)

A

vasodilation, algesic

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54
Q

bradykinin is how many times more of a potent vasodilator than histame?

A

10 times

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55
Q

what is a real life examples of bradykinin causing phospholipase C activation, which increases sodium ion conduct and depolarizes sensory fibers?

A

snake bite

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56
Q

bradykinin stimulates what acid in the brain and increases what outflow? (A, S)

A

arachidonic acid, sympathetic outflow

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57
Q

does serotonin respond to excitatory neurons, inhibitory neurons or both?

A

both

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58
Q

what med works on 5-HT3 subtype?

A

zofran

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59
Q

how many 5-HT3 subtypes are there?

A

14

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60
Q

in what 3 places does serotonin work? (GIT, P, C)

A

GI tract, plts, CNS

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61
Q

does serotonin increase or decrease plt aggregation?

A

increase

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62
Q

serotonin is one of the 3 what? (BM)

A

biogenic monamines

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63
Q

serotonin is synthesized from what essential AA? (T)

A

trypotophan

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64
Q

tryptophan needs what for for cerebral uptake? (C)

A

carrier

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65
Q

what system controls the tone of the airways?

A

autonomic nervous system

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66
Q

what system and what class of drugs cause bronchodilation?

A

SNS, sympathomimetic

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67
Q

what system works to protect the lungs from insult?

A

PNS

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68
Q

beta 2 receptor activation causes what?

  1. increased or decreased cAMP
  2. increased or decreased Ca influx
A
  1. increased

2. decreased

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69
Q

what does PNS release to cause bronchoconstriction?

A

Ach

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70
Q

what 2 parasympatholytic drugs decrease parasympathetic tone and thus cause bronchodilation? (A, I)

A

atropine, ipratropium

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71
Q

name the 4 short acting beta 2 agonists (L, A, M, P)

A

levalbuterol, albuterol, metaproterenol, pirbuterol

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72
Q

name the 3 long acting beta 2 agonists (S, A, F)

A

salmeterol, arformoterol, formoterol

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73
Q

albuterol

  1. minute range onset
  2. hour range DOA
  3. how many mcg of the 90 mcg reach the active site?
  4. minute range for max effect
A
  1. 5-7 minutes
  2. 4-6 hours
  3. 18 mcg
  4. 60-90 minutes
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74
Q

salmeterol/formoterol

  1. onset minutes
  2. hour range DOA
A
  1. 35 minutes

2. 10-12 hours

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75
Q

what corticosteroid is salmeterol combined with? (F)

A

fluticasone

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76
Q

what corticosteroid is formoterol combined with? (B)

A

budesonide

77
Q

can hi concnetrations of beta2 agonists stimulate beta 1 receptors?

A

yes

78
Q

can high concentrations of beta2 agonists stimulate beta 1 receptors?

A

yes

79
Q

what are the 6 SEs of beta 2 agonists? (T, N, T, H, P, N/V)

A

tremor, nervousness, tachycardia, HTN, palpitations, N/V

80
Q

what do beta 2 agonists increase intracellularly?

A

cAMP

81
Q

what is the largest factor that determines the amount of drugs that reaches the SM target? (T)

A

technique

82
Q

what is the largest factor that determines the amount of drugs that reaches the SM target? (T)

A

technique

83
Q

give prphylactice beta 2 agonist or anticholinergic drugs how many hours before intubation?

A

1 hour

84
Q

give prophylactic beta 2 agonist or anticholinergic drugs how many hours before intubation?

A

1 hour

85
Q

albuterol should be used with extreme caution with what 2 drug classes? (MI, TA)

A

MAO inhibitors, tricyclic antidepressants

86
Q

albuterol should be used with extreme caution with what 2 drug classes? (MI, TA)

A

MAO inhibitors, tricyclic antidepressants

87
Q

albuterol given with MAO inhibitors and TCAs can have what effect on the BP and what effect on the HR?

A

lower BP, increase HR

88
Q

albuterol has decreased effectiveness with what drug class? (NBB)

A

nonselective beta blockers

89
Q

bronchospasms is best treated prophylactically with inhaled what?

A

beta 2 agonists

90
Q

VAs are potent bronchoconstrictors or bronchodilators?

