pulmonary drugs
Terms
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- Thiopental
-
IV anesthetic
not good for sick or injured - Methohexital
-
iv anesthetic
not good for sick or injured
oxybarbitol
short acting, can use repeatedly and prolonged - propofol
-
gold standard for routine casesIV anesthetic
rapid recovery time
antiemetic effect - etomidate
-
IV anesthetic
less vasodilation and heart rate depression
used for hypovolemics causes post nausea - ketamine
-
psychomimetic effects can be blunted with comb Tx
dissociative anesthesia
patient remains responsive
good with trauma pts./
stimulated CV systen and preserves aireway reflexes leading to bronchodilation
Increases cerebral blood flow
good for hemorrhaging patients, stat c section - general characteristics of IV anesthetics
-
rapid onset
short duration
fill volume of distribution
can have high lipid solubility leading to high Vd
usually decreased cerebral blood flow -
tetracain
procaine
chloroprocain -
local anesthetic
metabolized in the blood -
toxicity of local anesthetics
contraindications -
sedation,
seizures,
tinnitus
decreased contractility, rate and conduction
contra:aortic stenoisis coaguopathy and shock - types of nervous blockades
-
topical (for intubation and dental procedures)
infiltration (sub q for stitches and biopsy)
nerve block: inject near nerve to numb who region
intravenous limb block: use of tournequet
nueraxis block: lowe ab. and limb only -
lidocaine
bupivicaine
mepivicaine - local anesthetics metabolized in the liver
- nonanesthetics
-
narcotics
sedatives
muscle relaxants - narcotic characteristics
-
analgesic, sedative, not anesthetic, not amnestic
intense pain relief
reverse with naxolone
not good for chronic or post op pain
quick, short acting - benzodiazapenes
-
pre op sedatives, reduce anxiety
produce amnesia and unconsciousness -
pancuronium
curare
succinylcholine - muslce paralysis only, no analgesic or anesthetic
- H1 organs
-
blood vessels
capillaries
bronchioles
GI
uterus
Sa node
myocardium
nerve - H2 organs
-
sa node
myocardium
secretory tissues
blood vessels - diphenhydramamine
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotension
benadryl
allergies
motion - dimenhydrinate
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotensiondramamine
motion sickness - tripelenamine
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotension
allergies - hydroxyzine
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotension
allergies pruritis - meclizine
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotension
motion sickness antiemetic - chlorpheniramine
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotension
allergies - promethizine
-
first generation h1 receptor competitive antagonists
PO, 2-4 hours
cause sedation, dry mouth
hypotension
antiemetic - terfenadine
-
with arrythromyaacin causes torsades de pointes
allergies - loratidine
-
minor tremor, headache rash
for allergies
second generation longer lasting
no sedative, anticholinergic effects PO - cetirizine
-
minor tremor, headache rash
for allergies
second generation longer lasting
no sedative, anticholinergic effects PO - fexofenadine
-
minor tremor, headache rash
for allergies
second generation longer lasting
no sedative, anticholinergic effects PO - Cimetidine
-
h 2 receptor competitive antagonist
PO short duration
p450 inhibition
anti adrogenic
for peptic ulcers
CNS confusion -
ranitadine
nizatidine
famotidine -
h 2 receptor competitive antagonist
PO short duration
for peptic ulcers
CNS confusion - isoniazide
-
tb TX
pro drug
decreases mycolic acid synthesis
acetylated in liver then ecreted in urine
#1prophylaxis
AE peripheral neuropathy
risk of hep
GI malaise - rifampin
-
tb TX
blocks bacterial dna dependent RNA pol
increased hepatic enzymes
cidal
used in multi drug tx
ORANGE excretions!! - ethambutanol
-
TB Tx static
limits sx's
stops cell wall arabinogalactin synth
AE optic neuritis
contraindicated in kids who can't do eye exams - pyrazinamide
-
TB Tx
nicotinimide analog
pro drug
cidal prophylaxis
hepatotoxicity acute episodes of gout - streptomyacin
-
aminoglycoside
works slowly
block protein synth
IM or IV
cidal - ciprofloxacin
-
TB tx
blocks bacterial DNA synth
cidal
especially MAC
some tendonitis and joint pain - rifabutin
-
MAC tx
disseminated - ethionamide
-
similar to INH
no x resistance - cycloserine
-
highly toxic
but very effective for TB tx. last resort -
cromolyn
nedocromil -
prophylactic
inhibits mast cell degranulation
inhalation and nasal spray for allergic rhinitis - theophylline (caffeine)
-
inhibition of PDE
bronchodilation
PO but systemic AE
CNS tremor
increased chronotropy, inotropy
increased gastric secretion -
b agonists
albuterol
metorpterenol
terbutaline
pirbuterol -
bronchodilation
short acting
inhaler -
salmeterol
formeterol - longer lasting bs agonist
- ipratroprium
-
muscarinis antagonist
decreases vagal ACh
inhaled
45 min
used especially for COPD -
corticosteroids
beclomethasone
triamcinolone
fluticasone -
inhaled or PO
(thrush) (withdrawal) (iatrogenic cushings)
antiinflammatory
not for acute Tx
doesn't reverses bronchospasm
prophylactic -
zileuton
zariflukast -
blocks 5 lipoxygenase
blocks LTD4
PO only works for some pts - aldosterone
-
adrenal steroid
replacement therapy
mineralcorticoid
AE HTN hypokalemia
h20 retention - spirolactone
-
comeptitive inhibitor of aldosterone
used in CHF or hyperald.
