resp agents Flashcards
1
Q
what are the 2 major sources of histamine? (MC, B)
A
mast cells, basophils
2
Q
what are the 4 common H2 antagonists? (CRFN)
A
cimetidine, ranitidine famotidine, nizatadine
3
Q
what are the 3 primary clinical applications for h1 antagonists? (AR, AC, U)
A
allergic rhinitis, allergic conjunctivitis, urticaria
4
Q
what are the 2 primary clinical applications of h2 antagonists? (PUD, GERD)
A
peptic ulcer disease, gastroesophageal reflux disease
5
Q
potential uses of h3 blockers are what body system disorders? (N)
A
neurologic (alzheimer’s, ADHD, schizophrenia, epilepsy
6
Q
what are 4 systemic reactions to h1 stimulation? (SW, MS, BC, NC)
A
skin wheals, mucous secretions, bronchial constriction, nasal congestion
7
Q
what 2 drugs stimulate histamine release? (M, A)
A
morphine atracurium
8
Q
h1 receptors stimulation decreases conduction where and reduces the releaese of what peptide?
A
AV node conduction, atrial natriuretic peptide
9
Q
h1 receptor stimulation causes blood vessel dilation or constriction?
A
dilation
10
Q
h1 stimulation decreases or increases capillary permeability?
A
increaes
11
Q
h1 stimulation causes bronchial SM dilation or constriction?
A
constriuction
12
Q
h2 stimulation causes bronchial SM dilation or constriction?
A
dilation
13
Q
what 2 meds can you give for bronchospasms? (A, E)
A
albuterol, epinephrine
14
Q
what 2 things can you do for laryngospasms? (DVA, P)
A
deepen VA, paralytic
15
Q
h2 stimulation increases the secretion of what fluid? (G)
A
gastric
16
Q
does h2 stimulation cause vasoconstriction or vasodilation?
A
vasodilation
17
Q
h2 stimulation causes vasodilation that is free from what control resulting in maximal dilation of vasculature? (A)
A
autonomic control
18
Q
does h2 stimulation relax or constrict bronchial SM?
A
relax
19
Q
does h2 stimulation increase or decrease inotropic and chronotropic response?
A
increase
20
Q
h2 stimulation causes a more what and what vasodilation compared to h1 stimulation? (S, G)
A
sustained, generalized
21
Q
is the h2 vasodilation slower or faster onset than h1?
A
slower
22
Q
antihistamines prevent what 2 things? (E, P)
A
edema, pruritus
23
Q
do antihistamines prevent bronchospasms?
A
no
24
Q
what autocoid plays a predominant role in allergic responses like bronchospasms that is not blocked by antihistamines? (L)
A
leukotrienes
25
is hypotension attenuated or totally blocked by antihistamines?
attenuated
26
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)
1. diphenhydramine, chlorpheniramine, hydroxyzine
2. sedating
3. non-selective
4. cross BBB
5. yes
6. serotonin, alpha, muscarinic
27
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?
1. astemizole, loratadine
2. non-sedating
3. selective
4. don't cross BBB
5. no
28
h1 antagonists peak within what hour range?
2-3 hours
29
what enzyme metabolizes h1 antagonists in the liver? (MFO)
mixed function oxidase
30
h1 antagonists have potential drug interactions in what 3 pt conditions? (LD, PQTI, MD)
liver dysfunction, prolong QT interval, metabolic disorders
31
h1 antagonists SEs can be of what 3 kinds? (CNS, A, GR)
CNS, anticholinergic, gastric related
32
toxic manifestations of h1 antagonists are related to which one of the 3 kinds of SEs?
anticholinergic properties
33
what are the 3 h1 antagonist AEs on the CNS? (S, DA, SRT)
somnolence, decreased alertness, slowed reaction time
34
what are the 4 h1 antagonists anticholinergic effects? (DM, BV, UR, I)
dry mouth, blurred vision, urinary retention, impotence
35
what 3 reasons is diphenhydramine prescribed for? (S, A, A)
sedative, antipruritic, antiemetic
36
diphenhydramine can treat phenothiazine-related what SEs in early stages of PD? (E)
extrapyramidal
37
name 3 h2 antagonists (R,C,F)
ranitidine, cimetidine, famotidine
38
h2 antagonists reduce gastric acid secretions stimulated by what 3 things? (H, G, A)
histamine, gastrin, acetylcholine
39
h2 antagonists inhibit what 2 forms of gastric secretions? (S, B)
stimulated, basal
40
h2 antagonists what % of first pass effect?
