resp- anticholinergics, inhaleds, SABAs LABAs Meths

Question 1

most of the resp agents we use now are specific to which muscarinic receptor?

Answer 1

M3

Question 2

does ipratropium have a fast or slow onset?

Answer 2

slow (30-90min) so its better for chronic bronchitis or emphysema

Question 3

does ipratropium absorb systemically?

Answer 3

no. <1%. so no significant tachyarrythmias

Question 4

inhaled anticholinergics end in

Answer 4

ium

Question 5

which inhaled agent is a long acting anticholinergic bronchodilator used as a maintenance treatment of bronchospasm associated with COPD including chronic bronchitis and emphysema?

Answer 5

tiotropium (spiriva)

Question 6

tiotropium works on M_ and M_

Answer 6

1 & 3, facilitates bronchodilation and reduces mucous secretion

Question 7

aclindinium is similar to spiriva, but it’s given __ daily, and has a ___ onset

Answer 7

twice, faster

Question 8

with long term use or ineffective use of inhaled anticholinergics pt can get side effects such as

Answer 8

increased IOP, tachycardia, urinary retention

Question 9

why cant you use inhaled norepinephrine ?

Answer 9

because it doesnt have good afifinity for beta 2

Question 10

ephedrine, isoproterenol albuterol and terbutaline are all

Answer 10

beta agonists

Question 11

ephedrine and epi have bronchodilating effects from activation of ____ receptors

Answer 11

beta 2

Question 12

which adrenergic agent is highly proarrhythmic?

Answer 12

isoproterenol

Question 13

in the periphery, cAMP works as a vaso___ and broncho____

Answer 13

dilator, dilator

Question 14

beta 2 agonists have a structure resistant to COMT, which accounts for?

Answer 14

their sustained duration of action

Question 15

T/F you can get tolerance with atropine, but this is not seen with ipratropium

Answer 15

TRUE

Question 16

what receptors does isoproterenol work on?

Answer 16

beta 1 and beta 2

Question 17

at alpha 1 and beta 1 we have ___, ____

Answer 17

constriction, contraction

Question 18

T/F Beta 2 Agonists lack stimulating effects on the heart at therapeutic doses

Answer 18

TRUE - but they can be stimulated in an overabundance

Question 19

what is the preferred beta2 agonist for acute bronchospasm,

Answer 19

albuterol

Question 20

when using an inhaler, how much of it is actually delivered to the lungs

Answer 20

12%

Question 21

presence of an ETT decreases by ___% the amount of drug delivered by an MDI that reaches the trachea

Answer 21

50-70%

mechanical ventilation INCREASES the act of drug that passes beyond the distal end of the ETT

Question 22

T/F Dose delivered by a nebulizer requires less than an MDI dose to produce the same degree of bronchoconstriction.

Answer 22

FALSE.

nebuilizer requires 6-10x that of an MDI dose.

Question 23

side effects of inhaled beta2 agonists include ____Glycemia, ____kalemia, and ____magnesemia

Answer 23

hyperglycemia
hypokalemia
hypomag

think you’re pushing those lytes back in the cell so they aren’t in the blood.

Question 24

insulin and beta2 agonists both work at the ______ exchanger

Answer 24

Na K ATPase exchanger

Question 25

is albuterol a SABA or a LABA

Answer 25

SABA - works fast

Question 26

T/F Levoalbuterol is similar to albuterol but has significantly less adverse effects.

Answer 26

FALSE - little or no clinically significant difference in adverse effects compared to albuterol

the only time you would give this over albuterol is if you know the person has used albuterol in the past w bad results

Question 27

What is the BB warning with LABA’s , and what two drugs fall under this category

Answer 27

BB warning = increased risk of asthma related death - do not use alone

salmeterol + vilanterol

Salmon and Villian = LABA = asthma death = dont use alone!

Question 28

salmeterol is frequently administered in combination with ____

Answer 28

steroids

like salmeterol/fluticasone = advair

Question 29

how do LABAs increase the risk of asthma related death?

Answer 29

because you are essentially preventing the lungs from responding to a dangerous situation.

bronchoconstriction is your body’s way of trying to get the irritating agent out.. and these drugs prevent that response.

so these drugs used alone prevent oxygen exchange…death

Question 30

Which drug does NOT have anything to do with bronchoconstriction/dilation - works on histaminerigic pathway

Answer 30

cromolyn sodium (intal)

cromo — no-mo broncho
cromo has no chill, does not relax anything

Question 31

T/F Cromolyn may be used for an acute asthma attack

Answer 31

FALSE.

it does not relax bronchial or vascular smooth muscle.
it just suppresses the secretory response. [inhibits antigen-induced release of histamine from palm mast cells during antibody mediated allergic responses.]

its really only used for long term prevention.

Question 32

which 3 drugs fall under the methylxanthines cateogry?

Answer 32

TACT

Theophylline/aminophylline
caffeine
theobromine

theo, theo, and caffeine.

Question 33

methylxanthines :  
stimulate or suppress CNS?
inc or dec BP?
inc or dec contractility/HR?
relax or constrict smooth airways?

Answer 33

stimulate CNS
INC bp
INC ct & HR
RELAX smooth airways

[basically everything you could want in a pre-workout drink aka coffee rules]

Question 34

whats the MOA of methylxanthines? (2)

hint: block & compete

Answer 34

non-selective phosphodiesterase inhibitors (block them all)

competitive antagonists of adenosine receptors
(theophylline is the most active)

inhibt phospho & compete w adenosine

Question 35

so what do PDEs do? and how does blocking them like in the case of the meths (theo,theo,caffeine) produce better airway conditions

Answer 35

PDE’s are responsible for breaking down cyclic AMP and cyclic GMP.

more cAMP —> more bronchodilation

so we wanna INHIBIT PDE’s so that cAMP doesnt get broken down

Question 36

T/F Theophylline is used for the treatment of bronchospasm d/t acute exacerbation of asthma

Answer 36

TRUE

but inhaled selective beta2’s are better

Question 37

which drug treats apnea of prematurity in infants

hint: it’s a CNS stimulant

Answer 37

theophylline

by blocking adenosine, you increase neuroactivity

Question 38

Theophylline toxicity:
___-___ GI nv tremor
___ tachycardia, PVCs
___ Vtach, seizures

Answer 38

15-25 GI,shakes
35 tachy, PVCs
>35 VT sz

Question 39

what causes caffeine headaches?

Answer 39

caffeine is a cerebral vasoconstrictor so the rebound vasodilation gives you a HA

Question 40

inhalers hit M3 as an agonist or antagonist ?

Answer 40

ANTAGONIST
causing bronchodilation

bc M3 is stimulatory

Question 41

T/F Never use cromolyn for acute exacerbation of asthma

Answer 41

TRUE

Question 42

what is the main concerning side effect with ritodrine?

Answer 42

pulmonary edema