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Anesthesia-Pulmonary > Pulmonary Pharamacology > Flashcards

Pulmonary Pharamacology Flashcards

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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
List of Corticosteroids
Fluticasone Mometasone Methylprednisolone *Prednisone Hydrocortisone Fluticasone/Salmeterol Budesonside/Formoterol
26
What are some SIDE EFFECTS of Corticosteroids?
Infection HYPERglycemia HTN Adrenal Suppression Psychosis Ulcers Osteoporosis
27
MOA for Leukotriene Modifiers
They block the conversion of Arachidonic Acid to leukotriene Block leukotriene receptors
28
What medications are Leukotriene Modifiers?
Montelukast & Zileuton
29
What medications are Mast Cell Stabilizers?
Cromolyn Sodium & Nedocromil
30
MOA of Mast Cell Stabilizers
Stabilize mast cell by blocking mast cell degranulation, block release of histamine, block bronchoconstriction, mucosal edema and secretion
31
Which volatile anesthetics DO NOT decrease bronchomotor tone?
DESflurane & Nitrous Oxide
32
Which channels are sensitive to volatile anesthetics?
T-type Ca+ channels
33
Which IV anesthetics decrease bronchomotor tone?
Propofol, Ketamine, & Midazolam
34
What adjuncts can suppress cough, relax ASM, and blunt hemodynamic response to airway manipulation?
Local Anesthetics
35
Magnesium Sulfate can
improve bronchodilation and can be given via IV or NEB treatment
36
Beta agonist activate
adenylate cyclase, which activates an increase in cAMP
37
Methylxanthines block________, which increases cAMP and promotes vasodilation
PDE(phosphodiesterase and blocks adenosine
38
M3 antagonist block
ACh, promoting bronchodilation
39
cAMP________in VASCULAR smooth muscle when agonist bind Gs couple receptors
INCREASES, causing a decrease in vascular tone
40
IP (prostacycline) has the same affects as
Beta-2
41
Alpha-2 bind to Gi protein, causing cAMP to ________in the vascular smooth muscle, ________vascular tone
DECREASE; increase (activates MLCK)
42
An ______in cAMP will ______MLCK, causing________
increase; inhibit; relaxation
43
Endothelin-1 is a potent
vasoCONTRICTOR
44
What receptors are bound to Gq proteins?
Alpha-1, ET-A, and M3
45
What happens to IP3 levels in vascular smooth muscle when agonist bind to Gq receptors?
IP3 increases, causing an increased release in Ca+, causing contraction of vascular tone
46
Alpha-1 binds
catecholamines
47
Increased cGMP causes
relaxation
48
L-arginine breaks down into
Nitric Oxide, influenced by blood flow (sheering force), which releases Ca+ and increases the formation of nitric oxide and nitric oxide synthase
49
What are the 3 mechanisms for cGMP?
Inhibits Ca+ entry Activates K+channels (hyperpolarizing) Activates MLCP (not MLCK), to breakdown MLCK ALL causing VASODILATION
50
What medications are used to treat PH?
Inhaled nitric oxide Phosphodiesterase inhibitors Endothelin receptor antagonists Prostacyclin Derivatives Prostaglandins
51
Should PH therapy be discontinued?
NO!!
52
How do you avoid increases in Pulmonary Vascular Resistance?
Avoid: Hypoxia Hypercarbia Acidosis Pain Hypothermia Ketamine Nitrous Avoid Large deceases in SVR Preserve Preload, CO, & perfusion Use vasopressors for intra-op HOTN
53
What medication can either improve or have no harmful effects on PH
Etomidate Opioids Low Volatile agent Concentrations
54
Decreased flow through the lungs to the _______will affect CO
Right side of the heart
55
Inhaled Nitric Oxide treats PH by
activating guanyl cyclase to increase cGMP and improves perfusion. to ventilated lung units
56
Inhaled Nitric Oxide causes vaso/broncho_______& is an anti______, _____, and ______
Dilation; thrombotic, inflammatory, and proliferative
57
Giving systemic sodium nitroprusside, nitroglycerinne, prostraglandin I2, and PDE5 inhibitors will
worsen any shunt since medications given systemically will oncrease blood flow to areas that are NOT vented well
58
Inhaled therapy is better because it causes
localized effects
59
In treating PH, phosphodiesterase inhibitors
increase and prevent the breakdown of cGMP and cAMP, decrease Ca+ levels, causing vasodilation and smooth muscle relaxation
60
What medications are PDE inhibitors?
Milrinone, Sildenafil, & Tadalafil
61
PDE inhibitors in myocardial cells are ________ _______
Positive inotropes
62
PDE inhibitors in the systemic vasculature cause
Vasodilation & Hypotension
63
Which PDE inhibitors are present in high amounts in the lungs?
PDE-5
64
SIDE EFFECTS of PDE5 inhibitors
Headache Nasal Congestion Dyspepsia (indigestion) Flushing Priapism (prolonged erection)
65
MOA of Endothelin Receptor Antagonists in the treatment of PH
Block ET-A &/or ET-B, relaxing vascular smooth muscle, decrease smooth muscle cell proliferation
66
What medications are considered Endothelin Receptor Antagonists
Bosentan & Ambrisentan
67
What are the SIDE EFFECTS of Endothelin receptor antagoonosist?
Side effects are related to vasodilatory properties (like flushing)
68
What are Prostacyclin Derivatives/Prostaglandin medications?
Epoprostenol, Iloprost, Prostacyclin,Trepostinil, & Remodulin (IV)
69
MOA of Prostacyclin Derivatives/Prostaglandins
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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