A

bronchodilators

91
Q

Order these VAs in order of most potent bronchodilator to least potent bronchodilator: des, sevo, iso, halo

A

Halo>iso=sevo>des

92
Q

methylxanthines (theophylline) are nonselective inhibitors of what enzyme?

A

phosphodiesterases

93
Q

methylxanthines (theophylline) enhance liver metabolism of what 2 drugs? (C, R)

A

carbamazepine, rifampin

94
Q

methylxanthines (theophylline) inhibit liver metabolism of what 2 drugs? (C, E)

A

cimetidine, erythromycin

95
Q

what drug may lower theophylline’s seizure threshold?

A

ketamine

96
Q

methylxanthines (theophylline) enhance or inhibit the effect of nondepolarizing muscle blockers?

A

inhibit

97
Q

anticholinergics inhibit what 2 muscarinic receptors on airway SM?

A

m2, m3

98
Q

what does PNS release during asthma exacerbations and intubation?

A

Ach

99
Q

what drug is the short acting inhaled anticholinergic?

A

ipratropium

100
Q

what drugs is the long acting inhaled anticholinergic?

A

tiotropium

101
Q

how do anticholinergics have a potential drug interactions with viral infections?

A

dysfunction of m2 can result in an increased Ach release

102
Q

pts with recent what may have a greater benefit from anticholinergics than beta agonists?

A

respiratory infection

103
Q

what 2 step MOA of corticosteroids for chronic asthma therapy?

A
  1. enter airway cell

2. directly inhibit cells involved with airway inflammation

104
Q

what are the 2 classes of leukotriene pathway inhibitors? (5-LI, CLA)

A

5-lipoxygenase inhibitors, cysteine-leukotriene antagonists

105
Q

5-lipoxygenase inhibitors impair the conversion of what to leukotriene A4? (AA)

A

arachadonic acid

106
Q

cysteine-leukotriene antagonists competitively block what from binding to CysLT1 receptor? (L)

A

LTD4

107
Q

name the one 5-lipoxygenase inhibitor (Z)

A

Zileuton

108
Q

name the 2 cysteine-leukotriene antagonists (M, Z)

A

montelukast, zafirlukast

109
Q

aspirin-sensitive and exercise-induced asthmatics are most likely to benefit from which leukotriene pathway inhibitor?

A

cysteine-leukotriene antagonists

110
Q

asthmatics have an increased production of what, which causes airway recruitment of what that causes bronchospasms? (CL, E)

A

cysteinyl leukotrienes, eosinophils

111
Q

asthmatics have increased what 3 things? (AH, ME, MP)

A

airway hyperresponsiveness, mucosal edema, mucus production

112
Q

asthmatics have airway proliferation of what? (SM)

A

smooth muscle

113
Q

what is drug is used for mild-intermittent asthma (<2 symptoms per week)?

A

b2 agonist inhaler

114
Q

what drug is used for mild-persistent asthma (>2 symptoms per week but <1 per day)?

A

inhaled low dose corticosteroids

115
Q

what 2 drug regimens can be used for moderate persistent asthma (daily symptoms)?

A
  1. medium dose inhaled corticosteroids

2. low to medium dose inhaled corticosteroids plus long-acting bronchodilator

116
Q

what 3 drugs can be used for severe persistent asthma (continuous symptoms)?

A
  1. inhaled high dose corticosteroids
  2. long-acting bronchodilator
  3. systemic corticosteroids
117
Q

what are 5 inhaled corticosteroids? (B, B, F, F, T)

A

beclomethasone, budesonide, fluticasone, flunisolide, triamcinolone

118
Q

asthma pts who received systemic steroids within the past how many months should receive them during surgery?

A

6 months

119
Q

asthma pts who received systemic steroids in the past 6 months should received how many mg of IV hydrocortisone every how many hours during surgery with a rapid decrease in doses within how many hours of surgery?

A

100 mg IV hydrocortisone Q 8 hr; 24 hours

120
Q

pulmonary HTN is a sustained mean PAP > what at rest and > what with activity?

