wwall RX Review Ch 1,2,10&11 6/08
Help!
|
|
||||
|---|---|---|---|---|---|
| Anticholenergic action | blocks ACH causing bronchodilation
🗑
|
||||
| calculating dose | mg=mL x % x 10
🗑
|
||||
| powder aerosols | activated by pt breath, advantage is pt must breath correctly for device to work, no propellant
🗑
|
||||
| Checking MDI contents | full=fully submerged and upside down in water, 1/2 full= upside down but not fully submerged, empty, canister will float on side
🗑
|
||||
| MDI technique | 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.
🗑
|
||||
| sympathomimetic bronchodilators method of action | stimulate production of cAMP causing bronchodilation
🗑
|
||||
| Adrenergic agonist method of action | stimulates G protein in bronchial smooth muscle, G protein makes cAMP and cAMP equals bronchodilation
🗑
|
||||
| atropine and method of action | aka anticholinergic, aka antimuscarinic, blocks ACH receptor sites, causes bronchodilation by blocking ACH, competitive antagonist for M receptor
🗑
|
||||
| Cholinergic | indirect acting, drug that acts or mimics parasympathetic action, stimulates M receptor
🗑
|
||||
| ACH regulation | 1. metabolized by enzyme ACHase aka acetylcholinesterase 2. ACH blockers like atropine, Ipratropium or Tiotropium
🗑
|
||||
| NE regulation at synapse | 1. re-uptake via active transport 2. MOA and COMT enzymes
🗑
|
||||
| NE regulation at cells | cells regulate NE by increasing cAMP or blocking phosphodiesterase (enzyme that breaks up cAMP)
🗑
|
||||
| Un-ionized | un-ionized are very water and lipid soluble and absorb quickly, because they are able to pass easily through plasma membrane
🗑
|
||||
| Muscarinic | receptor site of ACH, parasympathetic, class of drugs that stimulate ACH, action is decreased HR, bronchoconstriction and vasodilation
🗑
|
||||
| Potentiation | special case of synergism where one has no effect but can increase the effectiveness of the other 1+0=2
🗑
|
||||
| Ne | norepinephrine, neurotransmitter of sympathetic nervous system, receptors sites are a, B1 and B2
🗑
|
||||
| a action | vasoconstriction, increased BP, stops bleeding,decrease swelling,
🗑
|
||||
| B1 action | increased HR, increased contractility, increased cardiac output
🗑
|
||||
| B2 action | smooth muscle relax, bronchodilation
🗑
|
||||
| Metabolism | liver * alphabetically e and k come first in alphabet fallowed by l and m, so excretion = kidney and liver=metabolism
🗑
|
||||
| Excretion | 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
🗑
|
||||
| ACHase | acetylcholinesterase aka ACHE, enzyme that metabolizes excess ACH
🗑
|
||||
| Drug absorption | many membranes; stomach, capillaries and tissues-3 factors, transport mechanism, lipid solubility and drug ionization (un-ionized)
🗑
|
||||
| ACH | aka acetylcholine, aka cholinergic, aka parasympathetic, receptor site M, action decreased HR, decreased BP, bronchoconstriction
🗑
|
||||
| Potency | more physiological effect with smaller dose, more potent-more toxic, lower the effective dose-more potent
🗑
|
||||
| Parenteral | injectable aka IM, IV
🗑
|
||||
| Entral | GI tract, pills caplets, suppository, elixir, suspension (most common)
🗑
|
||||
| Topical | transdermal, cream patch ointment, inhaled, MDI, DPI, SVN, USN, atomized, vaporized
🗑
|
||||
| Adrenergic | receptor site of Sympathetic NS aka adrenomimetic, receptors sites are a, B1 and B2
🗑
|
||||
| Pharmacokinetics | quantifies the time required for drug absorption, distribution, metabolism and method of excretion
🗑
|
||||
| tid | 3 times per day
🗑
|
||||
| q4h | every 4 hours
🗑
|
||||
| qid | 4 times daily
🗑
|
||||
| bid | 2 times daily
🗑
|
||||
| drug distribution | plasma protein binding, tissue affinity and blood flow
🗑
|
||||
| drug transport | passive diffusion (most common) moves from high to low, filtration, and active transport
🗑
|
||||
| prototype | "a drug that acts like" i.e. atropine is prototype anticholinergic and epinephrine is prototype adrenergic
🗑
|
||||
| pharmacodynamics | studies the actions of drugs on the body, how drugs work
🗑
|
||||
| sympathetic nervous system | fight or flight aka adrenergic, more dominant side of ANS, functions as a unit, effector site neurotransmitter is Ne. increases HR, increases BP, vasoconstriction, bronchodilation, contractility
🗑
|
||||
| LD 50 | median lethal dose
🗑
|
||||
| TI | 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.
