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Pharmacology II - CP > Respiratory Agents > Flashcards

Respiratory Agents Flashcards

1
Q

Is asthma an obstructive disease or a restrictive disease?

A

Obstructive disease - problem with outflow

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2
Q

which obstructive disease is reversible?

A

Asthma

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3
Q

What is the airway smooth muscle influenced by?

A

PSNS and SNS

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4
Q

What does the SNS cause in the airway smooth muscle?

A

Bronchodilation

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5
Q

What does the PSNS cause in the airway smooth muscle?

A

Bronchoconstriction

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6
Q

Which receptors cause bronchodilation?

A

beta 2 receptors

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7
Q

PSNS innervation is via the ____

A

vagus nerve

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8
Q

Which receptors cause bronchoconstriction?

A

muscarinic (M3) receptors

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9
Q

Beta 2 receptors causes

A

smooth muscle relaxation in blood vessels, bronchi, uterus, and bladder, bronchodilation, increased intracellular cAMP

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10
Q

NonAdrenergic NonCholinergic Nerves (NANC)

A

influences on inflammation and smooth muscle tone

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11
Q

Stimulation of the vagus nerve leads to?

A

bronchoconstriction

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12
Q

How does M3 receptors mediate bronchoconstriction?

A

via the activation of IP3 which increases the intracellular Ca++ concentrations

also mediates mucus secretion

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13
Q

Asthma description

A

chronic inflammatory disorder of the airways characterized by increase responsiveness of the tracheobronchial tree to a variety of stimuli

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14
Q

Asthma recurrent symptoms

A

wheezing, breathlessness, chest tightness, cough, tachypnea, prolonged expiration phase, fatigue

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15
Q

Main goal of therapy for treating asthma

A

decrease stimulus (flatten the response to mediators)

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16
Q

asthma creates airways that are

A

inflamed, edematous airways, bronchial hypersensitivity, reactivity to irritant stimuli, difficulty with outflow

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17
Q

asthma hyperresponsiveness and inflammation from allergen leads to

A

activation of T2 lymphocytes and cytokine release

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18
Q

bronchospasm

A

lower in the bronchus/in the lungs

treat with gas (sevo or iso)

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19
Q

laryngospasm

A

glottic closure

break with 3-5mg rocuronium

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20
Q

Mediators involved in asthma

A

eosinophils and mast cells mostly

other probable mediators - cytokines, interleukins, leukotrienes, histamine

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21
Q

What kinds of things can cause/lead to COPD?

A

genes, smoking, age/gender, lung growth/development, exposure to particles, socioeconomic status, asthma, chronic bronchitis, infections

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22
Q

COPD description

A

cell death and destruction of the alveoli due to impaired lung parenchyma, degraded matrix, and toxic actions of inflammatory cells that leads to enlargement of air spaces, fibrosis, and increased mucus production

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23
Q

Steroids have limited effect on inflammation in ___

A

COPD

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24
Q

Which type of treatments are used in airway outflow disorders?

A

short acting bronchodilators, regular inhaled corticosteroid, long acting bronchodilators, phosphodiesterase inhibitors, methylxanthines, leuokotriene inhibitors, oral corticosteroids, cromolyns