A

> 25 mmHg at rest; > 30 mmHg with activity

121
Q

what 3 increased factors can cause pulmonary HTN? (LAP, CO, PVR)

A

left atrial pressure, cardiac output, pulmonary vascular resistance

122
Q

what are the 5 diagnostic categories of pulmonary HTN? (PAH, PVH, pulmonary htn AWH, pulmonary htn d/t T/ED, M)

A

pulmonary arterial htn, pulmonary venous htn, pulmonary htn associated with hypoxemia, pulmonary HTN d/t thrombotic/embolic disease, miscellaneous

123
Q

which pulmonary hypertension category is primary pulmonary hypertension?

A

pulmonary arterial hypertension

124
Q

which pulmonary hypertension category is form mitral valve disease?

A

pulmonary venous hypertension

125
Q

which pulmonary hypertension category is is associated with COPD?

A

pulmonary htn associated with hypoxemia

126
Q

which pulmonary hypertension category is is associated inflammation?

A

miscellaneous

127
Q

acute increase in pulmonary vascular resistance is d/t what 5 things? (H, H, A, IST, PV)

A

hypoxia, hypercarbia, acidosis, increased sympathetic tone, pulmonary vasoconstriction

128
Q

pts with pulmonary htn have decreased amounts of what 2 autacoids? (P, N)

A

prostacyclin, nitric oxide

129
Q

pts with pulmonary htn have increase amounts of what 4 autacoids? (T, E , S, N)

A

thromboxane, endothelin, serotonin, NE

130
Q

lungs synthesize/inactivate what 3 groups of autacoids? (P, T, L)

A

prostaglandins, thromboxanes, leukotrienes

131
Q

do leukotrienes cause pulmonary vasoconstriction or vasodilation?

A

vasoconstriction

132
Q

bradykinin is inactivated in the lung by what enzyme?

A

ACE

133
Q

bradykinin causes direct pulmonary vasoconstriction by binding to what receptor and causes indirect pulmonary vasodilation by causing the endothelium to produce what?

A

BK2, NO

134
Q

histamine a strong pulmonary vasodilator or vasoconstrictor and a systemic vasodilator or vasoconstrictor?

A

pulmonary vasoconstrictor, systemic vasodilator

135
Q

do alpha adrenergic agonists (NE) cause pulmonary vasodilation or vasoconstriction?

A

vasoconstriction

136
Q

do beta adrenergic agonists (isoproterenol) cause pulmonary vasodilation or vasoconstriction?

A

vasodilation

137
Q

do stress and pain exacerbate pulm htn?

A

yes

138
Q

PaO2 less than what causes hypoxic pulmonary vasoconstriction

A

< 70 mmHg

139
Q

what is the net effect of BF in hypoxic pulmonary vasoconstriction?

A

it is diverted away from poorly ventilated alveoli

140
Q

does pulmonary artery SM rapidly constrict or dilate in response to hypoxia?

A

constrict

141
Q

where is the site of O2 sensing in hypoxic pulmonary vasoconstriction? (SPA)

A

small pulmonary arteries

142
Q

the goal of shunting in hypoxic pulmonary vasoconstriction is to increase what?

A

PaO2

143
Q

is hypoxic pulmonary vasoconstriction pathologic?

A

no

144
Q

is hypoxic pulmonary vasoconstriction a local mediated response?

A

yes

145
Q

what 2 drugs are used to treat hypoxic pulmonary vasoconstriction?

A

nitroprusside, nitroglycerin

146
Q

what type of chronic therapy may improve survival for treating idiopathic pulmonary arterial hypertension (IPAH)?

A

chronic anticoagulation therapy

147
Q

what is the major limitation of all vasodilators for pulmonary htn?

A

they are not selective for pulmonary vessels

148
Q

do all systemic vasodilators cause pulmonary vasodilation?

A

yes

149
Q

what drug is the most effective option for chronic therapy of pulmonary htn? (N)

A

nifedipine

150
Q

what does nifedipine worsen in pts with lung disease?

A

V/Q mismatch

151
Q

nifedipine decreases the level of what 2 meds? (C, Q)

A

clopidogrel, quinidine

152
Q

what med is useful for pulmonary htn caused by HF?

A

nitroprusside

153
Q

nitroprusside activates what enzyme and increases the level of what that causes vasodilation?