🗑
|
||||
| Antimuscarinic | specifically blocks m receptor sites
🗑
|
||||
| Competitive antagonist | competes for receptor site, blocks but has no effect
🗑
|
||||
| Functional antagonist | effects of two drugs cancel each other out
🗑
|
||||
| ED50 | effective dose
🗑
|
||||
| Idiosyncrasy | unexplained or unpredictable susceptibility to a drugs action
🗑
|
||||
| Tachyphylaxis | rapidly developing tolerance to a drug
🗑
|
||||
| Anticholinesterase | blocks ACHase enzyme
🗑
|
||||
| COMP & MOA | enzymes that metabolize excess Ne, can be injected or inhaled
🗑
|
||||
| Pharmacology | study of drugs and their origin plants animals and minerals
🗑
|
||||
| Epinephrine | not a neurotransmitter, released by adrenal gland in response to sympathetic activation
🗑
|
||||
| Ceiling effect | response increases with dose until dosage increase does not increase effect-used to check relative potency of 2 or more drugs
🗑
|
||||
| Phosphodiesterase | enzyme that breaks up cAMP
🗑
|
||||
| Choline esters action | stimulate m receptors and mimic effects of ACH
🗑
|
||||
| SLUD | salivation, lacrimation, urination, defecation; to much ACH to much slud, to much slud –death
🗑
|
||||
| Antagonist categories | competitive (affinity but no effect), functional (effects of 2 cancel each other), chemical (physically chemically binds in blood stream)
🗑
|
||||
| Additive effect | two drugs act on receptors to have a combined effect that is the sum of the two drugs effect 1+1-2
🗑
|
||||
| Drug info | USP, NF, PDR
🗑
|
||||
| drug class that includes Albuterol that cause bronchodilation | adenergic B-agonist
🗑
|
||||
| Synergistic response | aka synergism when two drugs are combined and the effect is greater than the sum, 1+1-3
🗑
|
||||
| Parasympathetic | aka cholinergic, rest and digest, neurotransmitter is ACH, receptor sites are Muscarinic and nicotinic, blocker is atropine, does not function as a unit
🗑
|
||||
| MDI on Mechanical Vent | medial to pt on circuit, actuate at end expiration adjust dosage as needed, minimum 8 puffs may go to 20, 15 seconds between puffs
🗑
|
||||
| High dosing Albuterol | effective ceiling is 15 mg, heart neb for continuous, hazard is hypovolemia, decreased k+, increased glucose
🗑
|
||||
| Aerosol advantages | 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
🗑
|
||||
| Aerosol disadvantages | exact dose is unknown, only 10-20% is deposited, breathing pattern effects airway deposit, 2/3 exhaled, much swallowed, wrong neb or flow effects delivery
🗑
|
||||
| Nebulizer flow rates | 6-7 L/min * however since neb can run at 10 L/min and not 4 L/min appropriate answer on test is 7-10 L/min
🗑
|
||||
| SVN delivery factors | 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
🗑
|
||||
| MDI advantages | convenient, inexpensive, no prep, new MDI’s are patent actuated and assures proper aspiratory flow and pattern
🗑
|
||||
| MDI disadvantages | requires pt coordination, pharyngeal deposits, abuse risks, cfc’s 75% of pt’s and 50% of medical workers don’t know how to use them
🗑
|
||||
| Mech vent and SVN | 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
🗑
|
||||
| Spacer | reservoir, improves med delivery, holds in suspension
🗑
|
||||
| Bronchodilator side effects | tachycardia and shakiness
🗑
|
||||
| SVN particle size | 1-5 microns
🗑
|
||||
| Direct installation | giving meds directly down ET tube or trach, 3-5 ml normal dose, no guarantee of dose, most often used for mucus plugging. Disadvantage, violent cough and systemic side effects
🗑
|
||||
| Direct installation drugs | Epi-cardiac arrest, NS-sputum sample, B2, mucomyst, surfactant in premies.