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25
Example of bronchodilators
beta adrenergic agonists, anticholinergics, methylxanthines
26
Short acting beta agonists
terbutaline, albuterol, levalbuterol, salbutamol
27
Which short acting beta agonist is B2 selective?
levalbuterol
28
what is an example of a long acting beta agonist
salmeterol
29
MOA of beta agonists
GPCRs, activate adenlyl cyclase which increases the production of cAMP and decreases intracellular Ca++ release which leads to bronchodilation directly on beta 2 receptors
30
Onset of action, DOA, route of administration of beta agonists
Onset - rapid, within minutes DOA - short, 4-6 hours Route - inhalation, aerosol, powder or nebulized, orally, SQ
31
Side effects of beta agonists
minimized by inhalation delivery, tremor, increased HR, vasodilation, hyperglycemia, hypokalemia, hypomagnesemia
32
Albuterol dosing
inhaler 100 mcg/puff; 2 puffs q 4-6hours | nebulizer 2.5-5 mg in 5mL of saline
33
Albuterol effect with volatile anesthetics
additive effect on bronchomotor tone
34
Albuterol side effects
tachycardia, hypokalemia, blunt airway responses to tracheal intubation
35
Which volatile agent should be avoided in asthmatics?
Desflurane
36
Dosing considerations for Metaproterenol-Alupent
not to exceed 16 puffs/day | administered via a metered dose
37
Dosing considerations for Pirbuterol-Maxair
``` 2 puffs (400 mcg) via metered dose not to exceed 12 inhalations/day ```
38
Terbutaline dosing and route administration(s)
``` oral, SQ, inhalation SQ = response of epi Child SQ dose = 0.01 mg/kg Adult SQ dose = 0.25 mg q 15 minutes inhaler = 16-20 puffs/day (200 mcgs per dose) ```
39
Long acting beta agonists
have a lipophilic side chain that resists degradation duration 12-24 hours good for prevention
40
Anticholinergics MOA
competitive antagonist at muscarinic acetylcholine receptors
41
by antagonizing endogenous ACh leads to
bronchorelaxation, decreased mucus secretion
42
what are anticholingeric used for?
treatment of COPD, secondary treatment of asthma that are resistant to beta agonist or significant cardiac disease
43
should asthma patients be on long acting beta agonists?
not unless they're on a corticosteroid otherwise high risk of death
44
atropine
1-2mg diluted in 3-5 mL of saline via neb | highly absorbed and can cause systemic effects including tachycardia, nausea, dry mouth, GI upsest
45
ipratropium bromide
antagonizes the effect of endogenous acetylcholine at M3 receptors
46
ipratropium bromide dosing
inhaler 40-80 mcg in 2-4 puffs slow onset 30 minutes DOA 4-6 hours
47
Methylxanthines- Phosphodiesterase Inhibitors MOA
nonspecific inhibition of phosphodiesterase isoenzymes which prevents cAMP degradation in airway smooth muscle as well as in inflammatory cells that leads to airway relaxation and bronchodilation
48
What is something you want to monitor with someone taking theophylline?
blood levels has narrow therapeutic index therapeutic level 10-20mcg/mL toxic level >20 mcg/mL
49
Which inhalational agent should you take caution using with theophylline?
halothane
50
Which bronchodilator is contraindicated with drugs metabolized by the CYP450 system?
theophylline
51
side effects of methylxanthines- PIs
HA, N/V, irritability, insomnia, cardiac arrhythmias, seizures, stevens johnson syndrome
52
inhaled corticosteroids MOA
major preventive treatment for asthma alter genetic transcription reduce the number of inflammatory cells in the airways and the damage to airway epithelium
53
which drug class is considered the most important in managing asthma?
inhaled corticosteroids
54
Anesthesia considerations for inhaled corticosteroids
give 1-2 hours preop, prolongs the response of beta agonists, may have 5 day course of combined corticosteroid and albuterol to minimize the risk of intubation evoked bronchospasm
55
side effects of corticosteroids
oropharyngela candidiasis, osteopenia/osteoporosis, delayed growth, hoarseness, hyperglycemia
56
Cromolyn MOA
stabilize mast cells inhibits antigen-induced release of histamine and immediate allergic response to an antigen administered via inhalation 4x/day
57
Cromolyn side effects
infrequent but serious! | laryngeal edema, angioedema, urticaria, anaphylaxis
58
leukotriene inhibitors MOA
inhibit leuokotriene pathways which are synthesized by arachidonic acid when inflammatory cells are activated
59
Examples of leukotriene inhibitors
zileuton and montelukast
60
zileuton MOA and why it isn't widely used
blocks biosynthesis of leukotrienes from arachidonic acid leading to bronchodilation and improves asthma symptoms not widely used because it is hepatotoxic and can cause hepatitis
61
montelukast-singulair MOA and which drug to use with caution
block the mechanism of bronchoconstriction and smooth muscle effects improving bronchial tone, pulmonary function, and asthma symptoms use caution with warfarin because it can prolong the PT
62
Omalizumab
anti-IgE monoclonal antibody derived from DNA that is given in the early and late phase of asthmatic response decreases quantity of IgE and prevents binding to mast cells very expensive and inconvenient last ditch effort

Pharmacology II - CP (12 decks)

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