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Pharm 2 > Class 9 Deck 1 > Flashcards

Class 9 Deck 1 Flashcards

1
Q

Atropine antagonizes ACh effects on __________ via the ___________ receptors in large and medium airways that respond to __________ stimulation

A
  • Airway smooth muscle
  • Muscarinic
  • Vagal
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2
Q

Atropine ___________ airway resistance and _______ dead space.

A
  • Decreases

- Increases

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3
Q

What is the most common anticholinergic used for aerosol administration?

A

-Ipratropium

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4
Q

Ipratropium is most effective in treating _______ due to _______ .

A
  • Bronchospasms

- Beta antagonists

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5
Q

How does ipratropium compare to beta agonists in treating asthma?

A
  • Slower onset

- Less effective

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6
Q

How does ipratropium compare to beta agonists in treating bronchitis / emphysema?

A

-More effective due to M3 receptors

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7
Q

Ipratropium may cause paradoxical bronchospasm due to what?

A

-M2 blockade

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8
Q

what is Tiotropium (Spiriva)? and what does it treat?

A
  • Long acting anticholinergic bronchodilator

- Bronchospasms associated with COPD, bronchitis, emphysema

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9
Q

Tiotropium (Spiriva) blocks what 2 receptors and what do they do?

A
  • M1 = Bronchodilation

- M3 = reduce mucus

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10
Q

How does ephedrine treat bronchial asthma?

A

-Bronchodilating effect from beta 2 activation

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11
Q

What is isoproterenol? How does it effect the lungs?

A
  • beta sympathomimetic

- Bronchodilator, ↑HR, ↓ PVR in pulmonary HTN

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12
Q

What makes Beta 2 selective sympathomimietics (albuterol) work?

A
  • Relax bronchial and uterine smooth muscle (Beta 2)
  • No beta 1 stimulating effects on heart
  • COMT resistant (sustained duration)
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13
Q

What are the uses of Beta 2 selective sympathomimietics?

A
  • Acute asthma
  • Prevent exercise induced asthma
  • Improve airflow in COPD
  • Tocolytic (stop uterine contractions)
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14
Q

What are the 2 classes of Beta 2 selective sympathomimietics?

A
  • Intermediate acting (3-6 hours)

- Long acting (>12)

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15
Q

What are the side effects of Beta 2 adrenergic agonists?

A
  • Tremor
  • Tachycardia
  • Metabolic (Hyperglycemia, Hypokalemia, Hypomag)
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16
Q

What is the preferred beta 2 agonist for bronchospasm? and how long will it last? And what are the side effects?

A
  • Albuterol
  • 4 hours (relief up to 8)
  • Tachy & HypoK
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17
Q

How does albuterol effect volatile anesthetics?

A

-Additive effects

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18
Q

What is the (R)-enantiomer of racemic albuterol. How is it different than albuterol?

A
  • Levoalbuterol (Xopenex):

- Little or no clinically significant difference

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19
Q

What kind of drug is terbutaline? and when is it used?

A
  • Beta 2 selective agonist

- Ashtma and tocolytic

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20
Q

What kind of drug is salmeterol? and what is it frequently administered with?

A
  • Long acting Beta 2 agonist (>12 hours)

- Steroid (advair) prophylaxis of asthma

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21
Q

What is the most common membrane stabilizer?

A

-Cromolyn Sodium (Intal)

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22
Q

What does cromolyn do?

A
  • Stabilizes mast cell membrane to prevent release of histamine.
  • Suppresses secretory response
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23
Q

Does cromolyn treat established bronchoconstriction?

A

No, it is a prophylatic treatment

24
Q

Name the 3 methylxanthines

A
  • Theophylline
  • Caffeine
  • Theobromine
25
Q

What 4 things does methylxanthines do?

A
  • Stimulate CNS
  • Diuresis
  • Increase myocardial contractility
  • Relax airway smooth muscle
26
Q

methylxanthines are what kind of drugs?

A

-Non-selective PDE inhibitors

27
Q

methylxanthines do what to adenosine receptors?

A

-Competitive antagonist

28
Q

What are the uses of theophylline?

A
  • Bronchospasms due to acute asthma

- CNS stimulant (apnea in premies)

29
Q

What are caffeine’s effects?

A
  • CNS stimulant
  • Cerebral vasoconstrictor
  • gastric acid secretion
30
Q

What are caffeine’s uses?

