unit 4 adrenergic bronchodiltors Flashcards
lumen of airway reduced. can be due to bronchospasm, mucosal edema or secretions
bronhoconstriction
muscle constriction
bronchospasm
swelling
mucosal edema
occluded airways
airway secretions
what are some agents that will provide bronchospasm relief?
- sympathomimetic
- parasympatholytic agents
- methylxanthines
what are some agents that will relieve mucosal edema?
- alpha adrenergic agents
- corticosteroids
what are some agents the will relieve airway secretions?
mucolytic agents
bronchospasm always results in what?
bronchoconstriction
not all bronchoconstrictions is caused by what?
bronchospasm
what kind of bronchodilators would be needed for relaxation of airway smooth muscle in the presence of reversible airflow obstruction?
adrenergic bronchodilators
what would be some diseases that would indicate the need for adrenergic bronchodilators?
- asthma
- bronchitis
- emphysema
- bronchiectasis
- other obstructive diseases
stimulation of B2 receptor, activation of Gs protein, release of adenylyl cyclase, synthesis of 3’5 cAMP would indicate what theory?
Beta receptor theory
in the beta receptor theory what does the synthesis of 3’5 cAMP do?
- direct bronchodilation
- inhibit mast cell degranulation
Name the three ultra short acting agents?
- epinephrine
- racemic epinephrine
- isoetharine
in what kind of situation would ultra short acting agents be used in ?
emergency situations
all ultra short acting agents are catecholamine what is the duration it last?
less than 3 hours
what medication is used for 1st line treatment for anesthesia induced post op ghasping?
Vaponepherine
what are 5 short acting agents?
- metaproterenol
- albuterol
- pirbuterol
- levabuterol
- bitolterol
what are indications that a short acting agent need to be used?
Acute reversible obstruction
how long does a short acting rescue agent usually last?
4 to 6 hours
what is an example of a Resorcinal and is available as a nebulizer?
metaproterenol
what are 3 examples of a Saligenin?
- Albuterol
- pirbuterol
- levabuterol
what are 3 long acting agents?
- salmererol
- formoterol
- Arformoterol
what kind of agents would you use to maintenance bronchodilation and control of bronchospasm and nocturnal symptoms in asthma or other obstructive diseases?
long acting “controller” agents
what agent is usually given with anti-inflammatory medications?
Long acting agents
what is the duration of a long acting agent?
12 hours
enzyme found in liver and kidneys degrades catechols and is short acting? metabolized buy what?
COMT
unsuitable for oral administration because they are inactivated in the gut and liver?
catecholamines
what is stored in an amber colored bottle or a foil protected wrapper because its inactivated by heat light or air?
racemic epinephrine or catecholamines
what color of rainout in the nebulizer or patients secretions would indicate aerosols of catecholamines?
may be pink
catecholamines inactive by heat or light and is a phenomenon know as what?
beta blockade
what are some side effects for catecholamines?
- tachycardia
- hypertension
- tremor
- glycogenesis
- CNS stimulation
what are three naturally occurring catecholamines?
- epinephrine
- dopamine
- norepinephrine
what are two man made catecholamines?
- isoproterenol
- isoetharine
Natural epinephrine isomers occurs where?
R isomer or the( L,-) levo
Man made epinephrine, albuterol and salmeterol is a 50:50 racemic mixture of what?
(R) and (S) sinister
(S) sinister is also known as what?
(D, + ) dextro
why are isomers mirror images of themselves?
because they rotate light in opposite directions
is the single (R) isomer form of racemic albuterol and contains no (S) isomer?
Levalbuterol
ultra short acting epinephrine, racemic epinephrine, isoetharine lack —— but have lots of cardiac effects
B2 specificity
how is epinephrine administered in emergency situations? it is a alpha and beta
inhalation or injection not to be given by mouth
used for adrenergic vasoconstriction effects also used to dectease airway swelling after extubation, during epiglottitis, croup, nasal swelling or to control airway bleeding what are 3 racemic epinephrines?
- vaponefrin
- microNefrin
- asthmaNefrin
the larger the catecholamine side chain the more —–specific?
B2
is a short acting resorcinol agent used for premature labor and is oral or injection?
Terbutaline
what is the peak effect for short acting agents?
30 to 60 minutes
what is the onset of short acting agents?
5 to 8 minutes
Albuterol contains what isomer?
both (R) and (S)
levalbuterol (xopenex) is available as MDI and nebulizer solution what is the doses?
- 31mg/3mL
- 63mg/3mL
- 25mg/3mL
- 25 mg/0.5 mL concentrate
what are some effects of (S) ?
- slower metabolism than (R)
- enhances airway responsiveness
- activity is blocked by atropine
long acting agents such as salmeterol, formoterol, and Arformoterol are they saligenin, resorcinol or catecholamines?
Saligenins
extended release albuterol vospire is available in tablet for in what mg? and activity time?
- 4 or 8 mg tablet
- 8 to 12 hours activity time
what is the bronchodilator salmeterol (serevent) peak bronchodilating effect? and the duration?
- 3 to 5 hours- peak effect
- duration 12 hours
formoterol (foradil) is used for asthma, exercise induced bronchospasm and copd what is the peak effect and the duration?
- peak effect- 3 minutes
- 12 hours duration
Arformoterol is also known as what?
Brovana
Arformoterol is single isomer version of the long acting dry power inhaled formoterol power approved for what type of patient?
COPD
Ultra long DPI used once daily in Europe only for COPD?
Indacaterol
a receptor what mode of action?
vasoconstriction of lungs and blood vessels
B1 receptor what mode of action?
increased heart rate and contractile force
B2 receptor what mode of action?
relaxation of bronchial smooth muscle , bronchodialation of lungs and blood vessels
Binds to —rectptor, ultimately causing increased synthesis of cAMP
B receptor activation
inhibits release of neurotransmitter from presynaptic neuron, but may also lower synthesis of intracellular cAMP?
a receptor activation
a1 receptor activation release agonists such as what?
- phenylephrine
- Epinephrine
what drugs are lipophilic (stick to receptor site) and approaches B receptor laterally?
- salmeterol
- formoterol
- Arformoterol
continuous nebulization is generally how many mg/hour?
10 to 15 mg/hour