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69 Cards in this Set
- Front
- Back
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What must ALWAYS be administered with a LABA to prevent increased risk of death for asthmatics?
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inhaled corticosteroid
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What is a potential negative effect of long-term beta agonist use for asthmatics?
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Both SABAs and LABAs are pro-inflammatory even at small doses
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What medication can be taken to prevent altitude sickness?
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Acetazolamide - CA inhibitor causes loss of bicarb, causing metabolic acidosis, counteracting respiratory alkalosis.
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What causes HAPE?
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High altitude causes hypoxia, inducing vasoconstriction. Some of the endothelium may be damaged due to hypoxia, and eventually pulmonary hypertension and edema can drown patient
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How do you treat HAPE?
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Oxygen, move to lower altitude, hyperbaric chamber/bag.
Drugs: Ca channel blockers, NO, sildenafil are all pulmonary vasodilators |
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What pharmacologic agents can be given to someone experiencing high-altitude pulmonary edema?
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Drugs: Ca channel blockers, NO, sildenafil are all pulmonary vasodilators
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What two drugs are foundational for TB tx?
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Isoniazid and Rifampin
+Pyrazinamide and Ethambutol |
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Rifampin induces CP450 enzymes. What does this mean for a patient taking other drugs metabolized by CP450?
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You need to up their doses, because their half-life will decrease when CP450 is induced by rifampin.
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What is the drug most likely to have resistance in the typical TB tx?
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Isoniazid
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If there is >4% isoniazid resistance in an area, what drug regimen can you prescribe?
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Rifampin, pyrazinamide, Ethambutol and a fluoroquinolone (levo- or moxifloxacin)
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If you're only going to give 3 drugs, which 3 should you give for TB?
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Rifampin, isoniazid, ethambutol for 9 MOS
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If you are treating rifampin resistant TB, which drugs should you give?
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Fluoroquinolone (moxi or levo) + isoniazid + ethambutol + pyrazinamide for 2 months.
Can drop pyrazin after that, but continue other 3 for 16 mos. |
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For rifampin and isoniazid resistant TB, which drugs should you give?
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Fluoroquinolone (moxi or levo) + pyrazinamide + ethambutol + aminoglycoside (amikacin or streptomycin) for 18-24 mos
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How does isoniazid work?
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Inhibits FA synthesis, interfering with TB cell wall synthesis
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What is a potential side effect of isoniazid use?
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Combines with B6, causing burning and tingling in extremities.
Administer B6 (pyridoxine) with isoniazid |
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Why should people on isoniazid avoid alcohol?
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Isoniazid can damage liver on it's own, alcohol worsens this.
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What epileptic drug should be lowered when using isoniazid?
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Pheynytoin - INH inhibits its metabolism, increasing half-life
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How many days does it take for Rifampin's drug metabolism inducing activities to take effect?
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6 days
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What common drugs are induced by rifampin?
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Warfarin, Prednisone, OCPs, Digoxin, propanolol, Sulfonylureas
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What is a side effect of rifampin use?
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Orange/red colored tears, urine and sweat
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Which 1st line TB drug can cause ototoxicity?
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Amikacin (aminoglycoside)
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How does aminosalycilic acid work against TB?
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Inhibits folate synthesis (we don't have to do that because we eat ours)
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What physiologic response happens as a result of intubation that you will NOT get with proper anesthestic induction?
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Tachycardia and hypertension
(Induction causes lack of awareness and blunted hemodynamic response) |
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What are the most common induction agents?
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BBOPE:
Benzos Barbits Opioids Propofol/Fospropofol Etomidate |
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What is the only induction agent that avoids cardiac depression?
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Etomidate
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Of the benzodiazepines (most common induction agents), which is most potent?
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Midazolam
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Which of the following would you want to use in someone who you wanted to avoid depressing breathing activity? Benzo or barbiturates?
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Benzodiazepines - do not depress medullary respiratory fxn
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Which of the following should NOT be depressed as a result of administering the barbiturate thiopental? HR, RR, BP
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HR - reflex tachycardia might occur as a result of depressed BP and RR
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Why isn't etomidate the most ideal induction agent?
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It causes myoclonic jerking, nausea and vomiting in 50%, even though it is least likely to depress heart function
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How does glutamate work?
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Blocks NMDA (glutamate receptor)
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What needs to be administered with ketamine, and why?
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Always administer a benzodiazepine with ketamine (like Versed).
Ketamine is similar to PCP structurally, and also causes hallucinations which can be unpleasant. |
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What is a side effect common to most of the induction agents?
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Injetion site burning
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Put the following in order from longest to shortest recovery time:
Midazolam, Etomidate, Propofol, Thiopental, Diazepam |
Diazepam (longest half life)
Thiopental Midazolam Propofol Etomidate (shortest half life) |
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Why is NO used with anesthetics?