🗑
|
||||
| Combivent | ventolen + atrovent combination sympathomimetic and anticholinergic, best with copd’er
🗑
|
||||
| Finding active ingrediance | mg-mL* % * 10
🗑
|
||||
| Bronchodilator categories | sympathomimetic (increase cAMP), anticholinergic (block ACH), Xanthines (inhibit Phosphodiesterase increasing cAMP)
🗑
|
||||
| Xanthines | aka theophylline, caffeine, thrombromine & theophylline, Phosphodiesterase inhibiter, used in treating neonate apnea and bradycardia, long term COPD. Bad side effects.
🗑
|
||||
| Finding desired dose | 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
🗑
|
||||
| Anticholinergic bronchodilators | blocks ACH-blocks SLUD, causes decreased secretions, increased HR, bronchodilation, prototype is atropine (bad side effects) Ipratropium is safer alternative, good choice for bronchospasm in COPD with B2 agonist
🗑
|
||||
| Swelling & edema treatment | alpha (racemic epi)+ steroids. Steroids also treats secretions, treat swelling and secretions will go down too.
🗑
|
||||
| what is Bronchoconstriction | REDUCED AIRWAY LUMEN , caused by smooth muscle bronchospasm, swelling and edema, excess secretions
🗑
|
||||
| the anticholinergic bronchodilators drugs are | atropine (prototype), ipratropium (Atrovent) tiatropium (Spiriva) glycopyrrolate (Robinol)
🗑
|
||||
| Combovent | albuterol + ipratropium (Ventolen + Atrovent), B2 agonist plus anticholinergic
🗑
|
||||
| Albuterol dosage | .5% mL or 2.5 mg (.5mL+2.5mL NS), MDI 2 puffs 3-4 hrs, rapid onset=5 mins, effective 4-6 hrs aka Provental or Ventolen,
🗑
|
||||
| Xopenex dosage | aka levalbuteral, single isomer albuterol with no side effects, but very expensive, standard dose .63 mg, max 1.25 every 4-6 hrs
🗑
|
||||
| what are catecholamines and what are their actions? | 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)
🗑
|
||||
| the recorcinol drugs are | modified catecholamines, resistant to MAO and COMT, terbuterline (stops contractions) and metaproterenol (not used now because of B1 side effects, hard on heart)
🗑
|
||||
| the saligenin drugs are | albuterol, levalbuterol, (Xopenex) and salmeterol (Serevent)
🗑
|
||||
| strong a, B1, B2 drugs | epinephrine and racemic epinephrine (Vaponephrine)
🗑
|
||||
| Strong B2 agonist drugs | levalbuterol (Xopenex) is the only single isomer B2 agonist drug, all others have some B1 effects
🗑
|
||||
| Strong B2, strong B1 agonist are | Isoproterenol (Isuprel)
🗑
|
||||
| strong B2, mild B1 agonist are | bitolterol (Tornalate), albuterol, (Provental, Ventolen), pirbuterol (Maxair), salmeterol (Serevent) terbutaline, metaproterenol (Alupent)
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
annabannana
Popular Respiratory Therapy sets