50%
41
because h2 antagonists are so protein bound, they are less effective in what pts? (O)
obese
42
h2 antagonists are metabolized by what in the liver?
CYP 450
43
decrease h2 antagonists dose in what 4 pts? (HD, RD, B, E)
hepatic dysfunction, renal dysfunction, burns, eldery
44
what are 3 clinical uses of h2 antagonists? (PU, APP, HPIA)
peptic ulcers, aspiration pna prophylaxis, h. pylori infection adjunct
45
do h2 antagonists have an influence on pH of current stomach contents?
no
46
do h2 antagonists solely protect against histamine release from IV drugs?
no
47
give cimetidine what range of hours before induction?
1.5-2 hours
48
what group of substances are the most potent endogenous vasodilators after allergic reaction and tissue damage?
kinins
49
bradykinin is a product of what biochemical cascade? (KK)
kallikrein-kinin
50
Kinins modulate what 4 events during inflammation? (V, ICP, H, P)
vasodilation, increased cellular permeability, hyperalgesia, pain
51
bradykinin exists in small amounts in the blood because it circulates as what? (P)
prekallikrein
52
changes in what 2 things convert prekallikrein to bradykinin after tissue damage?
pH and temperature
53
bradykinin is potent for what 2 things? (V, A)
vasodilation, algesic
54
bradykinin is how many times more of a potent vasodilator than histame?
10 times
55
what is a real life examples of bradykinin causing phospholipase C activation, which increases sodium ion conduct and depolarizes sensory fibers?
snake bite
56
bradykinin stimulates what acid in the brain and increases what outflow? (A, S)
arachidonic acid, sympathetic outflow
57
does serotonin respond to excitatory neurons, inhibitory neurons or both?
both
58
what med works on 5-HT3 subtype?
zofran
59
how many 5-HT3 subtypes are there?
14
60
in what 3 places does serotonin work? (GIT, P, C)
GI tract, plts, CNS
61
does serotonin increase or decrease plt aggregation?
increase
62
serotonin is one of the 3 what? (BM)
biogenic monamines
63
serotonin is synthesized from what essential AA? (T)
trypotophan
64
tryptophan needs what for for cerebral uptake? (C)
carrier
65
what system controls the tone of the airways?
autonomic nervous system
66
what system and what class of drugs cause bronchodilation?
SNS, sympathomimetic
67
what system works to protect the lungs from insult?
PNS
68
beta 2 receptor activation causes what?
1. increased or decreased cAMP
2. increased or decreased Ca influx
1. increased
| 2. decreased
69
what does PNS release to cause bronchoconstriction?
Ach
70
what 2 parasympatholytic drugs decrease parasympathetic tone and thus cause bronchodilation? (A, I)
atropine, ipratropium
71
name the 4 short acting beta 2 agonists (L, A, M, P)
levalbuterol, albuterol, metaproterenol, pirbuterol
72
name the 3 long acting beta 2 agonists (S, A, F)
salmeterol, arformoterol, formoterol
73
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
1. 5-7 minutes
2. 4-6 hours
3. 18 mcg
4. 60-90 minutes
74
salmeterol/formoterol
1. onset minutes
2. hour range DOA
1. 35 minutes
| 2. 10-12 hours
75
what corticosteroid is salmeterol combined with? (F)
fluticasone
76
what corticosteroid is formoterol combined with? (B)
budesonide
77
can hi concnetrations of beta2 agonists stimulate beta 1 receptors?
yes
78
can high concentrations of beta2 agonists stimulate beta 1 receptors?
yes
79
what are the 6 SEs of beta 2 agonists? (T, N, T, H, P, N/V)
tremor, nervousness, tachycardia, HTN, palpitations, N/V
80
what do beta 2 agonists increase intracellularly?
cAMP
81
what is the largest factor that determines the amount of drugs that reaches the SM target? (T)
technique
82
what is the largest factor that determines the amount of drugs that reaches the SM target? (T)
technique
83
give prphylactice beta 2 agonist or anticholinergic drugs how many hours before intubation?
