Respiratory Therapy Pharmacology – Flashcards
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What does phosphodiesterase inhibitor do?
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Inhibits phosphodiesterase and thus maintains the activity of cAMP --> further activation of protein kinase A Inhibits the breakdown of cyclic AMP
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What does a sympathomimetic do?
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Mimics the sympathetic system
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What does a parasympathomimetic do?
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Mimics the parasympathetic system
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List 5 non respiratory effects of the stimulation of the Parasympathetic Nervous System
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SLUD -salivation -lacrimation -urination -defecation -sweating
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List 2 Respiratory effects of stimultaion of the Parasympathetic Nervous System
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Mucus production Bronchoconstriction
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List 2 Respiratory effects of stimulation of Sympathetic Nervous System
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Mucus mobilization Bronchodilation
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What is the neurotransmitter for the Parasympathetic Nervous System?
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Acetylcholine
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What are the natural neurotransmitters of the Sympathetic Nervous System at the smooth muscle?
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Norepinephrine Epinephrine Dopamine
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What is the neurotransmitter of the Sympatheic Nervous System at the SKELETAL muscle?
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Acetylcholine
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What happens inside the smooth muscle cell when Beta 2 receptors are stimulated in the AIRWAYS?
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1.Increased adenyl cyclase 2.Increased cyclic AMP 3.Decrease in intracellular Ca+ 4.Smooth muscle relaxes 5. Bronchodilation (phosphodiasterase stops the process)
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Define the response of each of the following receptors when stimulated.
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Alpha 1- Vasoconstriction Beta 1- Increases heart contractility and heart rate Beta 2- Bronchodialtion (Relaxes smooth muscle)
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What happens when the following are Blocked? Alpha 1 receptor Beta 1 receptor Beta 2 receptor Acetylcholine
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Alpha 1- Vasodilation (decreased blood pressure by decreased SVR) Beta 1- Reduces heart rate and contractility Beta 2- Bronchoconstriction (smooth muscle constricts) Acetylcholine- Brochodilation
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Metaproteranol is indicated for what and why?
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Non-cardiac patients due to increased heart rate Fast onset bronchodilator asthma
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Racemic epinephrine is indicated for what and why?
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Croup Non-severe epiglottitis
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Atropine is indicated for what and why?
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Slow heart rates with symptoms Increases heart rate
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Caffeine is indicated for what and why?
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Sleep apnea in infants
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Acetylcysteine is indicated for what and why?
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COPD & Pnuemonia patients with thick mucus (normalizes mucus viscosity by breaking disulfide bonds in mucus)(Mucomyst)
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Dornase Alfa is indicated for what and why?
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Cystic Fibrosis patients with thick, tenacious mucus (normalizes mucus viscosity by breaking down DNA strands in mucus) (Pulmozyne)
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List 10 side effects of Beta-2 Agonsists.
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1.headache 2.nausea 3.tremors 4.palpitations & tachycardia 5.insomnia 6.nervousness 7.dizziness 8.increased blood pressure 9.tolerance to bronchodialtion 10.loss of bronchoprotection
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What happens inside the smooth muscle cell in the airway when the PNS is stimulated?
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1. Increased cyclic GMP 2. Increased intracellular Ca+ 3.Smooth muscle contracts 4.Brochoconstriction
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List 4 adverse effects of anticholinergic drugs.
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1.Dry mouth 2.Headache 3.Nervousness 4.Insomnia 5.Cough 6.Irritation 7.Palpitations 8.Dizziness
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What does S-T elevation indicate?
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Myocardial Infarction (MI) acute heart injury
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List 2 Xanthine (generic) drugs.
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1.Theophylline 2.Aminophylline
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List 3 clinical uses of theophylline
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1. Sleep apnea in infants 2. COPD (improves muscle strength and endurance) 3. Rarely in Asthma as bronchdilator
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Describe the 3 modes of action of theophylline
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1. Prevents phosphodiesterase from breaking down cyclic AMP 2.Increases Epinephrine & stimulates Beta 2 receptors 3.Blocks Adenosine receptors
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List 4 side effects of theophylline
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1.Tremors 2.Nervousness 3.Seizures 4.Convulsions 5.Cardiac arrhythmias
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List at least 3 Xanthine drugs
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1.Bronkodyl 2.Elixophyllin 3.Slo-bid 4.Theolair 5.Constant-T 6.Respbid 7.Oxtriphylline 8.Choledyl
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List 3 natural surfactants and their dose
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1. Survanta 4 ml/kg (Bearctant) 2.Infasurf 3 ml/kg (Calfactant) 3.Curasurf 2.5 ml/kg
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What is used to treat Infant Respiratory Distress Syndrome?
