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ARCHIVED: Pharmacology for Nurse Anesthesia > Exam 4: Pulmonary Pharmacology > Flashcards

Exam 4: Pulmonary Pharmacology Flashcards

(94 cards)

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1
Q

Pulmonary SNS innervation:

A

SNS fibers from thoracic ganglia innervating smooth muscles of bronchi, pulmonary blood vessels
Sympathetic tone: bronchodilation via β2 receptors

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2
Q

Pulmonary PSNS innervation:

A

Vagus nerve

Parasympathetic tone: bronchoconstriction via M3 receptors

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3
Q

β2 receptors in the lungs cause these effects (3):

A

Bronchodilation
Increased cAMP
Greater sensitivity to epi vs. norepi

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4
Q

NANC nerves & role:

A

Non-adrenergic, non-cholinergic; relax airway smooth muscle by releasing NO and VIP

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5
Q

M3 receptors in the lungs cause these effects (2):

A

Bronchoconstriction via IP3 –> ↑Ca2+

Increased mucus secretions

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6
Q

Effects of M3 stimulation on pulmonary blood vessels:

A

None

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7
Q

Asthma is:

A

Chronic inflammatory disorder of airways with increased responsiveness of tracheobronchial tree to stimuli

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8
Q

Characteristics of asthma obstruction:

A

Variable and reversible

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9
Q

Characteristics of airways during asthma:

A

Inflamed
Edematous
Hypersensitive to irritant stimuli

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10
Q

Cells activated in the bronchial mucosa by allergens:

A

Th2 lymphocytes (which release cytokines)

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11
Q

Mediator cells in asthma:

A

Eosinophils
Mast cells
Neutrophils
Macrophages
Basophils
T lymphocytes

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12
Q

Chemical mediators in asthma:

A

Cytokines
Histamines
Interleukins 3-4-5
Leukotrienes
Prostaglandins
Adenosine
Platelet activating factor

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13
Q

Atopic asthma:

A

Mediated by IgE

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14
Q

Goal of medications in asthma:

A

Flattening the response to mediators

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15
Q

Characteristics of COPD obstruction:

A

Non- or incompletely reversible

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16
Q

Causes (3) of cell damage in COPD:

A

Impaired lung parenchyma
Degraded matrix
Toxic action of macrophages and neutrophils

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17
Q

Changes to lung tissue in COPD:

A

Enlarged air spaces
Fibrosis
↑ mucus production

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18
Q

Steroid and bronchdilator efficacy in COPD:

A

Steroids: limited effect
Bronchodilators: modest role in breathlessness

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19
Q

Step 1 of airway outflow d/o treatment:

A

Short-acting bronchodilators

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20
Q

Step 2 of airway outflow d/o treatment:

A

Regular inhaled corticosteroid

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21
Q

Step 3 of airway outflow d/o treatment:

A

Long-acting bronchodilators

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22
Q

Step 4 of airway outflow d/o treatment:

A

Phosphodiesterase inhibitors
Methylxanthines
Leukotriene inhibitors

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23
Q

Step 5 of airway outflow d/o treatment:

A

Oral corticosteroid

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24
Q

Three classes of bronchodilators:

