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Anesthesia-Pulmonary > Pulmonary Pharamacology > Flashcards

Pulmonary Pharamacology Flashcards

1
Q

With the use of BETA-2 adrenergic Agonist, cAMP________in SMOOTH muscle

A

INCREASES

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2
Q

BETA-2 and an increase in cAMP will__________myosin light chain kinase

A

Inhibit

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3
Q

Inhibition of MLCK and an increase in cAMP will cause_______

A

SMOOTH muscle relaxation

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4
Q

Albuterol, Levalbuterol, Salmeterol, and Formoterol are examples of

A

INHALED BETA-2 Adgrenergic Agonsist

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5
Q

Salbutamol, Epinephrine, and Terbutaline are examples of

A

IV BETA-2 Adrenergic Agonsist

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6
Q

List Effects of using BETA-2. Adrenergic Agonsists

A

Bronchodilation
Vasodilation
Stimulation of NaK ATPase
Release of Glucagon
Decreased DBP

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7
Q

SIDE EFFECTS of BETA-2

A

Tremor
Tachycardia
HYPERglycemia
HYPOkalemia/magnesia
Decreased PaO2 (vasodilate in poorly ventilated lung-shunting)
Tolerance
Withdrawl

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8
Q

Patient on a non-selective BETA agonists can

A

target BETA-1

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9
Q

What medication is the prototype for inhaled BETA-2

A

Albuterol (little effect on heart)
Onset 5-10min
PO onset 15-30min
Duration 4-6 hours
Dose (acute) 4-8 puffs (90mcg/puff)

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10
Q

Racemic EPI can relieve _______ and _________

A

Airway Obstruction & Edema

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11
Q

What is the dose of Racemic EPI?

A

0.5mL of 2.25% IN 4mL NS

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12
Q

Muscarinic Antagonist (Anticholinergics) MOA

A

stops binding of ACh to M3 receptors, stops Gq, inactivates phospholipase C and IP3, causing bronchodilation

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13
Q

SIDE EFFECTS of M3 antagonists

A

Tachycardia
Dry Mouth
Blurred Vision
Mydriasis
GI upset
Nausea
Urinary retention
Tremors

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14
Q

Common M3 antagonist drugs

A

Ipratropium
Tiotropium
Atropine
Glycopyrrolate

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15
Q

Which M3 antagonist medication is short acting?

A

Ipratropium- good for COPD

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16
Q

Which M3 antagonist medication is long acting?

A

Tiotropium

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17
Q

Atropine can cross the ________and cause CNS effects

A

Blood Brain Barrier

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18
Q

What medication is a Methylhxanthine?

A

Theophylline

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19
Q

How do Methylxanthines work (MOA)?

A

Inhibit Phosphodiesterase, which stops the breakdown of cAMP, causing relaxation

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20
Q

Methylxanthines also decrease______&_____

A

Eosinophils & Neutrophils

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21
Q

Methylxanthines can also block________, which ________release of _______, _______, and ________

A

Adenosine; decreases; ACh; histamine; leukotrienes

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22
Q

What are the SIDE EFFECTS of using Methylzanthines?

A

GERD
GI upset
N/V
Restlessness
SEIZURES
ARRHYTHMIAS
DEATH

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23
Q

What is the toxic level of Methylxanthines (Theophylline)

A

> 20mcg/mL

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24
Q

MOA of Corticosteroids

A

Alter genetic expression of pro-inflammatory mediators & inflammatory gene products

(effects DNA transcription in ability to form certain proteins)

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25
Q

List of Corticosteroids

A

Fluticasone
Mometasone
Methylprednisolone
*Prednisone
Hydrocortisone
Fluticasone/Salmeterol
Budesonside/Formoterol

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26
Q

What are some SIDE EFFECTS of Corticosteroids?

A

Infection
HYPERglycemia
HTN
Adrenal Suppression
Psychosis
Ulcers
Osteoporosis

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27
Q

MOA for Leukotriene Modifiers

A

They block the conversion of Arachidonic Acid to leukotriene

Block leukotriene receptors

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28
Q

What medications are Leukotriene Modifiers?

A

Montelukast & Zileuton

29
Q

What medications are Mast Cell Stabilizers?

A

Cromolyn Sodium & Nedocromil

30
Q

MOA of Mast Cell Stabilizers

A

Stabilize mast cell by blocking mast cell degranulation, block release of histamine, block bronchoconstriction, mucosal edema and secretion

31
Q

Which volatile anesthetics DO NOT decrease bronchomotor tone?

A

DESflurane & Nitrous Oxide

32
Q

Which channels are sensitive to volatile anesthetics?

A

T-type Ca+ channels

33
Q

Which IV anesthetics decrease bronchomotor tone?

A

Propofol, Ketamine, & Midazolam

34
Q

What adjuncts can suppress cough, relax ASM, and blunt hemodynamic response to airway manipulation?

