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pharmacology > Respiratory 1 > Flashcards

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
Q

What is relief therapy

A

short-acting Beta-2 agonists for acute exacerbations
-some will have mucolytics

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26
Q

Mucolytics

A

target destruction of mucus

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27
Q

What addresses the underlying inflammation and when is it indicated?

A

Steroids
indicated if controller therapy and relief therapy don’t work

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28
Q

What do steroids address and what do they not work on?

A

They address inflammation, NOT smooth muscle constriction

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29
Q

What is the mechanism of Adrenergic agonist

A

stimulates Beta-2 adrenoceptors
-Increases cAMP monophosphate levels
-leads to relaxation of bronchial smooth muscle

-inhibits the release of mediators and stimulate mucociliary clearance

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30
Q

what are adrenergic agonists used to treat?

A

acute bronchoconstriction of asthma

31
Q

what type of therapy is adrenergic agonist used for?

A

quick relief and controller depending on the half life of the drug

32
Q

any Beta-2 agonist stimulates what?

A

smooth muscle relaxtions

33
Q

Use of short acting adrenergic agonists daily indicates

A

need for additional long term therapy

34
Q

Side effects of the adrenergic agonists

A

increased heart rate

35
Q

What is the gold standard of asthma treatment

A

albuterol

36
Q

Methacholine challenge test

A

muscarinic cholinergic agonist
used to diagnosis asthma

37
Q

names of short acting Beta-2 adrenoreceptor agonists

A

Albuterol, Terbutaline, Pirbuterol, Metaproterenol

38
Q

Short acting beta-2 agonists have what characteristics

A

-enhanced beta-2 receptor selectivity
-commonly inhaled
-onset is 1-5 minutes

39
Q

Long term use of short-term B-2 agonists lead to what?

A

Tolerance
diminished control due to beta receptor down regulation

40
Q

Names of Non-Selective Beta-2 receptor agonist

A

Isoproterenol
Epinephrine

41
Q

Characteristics of Isoproterenol

A

-relative non selective beta receptor agonist
-potent bronchodilator
-Most effective when inhaled

42
Q

Isoproterenol dosing

A

acute attacks- Q1-2 h
Oral preps: Q 4x

43
Q

Characteristics of Epinephrine

A

Acts as B1, B2 and alpha 1 andrenoceptor agonist
-Inhalant
-SQ (in emergencies) (onset 5-10 min and lasts 60-90 min)

44
Q
A
45
Q

Names of Long acting B-2 adrenoceptor agonist

A

salmeterol (serevent)
formoterol (Foradil)
albuterol and terbutaline IF oral pill

46
Q

How are long acting B2 agonists administered? When?

A

as inhalants
For prophylaxis of asthma (NOT acute attacks)

47
Q

Why are long acting B2 agonists long acting?

A

slower onset and longer duration
-LIPOPHILIC SIDE CHAINS allow for slow diffusion out of the airway

48
Q

“Lipophilic” indicates

A

takes a long time

49
Q

side effects of Salmeterol

A

(Serevent) can lead to arrhythmia

50
Q

side effect of albuterol and terbutaline as controller therapies?

A

gets into the systemic system and causes cardiovascular problems

51
Q

adverse effects of Isoproterenol and Epinephrine

A

Heart impacts (bc B1 affinity)
-tachycardia, arrhythmia, angina exacerbation

52
Q

Most common side effect of Beta-2

A

muscle tremors

53
Q

alpha-adrenoceptor agonist effect

A

vasoconstriction and HTN

53
Q

all B2 adrenoceptors agonists can cause

A

tachyphylaxis
-blunting in the response to adrenergic agonists with repeated use (tolerance)
-counter: methylxanthine or corticosteroid

54
Q

adverse affects are based on

A

receptor occupancy

55
Q

What minimizes effects of adrenergic agonists

A

inhalant delivery

56
Q

Methylxanthine names

A

Theophylline (most commonly administered)
Theobromine and caffeine

57
Q

Why is methylxanthine not used as much anymore?

A

adverse effects too severe
-older patients use it frequently

58
Q

How is theophylline complexed

A

salt bc limited solubility
aminophylline and oxtriphylline

59
Q

Mechanism of action of methylxanthine

A

Bronchodilation (adenosine causes bronchial constriction and promotes the release histamine)

Decrease in ICF calcium (muscles can’t contract)

60
Q

What does theophylline inhibit?

A

Phosphodiesterase
PDE3 and PDE4 (most important)
leads to cAMP increase

60
Q

How does theophylline have anti-inflammatory properties?

A

reduces the airway responsiveness to agents (histamines and allergens)
reduces the synergistic effects of adenosine and antigen stimulation on histamine release

61
Q

Pharmalogical effects of Methylxanthine in the respiratory system

A

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
Q

Pharmacological effects on the rest of the body

A

-chronotropic and inotropic actions on the heart
-pulmonary and peripheral vasodilation
-cerebral vasoconstriction
-gastric acid and pepsinogen release
-diuresis

63
Q

Low doses of methylxanthine leads to

A

increase in alertness and cortical arousal

64
Q

High doses of methylxanthine

A

severe nervousness and seizures (bc medullary action)

65
Q

Pharmacological Properties of Methylxanthine

A

-narrow therapeutic index (blood levels monitored)
-easily crosses the placenta and breast milk
-metabolized extensively in the liver and excreted by kidneys

66
Q

what should always be checked when prescribing methylxanthine

A

KIDNEY AND LIVER FUNCTION
-impacted by old age, meds, etc

67
Q

Contraindications of Methylxanthine

A

pregnancy
HX of seizure or arrythmia
older age
decreased renal function

68
Q

Theophylline characteristics

A

microcrystalline form for inhalation
IV- sustained release (half life is 8-9 hrs)
clearance affected by: drugs, diet, hepatic disease

69
Q

Methylxanthine therapeutic uses

A

-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
Q

What is responsible for the recent rise in asthma mortality

A

Combining B-2 adrenoceptor agonists with methylxanthine

71
Q

Hypoxic drive

A

too much O2, your brain has no CO2 so your brain shuts down the need to breath
-CO2 is what establishes normal respiratory

72
Q

What can you do in very serious cases of respiratory disease

A

combine Beta-2 agonists, steroids and methylxanthine

pharmacology (32 decks)

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