A

β-agonists
Anticholinergics
Methylxanthines

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25
Short-acting β2-agonists:
Terbutaline Albuterol Levalbuterol Salbutamol
26
Long-acting β2-agonist:
Salmeterol
27
Indication for long-acting β2-agonists:
Nocturnal asthma
28
Refresh: Stimulatory G-protein cascade?
Gαs → ↑cAMP → ↓Ca++
29
Onset of action of β-agonists:
Rapid; 15-30 min
30
Duration of action of β-agonists:
30-60 minutes | Salmeterol up to 4 hours
31
Indication for β-agonists:
Rescue inhaler
32
Delivery of β-agonists:
Inhalation/aerosol, powder or nebulized | Exception: terbutaline is SC
33
Side effects of β-agonists:
Tremor ↑ HR Vasodilation Hyperglycemia, hypokalemia (d/t insulin release), hypomag
34
Preferred β2-selective agonist:
Albuterol
35
Dosing of albuterol:
100 mcg/puff 2 puffs q4-6hr 2.5 - 5.0mg nebulized in 5ml saline
36
Duration of action of albuterol:
4 hours; some relief up to 8 hours
37
Anesthetic considerations for albuterol:
Additive effect with volatile anesthetics on bronchomotor tone
38
2 isomers of albuterol:
R-albuterol more β2 affinity | S-albuterol more β1 affinity
39
Side effects of albuterol:
Tachycardia | Hypokalemia
40
Anesthesia uses of albuterol:
4 puffs to blunt AW response to tracheal intubation in asthmatics
41
Dosage of metaproterenol:
No more than 16 puffs/day
42
Advantage of bitolterol:
Longer lasting | CV side effects rare
43
Dosage of bitolterol:
16-20 puffs/day | 270 mcg/puff
44
Indications for terbutaline:
Asthma, esp. status asthmaticus | Preterm labor
45
Delivery of terbutaline:
Oral, SC, inhalation
46
Dosage of terbutaline:
SC: 0.25mg q15min (adult) SC: 0.01 mg/kg (child) MDI: 16-20 puffs/day (200 mcg/puff)
47
Examples of long-acting β-agonists:
Salmeterol Advair: fluticasone and salmeterol Formoterol
48
Long-acting β-agonists are long acting because:
Lipophilic side chains resisting degradation
49
Duration of action of long-acting β-agonists:
12-24 hours
50
Indications for long-acting β-agonists:
Prevention, not flare-up
51
Indications for anticholinergics:
Treatment of COPD | Secondary tx for asthma (resistant to β-agonist or w/ cardiac disease)
52
Model of asthma exacerbation d/t viral infection:
Activated T-cell → eosinophilic activation → mediator release via degranulation → deposition on airway smooth muscle and stimulate PSNS bronchoconstriction
53
Classification of atropine:
Naturally occuring tertiary amide alklaoid
54
Dosing of atropine for asthma:
1-2mg neb in 3-5ml NS
55
Side effects of atropine:
Tachycardia Nausea Dry mouth GI upset
56
Classification of ipratropium bromide:
Quaternary ammonium salt derived from atropine
57
Dosing of ipratropium bromide:
40-80mcg in 2 puffs MDI or via neb
58
Onset of ipratropium bromide:
Slow; 30-90 min
59
Duration of action of ipratropium bromide:
4-6 hours
60
Absorption of ipratropium bromide relative to atropine:
Not significantly absorbed, so less cardiac/systemic side effects
61
Side effects of ipratropium bromide:
If inadvertently orally ingested, dry mouth/GI upset
62
Structure of tiotropium:
Quaternary ammonium salt
63
Duration of action of tiotropium:
Long acting
64
Advantage of tiotropium:
Not significantly absorbed so few systemic side effects
65
Indication for tiotropium:
COPD
66
MoA for methylxanthines:
Nonspecific inhibition of phosphodiesterase isoenzymes
67
Function of phosphodiesterase isoenzymes:
Prevent cAMP degradation → ↑cAMP → ↓Ca++ → bronchodilation
68
Indications for methylxanthines:
COPD/asthma
69
Examples of methylxanthines:
Theophylline | Aminophylline
70
Therapeutic plasma level of theophylline:
10-20 mg/ml
71
Toxic level of theophylline:
> 20 mg/ml
72
Toxic level of theophylline:
> 20 mg/ml
73
Drug interactions with theophylline:
Halothane (not in US) | Activates CYP450
74
Side effects of methylxanthines:
``` Arrythemias N/V Irritability Insomnia Seizures Brain damage Hyperglycemia Hypokalemia Hypotension ```
75
Indication for inhaled corticosteroids:
Major preventative treatment for asthma
76
MoA (3) of inhaled corticosteroids:
Alters genetic transcription to ↓ pro-inflammatory protein synthesis, ↑ anti-inflammatory proteins and β2 receptors Induces apoptosis of inflammatory cells Indirectly inhibits mast cells over time
77
Relative importance of inhaled corticosteroids for asthma mgmt:
Most important drug in the arsenal!!
78
Examples of inhaled corticosteroids:
Beclomethasone Triamcinolone Fluticasone Budesonide
79
Anesthesia uses of inhaled corticosteroids:
Consider using 1-2 hours pre-op | Consider 5 day course of combined inhaled corticosteroids/albuterol to minimize risk of intubation bronchospasm
80
Drug interactions with inhaled corticosteroids:
Prolong the response of β-agonists (hence combination drugs like Advair)
81
% of inhaled corticosteroids that reach the airway vs. the oropharynx:
25% into airway | 80-90% into oropharynx
82
Side effects of inhaled corticosteroids:
``` Osteopenia/porosis Delayed growth in children Oropharyngeal thrush Hoarseness Hyperglycemia ```
83
MoA of cromolyn:
Stabilizes mast cells and inhibits antigen-induced release of histamine Inhibits the immediate allergic response to an antigen, BUT NOT the response once activated
84
Indications for cromolyn:
Prevention, not rescue!
85
Delivery of cromolyn:
Inhalation; 8-10% enters systemic circulation
86
Dosing of cromolyn:
4 times daily | 7 days to effect!
87
Side effects of cromolyn:
``` Infrequent but serious: Laryngeal edema Angioedema Urticaria Anaphylaxis ```
88
Leukotrienes synthesized from:
Arachidonic acid in the presence of activated inflammatory cells
89
MoA of zileuton:
Blocks the biosynthesis of leukotrienes
90
Disadvantages of zileuton:
Low bioavailability Low potency Significant adverse effects Hepatotoxic
91
MoA of monteleukast:
Blocks the Cysteinyl-Leukotriene 1 receptors on the smooth muscle
92
Drug interaction with monteleukast:
Coadministration with warfarin can prolong PT
93
MoA of omalizumab:
Short-term: Binds to IgE antibodies and prevents their binding to mast cells to mitigate the acute response to inhaled allergen Long-term: IgE receptors on mast cells/basophils/dendritic cells are down-regulated
94
Delivery of omalizumab:
Given SQ for 2-4 weeks or parenterally infused; during early and late phase of asthmatic response

ARCHIVED: Pharmacology for Nurse Anesthesia (20 decks)

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