A

Local Anesthetics

35
Q

Magnesium Sulfate can

A

improve bronchodilation and can be given via IV or NEB treatment

36
Q

Beta agonist activate

A

adenylate cyclase, which activates an increase in cAMP

37
Q

Methylxanthines block________, which increases cAMP and promotes vasodilation

A

PDE(phosphodiesterase and blocks adenosine

38
Q

M3 antagonist block

A

ACh, promoting bronchodilation

39
Q

cAMP________in VASCULAR smooth muscle when agonist bind Gs couple receptors

A

INCREASES, causing a decrease in vascular tone

40
Q

IP (prostacycline) has the same affects as

A

Beta-2

41
Q

Alpha-2 bind to Gi protein, causing cAMP to ________in the vascular smooth muscle, ________vascular tone

A

DECREASE; increase (activates MLCK)

42
Q

An ______in cAMP will ______MLCK, causing________

A

increase; inhibit; relaxation

43
Q

Endothelin-1 is a potent

A

vasoCONTRICTOR

44
Q

What receptors are bound to Gq proteins?

A

Alpha-1, ET-A, and M3

45
Q

What happens to IP3 levels in vascular smooth muscle when agonist bind to Gq receptors?

A

IP3 increases, causing an increased release in Ca+, causing contraction of vascular tone

46
Q

Alpha-1 binds

A

catecholamines

47
Q

Increased cGMP causes

A

relaxation

48
Q

L-arginine breaks down into

A

Nitric Oxide, influenced by blood flow (sheering force), which releases Ca+ and increases the formation of nitric oxide and nitric oxide synthase

49
Q

What are the 3 mechanisms for cGMP?

A

Inhibits Ca+ entry

Activates K+channels (hyperpolarizing)

Activates MLCP (not MLCK), to breakdown MLCK

ALL causing VASODILATION

50
Q

What medications are used to treat PH?

A

Inhaled nitric oxide
Phosphodiesterase inhibitors
Endothelin receptor antagonists
Prostacyclin Derivatives
Prostaglandins

51
Q

Should PH therapy be discontinued?

A

NO!!

52
Q

How do you avoid increases in Pulmonary Vascular Resistance?

A

Avoid:
Hypoxia
Hypercarbia
Acidosis
Pain
Hypothermia
Ketamine
Nitrous
Avoid Large deceases in SVR
Preserve Preload, CO, & perfusion
Use vasopressors for intra-op HOTN

53
Q

What medication can either improve or have no harmful effects on PH

A

Etomidate
Opioids
Low Volatile agent Concentrations

54
Q

Decreased flow through the lungs to the _______will affect CO

A

Right side of the heart

55
Q

Inhaled Nitric Oxide treats PH by

A

activating guanyl cyclase to increase cGMP and improves perfusion. to ventilated lung units

56
Q

Inhaled Nitric Oxide causes vaso/broncho_______& is an anti______, _____, and ______

A

Dilation; thrombotic, inflammatory, and proliferative

57
Q

Giving systemic sodium nitroprusside, nitroglycerinne, prostraglandin I2, and PDE5 inhibitors will

A

worsen any shunt since medications given systemically will oncrease blood flow to areas that are NOT vented well

58
Q

Inhaled therapy is better because it causes

A

localized effects

59
Q

In treating PH, phosphodiesterase inhibitors

A

increase and prevent the breakdown of cGMP and cAMP, decrease Ca+ levels, causing vasodilation and smooth muscle relaxation

60
Q

What medications are PDE inhibitors?

A

Milrinone, Sildenafil, & Tadalafil

61
Q

PDE inhibitors in myocardial cells are ________ _______

A

Positive inotropes

62
Q

PDE inhibitors in the systemic vasculature cause

A

Vasodilation & Hypotension

63
Q

Which PDE inhibitors are present in high amounts in the lungs?

A

PDE-5

64
Q

SIDE EFFECTS of PDE5 inhibitors

A

Headache
Nasal Congestion
Dyspepsia (indigestion)
Flushing
Priapism (prolonged erection)

65
Q

MOA of Endothelin Receptor Antagonists in the treatment of PH

A

Block ET-A &/or ET-B, relaxing vascular smooth muscle, decrease smooth muscle cell proliferation

66
Q

What medications are considered Endothelin Receptor Antagonists

A

Bosentan & Ambrisentan

67
Q

What are the SIDE EFFECTS of Endothelin receptor antagoonosist?

A

Side effects are related to vasodilatory properties (like flushing)

68
Q

What are Prostacyclin Derivatives/Prostaglandin medications?

A

Epoprostenol, Iloprost, Prostacyclin,Trepostinil, & Remodulin (IV)

69
Q

MOA of Prostacyclin Derivatives/Prostaglandins

A

Increase PGI2 to target IP receptors, inhibit smooth muscle cell growth & platelet aggregation, improve oxygenation.

(all results in relaxation of vascular smooth muscle)

Anesthesia-Pulmonary (2 decks)

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