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Respiratory 1 Flashcards

1
Q

What Beta receptors are most common in the respiratory system

A

Beta 2 receptors

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2
Q

What receptors do the respiratory vascular system SOMETIMES respond to?

A

Alpha recetors

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3
Q

3 reasons for decreased airway conduction

A
  1. constriction of smooth muscle
  2. production of mucus
  3. inflammation
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4
Q

Therapy goal of Respiratory drugs

A

decrease airway resistance (increases the diameter of the bronchi)

decrease mucus secretion or stagnation in airways

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5
Q

Percentage of O2 in RA

A

21%

body doesn’t get all 21% but USES all it gets

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6
Q

Asthma is characterized by

A

acute bronchoconstriction caused by underlying airway inflammation

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7
Q

Antigenic stimuli trigger the release of

A

mediators that cause bronchospastic response w
SMOOTH MUSCLE CONTRACTION
mucus secretion
recruitment of inflammatory cells

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8
Q

What happens in the early phase response?

A

Inflammatory cells
-neutrophils increases

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9
Q

What is not present in chronic inflammatory response

A

increased levels of neutrophils

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10
Q

Mediators of bronchospastic response

A

leukotrienes
histamines
PGD2

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11
Q

when is the Late Phase response?

A

hours or days after the onset

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12
Q

What happens at a histological level during late phase response?

A

Fibrin and collagen deposition
tissue destruction

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13
Q

What happens to the smooth muscle in chronic asthma and late phase response inflammation?

A

hypertrophy occurs
(increase in size, not number)

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14
Q

Antigen

A

something in the body that shouldnt be

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15
Q

What happens when exposed to non-antigenic stimuli in late phase response inflammation?

A

non-antigen triggers response after early phase sensitization

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16
Q

Examples of Non antigenic stimuli

A

cold air
exercise
non-oxidizing pollutants

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17
Q

what is Chronic bronchitis characterized by

A

pulmonary obstruction characterized by hyperplasia and hyper functioning of mucus secreting goblet cells
-chronic cough
-induced by smoking or environmental

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18
Q

What is smoke

A

a solid and antigen

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19
Q

what characterizes Emphysema

A

irreversible loss of alveoli b/c of destruction
-decreased surface area available for gas exchange

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20
Q

What characterizes rhinitis

A

decrease in nasal airways due to thickening of mucosa and increased mucus secretion

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21
Q

What causes rhinitis

A

allergies, viruses, motor abnormalities, rhinitis medicamentosa

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22
Q

what is rhinitis medicamentosa

A

inflammation of the nasal mucosa caused by the overuse of topical nasal decongestants
“Rebound congestion”