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It potentiates other agents (fluranes)
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What is meant by "minimal alveolar concentration"? MAC-BAR?
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The dose at which an inhalation anesthetic is administered and 50% of humans do not respond to a surgical incision
MAC-BAR = MAC needed to block the autonomic response to intubation |
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How many times MAC is required for a dose of inhaled anesthetic to prevent movement?
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1.3 MAC = no movement usually
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How is anesthesia usually monitored for adequacy?
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Hemodynamic response and movement
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What can you add to inspired ventilation to increase excretion of inhaled anesthetic?
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CO2
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Why has halothane fallen out of favor as an inhalation agent?
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Sensitizes myocardium to catecholamines, predisposing to ventricular arrhythmia
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Why is sivoflurane the agent of last resort for refractory asthma?
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It dilates bronchioles
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What anesthetics can enhance activity of GABA and glycine in CNS?
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Inhaled anesthetics
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What receptor do many anesthetics act through, which, when mutated, can cause unresponsiveness to anesthetics?
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GABA-A, in TM2 area
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What receptors does NO act through?
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NMDA
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What do the following accomplish?
succinylcholine, pancuronium, vecuronium, atracurium, rocuronium |
Curare derivatives - bloch nicotinic ACh receptors
MUSCLE RELAXANTS |
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What is the most important function to manage for a person on muscle relaxants?
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Airway!
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How can you reverse the effects of muscle block caused by pancuronium?
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AChEI can reverse a partial block, but not complete block
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Sux (succinylcholine), an ACh mimetic, is great because it works fast and is eliminated quickly.
Why is it hazardous? |
Malignant hyperthermia, bradycard in kids, possibly renal failure
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Should a patient recovering from the muscle relaxant vecuronium be able to breath or move first?
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Breath (laryngeal muscles recovers first)
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What should be administered with AChEIs (-stigmines) for a patient recovering from muscle relaxants to prevent GI/bronchospasm?
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Antimuscarinic agents (atropine/scopolamine)
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How many seconds should a patient hold up their head before extubating is generally safe?
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5 seconds
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What electrolyte disturbance can come with SABA overuse?
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Hypokalemia, due to adrenergic pumping of K into cells
Hyperglycemia, due to counterregulatory effect of adrenergic agonist |
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What must you ALWAYS take with a LABA for asthma?
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Inhaled corticosteroid to prevent inflammation - B agonists are proinflammatory
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What is ipratropium used for?
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COPD, Acute bronchospasm
Tx of choice for beta blocker induced bronchospasm NOT FDA approved for asthma, but you might use it if a patient did not tolerate BAgonists |
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What are systemic corticosteroids two uses in asthma?
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Burst therapy - acute exacerbations
Long term therapy in severe, persistant asthma sufferers |
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What do systemic corticosteroids do that is so great for asthma?
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Increase B receptors, improving response from B agonists
Prevent inflammation that would induce airway remodeling Prevent hyperresponive mucus secretion |
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What is the longest that burst therapy should last?
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10 days
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What class are the following:
Beclomethasone, fluticasone, budesonide |
Inhaled corticosteroids
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What should patients do after taking inhaled CS?
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rinse mouth
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What is cromolyn's MOA?
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Mast-cell stabilizer - prevents degranulation of inflammatory mediators
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What is theophylline indicated for?
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COPD in patients who can't use inhalers
Long-term prevention of asthma exacerbations, particularly at night |
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What is Theophylline's MOA?
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PDE inhibitor - causes bronchodilation
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What do montelukast and zileuton have in common?
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Leukotriene modifiers for COPD/asthma
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What is Omalizumab's (Xolair) MOA?
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Antibody for IgE, used for asthma
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How is xolair (Anti-IgE) administered?
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Injection
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What specific condition is Roflumilast (a PDE-4 inhibitor) approved for?
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Severe COPD combined with chronic bronchitis
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Which of the following is the most likely cause of a patient’s change in visual acuity?
Isoniazid toxicity Ethambutol toxicity Pyrazinamide toxicity Rifampin toxicity |
Ethambutol toxicity - visual changes
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Which of the following medications most likely would have elicited hypokalemia?
Zileuton Tiotropium Theophylline Albuterol |
Albuterol
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A 10 yo asthmatic is prescribed a cromolyn sodium to be administered prior to vigorous activity to prevent an attack. Which of the following is the mechanism of action of this drug?
It blocks muscarinic receptors It inhibits the degranulation of mast cells It reduces bronchial inflammation and edema It selectively stimulates beta 2 receptor It stimulates all beta receptors |
Inhibits mast cell degranulation
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Which of the following medications can be used effectively to stop the bronchoconstriction resulting from her aspirin allergy?
Cromolyn Methylxanthines Prednisone Zileuton |
Zileuton - good for ASA induced asthma
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