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RC Test 4 > B4.078 Treatment of Pulmonary Disorders > Flashcards

B4.078 Treatment of Pulmonary Disorders Flashcards

1
Q

advantages of inhalation delivery

A

higher concentration of drug at the site of action

limits systemic side effects

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2
Q

disadvantages of inhalation delivery

A

airway hypersensitivity
delivery may be deranged due to underlying lung disease, mucous production
70% of people don’t use inhalers with the proper technique

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3
Q

what are 2 methods of inhalation

A

metered dose inhaler

nebulizer

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4
Q

discuss metered dose inhaler delivery

A

bronchodilator
beta 2 receptor agonists
improve airflow in obstructive lung diseases

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5
Q

what is Advair?

A

combo of LABA/ICS
dry powder administration
easier to take than a traditional inhaler

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6
Q

what is the principle behind nebulizer delivery

A

air passes through a liquid to turn it into an aerosol, which is then inhaled

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7
Q

what are some benefits to using nebulizers

A

cheaper drugs than metered dose inhalers

can be more effective if improper technique used on an inhaler (same effectiveness if both used properly, however)

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8
Q

downside to nebulizers

A

takes 10-15 minutes

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9
Q

what is bronchiectasis

A

inflamed and easily collapsible airways
progressive airway destruction with loss of airway clearance with colonization by bacteria
frequent exacerbations resulting in repeated antibiotics and hospitalizations

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10
Q

types of systemic pharm interventions for pulm disorders

A 
inhalation
oral
IV
intramuscular/subQ injection
transdermal
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11
Q

most common drug in pulmonary medicine (oral admin)

A

prednisone
glucocorticoid that suppresses inflammation systemically
used for asthma, COPD, autoimmune diseases, etc

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12
Q

IV drug used in pulmonary medicine

A

prostacyclin
vasodilator for pulmonary hypertension
short half life, unstable

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13
Q

injections used in pulmonary medicine

A

influenza and pneumococcal vaccines

biologics

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14
Q

transdermal drug used in pulmonary medicine

A

nicotine patch for smoking cessation

also can treat inflammatory diseases

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15
Q

side effects of glucocorticoids like prednisone (long term)

A 
euphoria
buffalo hump
hypertension
thinning skin
thin arms and legs, muscle wasting
benign intracranial hypertension
cataracts
moon face with red cheeks
increased abdominal fat
easy bruising
poor wound healing
osteoporosis
hyperglycemia
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16
Q

what is transrepression

A

activated receptor interacts with specific transcription factors (AP-1 and NF-kB) and prevents transcription of pro-inflammatory genes
inhibits cell mediated and humoral immunity

17
Q

what is transactivation

A

glucocorticoids bind to the cytosolic glucocorticoid receptor (GR)
newly formed complex translocates into the nucleus, where it binds to glucocorticoid response element (GRE) resulting in the regulation of gene expression
increased gluconeogenesis and other negative side effects**

18
Q

what is a focus of glucocorticoid drug development

A

blocking binding at GRE (blocking transactivation)

19
Q

non pharmacological interventions for pulm disorders

A

pressure
gases
surgical
potpourri

20
Q

negative pressure

A

devices work by producing an intermittent negative pressure around the thorax and abdomen
transpulmonary pressure increases, thereby assisting inhalation and inflating the lungs
passive elastic recoil deflates the lungs

21
Q

positive pressure

A

elevation of central airway pressure above atmospheric pressure
pressure gradient between central airways and the alveoli causes air to move into the pulmonary parenchyma
as the lung inflates, alveolar pressure also becomes positive relative to atm pressure
exhalation takes place when mouth pressure returns to atm and gradient is reversed

22
Q

what is a protective strategy to avoid damage from positive pressure ventilation

A

volume restriction and airway pressures below 30 cm H2O

23
Q

indications for invasive positive pressure ventilation (intubation)

A

respiratory failure
hemodynamic instability
paralysis (trauma, anesthesia)
decreased level of consciousness

24
Q

indications for noninvasive positive pressure ventilation

A

hypoxia
hypercapnia
obstructive sleep apnea

25
Q

contraindications for noninvasive positive pressure ventilation

A

hemodynamic instability (MI)
decreased level of consciousness
copious secretions
active nausea/vomiting

26
Q

when is helium used in pulm dysfunction

A

cases of airflow obstruction
low density gas facilitates flow
paired with O2

27
Q

when should supplementary O2 be prescribed?

A 
PaO2 < 55 or SaO2 < 88%
PaO2 56-59 with evidence of:
-P pulmonale
-pedal edema
-secondary erythrocytosis
28
Q

what are some examples of surgical interventions in lung disease

A

resection
volume reduction
excision of large bullae

29
Q

what is a resection

A

lobar resection vs. pneumonectomy

done w lung cancer

30
Q

what is volume reduction surgery

A

resection/oversewing of upper lobe of emphysematous lung tissue

31
Q

why does volume reduction surgery help emphysema

A

better generation of breaths

diaphragm less flattened

32
Q

who should be considered for lung transplant evaluation

A

any ambulatory patient less than 65 years old with end stage pulmonary disease in the absence of other significant organ dysfunction

33
Q

criteria for transplant

A

medical therapy ineffective or unavailable
limited life expectancy, usually <2 yrs
ambulatory with rehab potential
acceptable nutritional status
satisfactory psychosocial profile and support system
adequate coverage for the procedure and care after transplant

34
Q

1st line treatment for pulmonary embolus

A

anticoagulation

35
Q

2nd line treatment for pulmonary embolus

A

IVC filter interruption

36
Q

what % of PEs arise from lower extremities

A

65-90%

37
Q

ipratropium

A

anti-cholinergic

38
Q

cromolyn

A

mast cell stabilizers

39
Q

montelukast

A

leukotriene antagonist

RC Test 4 (22 decks)

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