1 hour
84
give prophylactic beta 2 agonist or anticholinergic drugs how many hours before intubation?
1 hour
85
albuterol should be used with extreme caution with what 2 drug classes? (MI, TA)
MAO inhibitors, tricyclic antidepressants
86
albuterol should be used with extreme caution with what 2 drug classes? (MI, TA)
MAO inhibitors, tricyclic antidepressants
87
albuterol given with MAO inhibitors and TCAs can have what effect on the BP and what effect on the HR?
lower BP, increase HR
88
albuterol has decreased effectiveness with what drug class? (NBB)
nonselective beta blockers
89
bronchospasms is best treated prophylactically with inhaled what?
beta 2 agonists
90
VAs are potent bronchoconstrictors or bronchodilators?
bronchodilators
91
Order these VAs in order of most potent bronchodilator to least potent bronchodilator: des, sevo, iso, halo
Halo>iso=sevo>des
92
methylxanthines (theophylline) are nonselective inhibitors of what enzyme?
phosphodiesterases
93
methylxanthines (theophylline) enhance liver metabolism of what 2 drugs? (C, R)
carbamazepine, rifampin
94
methylxanthines (theophylline) inhibit liver metabolism of what 2 drugs? (C, E)
cimetidine, erythromycin
95
what drug may lower theophylline's seizure threshold?
ketamine
96
methylxanthines (theophylline) enhance or inhibit the effect of nondepolarizing muscle blockers?
inhibit
97
anticholinergics inhibit what 2 muscarinic receptors on airway SM?
m2, m3
98
what does PNS release during asthma exacerbations and intubation?
Ach
99
what drug is the short acting inhaled anticholinergic?
ipratropium
100
what drugs is the long acting inhaled anticholinergic?
tiotropium
101
how do anticholinergics have a potential drug interactions with viral infections?
dysfunction of m2 can result in an increased Ach release
102
pts with recent what may have a greater benefit from anticholinergics than beta agonists?
respiratory infection
103
what 2 step MOA of corticosteroids for chronic asthma therapy?
1. enter airway cell
| 2. directly inhibit cells involved with airway inflammation
104
what are the 2 classes of leukotriene pathway inhibitors? (5-LI, CLA)
5-lipoxygenase inhibitors, cysteine-leukotriene antagonists
105
5-lipoxygenase inhibitors impair the conversion of what to leukotriene A4? (AA)
arachadonic acid
106
cysteine-leukotriene antagonists competitively block what from binding to CysLT1 receptor? (L)
LTD4
107
name the one 5-lipoxygenase inhibitor (Z)
Zileuton
108
name the 2 cysteine-leukotriene antagonists (M, Z)
montelukast, zafirlukast
109
aspirin-sensitive and exercise-induced asthmatics are most likely to benefit from which leukotriene pathway inhibitor?
cysteine-leukotriene antagonists
110
asthmatics have an increased production of what, which causes airway recruitment of what that causes bronchospasms? (CL, E)
cysteinyl leukotrienes, eosinophils
111
asthmatics have increased what 3 things? (AH, ME, MP)
airway hyperresponsiveness, mucosal edema, mucus production
112
asthmatics have airway proliferation of what? (SM)
smooth muscle
113
what is drug is used for mild-intermittent asthma (<2 symptoms per week)?
b2 agonist inhaler
114
what drug is used for mild-persistent asthma (>2 symptoms per week but <1 per day)?
inhaled low dose corticosteroids
115
what 2 drug regimens can be used for moderate persistent asthma (daily symptoms)?
1. medium dose inhaled corticosteroids
| 2. low to medium dose inhaled corticosteroids plus long-acting bronchodilator
116
what 3 drugs can be used for severe persistent asthma (continuous symptoms)?
