wwall RX Review Ch 1,2,10&11 6/08
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| show | blocks ACH causing bronchodilation
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| calculating dose | show 🗑
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| powder aerosols | show 🗑
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| Checking MDI contents | show 🗑
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| show | hold 1" from mouth, exhale normally, squeeze MDI at beginning of slow deep inhalation, inhale fully and hold for 5 seconds, exhale-wait 2 mins and repeat.
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| sympathomimetic bronchodilators method of action | show 🗑
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| show | stimulates G protein in bronchial smooth muscle, G protein makes cAMP and cAMP equals bronchodilation
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| atropine and method of action | show 🗑
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| Cholinergic | show 🗑
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| ACH regulation | show 🗑
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| show | 1. re-uptake via active transport 2. MOA and COMT enzymes
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| NE regulation at cells | show 🗑
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| show | un-ionized are very water and lipid soluble and absorb quickly, because they are able to pass easily through plasma membrane
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| show | receptor site of ACH, parasympathetic, class of drugs that stimulate ACH, action is decreased HR, bronchoconstriction and vasodilation
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| show | special case of synergism where one has no effect but can increase the effectiveness of the other 1+0=2
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| show | norepinephrine, neurotransmitter of sympathetic nervous system, receptors sites are a, B1 and B2
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| a action | show 🗑
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| show | increased HR, increased contractility, increased cardiac output
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| B2 action | show 🗑
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| show | liver * alphabetically e and k come first in alphabet fallowed by l and m, so excretion = kidney and liver=metabolism
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| show | kidneys * alphabetically e and k come first in alphabet fallowed by l and m, so excretion equal kidney and liver equals metabolism, excretions also takes place in lungs and GI tract
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| ACHase | show 🗑
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| show | many membranes; stomach, capillaries and tissues-3 factors, transport mechanism, lipid solubility and drug ionization (un-ionized)
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| show | aka acetylcholine, aka cholinergic, aka parasympathetic, receptor site M, action decreased HR, decreased BP, bronchoconstriction
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| show | more physiological effect with smaller dose, more potent-more toxic, lower the effective dose-more potent
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| Parenteral | show 🗑
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| show | GI tract, pills caplets, suppository, elixir, suspension (most common)
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| show | transdermal, cream patch ointment, inhaled, MDI, DPI, SVN, USN, atomized, vaporized
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| show | receptor site of Sympathetic NS aka adrenomimetic, receptors sites are a, B1 and B2
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| Pharmacokinetics | show 🗑
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| tid | show 🗑
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| show | every 4 hours
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| qid | show 🗑
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| show | 2 times daily
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| drug distribution | show 🗑
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| show | passive diffusion (most common) moves from high to low, filtration, and active transport
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| show | "a drug that acts like" i.e. atropine is prototype anticholinergic and epinephrine is prototype adrenergic
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| pharmacodynamics | show 🗑
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| sympathetic nervous system | show 🗑
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| show | median lethal dose
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| show | Therapeutic Index, ratio of LD50 to ED50 indicates drugs safety, lower TI is the more toxic the drug, higher the TI, the safer the drug.
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| show | specifically blocks m receptor sites
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| Competitive antagonist | show 🗑
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| show | effects of two drugs cancel each other out
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| show | effective dose
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| Idiosyncrasy | show 🗑
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| show | rapidly developing tolerance to a drug
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| show | blocks ACHase enzyme
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| show | enzymes that metabolize excess Ne, can be injected or inhaled
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| Pharmacology | show 🗑
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| Epinephrine | show 🗑
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| Ceiling effect | show 🗑
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| show | enzyme that breaks up cAMP
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| Choline esters action | show 🗑
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| SLUD | show 🗑
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| show | competitive (affinity but no effect), functional (effects of 2 cancel each other), chemical (physically chemically binds in blood stream)
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| show | two drugs act on receptors to have a combined effect that is the sum of the two drugs effect 1+1-2
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| show | USP, NF, PDR
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| drug class that includes Albuterol that cause bronchodilation | show 🗑
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| show | aka synergism when two drugs are combined and the effect is greater than the sum, 1+1-3
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| Parasympathetic | show 🗑
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| MDI on Mechanical Vent | show 🗑
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| show | effective ceiling is 15 mg, heart neb for continuous, hazard is hypovolemia, decreased k+, increased glucose
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| show | immediate onset of action at site, reduced systemic side effects, smaller doses, pt can be taught to self admin, convenient and rapidly effective while minimizing side effects
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| Aerosol disadvantages | show 🗑
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| Nebulizer flow rates | show 🗑
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| show | inspiratory hold (3-5 seconds) is most important for distribution and retention of meds-slow deep breath, 6 L/min flow for 1-5 micron particles, 2.5-4 ml’s solution, inspiration only
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| show | convenient, inexpensive, no prep, new MDI’s are patent actuated and assures proper aspiratory flow and pattern
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| MDI disadvantages | show 🗑
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| show | meds tend to stick to tube or baffle, 1.5 to 3% make it to airway, SVN should be distal to pt in circuit (close to flow source) often requires double dose
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| show | reservoir, improves med delivery, holds in suspension
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| show | tachycardia and shakiness
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| show | 1-5 microns
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| Direct installation | show 🗑
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| show | Epi-cardiac arrest, NS-sputum sample, B2, mucomyst, surfactant in premies.
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| Combivent | show 🗑
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| show | mg-mL* % * 10
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| show | sympathomimetic (increase cAMP), anticholinergic (block ACH), Xanthines (inhibit Phosphodiesterase increasing cAMP)
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| show | aka theophylline, caffeine, thrombromine & theophylline, Phosphodiesterase inhibiter, used in treating neonate apnea and bradycardia, long term COPD. Bad side effects.
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| show | desired dose/dose on hand=amount/X example morphine in 10 mg/5mL vial, need 4 mg.....10/5=4/X.....10X/10=20/10.....X=2 vials
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| Anticholinergic bronchodilators | show 🗑
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| show | alpha (racemic epi)+ steroids. Steroids also treats secretions, treat swelling and secretions will go down too.
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| what is Bronchoconstriction | show 🗑
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| the anticholinergic bronchodilators drugs are | show 🗑
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| Combovent | show 🗑
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| Albuterol dosage | show 🗑
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| Xopenex dosage | show 🗑
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| show | strong a, B1, and B2 drugs, cannot be taken orally, (because of stomach MAO & COMT), very short duration 1- 3 hrs, epi, racemic epi (Vapoenephrine), isoproterenal (Isuprel)
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| the recorcinol drugs are | show 🗑
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| show | albuterol, levalbuterol, (Xopenex) and salmeterol (Serevent)
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| strong a, B1, B2 drugs | show 🗑
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| Strong B2 agonist drugs | show 🗑
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| show | Isoproterenol (Isuprel)
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| strong B2, mild B1 agonist are | show 🗑
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