Class 9 Deck 1

Question 1

Atropine antagonizes ACh effects on __________ via the ___________ receptors in large and medium airways that respond to __________ stimulation

Answer 1

• Airway smooth muscle
• Muscarinic
• Vagal

Question 2

Atropine ___________ airway resistance and _______ dead space.

Answer 2

• Decreases

- Increases

Question 3

What is the most common anticholinergic used for aerosol administration?

Answer 3

-Ipratropium

Question 4

Ipratropium is most effective in treating _______ due to _______ .

Answer 4

• Bronchospasms

- Beta antagonists

Question 5

How does ipratropium compare to beta agonists in treating asthma?

Answer 5

• Slower onset

- Less effective

Question 6

How does ipratropium compare to beta agonists in treating bronchitis / emphysema?

Answer 6

-More effective due to M3 receptors

Question 7

Ipratropium may cause paradoxical bronchospasm due to what?

Answer 7

-M2 blockade

Question 8

what is Tiotropium (Spiriva)? and what does it treat?

Answer 8

• Long acting anticholinergic bronchodilator

- Bronchospasms associated with COPD, bronchitis, emphysema

Question 9

Tiotropium (Spiriva) blocks what 2 receptors and what do they do?

Answer 9

• M1 = Bronchodilation

- M3 = reduce mucus

Question 10

How does ephedrine treat bronchial asthma?

Answer 10

-Bronchodilating effect from beta 2 activation

Question 11

What is isoproterenol? How does it effect the lungs?

Answer 11

• beta sympathomimetic

- Bronchodilator, ↑HR, ↓ PVR in pulmonary HTN

Question 12

What makes Beta 2 selective sympathomimietics (albuterol) work?

Answer 12

• Relax bronchial and uterine smooth muscle (Beta 2)
• No beta 1 stimulating effects on heart
• COMT resistant (sustained duration)

Question 13

What are the uses of Beta 2 selective sympathomimietics?

Answer 13

• Acute asthma
• Prevent exercise induced asthma
• Improve airflow in COPD
• Tocolytic (stop uterine contractions)

Question 14

What are the 2 classes of Beta 2 selective sympathomimietics?

Answer 14

• Intermediate acting (3-6 hours)

- Long acting (>12)

Question 15

What are the side effects of Beta 2 adrenergic agonists?

Answer 15

• Tremor
• Tachycardia
• Metabolic (Hyperglycemia, Hypokalemia, Hypomag)

Question 16

What is the preferred beta 2 agonist for bronchospasm? and how long will it last? And what are the side effects?

Answer 16

• Albuterol
• 4 hours (relief up to 8)
• Tachy & HypoK

Question 17

How does albuterol effect volatile anesthetics?

Answer 17

-Additive effects

Question 18

What is the (R)-enantiomer of racemic albuterol. How is it different than albuterol?

Answer 18

• Levoalbuterol (Xopenex):

- Little or no clinically significant difference

Question 19

What kind of drug is terbutaline? and when is it used?

Answer 19

• Beta 2 selective agonist

- Ashtma and tocolytic

Question 20

What kind of drug is salmeterol? and what is it frequently administered with?

Answer 20

• Long acting Beta 2 agonist (>12 hours)

- Steroid (advair) prophylaxis of asthma

Question 21

What is the most common membrane stabilizer?

Answer 21

-Cromolyn Sodium (Intal)

Question 22

What does cromolyn do?

Answer 22

• Stabilizes mast cell membrane to prevent release of histamine.
• Suppresses secretory response

Question 23

Does cromolyn treat established bronchoconstriction?

Answer 23

No, it is a prophylatic treatment

Question 24

Name the 3 methylxanthines

Answer 24

• Theophylline
• Caffeine
• Theobromine

Question 25

What 4 things does methylxanthines do?

Answer 25

- Stimulate CNS - Diuresis - Increase myocardial contractility - Relax airway smooth muscle

Question 26

methylxanthines are what kind of drugs?

Answer 26

-Non-selective PDE inhibitors

Question 27

methylxanthines do what to adenosine receptors?

Answer 27

-Competitive antagonist

Question 28

What are the uses of theophylline?

Answer 28

- Bronchospasms due to acute asthma | - CNS stimulant (apnea in premies)

Question 29

What are caffeine's effects?

Answer 29

- CNS stimulant - Cerebral vasoconstrictor - gastric acid secretion

Question 30

What are caffeine's uses?

