Respiratory Meds

Question 1

Inhalation Technique

Answer 1

deep breath in, blow all out
MDI over 5-6 sec slow inhale
hold breathe x10 sec
repeat

Question 2

How much is delivered to lungs with inhalation?

Answer 2

12%

ETT - less delivered unless mechanically ventilated

Question 3

How much delivered by nebulizer vs MDI for same degree of bronchodilation?

Answer 3

need 6-10x amount for neb compared to MDI

Question 4

T/F: Admin bronchodilators before corticosteroids?

Answer 4

TRUE

Question 5

M1 Muscarinic Receptors

Answer 5

Location: endocrine glands, autonomic ganglia, salivary glands, stomach

Function: arousal, attention, REM, emotional response

Question 6

M2 Muscarinic Receptors

Answer 6

Location: atria, conducting heart tissues

Function: cardiac inhibition

Question 7

M3 Muscarinic Receptors

Answer 7

Location: exocrine glands, smooth muscle, lungs, GI tract

Function: lacrimal, salivary, mostly stimulatory

Question 8

M4 Muscarinic Receptors

Answer 8

Location: CNS

Function: direct regulatory action on K and Ca channels

Question 9

M5 Muscarinic Receptors

Answer 9

Location: substantia nigra, CNS

Function: may regulate dopamine release

Question 10

Metabolic response of beta 2 agonism?

Answer 10

hyperglycemia
hypokalemia
hypomagnesemia

Question 11

Black Box warning of LABA’s

Answer 11

increased risk of asthma related death, should not be used alone

Question 12

Histamine…

Answer 12

naturally occurring, low molecular weight, hydrophillic endogenous amine.

produces variety of responses

Question 13

Histamine acts..

Answer 13

through G-protein coupled membrane receptors

Question 14

What is an example of a chemical mediator of inflammation in allergic reaction?

Answer 14

Histamine

Question 15

Which cells contain large amounts of histamine and where are they located

Answer 15

mast cells, located in skin, lungs, GI and circulating basophils

Question 16

What is histamine released in response to?

Answer 16

certain drugs
AG-AB reactions

*histamine does not easily cross the BBB

Question 17

H1 Receptors

Answer 17

1. evoke smooth muscle contraction in resp and GI tract
2. pruritis, sneezing
3. NO mediated vasodilation
4. slow HR (decreased AV nodal conduction)

Question 18

Through H1 and H2 receptors, histamine causes…

Answer 18

increased capillary permeability**, HoTN, tachycardia, flushing, headache

Question 19

H2 Receptors

Answer 19

1. activates adenyl cyclase and increase intracellular cAMP
2. activates proton pump of gastric parietal cells - secrete hydrogen ion
3. Increase HR - vasodilating effects at coronary vasc contradicts H1 actions

Question 20

Histamine: CV

Answer 20

dilation - flushing, decreased SVR, HoTN, edema

inotropic, chronotropic, coronary vasodilation (H2) and vasocontriction (H1)

Question 21

T/F: Need H1 and H2 blockers to competitively block the vasodilatory effects

Answer 21

TRUE

Question 22

Triple Response: Wheal and Flare

Answer 22

1. edema - d/t increased permeability
2. Dilated arteries around edema (flare)
3. pruritis - histamine at superficial layers

Question 23

Histamine: Respiratory

Answer 23

H1 - contricts bronchioles - usually ok but not if asthmatic

H2- relaxes bronchiol smooth muscle

Question 24

Gastric Hydrogen Ion Secretion

Answer 24

• can increase even if not enough to cause HoTN, due to H2 stim
• vagal stim alsto increases H+ secretion

Question 25

Histamine Receptor Antagonists

Answer 25

-competitive, reversible antagonists of histamine receptors **does not inhibit release, blocks receptors

Question 26

Adrenal Cortex Layers and secretions

Answer 26

1. Outermost - Zona Glomerulosa - Minralocorticoid 2. Middle - Zona Fascicula - Glucocorticoids 3. Inner - Zona Reticularis - Weak androgens

Question 27

Cortisol

Answer 27

hormone - released d/t stim of HPA axis by stress

Question 28

Cortisol metabolic effects

Answer 28

carb, protein, fat metab fluid and electrolyte balance multiple organ system stability inhibition of allergic/inflam rspons

