Respiratory

Question 1

Asthma meds are aimed at

Answer 1

flattening the response to inflammatory mediators

Question 2

Why is it that steroids that work in asthma have minimal response in COPD?

Answer 2

Because the inflammation in COPD is of a different pathway than that of asthma

Question 3

Inhaled _________ can help reduce the frequency of COPD exacerbations

Answer 3

corticosteroids

Question 4

This type of medication has only a modest ole in increasing air outflow in a patient with COPD with chronic breathlessness that is worsened by exercise

Answer 4

Bronchodilators

So basically in COPD, bronchodilators don’t really help and the steroids used in asthma don’t really work either. People with COPD are placed on corticosteroids.

Question 5

R sided heart failure with COPD

Answer 5

Those with CB experience R HF and cor pulmonale as part of the disease process

Those with emphysema experience R heart problems during acute infections

Question 6

Pink puffers refer to __1___

Blu bloaters refer to __2__

Answer 6

1= emphysema
2= CB

Question 7

PaCO2 in COPD

Answer 7

High in CB

Normal in emphysema

Question 8

Types of bronchodilators used

Answer 8

Beta agonists
Anti-cholinergics
Methyxanthines

Question 9

Problem with using epi for treatment of bronchoconstriction

Answer 9

It has B1 and alpha effects as well, which can cause tachycardia, palpitations, and vasoconstriction

Question 10

Selective B2 agonists

(Short and long acting)

Answer 10

Short acting:
- Terbutaline
- Albuterol
- Levalbuterol (the most B2 selective!)
- Salbumatol
^^ We go for the first three of these because we can repeat the dose multiple times

Long-acting

• Salmeterol (pts on this at home and use albuterol for acute attacks)
• Formoterol

All of these B2 selective agents have an affinity for B2 200-400 times stronger than that for B1.

Question 11

What happens at high doses of B2 selective agents?

Answer 11

They become less selective and start affecting other receptors

Question 12

Effect of B2 agonists on electrolytes

Answer 12

Hypokalemia**- increased uptake by skeletal muscle. Also there is release of glucose, causing an insulin spike, driving K+ into cells. Also, B2 stimulates the Na/K pump, further driving K+ into cells.

Hypomagnesemia

Hyperglycemia

Question 13

3 beneficial effects of B2 on the bronchi

Answer 13

Smooth muscle relaxation / bronchodilation
Decreased release of histamine from mast cells
Increased ciliary clearance of mucus

Question 14

Onset of action of B2 agonists

Answer 14

15-30 minutes

Levalbuterol may act as soon as 5 minutes

Question 15

How are B2 agonists given?

Answer 15

Inhaled, nebulized, aerosolized, powder, orally, SQ

Question 16

Only B2 agonist that can be given SQ

Answer 16

Terbutaline

Question 17

Side effects of B2 agonists

Answer 17

Muscle tremor (B2)
Increased HR (B1)
Vasodilation (B2)
Metabolic changes (B2)- hypokalemia, hyperglycemia, and mypomagnesemia

Question 18

How can B2 side effects be minimalized?

Answer 18

Inhalation delivery (decreases systemic effects by keeping it in the lungs)

Question 19

Albuterol dosing

Answer 19

100cmg/puff
2 puffs Q4-6 hours
Nebulizer dose: 2.5-5 mg in 5mL of saline

Question 20

Albuterol DOA

Answer 20

4-8 hours

Question 21

Albuterol has an additive effect with _______ on bronchomotor tone

Answer 21

Anesthetics

Question 22

2 Isomers of albuterol

Answer 22

R- This is Levalbuterol and is more B2 selective

S- This type of albuterol has more affinity for B1

Question 23

How to blunt airway hyperresponsiveness prior to anesthesia

Answer 23

4 puffs of albuterol

or

2 puff albuterol + 1mg/kg of lidocaine IV

Question 24

Bitolterol

Answer 24

B2 selective agent that resembles albuterol but is longer lasting.
CV side effects are rare
Dose is 270mcg/puff
Max of 16-20 puffs/day

Question 25

SQ use of terbutaline

Answer 25

SQ use resembles the effects of epinephrine. Used for status asthmaticus or pre-term labor Dose for adults in .25mg SQ Q 15 min Dose for peds is .01mg/kg SQ

Question 26

Terbutaline inhaler dose

Answer 26

200mcg/puff | Max of 16-20 puffs/day

Question 27

How can terbutaline be administered?

Answer 27

Inhalation SQ Oral

Question 28

How do long-acting B2 agonists work?

Answer 28

They have a lipophilic side chain that resists degradation. Results in a DOA of 12-24 hours. These are not used for acute attacks.

Question 29

How can the amount of time between asthma flare-ups be avoided?

Answer 29

Combined therapy of a long-acting B2 agonist and a steroid

Question 30

Methylxanthines are also called ______

Answer 30

Phosphodiesterase inhibitors

Question 31

What is the MAJOR PREVENTATIVE treatment for patients with asthma?

Answer 31

Inhaled corticosteroids

Question 32

This is the most important type of drug in the management of asthma

Answer 32

Inhaled corticosteroids

Question 33

Do corticosteroids cure asthma?

Answer 33

No. They are used as a supportive therapy, not a cure.

Question 34

The degree of bronchoconstriction and hyperresponsiveness in asthma paralleles _____

Answer 34

the degree of inflammation

Question 35

Asthma is characterized by these two features

Answer 35

Inflammation and hyperresponsiveness

Question 36

Effect of using corticosteroids with a B2 blocker

Answer 36

It increases the DOA of the B2 blocker

Question 37

Effect of eosinophil degranulation

Answer 37

Interferes with the activity of M2 receptor, causing bronchoconstriction

Question 38

Salmeterol is given as a combination of

Answer 38

Salmeterol and fluticasone

Question 39

These are the most important drugs in asthma management

Answer 39

Corticosteroids

Question 40

These are the most important drugs in COPD management

Answer 40

anticholinergics (tiotropium is best --> only FDA approved anticholinergic for COPD). Tiotropium has minimal SE because it doesn't cross the respiratory epithelium

Question 41

Methylxanthines (phosphodiesterase inhibitors) interact with this anesthetic

Answer 41

Halothane

Question 42

How long does it take for cromolyn to take effect? How does cromolyn work? What are the SEs?

Answer 42

It is a mast cell stabilizer (inhibits antigen-induced histamine release). It is for preventative therapy only!!! Takes 7 days for effect to kick in.

Question 43

Montelukast (Singulair) can interact with ____ and cause ______

Answer 43

Warfarin | Prolonged PT

Question 44

The Anti-IgE antibody we know if called

Answer 44

Omalizumab

Question 45

Nerves that aren't part of the ANS can release these substances to induce bronchiole dilation

Answer 45

NO and VIP