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23
Q

What approach is taken to threat asthma and bronchial disorders

A

Two pronged approach
-controller therapy
-relief therapy

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24
Q

what is controller therapy

A

inhaled corticosteroids and long-acting Beta-2 agonists

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25
What is relief therapy
short-acting Beta-2 agonists for acute exacerbations -some will have mucolytics
26
Mucolytics
target destruction of mucus
27
What addresses the underlying inflammation and when is it indicated?
Steroids indicated if controller therapy and relief therapy don't work
28
What do steroids address and what do they not work on?
They address inflammation, NOT smooth muscle constriction
29
What is the mechanism of Adrenergic agonist
stimulates Beta-2 adrenoceptors -Increases cAMP monophosphate levels -leads to relaxation of bronchial smooth muscle -inhibits the release of mediators and stimulate mucociliary clearance
30
what are adrenergic agonists used to treat?
acute bronchoconstriction of asthma
31
what type of therapy is adrenergic agonist used for?
quick relief and controller depending on the half life of the drug
32
any Beta-2 agonist stimulates what?
smooth muscle relaxtions
33
Use of short acting adrenergic agonists daily indicates
need for additional long term therapy
34
Side effects of the adrenergic agonists
increased heart rate
35
What is the gold standard of asthma treatment
albuterol
36
Methacholine challenge test
muscarinic cholinergic agonist used to diagnosis asthma
37
names of short acting Beta-2 adrenoreceptor agonists
Albuterol, Terbutaline, Pirbuterol, Metaproterenol
38
Short acting beta-2 agonists have what characteristics
-enhanced beta-2 receptor selectivity -commonly inhaled -onset is 1-5 minutes
39
Long term use of short-term B-2 agonists lead to what?
Tolerance diminished control due to beta receptor down regulation
40
Names of Non-Selective Beta-2 receptor agonist
Isoproterenol Epinephrine
41
Characteristics of Isoproterenol
-relative non selective beta receptor agonist -potent bronchodilator -Most effective when inhaled
42
Isoproterenol dosing
acute attacks- Q1-2 h Oral preps: Q 4x
43
Characteristics of Epinephrine
Acts as B1, B2 and alpha 1 andrenoceptor agonist -Inhalant -SQ (in emergencies) (onset 5-10 min and lasts 60-90 min)
44
45
Names of Long acting B-2 adrenoceptor agonist
salmeterol (serevent) formoterol (Foradil) albuterol and terbutaline IF oral pill
46
How are long acting B2 agonists administered? When?
as inhalants For prophylaxis of asthma (NOT acute attacks)
47
Why are long acting B2 agonists long acting?
slower onset and longer duration -LIPOPHILIC SIDE CHAINS allow for slow diffusion out of the airway
48
"Lipophilic" indicates
takes a long time
49
side effects of Salmeterol
(Serevent) can lead to arrhythmia
50
side effect of albuterol and terbutaline as controller therapies?
gets into the systemic system and causes cardiovascular problems
51
adverse effects of Isoproterenol and Epinephrine
Heart impacts (bc B1 affinity) -tachycardia, arrhythmia, angina exacerbation
52
Most common side effect of Beta-2
muscle tremors
53
alpha-adrenoceptor agonist effect
vasoconstriction and HTN
53
all B2 adrenoceptors agonists can cause
tachyphylaxis -blunting in the response to adrenergic agonists with repeated use (tolerance) -counter: methylxanthine or corticosteroid
54
adverse affects are based on
receptor occupancy
55
What minimizes effects of adrenergic agonists
inhalant delivery
56
Methylxanthine names
Theophylline (most commonly administered) Theobromine and caffeine
57
Why is methylxanthine not used as much anymore?
adverse effects too severe -older patients use it frequently
58
How is theophylline complexed
salt bc limited solubility aminophylline and oxtriphylline
59
Mechanism of action of methylxanthine
Bronchodilation (adenosine causes bronchial constriction and promotes the release histamine) Decrease in ICF calcium (muscles can't contract)
60
What does theophylline inhibit?
Phosphodiesterase PDE3 and PDE4 (most important) leads to cAMP increase
60
How does theophylline have anti-inflammatory properties?
reduces the airway responsiveness to agents (histamines and allergens) reduces the synergistic effects of adenosine and antigen stimulation on histamine release
61
Pharmalogical effects of Methylxanthine in the respiratory system
Respiratory system mainly -rapid relaxation of bronchial SM -Decreased histamine released in response to IgE stimulation -improved contractility of diaphragm -stimulates medullary respiratory center
62
Pharmacological effects on the rest of the body
-chronotropic and inotropic actions on the heart -pulmonary and peripheral vasodilation -cerebral vasoconstriction -gastric acid and pepsinogen release -diuresis
63
Low doses of methylxanthine leads to
increase in alertness and cortical arousal
64
High doses of methylxanthine
severe nervousness and seizures (bc medullary action)
65
Pharmacological Properties of Methylxanthine
-narrow therapeutic index (blood levels monitored) -easily crosses the placenta and breast milk -metabolized extensively in the liver and excreted by kidneys
66
what should always be checked when prescribing methylxanthine
KIDNEY AND LIVER FUNCTION -impacted by old age, meds, etc
67
Contraindications of Methylxanthine
pregnancy HX of seizure or arrythmia older age decreased renal function
68
Theophylline characteristics
microcrystalline form for inhalation IV- sustained release (half life is 8-9 hrs) clearance affected by: drugs, diet, hepatic disease
69
Methylxanthine therapeutic uses
-adjuncts to inhaled corticosteroids -treat acute or chronic asthma that is unresponsive to inhaled corticosteroids or B2 agonists -treats COPD -Treats apnea in preemies (caffeine common choice)
70
What is responsible for the recent rise in asthma mortality
Combining B-2 adrenoceptor agonists with methylxanthine
71
Hypoxic drive
too much O2, your brain has no CO2 so your brain shuts down the need to breath -CO2 is what establishes normal respiratory
72
What can you do in very serious cases of respiratory disease
combine Beta-2 agonists, steroids and methylxanthine

pharmacology (32 decks)

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