Bronchodilators, PDEI, Anticholinergics, Prostaglandins

prostaglandins, thromboxanes, leukotrienes, lipoxins

What are the 4 classes of eicosanoids?

20 carbon polyunsaturated fatty acids

What is the compound that makes up eicosanoids?

vasodilation, temp, WBCs, immune response

Eicosanoids regulate what functions?

Prostaglandins

What stimulates SM contraction, modulates CNS, and stimulates steroid synthesis?

Leukotrienes

What is synthesized and released by WBCs in response to injury/inflammation?

Thromboxanes

What alters platelet structure and plays a major role in clot formation?

Key role in inflammation, blood flow control, clot formation, and labor induction

What are the major functions of prostaglandins?

True

True or False: Prostaglandins are vasoactive and can dilate OR constrict arteries.

PGE1 and PGI2

What are the primary prostaglandins produced by the kidneys and act as vasodilators?

PGE1 and PGI2

Which prostaglandins act on the afferent arterioles to maintain glomerular perfusion and filtration and have the capacity to keep BF controlled despite systemic vasoconstriction?

Bronchodilators, anti-inflammatory, and methylxanthines

What are the three main pulmonary meds used to treat airway reactivity?

beta-2 agonists and anticholinergics

What are the two main classes of bronchodilators?

Corticosteroids, cromolyn, and leukotriene modifiers

What are the 3 main anti-inflammatory drugs classes?

Increase cAMP, decrease iCa, and stabilize mast cell membranes

What is the MOA of beta-2 agonists?

Albuterol, salmeterol

What are examples of beta-2 agonists?

Albuterol and terbutaline

Which beta-2 agonists are SELECTIVE?

Asthma and premature labor

What are the clinical uses for beta-2 selective agonists?

terbutaline, epi, albuterol

Which drugs are SYSTEMIC beta-2 agonists?

Albuterol, levalbuterol, metaproterenol

What drugs are INHALED SHORT acting beta-2?

Salmeterol

What drugs is a INHALED LONG acting beta-2?

Atropine, scopolamine, glyco

What drugs are SYSTEMIC anticholinergics?

Ipratropium

What drug is a INHALED SHORT acting anticholinergic?

Tiotropium

What drug is a INHALED LONG acting anticholinergic?

M3 antagonism leads to decrease IP3 and iCa

What is the MOA of anticholinergics?

Ipratropium

Which anticholinergic is a short-acting rescue med for asthma that causes bronchodilators r/t antimuscurinic actions?

Tiotropium

Which anticholinergic is a long acting maintenance therapy med used in COPD?

M2

Which M-receptor limits AcH, therefore preventing bronchoconstriction?

M1 and M3

Which M-receptor(s) are responsible for bronchoconstriction and mucous production and are the MAIN target sites for inhaled anticholinergics?

Atropine

What drug is a TERTIARY amine and can cross the BBB?

Glycopyrrolate

What drug is a QUATERNARY amine, hydrophilic, and can be used as an intermediate acting bronchodilator (not mainly used)?

Decrease airway inflammation and hyper responsiveness

What is the MOA of corticosteroids?

Dysphasia, laryngeal myopathy, oral yeast, and adrenal suppression

What are the SE of corticosteroids?

Cromolyn

Which drug stabilizes mast cell membranes and takes weeks to work?

Leukotriene modifiers

Which drug inhibits 5-lipoxygenase enzyme and decreases leukotriene synthesis?

Montelukast, Pranlukast

What drugs are leukotriene modifiers? (Think -KASTS)

Theophylline

Which drug is a methylxanthine?

Theophylline

Which drug inhibits phosphodiesterase, increases cAMP and endogenous catecholamine release?

N/V/D, HA, sleep issues

What are the SE of Theo when PK is >20?

Seizures, dysrhythmias, CHF

What are the SE of Theo when PK is >30?

Asthma

What disease is acute, has reversible obstruction accompanies by chronic inflammation, and bronchial hyper reactivity?

Atopy (condition of being hyper-allergic)

What is the greatest risk factor for developing asthma?

Allergic (extrinsic)

What type of asthma is IgE mediated, happens earlier in life, and involves SM contraction around airway?

Idiosyncratic (intrinsic)

What type of asthma is initiated by a NON-immune mechanism, develops later in life, no family hx involved, and can be induced by exercise/pollution/infection/or stress?

Asthma management

With what disorder would the following anesthesia management tactic be done: reflex suppression, ETT avoidance, deep extubation, lidocaine/opioids when awake, or HME usuage?

Albuterol and Sevoflurane

What 2 DRUGS can be used to treat acute bronchospasm?

IV agents

What must you do if you are unable to ventilate when bronchospasm present?

Parasympathetic

Which part of the ANS regulates airway caliber, gland activity, and microvasculature in the lungs?

True

True or false: SNS has NO direct control of muscle tone in airways?

100, DIIE, HAH

What are the major steps done to treat acute bronchospasm?

(100% FiO2, deepen anesthesia, inhaled B2 and anticholinergic, epi, hydrocortisone, aminophylline, Heliox)

COPD

Unlike asthma, obstruction is NOT fully reversible with what disorder?

Smoking, infection, dust exposure, anti trypsin deficiency

What are the main causes of COPD?

1-1.5mg/kg

What dose of lidocaine is used to suppress cough and blunt HD response for intubation?

2%/5mL OR 100mg

Vagal stimulation

Bronchospasm happens after intubation r/t to what?

Deep extubation

Be cautious in utilizing WHAT in patients with difficult airways, full stomachs, and obesity?

Helium

What anesthetic adjunct reduces PVR, WOB, and Reynolds's #?

Nitric oxide

What drugs is an inhaled selective dilator that is used to tx reversible pulmonary HTN and used a lot in newborns?

Ketamine

What drugs is an NMDA antagonist and acts as a powerful bronchial relaxant by DECREASING niTROUS oxide production and inflammation?

Ketamine

What drug binds to opioid and M-receptors and is considered cardiac stable?

Ketamine

What drug has the SE of INCREASING secretions?

Proposal

What drug increases the duration of GABA activation resulting in bronchodilation and decreased CRMO2?

Etomidate

What drug acts on GABA-A receptors and has vasorelaxant properties in pulmonary arteries?

Etomidate and ketamine

What 2 drugs are considered cardiac stable and can be used for induction if pt's BP is already very low?

Opioids and ketorolac

What drugs have a great affect on RR and can actually INCREASE airway resistance/cause bronchoconstriction?

Ketorolac

What drug must you avoid in patient with ASA-intolerant asthma?

Hemabate

What drug is used to help treat uterine bleeding and can cause bronchoconstriction in asthma patients?

IV hydration

What should you consider to help decrease viscosity of secretions?

Aspiration

Tilt head down, suction, secure airway, apply PEEP, use bronchodilators, and administer lidocaine to treat what?

NITROUS oxide, ketamine, desflurane

What drugs INCREASE PVR?

NITRIC oxide, NTG, PDI, PGE1, PGI2, CCBS, ACEI

What drugs DECREASE PVR?

PDE3

Which enzyme inhibitor increases cAMP and cGMP, promotes vasodilation of peripheral vessels, and prevents platelet aggregation?

PDE4

Which enzyme inhibitor targets airways, skin and immune system?

Roflumilast, Apremilast

What drugs are PDE4 inhibitors? (Think -LAST)

PDE5

Which enzyme inhibitor increases cGMP, targets genitals and lungs, and enhances nitric oxide mediated dilation?