A
  • Apnea of prematurity
  • PDPH
  • Offset sedation of cold remedies
31
Q

Which beta 2 agonist is the most frequently used tocolytic? How does it work?

A
  • Ritodrine

- Stimulates Beta 2 and activate adenyl cyclase

32
Q

When can ritrodine be safely used?

A
  • PO until fetus has matured

- No teratogenic effects after 20 weeks

33
Q

What are the side effects of ritodrine?

A
  • Increased HR, CO, Renin
  • Decreased Na, H+, K, BP, H2O secretion
  • Pulmonary edema
  • Hyperglycemia in mom, hypoglycemia in fetus
34
Q

How do Histamine receptor antagonists work?

A
  • Prevent response mediated by histamine

- Does not inhibit release of histamine

35
Q

what are the 2 generations of H1 receptor antagonists?

A
  • 1st gen = sedating (benadryl)

- 2nd gen = non-sedating (zyrtec, claritin, allegra)

36
Q

When is benadryl used?

A
  • Sedative, antiprurtic, antemetic,
  • Type 1 allergic reactions (Uticaria, angioedema)
  • Anaphylactoid reactions (IV contrast)
37
Q

What type of drug is benadryl?

A

-H1 histamine receptor antagonist

38
Q

What type of drug is dramamine? and when is it used?

A
  • -H1 histamine receptor antagonist

- Motion sickness and PONV

39
Q

What is the major benefit of H2 blockers?

A
  • keep histamine from binding to gastric parietal cells

- ↓ H+ ion secretion

40
Q

Which H2 blocker is the least potent and which is the most potent?

A
  • Cimetidine = Least potent & shortest acting

- Famotidine = most potent

41
Q

When are H2 blockers used?

A
  • Duodenal ulcers
  • GERD / PUD
  • Decrease risk of pneumonitis by increasing gastric PH
  • Preop prophylaxis for likely allergic reactions
  • Drug induced histamine release
42
Q

What are the most common side effects of H2 blockers? Most severe?

A
  • Diarrhea, headache, fatigue, muscle pain

- Mental confusion (high dose cimetidine), cardiac dysrhythmias

43
Q

What 2 H2 blockers inhibits CYP450? what drugs are prolonged?

A
  • Cimetidine and ranitidine

- (diazepam, propranolol, meperidine, lidocaine)

44
Q

H2 blockers may also alter ________ of some drugs due to ________ gastric fluid ________.

A
  • Absorption
  • Increasing
  • PH
45
Q

Which drugs are the most effective at controlling gastric acidity and volume?

A

-PPI’s

46
Q

PPI’s are used to treat what?

A
  • GERD
  • PUD
  • Hypersecretory disorders
47
Q

What drug combination can be given 1 hours prior to surgery to decrease gastric fluid and raise PH?

A

-Pantoprazole (potent and fast acting) w/ ranitidine

48
Q

What type of drug is metoclopramide? and how does it work?

A
  • Prokinetic (motility modulating)

- Cholinergic stimulation of GI tract

49
Q

What 3 things does metoclopramide do?

A
  • Increase LES tone
  • Enhance perastalsis (not opioid induced)
  • Accelerate gastric emptying
50
Q

Metoclopramide is a __________ antagonist that is structurally similar to _________ but lacks local anesthetic activity.

A
  • Dopamine

- Procainemide

51
Q

What drug may result in extrapyramidal effects

A

-Metoclopramaide

52
Q

How is metoclopramide cleared?

A
  • Hepatic metabolism (first pass)
  • Renal elimination
  • Crosses BBB and placenta
  • Excreted in breast milk
53
Q

What are the clinical uses of metoclopramide?

A
  • Preop decrease of gastric fluid
  • Antiemitic (dopamine antagonism CTZ)
  • Gastroperesis
  • GERD
54
Q

What are the side effects of metoclopramide?

A
  • Abd cramps
  • Akathesia
  • Extrapyramidal
55
Q

Metoclopramide drug interactions?

A
  • Inhibit plasma cholinesterase (prolong succs)

- Increase sedative effects of CNS depressants

56
Q

Avoid giving metoclopramide to what patients?

A
  • Seizures
  • Mechanical gastric outlet obstruction
  • Intestinal anastamosis (delay healing)

Pharm 2 (23 decks)

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