resp- anticholinergics, inhaleds, SABAs LABAs Meths Flashcards
most of the resp agents we use now are specific to which muscarinic receptor?
M3
does ipratropium have a fast or slow onset?
slow (30-90min) so its better for chronic bronchitis or emphysema
does ipratropium absorb systemically?
no. <1%. so no significant tachyarrythmias
inhaled anticholinergics end in
ium
which inhaled agent is a long acting anticholinergic bronchodilator used as a maintenance treatment of bronchospasm associated with COPD including chronic bronchitis and emphysema?
tiotropium (spiriva)
tiotropium works on M_ and M_
1 & 3, facilitates bronchodilation and reduces mucous secretion
aclindinium is similar to spiriva, but it’s given __ daily, and has a ___ onset
twice, faster
with long term use or ineffective use of inhaled anticholinergics pt can get side effects such as
increased IOP, tachycardia, urinary retention
why cant you use inhaled norepinephrine ?
because it doesnt have good afifinity for beta 2
ephedrine, isoproterenol albuterol and terbutaline are all
beta agonists
ephedrine and epi have bronchodilating effects from activation of ____ receptors
beta 2
which adrenergic agent is highly proarrhythmic?
isoproterenol
in the periphery, cAMP works as a vaso___ and broncho____
dilator, dilator
beta 2 agonists have a structure resistant to COMT, which accounts for?
their sustained duration of action
T/F you can get tolerance with atropine, but this is not seen with ipratropium
TRUE
what receptors does isoproterenol work on?
beta 1 and beta 2
at alpha 1 and beta 1 we have ___, ____
constriction, contraction
T/F Beta 2 Agonists lack stimulating effects on the heart at therapeutic doses
TRUE - but they can be stimulated in an overabundance
what is the preferred beta2 agonist for acute bronchospasm,
albuterol
when using an inhaler, how much of it is actually delivered to the lungs
12%
presence of an ETT decreases by ___% the amount of drug delivered by an MDI that reaches the trachea
50-70%
mechanical ventilation INCREASES the act of drug that passes beyond the distal end of the ETT
T/F Dose delivered by a nebulizer requires less than an MDI dose to produce the same degree of bronchoconstriction.
FALSE.
nebuilizer requires 6-10x that of an MDI dose.
side effects of inhaled beta2 agonists include ____Glycemia, ____kalemia, and ____magnesemia
hyperglycemia
hypokalemia
hypomag
think you’re pushing those lytes back in the cell so they aren’t in the blood.
insulin and beta2 agonists both work at the ______ exchanger
Na K ATPase exchanger
is albuterol a SABA or a LABA
SABA - works fast
T/F Levoalbuterol is similar to albuterol but has significantly less adverse effects.
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
What is the BB warning with LABA’s , and what two drugs fall under this category
BB warning = increased risk of asthma related death - do not use alone
salmeterol + vilanterol
Salmon and Villian = LABA = asthma death = dont use alone!
salmeterol is frequently administered in combination with ____
steroids
like salmeterol/fluticasone = advair
how do LABAs increase the risk of asthma related death?
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
Which drug does NOT have anything to do with bronchoconstriction/dilation - works on histaminerigic pathway
cromolyn sodium (intal)
cromo — no-mo broncho
cromo has no chill, does not relax anything
T/F Cromolyn may be used for an acute asthma attack
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.
which 3 drugs fall under the methylxanthines cateogry?
TACT
Theophylline/aminophylline
caffeine
theobromine
theo, theo, and caffeine.
methylxanthines : stimulate or suppress CNS? inc or dec BP? inc or dec contractility/HR? relax or constrict smooth airways?
stimulate CNS
INC bp
INC ct & HR
RELAX smooth airways
[basically everything you could want in a pre-workout drink aka coffee rules]
whats the MOA of methylxanthines? (2)
hint: block & compete
non-selective phosphodiesterase inhibitors (block them all)
competitive antagonists of adenosine receptors
(theophylline is the most active)
inhibt phospho & compete w adenosine
so what do PDEs do? and how does blocking them like in the case of the meths (theo,theo,caffeine) produce better airway conditions
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
T/F Theophylline is used for the treatment of bronchospasm d/t acute exacerbation of asthma
TRUE
but inhaled selective beta2’s are better
which drug treats apnea of prematurity in infants
hint: it’s a CNS stimulant
theophylline
by blocking adenosine, you increase neuroactivity
Theophylline toxicity:
___-___ GI nv tremor
___ tachycardia, PVCs
___ Vtach, seizures
15-25 GI,shakes
35 tachy, PVCs
>35 VT sz
what causes caffeine headaches?
caffeine is a cerebral vasoconstrictor so the rebound vasodilation gives you a HA
inhalers hit M3 as an agonist or antagonist ?
ANTAGONIST
causing bronchodilation
bc M3 is stimulatory
T/F Never use cromolyn for acute exacerbation of asthma
TRUE
what is the main concerning side effect with ritodrine?
pulmonary edema
