Cystic Fybrosis Flashcards
Cystic Fibrosis
autosomal recessive
MC life limiting genetic disorder in caucasian population
life expectancy: 40 yrs
salty
later onset chronic bacterial infection of airways
adequate pancreatic exocrine function or pancreatitis
CFTR membrane protein
Normal:
transports Cl- ions outside cell –> neg charge outside –> Na+ ions follow to outside–> water leaves cell –> thin mucus
Mutation:
- no transportation
- high electrolyte concentration in cell
- water stays in cell
- thick mucus –> blocked lung channels –> obstruction, infection, inflammation
Long arm chromosome 7 and CFTR gene
88% delta F508
also G551D
CFTR Mutations: Class I
defective protein production
worst to have
no synthesis
CFTR Mutations: Class II
MC
defective protein processing
includes delta F508
second most detrimental to have
reduced trafficking
CFTR Mutations: Class III
defective regulation
includes G551D
gating mutation (impairs opening of the ion channel)
reduced gating
CFTR Mutations: Class IV
defective conduction
decreased conductance
CFTR Mutations: Class V
reduced number of active CFTR
reduced synthesis
Cystic Fibrosis: treatment goals
slow/stop progression of disease
allow for normal growth/development
Cystic Fibrosis: approaches to care
good nutrition
pancreatic enzymes and vitamin supplementation
airway clearance and anti-inflammatory therapies
antipseudomonal agents
recognize altered pharmokinetics
Cystic Fibrosis: treatments
chest physiotherapy
antibiotics (tobramycin, aztreonam)
pancreatic enzyme supplements
multivitamins (including fat soluble)
anti-obstructives (dornase alpha, hypertonic saline, N-acetylcysteine, bronchodilators)
anti-inflammatory (macrolides-azithromycin, ibuprofen)
CFTR modulators (ivacaftor, lumacaftor, tezacaftor)
vaccinations (influenza, pneumonia) and palivizumab
supplemental oxygen
BiPAP
lung transplant
Chest Physiotherapy
postural drainage
chest percussion (cupped hand)
vibration technique device
“Pulmonary Toilet” Regimen
6+ yo and concurrent with percussion therapy
- bronchodilator (opens airways, prevents bronchospasm)
- hypertonic saline (hydration, facilitates mucociliary function)
- dornase alpha (dec viscosity of mucus)
- aerosolized abx
Anti-Obstructives: bronchodilator
beta 2 adrenergic agonists (albuterol)
theophylline
anticholinergic
- ipratropium (short acting)
- tiotropium (long acting, no significant improvement)
Anti-Obstructives: inhaled hypertonic saline
hydrates the mucus (draws water from airway to re-establish aqueous surface layer)
HyperSal
Anti-Obstructives: dornase alpha (rhDNase)
Pulmozyme
enzyme mucolytic agent
selectively cleaves DNA
- reduces mucus viscosity
- improved airflow
- dec risk of bacterial infection
Cystic Fibrosis: hallmark
abundant, purulent airway secretions composed of highly polymerized DNA from degenerated neutrophils
produces a viscous mucus (dec mucociliary transport and persistent secretions)
Dornase Alpha: ADEs
chest pain fever rash pharyngitis, rhinitis, FVC dec, dyspnea voice alteration dyspepsia conjunctivitis laryngitis **dornase alfa serum antibodies (decrease efficacy)** headache urticaria
Should we treat patients with CF with chronic oral antibiotics?
No
chronic treatment with ORAL antibiotics is not encouraged
Exceptions: azithromycin (anti inflammatory) nebulized tobramycin nebulized aztreonam inhaled colistin (MDR)
Cystic Fibrosis: pathogens
most prominent: S aureus
PSEUDOMONAS aeruginosa
and others but im too lazy to write them