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A1 > APEX Respiratory Pathophysiology > Flashcards

APEX Respiratory Pathophysiology Flashcards

1
Q

Chemicals that contribute to increased airway resistance

A

Inositol triphosphate
PLC
Leukotrines
Thromboxane A2

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2
Q

Bronchoconstriction MOA

A

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

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3
Q

bronchodilation moa

A

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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4
Q

Anticholinergic drugs

A

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

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5
Q

Anticholinergic MOA

A

M3 antagonism -> decrease IPC -> decrease iCA

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6
Q

anticholinergic side effects

A

inhibits secretions- dry mouth
urinary retention
blurred vision

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7
Q

B2 MOA

A

B2 increases cAMP -> decreases iCA

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8
Q

B2 SE

A

Tachycardia
dysrhythmias
hyperglycemia
tremors
hypokalemia
opposite of BB

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9
Q

Bronchodilator drug classes

A

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

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10
Q

Anti inflammatory drugs

A

Corticosteroids- budenoside, fluticasone
Cromolyn
Leukotrine modifiers- montelukast

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11
Q

Corticosteroid MOA

A

stimulates intracellular steroid receptors
Decreases airway inflammation and hyperresponsiveness

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12
Q

Methylxanthine MOA

A

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

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13
Q

Which PFT is most sensitive indicator of small airway disease

A

Forced expiratory flow 25-75%

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14
Q

Dynamic PFTs

A

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

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15
Q

FEV1:FVC ratio

A

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

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16
Q

FEF 25-75%

A

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

17
Q

Best PFT of endurance?

A

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

18
Q

PFTs measure ____ (3 things)

A

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

19
Q

Diffusing capcity of o2, co, co2

A

21
17
400

20
Q

Respiratory FV loop

A

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

21
Q

Patient predictors of post op pulmonary complications

A

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

22
Q

What isnt a predictor of post op pulmonary complications?

A

asthma
ABGs
PFTs

23
Q

Procedures that increase risk of post op pulmonary complications

A

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

24
Q

What does short term cessation do to pulmonary complications?

A

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

25
Q

ARM alveolar recruitment maneuvers

A

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

26
Q

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

A

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)

27
Q

Surgeries with highest risk of pulmonary complications

A

aortic
thoracic
upper abdominal

28
Q

What blood test indicates high risk of PPC

A

albumin <3.5

29
Q

Obstructive vs restrictive

A

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

30
Q

PFT differences between obstructive and restrictive

A

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

31
Q

Obstructive vs restrictive examples

A

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

32
Q

Stimuli for asthma attack

A

Cold air
Aspirin
Vagal stimulation
Physical activity

33
Q

Anesthetic considerations for asthma (airway and vent)

A

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

34
Q

Anesthetic considerations for asthma- drugs

A

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

35
Q

Opioids and NMBs that cause bronchoconstriction in asthmatics

A

Morphine and meperdine
Succ/ atracurium

36
Q

Acute treatment for bronchospasm

A

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

37
Q

Presentation of bronchospasm (vs asthma)

A

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

38
Q

Bronchospasm treatment

A

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

39
Q
A

A1 (122 decks)

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