1. inhaled high dose corticosteroids
2. long-acting bronchodilator
3. systemic corticosteroids
117
what are 5 inhaled corticosteroids? (B, B, F, F, T)
beclomethasone, budesonide, fluticasone, flunisolide, triamcinolone
118
asthma pts who received systemic steroids within the past how many months should receive them during surgery?
6 months
119
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?
100 mg IV hydrocortisone Q 8 hr; 24 hours
120
pulmonary HTN is a sustained mean PAP > what at rest and > what with activity?
> 25 mmHg at rest; > 30 mmHg with activity
121
what 3 increased factors can cause pulmonary HTN? (LAP, CO, PVR)
left atrial pressure, cardiac output, pulmonary vascular resistance
122
what are the 5 diagnostic categories of pulmonary HTN? (PAH, PVH, pulmonary htn AWH, pulmonary htn d/t T/ED, M)
pulmonary arterial htn, pulmonary venous htn, pulmonary htn associated with hypoxemia, pulmonary HTN d/t thrombotic/embolic disease, miscellaneous
123
which pulmonary hypertension category is primary pulmonary hypertension?
pulmonary arterial hypertension
124
which pulmonary hypertension category is form mitral valve disease?
pulmonary venous hypertension
125
which pulmonary hypertension category is is associated with COPD?
pulmonary htn associated with hypoxemia
126
which pulmonary hypertension category is is associated inflammation?
miscellaneous
127
acute increase in pulmonary vascular resistance is d/t what 5 things? (H, H, A, IST, PV)
hypoxia, hypercarbia, acidosis, increased sympathetic tone, pulmonary vasoconstriction
128
pts with pulmonary htn have decreased amounts of what 2 autacoids? (P, N)
prostacyclin, nitric oxide
129
pts with pulmonary htn have increase amounts of what 4 autacoids? (T, E , S, N)
thromboxane, endothelin, serotonin, NE
130
lungs synthesize/inactivate what 3 groups of autacoids? (P, T, L)
prostaglandins, thromboxanes, leukotrienes
131
do leukotrienes cause pulmonary vasoconstriction or vasodilation?
vasoconstriction
132
bradykinin is inactivated in the lung by what enzyme?
ACE
133
bradykinin causes direct pulmonary vasoconstriction by binding to what receptor and causes indirect pulmonary vasodilation by causing the endothelium to produce what?
BK2, NO
134
histamine a strong pulmonary vasodilator or vasoconstrictor and a systemic vasodilator or vasoconstrictor?
pulmonary vasoconstrictor, systemic vasodilator
135
do alpha adrenergic agonists (NE) cause pulmonary vasodilation or vasoconstriction?
vasoconstriction
136
do beta adrenergic agonists (isoproterenol) cause pulmonary vasodilation or vasoconstriction?
vasodilation
137
do stress and pain exacerbate pulm htn?
yes
138
PaO2 less than what causes hypoxic pulmonary vasoconstriction
< 70 mmHg
139
what is the net effect of BF in hypoxic pulmonary vasoconstriction?
it is diverted away from poorly ventilated alveoli
140
does pulmonary artery SM rapidly constrict or dilate in response to hypoxia?
constrict
141
where is the site of O2 sensing in hypoxic pulmonary vasoconstriction? (SPA)
small pulmonary arteries
142
the goal of shunting in hypoxic pulmonary vasoconstriction is to increase what?
PaO2
143
is hypoxic pulmonary vasoconstriction pathologic?
no
144
is hypoxic pulmonary vasoconstriction a local mediated response?
yes
145
what 2 drugs are used to treat hypoxic pulmonary vasoconstriction?
nitroprusside, nitroglycerin
146
what type of chronic therapy may improve survival for treating idiopathic pulmonary arterial hypertension (IPAH)?
chronic anticoagulation therapy
147
what is the major limitation of all vasodilators for pulmonary htn?
they are not selective for pulmonary vessels
148
do all systemic vasodilators cause pulmonary vasodilation?
yes
149
what drug is the most effective option for chronic therapy of pulmonary htn? (N)
nifedipine
150
what does nifedipine worsen in pts with lung disease?
