APEX Respiratory Pathophysiology Flashcards by Jacob Martinez

Chemicals that contribute to increased airway resistance

Inositol triphosphate
PLC
Leukotrines
Thromboxane A2

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Bronchoconstriction MOA

Vagus nerve-
ACH-
m3-Gq on cellulare membrane
PLC converts PIP2 to IP3
Increases CA
Contractio

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bronchodilation moa

non cholinergic PNS
VIP on cell membrane
NO
cGMP
Relaxations
——- 2 pathways
catecholamines
b2 receptor on cell membrane
Gs activates AC
Ac converts atp to cAMP
Decreases CA and causes relaxation
cAMP also increase PKA whick causes relaxation in lungs

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Anticholinergic drugs

Atropine (crosses BBB)
Glycopyrrolate (doesnt cross BBB)
Ipratropium
Scopalamine

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Anticholinergic MOA

M3 antagonism -> decrease IPC -> decrease iCA

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anticholinergic side effects

inhibits secretions- dry mouth
urinary retention
blurred vision

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B2 MOA

B2 increases cAMP -> decreases iCA

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B2 SE

Tachycardia
dysrhythmias
hyperglycemia
tremors
hypokalemia
opposite of BB

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Bronchodilator drug classes

Bronchodilators- B2 agonists, anticholinergics
Anti-inflammatories- corticosteroids, cromolyn, leukotriene modifiers
Methylxanthines- theophylline

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Anti inflammatory drugs

Corticosteroids- budenoside, fluticasone
Cromolyn
Leukotrine modifiers- montelukast

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Corticosteroid MOA

stimulates intracellular steroid receptors
Decreases airway inflammation and hyperresponsiveness

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Methylxanthine MOA

Theophylline- inhibits PDE -> increases cAMP
Increases catecholamine release
Inhibits adenosine receptors

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Which PFT is most sensitive indicator of small airway disease

Forced expiratory flow 25-75%

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Dynamic PFTs

FEV1
FVC
FEV1:FVC ratio
FEF 25-75%
MMV

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FEV1:FVC ratio

Normal- 75-80%
Compares the two
differentiates between obstructive and restrictive diseases
<70% indicates Obstructive, restrictive usually normal

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FEF 25-75%

AKA MMEF (mid maximal expiratory flow rate)
Normal: 100+/- 25%
Measures airflow in middle of FEV
Most sensitive indicator of small airway disease
Reduced with obstructive
Normal with restrictive

Best PFT of endurance?

Normal- M-140-180L W-80-120L
MMV Maximum voluntary ventilation
Max air that can be inhaled and exhaled in one minute

PFTs measure ____ (3 things)

Static lung volumes- how much air the lungs can hold at one single point in time
Dynamic lung volumes- how quickly air can be moved in and out of the lungs over time
Diffusing capacity- how well the lungs can transfer gas across capillary membrane

Diffusing capcity of o2, co, co2

21
17
400

Respiratory FV loop

Backwards
Starts on right side at 0, then goes down and to left during inspiration, and down and right for expiration

Patient predictors of post op pulmonary complications

Age over 60
CHF
COPD
Smokers (40 pack years)
Low albumin
NOT ASTHMA

What isnt a predictor of post op pulmonary complications?

asthma
ABGs
PFTs

Procedures that increase risk of post op pulmonary complications

2.5 hours and above
Surgical site neck or thoracic region or near diaphgram
GA

What does short term cessation do to pulmonary complications?

nothing- need atleast 6 weeks
at 6 weeks- increased airway function, increased cilia clearance, sputum production, immunity

ARM alveolar recruitment maneuvers

40cmh2o for 8 seconds then use peep to keep them open use lowest fio2 bc high fio2 causes atelectasis

Anesthetic considerations for pulmonary complications pre op, intra op, post op

Pre- bronchodilators, corticosteroids, abx, deep breaths intra- regional instead of GA, short procedures post- effective analgesia (nerve block, neuraxial opioids, PCA), recruitment maneuvers (cpap, spirometer, deep breathing)

Surgeries with highest risk of pulmonary complications

aortic thoracic upper abdominal

What blood test indicates high risk of PPC

albumin <3.5

Obstructive vs restrictive

O- problem getting air out, but can get it out over longer period of time R- small lung volumes are the problem, cant get volume up high bc restricted

PFT differences between obstructive and restrictive

O- increased FRC, increased RV, TLC O- decreased FEV1:FVC ratio, decreased fef 25-75%

Obstructive vs restrictive examples

O-COPD, asthma R- Fibrosis, kyphoscoliosis, obesity

Stimuli for asthma attack

Cold air Aspirin Vagal stimulation Physical activity

Anesthetic considerations for asthma (airway and vent)

Suppression of airway reflexes Avoid intubation if able- use regional or LMA Deep extubation should be considered If awake intubation- lidocaine and opioids will reduce airway activity Limit inspiratory time, prolong expiratory time HME will benefit patients with exercise induced asthma

Anesthetic considerations for asthma- drugs

Volatile agents reduce resistance and dilate the airway- sevo may also reduce coughing and spasm Ketamine only IV drug that bronchodilates, but also causes secretions prop reduces reflexes Lido before extubation suppresses refleces NO BB

Opioids and NMBs that cause bronchoconstriction in asthmatics

Morphine and meperdine Succ/ atracurium

Acute treatment for bronchospasm

Epi 1mcg/kg Ketamine 1mg/kg Lidocaine 1.5mg/kg NO HYDROCORTISONE- only for chornic

Presentation of bronchospasm (vs asthma)

Wheezing Decreased breath sounds Increased resistance Increased PIP with normal plateau pressure Increased alpha angle on capnography

Bronchospasm treatment

100% fio2 Deepen anesthetic Albuterol Ipratropium Epi 1mcg/kg iv Hydrocortisone 2-4mg/kg iv (for future prevention)