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Surfactant
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List four side effects of all surfactants
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1.Bradycardia 2.Excessive PaO2 & low PaCO2 3.Overventilation (barotrauma) 4.Pulmonary Hemorrhage
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List four things that are important to monitor in infant patients on mechanical ventilators, that were given surfactant
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1.Overventilation 2.Rise in chest, color & ABG's 3.Pressures & compliances 4.FiO2 & SpO2
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Monitoring newborn infants given surfactant is important because of the possible immediate risk
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Overventilation/barotrauma
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Describe how Surfactants work
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Decreases surface tension and WOB
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What side effect does artificial surfactants have that natural surfactants do not have?
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Larger dose is more likely to lead to airway obstruction.
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What side effect do natural surfactants have that artificial surfactants do not have?
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They have proteins that can elicit an immune or allergic response.
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Can acetylcysteine be taken orally?
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Yes, for Tylenol overdose
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Should acetylcysteine be taken with a Beta-2 agonist?
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Yes, to prevent bronchospasms.
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Which Beta-2 agonist would be best to take with Mucomyst?
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Metaproterenol for faster onset Albuterol for less cardiac symptoms Terbubtaline? for less cardiac symptoms
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List 2 drugs that Acetylcysteine is incompatible with.
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1. Ampicillin 2.Erythromycin 3.Tetracycline
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Which lung cells produce surfactant in lungs?
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Type II
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What happens as surface tension of the alveolus increases?
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The alveolus decrease in size increasing the WOB.
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List a natural steroid
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Cortisol
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List 2 control mechanisms, anatomical structure that are involved in the control of steroid production
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Pituitary Gland Hypothalamus
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List 4 processes of the inflammatory process
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1.Redness/red flare 2.Swelling 3.Vascular permeability 4.White Blood Cell infiltration
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List 5 airborne triggers of asthma
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1.toxic gases/fumes 2.dust 3.pollen/cold air 4.air pollution 5.dander
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List 3 mediators involved in the inflammation process
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1. Mast cell degranulation 2.Phospholipids 3.Phospholipase A2 4.Arachidonic Acid
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What is the mode of action for steroids (how they prevent inflammation process)
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1.Increases Lipocotin 2.Inhibits Phospholipase A2 (which breaks down Arachdonic acid) Steroids also increase other anti-inflammatory agents
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What does Arachdonic acid produce?
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1.Histamine (early) 2.Bradykinin 3.Leukotrienes 4.Prostaglandins (late)
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List one other physiological effect on beta receptors of steroids that helps asthma patients
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improves effectiveness=better bronchodilation
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List four pathophysiological effects of inflammation in the airways of asthma patients
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1.Swelling (microvascular leakage) 2.Bronchoconstriction 3.Mucus 4.Hyper-reactive airways
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List 4 side effects of steroids (PO)
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1.Swelling 2.Osteoporosis 3.Stunted/slow growth 4.Immunosupression 5.Myopathy 6.Cataracts 7.Hypertension 8.Increased blood glucose 9.Depression 10.Peptic Ulcer
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List 2 side effects for inhaled steroids
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1.Fungal infections 2.Hoarseness 3.Incorrect dose 4.Cough 5.Bronchospasm 6.Slow growth
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List the indication for inhaled & PO steroids
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Severe and persistent asthma
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List the indication for IV steroids
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Severe acute asthma in ER
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List 4 inhaled steroids
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1.Decadron 2.Fluticasone (Flovent) 3.Budesonide (Pulmicort) 4.Beclamethasone (Beclovent & Vanceril)
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List 2 systemic steroids
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1.Prednisone 2.Methylprednisolone 3.Prednisolone (Solu-Medrol)
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List which inhaled steroid is the most potent
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Beclamethasone (requires the lowest dose)
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What is Decadron used for
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Croup 2-5ml SVN
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What are anabolic steroids used for
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Building body mass
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What is the SVN dose for budesonide (Pulmicort)
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.25mg-.5mg
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List 2 drugs with steroids & B2 agonists that are inhaled by DPI
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Advair-fluticasone(Flovent) & salmeterol(Serevent) Symbicort-budesonide(Pulmicort) & fomoterol (Foradil)
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What is the mode of action for Cromolyn Sodium?
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Inhibits mast cell degranulation
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List 4 side effects of Cromolyn Sodium
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1.Nasal congestion 2.Cough 3.Nausea 4.Wheezing 5.Asthma 6.Headache
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What is the dose for Cromolyn Sodium?
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20mg in 2mL
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What is Cromolyn Sodium indicated for?
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Asthma
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When is Cromolyn Sodium indicated for Asthma?
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For prevention
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List 2 leukotriene inhibitors
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1.Ziflo (zileuton) 2.Accolate (zafilukast) 3.Singulair (montelukast)
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What is neostigmine used for?