V/Q mismatch
151
nifedipine decreases the level of what 2 meds? (C, Q)
clopidogrel, quinidine
152
what med is useful for pulmonary htn caused by HF?
nitroprusside
153
nitroprusside activates what enzyme and increases the level of what that causes vasodilation?
guanylate cyclase; cGMP
154
nitroglycerin vasodilates what vessels? (V, LCA)
veins, large coronary arteries
155
nitroglycerin decreases what 2 things while maintaining BP? (PVR, RVO)
pulmonary vascular resistance, RV output
156
does hydralazine vasodilate arteries, veins or both?
arteries
157
hydralazine works primarily by activating what enzyme?
guanylate cyclase
158
inhaled nitric oxide diffuses into adjacent pulmonary vascular SM, activates what and increases the levels of what?
guanylate cyclase, cGMP
159
what type of vasodilator is inhaled nitric oxide? (SEV)
selective endogenous vasodilator
160
what are 2 SEs of inhaled nitric oxide? (PI, RH)
plt inhibition, rebound hypoxia
161
inhaled nitric oxide is inactivated by binding to what? (H)
hemoglobin
162
what prostaglandin is a potent vasodilator?
prostacyclin
163
prostacyclin binds to what receptor, activates what enzyme and increases the levels of what?
prostaglandin I (IP), adenylate cyclase, cAMP
164
prostacyclin is also known as the most potent inhibitor to what? (PA)
plt aggregation
165
what is prostacyclin's elimination half time? (minutes)
6 minutes
166
what is nitroglycerin's minute range half-life?
1-4 minutes
167
what 4 short acting vasodilators can be used when measuring vasodilator responsiveness with a pulmonary artery catheter? (INO, P, A, A)
inhaled nitric oxide, prostacyclin, Ach, adenosine
168
what is the one endothelin antagonist? (B)
bosentan
169
what are the 2 endothelin receptors? (SMEA, EEB)
smooth muscle endothelin A, endothelial endothelin B
170
which endothelin receptor only mediates vasoconstriction and SM proliferation?
endothelin A
171
endothelin B causes what 2 things? (V, V)
vasodilation, vasoconstriction
172
antagonists were developed for which endothelin receptors to treat pulmonary htn?
endothelin A
173
pts with pulmonary htn have enhanced pulmonary production and increase circulation of what endogenous peptide? (E)
endothelin 1
174
what are the 2 actions of endothelin 1? (PV, PA)
powerful vasoconstrictor, proliferative agent
175
what number phosphodiesterase (PDE) inhibitor is relatively selective for pulmonary circulation?
PDE 5
176
why are PDE5 inhibitors relatively selective for pulmonary circulation compared to systemic circulation?
higher phosphodiesterase 5 in the pulmonary circulation
177
what is the one example of PDE5 inhibitor? (S)
sildenafil
178
PDE5 inhibitor potentiate the magnitude and prolong the effects of what other vasodilator?
nitrovasodilators
179
are PDE5 inhibitor used as a single agent because of their relatively selective pulmonary vasodilation?
yes
180
in pulm htn, should drugs be avoided that produce excessive ventilatory depression?
yes
181
which VA can cause pulmonary artery vasoconstriction and increased PVR?
nitrous
182
PPV increases what and distends what? (P, A)
increases PVR, distends alveoli
183
high sensory level blocks may adversely decrease what measurement in pts with a fixed increased PVR?
SVR
184
abrupt increases in right atrial pressure intraop demonstrate what 2 things? (RVD, IP)
RV dysfunction, increased PVR
185
avoid what 3 things in pts with pulmonary htn? (H, H, N)
hypoxemia, hypoventilation, nitrous
186
does M. tuberculosis thrive in tissues with high or low oxygen concentration?
high
187
can M. tuberculosis be reactivated in the elderly?
yes
188
what are the 4 first line drugs for M. tuberculosis? (R, E, P, S)
rifampicin, ethambutol, pyrazinamide, streptomycin
