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86 Cards in this Set
- Front
- Back
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From which portion of the spinal cord do the parasympathetic system branches arise?
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cranisacral
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what specifically does an anticholinergic do?
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blocks an acetylcholine receptor
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What specifically is a parasympatholytic?
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an agent that is blocking the parasympathetic system
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Which of the following does NOT help terminate the action of norepinephrine at the neuroeffector site? -
A. Reuptake 1 - absorption into the presynaptic neuron B. reuptake 2 - absorption into the tissue around the nerve terminal C. Stimulation of autoreceptors to inhibit norepinephrine release D. metabolism by cholinesterase |
metabolism by cholinesterase
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Heart rate will increase as a result of stimulation of which receptor?
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B1
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What is the action of cGMP in the cells of the airways?
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leads to bronchoconstriction
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What is the action of cAMP in the cells of the airways?
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It promotes relaxation of smooth muscle
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In which autonomic nervous system do the ganglia lie close to the organs or tissues that the neurons innervate and why?
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the parasympathetic system because the postganglionic fiber is shorter
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From which portion of the spinal cord does the sympathetic nervous system arise?
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thoracolumbar
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The drugs known as adrenergic bronchodilators are all based on which naturally occurring body substance?
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epinephrine
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What is the half life / duration of albuterol?
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6 hours
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What is the single -isomer B-2 Agonist?
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levalbuterol
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Terbutaline
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a β2-adrenergic receptor agonist, used as a "reliever" inhaler in the management of asthma symptoms and as a tocolytic (anti-contraction medication) to delay preterm labor for up to 48 hours. This time can then be used to administer steroid injections to the mother which help fetal lung maturity and reduce complications of prematurity
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Neurochemical Mediators in Sympathetic Bronchodilation
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Branchial nerves stimulated
Norepinephrine binds with B2 receptors ATP converts to cAMP cAMP = bronchodilation of smooth muscle Phosphodiesterase continually breaks down cAMP |
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isoetharine
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called the "granddaughter of adrenalin"
B2 selective May cause tremors, increased HR, nervousness, headache IMMEDIATE ACTION to about 3 hours |
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Tornalate
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Bitolterol
B2, mild B1 Prodrug = converted into active state by the body Action begins in 3-4 min. lasting about 8 hrs MDI European drug. Time release bronchodilator |
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What formulation is combined in Advair
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Long acting Beta agonist with inhaled corticosteroid
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Which Beta Adrenergic does theophylline NOT have an antagonistic effect?
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albuterol
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theophylline
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Xanthine Derivative
Enhances CO2 responsiveness in infants with apnea of prematurity Modes of action: Known as phosphodiesterase inhibitors Phosphodiesterase breaks down cAMP decreased cAMP = decreased bronchodilation Therefore:Inhibit phosphodiesterase = increase intracellular cAMP = mild bronchodilation does not increase pulmonary vascular resistance |
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what instances might you use neuromuscular blocking agents?
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Inverse ratio (always) dyschronous with vent
ICP |
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paralysation for status asthmaticus - why?
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relaxes body and allows room for the lungs to expand.
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What backdoor drugs cause bronchodilation?
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phosphodiesterase
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what do cholinergics refer to
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Acetylcysteine receptors
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what is a quaternary ammonium compound you’ve heard of?
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ipratropium bromide (atrovent)
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atrovent
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ipratropium bromide
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what is the way acetylcholine is inactivated?
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acetylcholinesterase - destroyed by hydrolysis - broken down by water
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name two mast cell stabilizers
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Cromylin sodium, (Intal) (mast cars have chrome bumpers)
chromlyn is the only SVN Nedocromil (tilad ) - MDI only |
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Nedocromil
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tilad
Mast cell stabilizer |
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what do you nebulize for idiopathic pulmonary hypertension?
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iloprost - nitric oxide on vent (INO)
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ilopros
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Ventavis
nebulize for idiopathic pulmonary hypertension Indication: Pulmonary hypertension dilates pulmonary arterial vascular beds Inhalation formulation Adaptive Aerosol Delivery Pro-dose or I-neb 2.5 - 5 mcg delivered dosage Common side effects: headache, dizziness, or lightheadedness Benefits Significant exercise capacity improvement decreased clinical deterioration |
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Ventavis
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ilopros
nebulize for idiopathic pulmonary hypertension Indication: Pulmonary hypertension dilates pulmonary arterial vascular beds Inhalation formulation Adaptive Aerosol Delivery Pro-dose or I-neb 2.5 - 5 mcg delivered dosage Common side effects: headache, dizziness, or lightheadedness Benefits Significant exercise capacity improvement decreased clinical deterioration |
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What is the first step in the inflammatory response?
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vasodilation
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what antihypertensive medications are potential issues for asthmatics and why?
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beta blockers. - Atenolol - Can block B2
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what is the first thing you do for prior to initializing treatment?
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identify underlying cause
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what antihypertensive medications are potential issues for asthmatics and why?
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beta blockers. - Atenolol
Not specific to B1 May cause bronchoconstriction Can block B2 |
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Atenolol
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Not specific to B1
May cause bronchoconstriction Can block B2 Hypertension SVT |
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what is the primary method to getting rid of norepinephrine in a neurotransmitter
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reuptake 1 and reuptake 2 - reuptake 1 sucks neurotransmitter back into neuron - AMOT CAM
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what happens to the vascular system when I stimulate alpha receptors
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causes vasoconstriction generally - stimulated by epinephrine
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what is the most often side effect with of atrovent?
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dry mouth
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how does a nondepolarizing agent work?
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inhibit acetylcholine at nicotinic receptor site
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what is dilantin used for?