A

guanylate cyclase; cGMP

154
Q

nitroglycerin vasodilates what vessels? (V, LCA)

A

veins, large coronary arteries

155
Q

nitroglycerin decreases what 2 things while maintaining BP? (PVR, RVO)

A

pulmonary vascular resistance, RV output

156
Q

does hydralazine vasodilate arteries, veins or both?

A

arteries

157
Q

hydralazine works primarily by activating what enzyme?

A

guanylate cyclase

158
Q

inhaled nitric oxide diffuses into adjacent pulmonary vascular SM, activates what and increases the levels of what?

A

guanylate cyclase, cGMP

159
Q

what type of vasodilator is inhaled nitric oxide? (SEV)

A

selective endogenous vasodilator

160
Q

what are 2 SEs of inhaled nitric oxide? (PI, RH)

A

plt inhibition, rebound hypoxia

161
Q

inhaled nitric oxide is inactivated by binding to what? (H)

A

hemoglobin

162
Q

what prostaglandin is a potent vasodilator?

A

prostacyclin

163
Q

prostacyclin binds to what receptor, activates what enzyme and increases the levels of what?

A

prostaglandin I (IP), adenylate cyclase, cAMP

164
Q

prostacyclin is also known as the most potent inhibitor to what? (PA)

A

plt aggregation

165
Q

what is prostacyclin’s elimination half time? (minutes)

A

6 minutes

166
Q

what is nitroglycerin’s minute range half-life?

A

1-4 minutes

167
Q

what 4 short acting vasodilators can be used when measuring vasodilator responsiveness with a pulmonary artery catheter? (INO, P, A, A)

A

inhaled nitric oxide, prostacyclin, Ach, adenosine

168
Q

what is the one endothelin antagonist? (B)

A

bosentan

169
Q

what are the 2 endothelin receptors? (SMEA, EEB)

A

smooth muscle endothelin A, endothelial endothelin B

170
Q

which endothelin receptor only mediates vasoconstriction and SM proliferation?

A

endothelin A

171
Q

endothelin B causes what 2 things? (V, V)

A

vasodilation, vasoconstriction

172
Q

antagonists were developed for which endothelin receptors to treat pulmonary htn?

A

endothelin A

173
Q

pts with pulmonary htn have enhanced pulmonary production and increase circulation of what endogenous peptide? (E)

A

endothelin 1

174
Q

what are the 2 actions of endothelin 1? (PV, PA)

A

powerful vasoconstrictor, proliferative agent

175
Q

what number phosphodiesterase (PDE) inhibitor is relatively selective for pulmonary circulation?

A

PDE 5

176
Q

why are PDE5 inhibitors relatively selective for pulmonary circulation compared to systemic circulation?

A

higher phosphodiesterase 5 in the pulmonary circulation

177
Q

what is the one example of PDE5 inhibitor? (S)

A

sildenafil

178
Q

PDE5 inhibitor potentiate the magnitude and prolong the effects of what other vasodilator?

A

nitrovasodilators

179
Q

are PDE5 inhibitor used as a single agent because of their relatively selective pulmonary vasodilation?

A

yes

180
Q

in pulm htn, should drugs be avoided that produce excessive ventilatory depression?

A

yes

181
Q

which VA can cause pulmonary artery vasoconstriction and increased PVR?

A

nitrous

182
Q

PPV increases what and distends what? (P, A)

A

increases PVR, distends alveoli

183
Q

high sensory level blocks may adversely decrease what measurement in pts with a fixed increased PVR?

A

SVR

184
Q

abrupt increases in right atrial pressure intraop demonstrate what 2 things? (RVD, IP)

A

RV dysfunction, increased PVR

185
Q

avoid what 3 things in pts with pulmonary htn? (H, H, N)

A

hypoxemia, hypoventilation, nitrous

186
Q

does M. tuberculosis thrive in tissues with high or low oxygen concentration?

A

high

187
Q

can M. tuberculosis be reactivated in the elderly?

A

yes

188
Q

what are the 4 first line drugs for M. tuberculosis? (R, E, P, S)

A

rifampicin, ethambutol, pyrazinamide, streptomycin

Anesthesia Pharm (6 decks)

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