AE hyperkalemia
gynecomastia, impotence - ACTH
-
causes release of steroids from the adrenal gland
IV or IM
prevent megacolon. test for adrenal fx - Hydrocortisone
-
upregulates mRNA/protein synth
protein breakdown
gluconeogenesis
lipolysis
buffalo hump
moon face due to NA h2o retent
increased BP
anti inflammatory due to suppression of ICAM, no PMN migration
binds albumin and other plasma protein
metabolized by liver
used for arthritis
asthma
allergies
immunosupression
AE osteoporosis
hyperglycemia
HTN
PUD
acne - prednisone
-
#1 PO
short - methylprednisone
-
#1 INSOLUBLE
short
arthritis - triamcinolone
-
topical
allergic rxns
intermed. - dexamethasone
-
long
asthma
poison ivy - betamethasone
-
long asthma,
hyalin membrane - dextromethorphan
-
OTC antitussive
decreases medullary cough center reflex
poor opiode
not analgesic/sedative, addiction etc - codeine
-
opiode antitussive
can cause sedation
addiction, tolerance
mucosal drying
used for PAINFUL cough - demulcents
-
cough drops
provides protective coating
antitussive -
local anesthetics (lidocaine
benzocaine
tetracaine) -
antitussive
used before bronchoscopy\
tetracain decreases pulmonary stretch receptors - iodides
-
expectorant
rarely used
liquefy secretions and increased secretions
unpleasant taste
skin eruptions
hypothyroid - guanifensin
-
robutussin
OTC expectorant
not clear efficacy - mucolytics (acetylcysteine)
-
free sulhydril groups
decrease viscosity of mucus
good fro chronic bronchitis or CF
can cause bronchoconstriction
used with bronchodilator - proteolytic enzymes
-
expectorant
break down lysed cells
dnases (dornase)
can cause local irritation and allergic rxn -
phenylephrine
phenylpropanolamine
oxymetazaline -
decongestents
alpha adrenergic agonists
vasoconstriction of blood vessels
topical therefore few systemic AE's
but only 2-3 days: downregulation of receptors that can lead to rebound hyperemia -
pseudoephedrine
ephedrine
sudaphed PE -
decongestents
alpha adrenergic agonists
vasoconstriction of blood vessels
long acting
PO: if no congested can't use nasal spray
can have increased BP esp. with MAOI -
nicotine
metabolism
mechanism
effects -
weak base
rapid absorption into CNS passive diffusion active uptake into choroid plexus
biotransformation in the liver cotinine: longer half life, also biotranformation in lung, renal excretion
effects at autonomic ganglia, adrenal medulla,
NMJ. reward pathway.
arousal, relaxation, euphoria, concentration memory
AE: bronchoconstriction
ACTH release
platelet aggregation
endothelial damage
increase cortisol
tolerance, wtihdrawal - buproprion
-
smoking cessation
decreases norepi, dopamine, seratonin reuptake - clonidine
-
smoking cessation
decreased norepi release with a2 antagonist - naloxone
- opiate antagonist
- Gamma vinyl GABA
- decreases nicotine craving by decreasing brain dopamine activity.