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(Phenytoin)
anti-arrythmic Aka anticonvulsant Common use: Digoxin toxicity |
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Phenytoin
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dilantin
anti-arrythmic Aka anticonvulsant Common use: Digoxin toxicity |
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What drug if electrocardioversion doesn’t work?
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adenosine - stops heart for up to 20 seconds
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adenosine
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Converts SVT to normal sinus rhythm
Relative contraindication for asthmatics Can cause bronchospasm Use Cardizem instead Temporary blockade of AV conduction decreased SA node activity Up to 20 seconds of asystole during conversion |
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how can you deliver drugs during an ACLS code?
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iv
ett tube intracardiac |
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What were some of the test listed to monitor the paralytics for extubation?
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mip, nif, vital capacity
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what are some good things about inhaled corticosteroids?
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helps improve b2 drug responsiveness
refreshes B2 receptors, prolongs natural catecholamine half life |
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why might you choose versed over valium?
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duration - versed wears off quicker
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valium
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diazepam
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what’s the generic name for versed?
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midazolam
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midazolam
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versed
Anxiolytics Benzodiazepines: decreases anxiety Little effect on respiratory & cardiac function Synergistic effect with opiates Uses: Seizure treatment, inducing sleep, general anesthesia induction, conscious sedation Versed has a short half life Reversal agent: Flumazenil |
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versed
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midazolam
Anxiolytics Benzodiazepines: decreases anxiety Little effect on respiratory & cardiac function Synergistic effect with opiates Uses: Seizure treatment, inducing sleep, general anesthesia induction, conscious sedation Versed has a short half life Reversal agent: Flumazenil |
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what might you give a patient in a code situation to increase their heart rate?
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epinephrine, atropine
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nebulized, this drug can reduce the perception of dyspnea?
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Morphine
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how might you reverse a non-depolarizing agent?
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Neostigmine
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how do you reverse a depolarizing agent?
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There is no reversal for depolarizing agents.
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how does atropine increase the heart rate?
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vagal nerve blocking
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how does the potassium sparing diuretic work?
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competitive agonist for aldosterone, blocks reabsorption of salt
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what increases the production of cAMP?
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B2 agonists / sympathomimetics
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what diuretic might cause metabolic acidosis?
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Carbonic Anhydrase Inhibitors
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what is the layman's term for analeptic?
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caffeine - increase respiratory center activity of the brain
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what breaks down CAMP?
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phosphodiesterase
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what is angina?
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decreased O2 to the heart, chest pain, MI
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increased blood glucose, hypokalemia, increase HR, smooth muscle dilation - what class of drugs might cause these metabolic actions?
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Beta adrenergics - bronchodilators
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what drug reverses narcotics?
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Narcan /Naloxone
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what drug might be used for relief of angina?
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nitroglycerine
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what is the generic name for versed?
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midazolam
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how would you classify racemic epinephrine
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alpha adrenergic
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what two drugs are most often used for intubation?
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Succs and Versed
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what drug might you give to calm a patient on a ventilator?
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Versed
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what is the anti-anxiety drug?
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ativan
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what does the acronym NAVAL stand for?
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narcan, atropine, valium, lidocaine
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nasty side effect to Carbonic Anhydrase inhhibitors
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metabolic acidosis
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diazepam, versed, phenobarbital: which has the shortest half life?
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versed (medazapam)
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enzymes for uptake 1 and uptake 2
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Metabolized (destroyed) by enzymes: COMT & MAO
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side effects of morphine
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Respiratory depression
decreased gastric function Constipation nausea vomiting |
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Pulmozyme
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Dornase alfa
approved for CF patients (only) patient mut be hydrated dissolves pus-related DNA in mucus decreases reoccurring infections decreases frequency of exacerbations usage: keep refrigerated, out of light separate specialized nebulizer dosage 2.5mg/UD SVN q-day must use its own SVN - accurage delivry $ drug NO MIXING with other drugs |
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Amiodarone
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Antiarrhythmic
First line VT/VF agent |
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What are the 3 bronchodilator MOA?
Sympathomimetics Anticholingergics Xanthines |
stimulate production of cAMP
Anticholinergics block production of cGMP Xanthines - inhibit phosphodiesterese |
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combivent
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Albuterol & Ipratropium Bromide
MDI |
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what are the brand names for albuterol?
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Proair, Proventil, Accuneb, ventolin
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what long acting bronchodilaters have the quickest onset?
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Arformoterol and Formoterol. Bravana and Foridil
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what specific disease processes do anticholinergics work well on?
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COPD - spiriva / atrovin
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arformoterol
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brovana - only for COPD
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Pentamidine
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NebuPent
Pneumocystis jiroveci pneumonia (PCJ) aka "carinii" common in HIV+ patients 2nd Line Prophylactic Therapy for chemotherapy pts If 1st line oral agent not tolerated Deliverying Pentamidine (super potent med - scary...) Respirgard II nebulizer - scavaging system Particles 1 - 2 mcg: reach alveoli Bronchospasm possible Negative pressure rooms / isolation chambers Protect care-giver From drug: expiratory filters / one-way valves From pathogenic organsms: N-95 respirator |
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Ribavirin
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Virazole (brand name)
Antiviral agent for respiratory syncytial virus infection (RSV) If child / infant at risk for severe disease - bonchiolitis / pneumonia Delivered with small particle aerosol generator SPAG II - 1.3mcg particles 12 to 18 hours per day 3 to 7 days Ribavirin administration Deliver via baby oxygen hood Use extreme caution if through ventilator Drug can clog valves, sensors or tubing Prevent healthcare worker exposure Filter gas escaping enclosure Administer in wll ventilated areas 6 + air changes per hour |