Question 29

Circadian Rhythm

Answer 29

secretory rates are high in early morning and low in late evening

Question 30

Primary Adrenocortical Insufficiency

Answer 30

addison's disease - adrenals do not secrete cortisol or aldosterone replacement therapy must include glucocorticoid and mineralocorticoid

Question 31

Secondary Adrenocortical Insufficiency

Answer 31

d/t chronic steroid use and suppression of HPA axis - aldosterone secretion is maintained - replacement must include glucocorticoid

Question 32

Physiological effects of cortisone

Answer 32

increased CO, RR, gluconeogenesis, analgesia decreased inflammation inhibition of digestion redistribution of CNS blood flow

Question 33

Glucocorticoid effect

Answer 33

anti-inflammatory response

Question 34

Mineralocorticoid effect

Answer 34

evoke distal renal tubular re-absorption of Na in exchange for K

Question 35

Naturally Occurring Corticosteroids

Answer 35

``` cortisol (hydrocortisone) cortisone corticosterone desoxycorticosterone aldosterone ```

Question 36

Synthetic Corticosteroids

Answer 36

``` Glucocorticoids: prednisolone prednisone methylprednisolone betamethasone dexamethasone triamcinolone ``` Mineralocorticoids: fludrocortisone

Question 37

Inhaled Corticosteroids

Answer 37

``` end in -sone or -ide fluticasone budesonide beclometasone mometasone cicleonide triple combos ```

Question 38

PK of corticosteroids

Answer 38

effective orally, water soluble forms can be given IV, prolonged effects IM

Question 39

Are corticosteroids able to cross the placenta?

Answer 39

yes

Question 40

Side Effects of Corticosteroids

Answer 40

tons, stimulatory adrenal atrophy, cushing's syndrome, diabetes, HTN, psychosis, immunosuppression, Na dn water retention, K and H loss, skin atrophy

Question 41

Hypokalemic Metabolic Alkalosis

Answer 41

mineralocorticoid effect of cortisol on distal renal tubules leading to enhanced absorption of Na and loss of K also leads to edema and weigh gain

Question 42

T/F: corticosteroids inhibit glucose use in peripheral tissues and promote hepatic gluconeogenesis

Answer 42

TRUE, may require diet and insulin

Question 43

Catabolic corticosteroid effects

Answer 43

peripherally, amino acids mobilize in tissues - decreased skeletal muscle mass, oseoporosis, thin skin

Question 44

How will long term corticosteroids effect hct and WBC counts?

Answer 44

increase Hct | increase WBC counts

Question 45

Fear going into surgery with patient who is on steroid therapy?

Answer 45

HPA Axis suppression --> hypotensive shock

Question 46

Therapies unlikely to suppress HPA axis

Answer 46

prednisone 5 mg/day or 10 mg QOD every other day dose < 3 wks

Question 47

T/F: Prednisone and dexamethasone (even physiologic doses) given as a single daily dose at bedtime is associated with HPA axis suppression

Answer 47

TRUE

Question 48

Therapies assumed to suppress HPA axis (high risk)

Answer 48

- prednisone 20 mg/day > 3 wks within previous year - pt with cushings presentation - dont test, just supplement

Question 49

Therapies that we don't really know how they effect HPA Axis

Answer 49

- >5 mg/day, < 20 mg/day of prednisone >3 wks | - test ACTH if possible, assume suppression and dose glucocorticoid

Question 50

Pts to supplement..

Answer 50

- diagnosed secondary adrenal insufficiency | - high risk pts

Question 51

How do burns/sepsis effect corticosteroid need?

Answer 51

may exaggerate need for exogenous corticosteroid supplementation

Question 52

S/S of Acute Adrenal Crisis

Answer 52

``` HoTn, unresponsive to tx hypoglycemia high K low Na hypovolemia metabolic acidosis decreased LOC ```

Question 53

What causes release of aldosterone?

Answer 53

increased K decreased Na decreased BP

Question 54

Effects of aldosterone?

Answer 54

increased excretion of K retention of Na retention of water