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1.To reverse non-depolarizing neuromuscular blocking agents (Curare) 2.Myesthenia Gravis
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What is the route of administration for Leukotirene inhibitors?
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PO
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List 4 side effects of Leukotriene Inhibitors
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1.Stomach pain 2.Headache 3.diarrhea 4.laryngitis
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What is Curare used for?
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Fighting the ventilator
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How does Curare work?
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Relaxes skeletal muscle non-depolarizing neuromuscular blocking agent
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What is succinylcholine used for?
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ET intubation
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How does succinylcholine work?
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Depolarizes the muscles
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List 3 modes of action for antimicrobial agents
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1.Inhibits cell membrane development 2.Inhibits cell wall synthesis 3.Inhibits cell permeability
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Define sensitivity
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Antibiotics effect on bacteria
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What microbe is Penicillin indicated for?
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1.Strep & H.Infuenza
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What microbe are Cephalosporins indicated for?
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Beta Lactamase producing bacteria- 1.Strep 2.Klebsiella 3.Proteus
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What microbe are Aminoglycosides indicated for?
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Gram negative- 1.Inhaled for Staph & Pseudomonas in CF patients
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What microbe is Tetracycline indicated for?
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1.Rare pneumonias (mycoplasm) 2.N.Meningitis
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What microbe is Fluoroquinolone indicated for?
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Gram negative 1.E.Coli 2.Klebsiella
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What microbe is Vancomycin indicated for?
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MRSA
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What microbe is Erythromycin indicated for?
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1.Patients allergic to Penicillin 2.Legionella 3.Mycoplasma Pneumoniae
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List 4 fungi that can cause pneumonia
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1.Coccidiosis 2.Aspergillis 3.Histoplasmosis 4.Candida
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List 2 antifungal agents
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1.Amphotercin B (IV) 2.Diflucan (PO)
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List 4 drugs used to treat TB
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1.Streptomycin 2.Rifampin 3.Isoniazid 4.Ethambutol 5.Prazinamide
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Identify gram negative microbes
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1.Pseudomonas 2.H.Influenza 3.Proteus
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Identify gram positive microbes
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1.Stap 2.Strept
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What type of antibiotic is Ampicillin?
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Penicillin
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What type of antibiotic is Rocephin
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Cephalosporin
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What type of antibiotic is Streptomycin
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Aminoglycoside
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What is the dose for Ribavirin
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6g in 300mL of sterile water
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What is Ribaviran used to treat?
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RSV Respiratory Syncytial Virus (rarely used)
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How is Ribavirin delivered?
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SPAG
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What is Pentamidine used for?
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PCP -Pneumocystis Carinii Pneumonia
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What is the dose for Pentamidine?
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300mg in 6mL of sterile water
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How is Pentamidine delivered?
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Respigard II or SVN with one way valve & filter
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List 3 side effects of these drugs
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1.Conjuncivitis 2.Blurred vision 3.Cancer 4.Bronchospasms
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What is the mode of action of Ribavirin and Pentamidine?
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Inhibiting or blocking the DNA in the microbes reproduction process
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Describe the precautions that need to be taken when working with Pentamidine and Ribvirin
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Use negative flow tents & or room & HEPA Mask (N95)(fit tested to assure no leakage) and universal precautions.
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List 3 complications that may be present in an infant with RSV that indicate the patient may need Ribavirin
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1.Cardiac problems 2.Ventilation problems 3.Pneumonia-severe 4.Likely in a childrens hospital
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List 2 narrow spectrum antibiotitcs
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1.Penecillin 2.Streptomycin
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List 2 Aminoglycosides that can be delivered (topically) by aerosol
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1.Tobramycin 2.Gentamycin
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Why is elastin important in lung tissue?
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It allows the lung to recoil
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What is Prolastin used to treat?
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Generic Emphysema caused by a deficiency in Protease Inhibitor Deficiency less than 11um
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How does Prolastin work?
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Inhibits elastase, which breaks down lung/ alveoli connective tissue
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List 3 signs that a patient is dependent on nicotine and may need nicotine replacement therapy
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1. Smokes 30 mins. after waking up in the morning 2. Smokes 1.5 packs or more a day 3. Inhales deeply and frequently 4. Uses brands with > .9mg nicotine
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What is Nitric Oxide used to treat?
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Pulmonary vasoconstriction/ pulmonary hypertension causing persistent Fetal circulation with RDS (PPHN)
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What is the dose of Nitric Oxide?
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2-20ppm
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List one side effect of Nitric Oxide
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1.Methomyoglobin 2.Pulmonary Edema
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What is methomyoglobin?
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Dysfunctional Hb (does NOT carry oxygen)
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At what level can Nitric Oxide be discontinued?
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When the baby is doing well with less than 1-2 ppm. Weaning from NO typically is: 20 to 10 to 5 to 1-2ppm then DC'd
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