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
What 4 things does methylxanthines do?
- Stimulate CNS - Diuresis - Increase myocardial contractility - Relax airway smooth muscle
26
methylxanthines are what kind of drugs?
-Non-selective PDE inhibitors
27
methylxanthines do what to adenosine receptors?
-Competitive antagonist
28
What are the uses of theophylline?
- Bronchospasms due to acute asthma | - CNS stimulant (apnea in premies)
29
What are caffeine's effects?
- CNS stimulant - Cerebral vasoconstrictor - gastric acid secretion
30
What are caffeine's uses?
- Apnea of prematurity - PDPH - Offset sedation of cold remedies
31
Which beta 2 agonist is the most frequently used tocolytic? How does it work?
- Ritodrine | - Stimulates Beta 2 and activate adenyl cyclase
32
When can ritrodine be safely used?
- PO until fetus has matured | - No teratogenic effects after 20 weeks
33
What are the side effects of ritodrine?
- Increased HR, CO, Renin - Decreased Na, H+, K, BP, H2O secretion - Pulmonary edema - Hyperglycemia in mom, hypoglycemia in fetus
34
How do Histamine receptor antagonists work?
- Prevent response mediated by histamine | - Does not inhibit release of histamine
35
what are the 2 generations of H1 receptor antagonists?
- 1st gen = sedating (benadryl) | - 2nd gen = non-sedating (zyrtec, claritin, allegra)
36
When is benadryl used?
- Sedative, antiprurtic, antemetic, - Type 1 allergic reactions (Uticaria, angioedema) - Anaphylactoid reactions (IV contrast)
37
What type of drug is benadryl?
-H1 histamine receptor antagonist
38
What type of drug is dramamine? and when is it used?
- -H1 histamine receptor antagonist | - Motion sickness and PONV
39
What is the major benefit of H2 blockers?
- keep histamine from binding to gastric parietal cells | - ↓ H+ ion secretion
40
Which H2 blocker is the least potent and which is the most potent?
- Cimetidine = Least potent & shortest acting | - Famotidine = most potent
41
When are H2 blockers used?
- Duodenal ulcers - GERD / PUD - Decrease risk of pneumonitis by increasing gastric PH - Preop prophylaxis for likely allergic reactions - Drug induced histamine release
42
What are the most common side effects of H2 blockers? Most severe?
- Diarrhea, headache, fatigue, muscle pain | - Mental confusion (high dose cimetidine), cardiac dysrhythmias
43
What 2 H2 blockers inhibits CYP450? what drugs are prolonged?
- Cimetidine and ranitidine | - (diazepam, propranolol, meperidine, lidocaine)
44
H2 blockers may also alter ________ of some drugs due to ________ gastric fluid ________.
- Absorption - Increasing - PH
45
Which drugs are the most effective at controlling gastric acidity and volume?
-PPI's
46
PPI's are used to treat what?
- GERD - PUD - Hypersecretory disorders
47
What drug combination can be given 1 hours prior to surgery to decrease gastric fluid and raise PH?
-Pantoprazole (potent and fast acting) w/ ranitidine
48
What type of drug is metoclopramide? and how does it work?
- Prokinetic (motility modulating) | - Cholinergic stimulation of GI tract
49
What 3 things does metoclopramide do?
- Increase LES tone - Enhance perastalsis (not opioid induced) - Accelerate gastric emptying
50
Metoclopramide is a __________ antagonist that is structurally similar to _________ but lacks local anesthetic activity.
- Dopamine | - Procainemide
51
What drug may result in extrapyramidal effects
-Metoclopramaide
52
How is metoclopramide cleared?
- Hepatic metabolism (first pass) - Renal elimination - Crosses BBB and placenta - Excreted in breast milk
53
What are the clinical uses of metoclopramide?
- Preop decrease of gastric fluid - Antiemitic (dopamine antagonism CTZ) - Gastroperesis - GERD
54
What are the side effects of metoclopramide?
- Abd cramps - Akathesia - Extrapyramidal
55
Metoclopramide drug interactions?
- Inhibit plasma cholinesterase (prolong succs) | - Increase sedative effects of CNS depressants
56
Avoid giving metoclopramide to what patients?
- Seizures - Mechanical gastric outlet obstruction - Intestinal anastamosis (delay healing)