Answer 30

- Apnea of prematurity - PDPH - Offset sedation of cold remedies

Question 31

Which beta 2 agonist is the most frequently used tocolytic? How does it work?

Answer 31

- Ritodrine | - Stimulates Beta 2 and activate adenyl cyclase

Question 32

When can ritrodine be safely used?

Answer 32

- PO until fetus has matured | - No teratogenic effects after 20 weeks

Question 33

What are the side effects of ritodrine?

Answer 33

- Increased HR, CO, Renin - Decreased Na, H+, K, BP, H2O secretion - Pulmonary edema - Hyperglycemia in mom, hypoglycemia in fetus

Question 34

How do Histamine receptor antagonists work?

Answer 34

- Prevent response mediated by histamine | - Does not inhibit release of histamine

Question 35

what are the 2 generations of H1 receptor antagonists?

Answer 35

- 1st gen = sedating (benadryl) | - 2nd gen = non-sedating (zyrtec, claritin, allegra)

Question 36

When is benadryl used?

Answer 36

- Sedative, antiprurtic, antemetic, - Type 1 allergic reactions (Uticaria, angioedema) - Anaphylactoid reactions (IV contrast)

Question 37

What type of drug is benadryl?

Answer 37

-H1 histamine receptor antagonist

Question 38

What type of drug is dramamine? and when is it used?

Answer 38

- -H1 histamine receptor antagonist | - Motion sickness and PONV

Question 39

What is the major benefit of H2 blockers?

Answer 39

- keep histamine from binding to gastric parietal cells | - ↓ H+ ion secretion

Question 40

Which H2 blocker is the least potent and which is the most potent?

Answer 40

- Cimetidine = Least potent & shortest acting | - Famotidine = most potent

Question 41

When are H2 blockers used?

Answer 41

- Duodenal ulcers - GERD / PUD - Decrease risk of pneumonitis by increasing gastric PH - Preop prophylaxis for likely allergic reactions - Drug induced histamine release

Question 42

What are the most common side effects of H2 blockers? Most severe?

Answer 42

- Diarrhea, headache, fatigue, muscle pain | - Mental confusion (high dose cimetidine), cardiac dysrhythmias

Question 43

What 2 H2 blockers inhibits CYP450? what drugs are prolonged?

Answer 43

- Cimetidine and ranitidine | - (diazepam, propranolol, meperidine, lidocaine)

Question 44

H2 blockers may also alter ________ of some drugs due to ________ gastric fluid ________.

Answer 44

- Absorption - Increasing - PH

Question 45

Which drugs are the most effective at controlling gastric acidity and volume?

Answer 45

-PPI's

Question 46

PPI's are used to treat what?

Answer 46

- GERD - PUD - Hypersecretory disorders

Question 47

What drug combination can be given 1 hours prior to surgery to decrease gastric fluid and raise PH?

Answer 47

-Pantoprazole (potent and fast acting) w/ ranitidine

Question 48

What type of drug is metoclopramide? and how does it work?

Answer 48

- Prokinetic (motility modulating) | - Cholinergic stimulation of GI tract

Question 49

What 3 things does metoclopramide do?

Answer 49

- Increase LES tone - Enhance perastalsis (not opioid induced) - Accelerate gastric emptying

Question 50

Metoclopramide is a __________ antagonist that is structurally similar to _________ but lacks local anesthetic activity.

Answer 50

- Dopamine | - Procainemide

Question 51

What drug may result in extrapyramidal effects

Answer 51

-Metoclopramaide

Question 52

How is metoclopramide cleared?

Answer 52

- Hepatic metabolism (first pass) - Renal elimination - Crosses BBB and placenta - Excreted in breast milk

Question 53

What are the clinical uses of metoclopramide?

Answer 53

- Preop decrease of gastric fluid - Antiemitic (dopamine antagonism CTZ) - Gastroperesis - GERD

Question 54

What are the side effects of metoclopramide?

Answer 54

- Abd cramps - Akathesia - Extrapyramidal

Question 55

Metoclopramide drug interactions?

Answer 55

- Inhibit plasma cholinesterase (prolong succs) | - Increase sedative effects of CNS depressants

Question 56

Avoid giving metoclopramide to what patients?

Answer 56

- Seizures - Mechanical gastric outlet obstruction - Intestinal anastamosis (delay healing)