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Pharm Exam 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Which two volatile anesthetics do NOT reduce bronchomotor tone?

A

desflurane and nitrous oxide

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2
Q

which three volatile anesthetics have a favorable effect on bronchomotor tone?

A

isoflurane
sevoflurane
halothane

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3
Q

Which three IV anesthetics have a favorable influence on bronchomotor tone?

A

propofol
ketamine
midazolam

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4
Q

what makes up the conduction zone?

A

upper airways: mouth, nose, pharynx

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5
Q

what is the respiratory zone?

A

lower airways: bronchioles, alveoli

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6
Q

What nervous system controls the respiratory system?

A

Vagus/PNS

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7
Q

What occurs when M3 receptors are activated?

A

bronchoconstriction

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8
Q

what are substance P and neurokinin A?

A

substances that cause neurogenic inflammation and broncoconstriction

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9
Q

How long do short acting beta 2 agonists last? (according to stoelting)

A

4-6 hours

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10
Q

T/F long acting beta agonists should be prescribed if short acting beta agonists are used greater than twice a week

A

TRUE

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11
Q

how does a beta agonist work?

A

causes stimulators G protein to activate adenylate cyclades converting adenosine triphophate into cyclic adenosine mono phosphate (cAMP) which decreased calcium and leads to smooth muscle relaxation

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12
Q

How do long acting beta agonists last longer than short acting?

A

lipophilic side chain allows a slow, steady release of medication

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13
Q

what are the most common side effects of a beta 2 agonist?

A

tremors, tachycardia, hyperglycemia, hypokalemia, and hypomagnesmia

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14
Q

What causes beta 2 agonist tolerance?

A

down regulation

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15
Q

What is ipratropium?

A

short acting anti cholinergic, anti muscarinic commonly used as maintenance therapy for COPD (blocks muscarinic receptors)

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16
Q

What is tiotropium?

A

the ONLY long acting anti cholinergic available for COPD

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17
Q

What are common side effects of anti cholinergics?

A

dry mouth, urinary retention, constipation, pupillary dilation, and blurred vision
can’t see, can’t pee, can’t spit, can’t shit

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18
Q

What is fluticasone?

A

inhaled corticosteroid

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19
Q

what is montlukast?

A

leukotriene modifiers

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20
Q

What is cromolyn?

A

mast cell stabilizer

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21
Q

What is theophylline?

A

methylxanthine

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22
Q

What are side effects of theophylline?

A

common: headache, nausea, vomiting, restlessness, abdominal discomfort, GERD, Diuesis
severe: seizures, cardiac dysrhythmias, and death

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23
Q

What is an undesired side effect of ketamine?

A

increase in salivation

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24
Q

What is an additional measure that can be taken, last resort to cause broncodialation?

A

Magnesium

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25
How does nitric oxide work?
non cholinergic PNS nerves release onto airway smooth muscle which causes relaxation; thus, broncodilation
26
What nerve innervates control of the airway smooth muscle?
vagus nerve
27
What cholinergic receptor interested the respiratory system?
M3
28
substances that could lead to bronchoconstriction:
histamine prostaglandins leukotrienes platelet activating factor bradykinin substance P neurokinin A
29
T/F COPD is reversible
FALSE
30
What is the primary cause of COPD?
Smoking
31
how long does a productive cough have to be present to be characterized as chronic bronchitis?
3 months in each of 2 successive years
32
What is emphysema?
permanent enlargement of the airspaces distal to the terminal bronchioles
33
copd treatment:
education/smoking cessation short acting bronchodialators long acting bronchodialators rehab inhaled steroids oxygen surgery
34
what is asthma?
allergen triggers/histamine inflammatory mediators that cause episodic attacks of bronchospasm, inflammation, edema, and mucus production
35
clinical manifestations of asthma:
expiratory wheezing, dyspnea, non productive cough, prolonged expiration, tachycardia, tachypnea
36
An asthma attack can lead to:
status asthmaticus which is a bronchospasm not reversed by usual measures
37
T/F neromuscular blockades are a first line treatment of status asthmaticus
FALSE
38
What are the 4 histamine releasing medications that should be avoided in patients with bronchoconstricting diseases?
atracurium, succs, morphine, merderidine
39
What is the beta blocker of CHOICE for individuals with lung disease?
Esmolol (beta1 selective)
40
asthma management:
SABA ICS LABA Theophylline daily systemic steroid
41
Where are the M3 receptors located?
lower airways (12-16 generation of bronchiole tree)
42
How do inhaled steroids work?
stabilize mast cells by preventing degranulation + production of cytokines
43
How do Leukotriene modifiers work?
inhibits histamines which prevents airway inflammation pathways
44
Where do anticholinergics work?
M3 receptor
45
When should inhalers be d/c'ed and continued after surgery?
they should be continued the morning of and be restarted immediately
46
Albuteral dose:
nebulized 2.5mg OR 90mcg/puff 2-3 puff
47
whats the difference between albuterol and levoalburerol?
levoalbuterol is a clockwise enatomer that causes less tachycardia
48
Salmeterol dosage:
49
What is the LABA black box warning?
can cause fatal or near fatal asthma attacks when NOT used in conjunction with a SABA
50
What is a side effect of inhaled anesthetics?
prolonged QT: increased risk for cardiac arrhythmias
51
Theophylline MOA:
inhibits phosphodiasterase -> increases cAMP -> decreases calcium releases endogenous catecholaminsa inhibits adenosine receptors
52
Methylxanthine side effects:
> 20mcg/ml: n/v, diarrhea, headache, sleep disturbances > 30mcg/ml: seizures, tachy dysrhythmias, CHF
53
when should methylxanthine be discontinued prior to surgery?
the evening before
54
What is an anesthesia specific consideration for methylxanthine?
check a serum level
55
inhaled corticosteroids are preferred over systemic because:
they have less systemic side effects being absorbed directly in the respiratory system
56
Side effects of inhaled corticosteroids:
oral pharyngeal canditis easy bruising osteoporosis increased intraocular pressures
57
How long should an individual be on systemic corticosteroids?
no greater than 2 weeks 3-10 days/no taper
58
side effects of systemic corticosteroids:
htn, hyperglycemia, adrenal suppression, increased infections, cataracts, dermal thinning, psychosis
59
Inhaled corticosteroids MOA:
acts on bronchioles- stimulate intracellular steroid receptors which decreases inflammatory protein synthesis
60
Anticholinergics/cholinergic antagonist MOA:
act on m3 receptor to decrease tone.
61
T/F Anticholinergics are used for maintenance therapy
FALSE
62
T/F Ipratropium is similar to atropine but doesn't cross BBB which decreases neuro side effects
TRUE
63
Ipratropium dose:
200unit/inhal 2 puffs QID
64
what is the ONLY long acting anti cholinergic used for treating COPD?
tiotropium
65
Which surgery necessitates pretreating with anticholinergics?
Gi surgery: large amount of vagal stimulation
66
What is the MOA of leukotriene modifiers?
inhibits 5-lipoxygenase enzyme- decrease leukotriene synthesis which decreases bronchospasm, vasoconstriction, eosinophil recruitment
67
T/F montelukast is used in the management of acute bronchospasm
FALSE
68
what is the most abused methylxanthine?
caffeine
69
When should we stop giving albuterol when pt has ETT present?
when tachycardia occurs
70
What is our first step to breaking a bronchospasm?
increase volatile gas bc it is PNS innervation

Pharm Exam 1 (4 decks)

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