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Respiratory > Obstructive and Restrictive Lung Disease > Flashcards

Obstructive and Restrictive Lung Disease Flashcards

1
Q

What are the two general categories for drugs that treat obstructive airway conditions?

A
  1. Relievers- bronchodilators

2. Preventers- ati- inflammatory

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2
Q

What is step 1 in asthma treatment?

A

SABA

Salbutamol

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3
Q

What is step 2 in asthma treatment?

A

SABA + ICS (200-800 micrograms)

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4
Q

What is step 3 in asthma treatment?

A

SABA + LABA + ICS

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5
Q

What is step 4 in asthma treatment?

A

Increase ICS dose from step 3

Add fourth drug e.g. theophylline or a leukotriene receptor antagonist

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6
Q

What is step 5 in asthma treatment?

A

Use daily steroid tablet ( prednisolone)

Maintain high dose ICS (2000 micrograms)

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7
Q

Which immune cells are corticosteroid effective against in the mucosa ?

A

Eosinophils

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8
Q

What is a downside to corticosteroid use in asthma or COPD?

A

It weakens the immune system, and impairs the mucociliary escalator.
This increases chance of infection
In COPD chances of pneumonia infection are boosted

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9
Q

ICS have a _____ therapeutic ratio and are ____ due to being delivered directly to the organ of interest

A

High

Topical

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10
Q

Oral corticosteroids have a ___ therapeutic ratio

A

Low

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11
Q

Why is a spacer useful for administering asthma medication?

A
  • Reduces oropharyngeal and laryngeal side effects (gag reflex/ nausea)
  • Reduces systemic absorption (no swallowing)
  • Acts as a holding chamber aiding inhalation
  • Reduces particle size and velocity allowing the particle to embed deeper in the lungs increasing effectivity
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12
Q

What are cromones and what is their function?

A
  • Cromones are used in asthma and are proposed mast cell stabilisers
  • This means they can prevent pro-inflammatory mediator release
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13
Q

How are leukotrienes formed during asthma?

A

They are produced due to processes involving the lipids in the cell membrane
The enzyme phospholipase A2 detaches fatty acids from the second carbon group of the glycerol molecule that makes up a lipid
One of these acids is arachinidonic fatty acids
When arachidonic acid is acted on by 5- lipoxygenase leukotrienes are formed

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14
Q

What happens when cycle-oxygenate acts on arachidonic acid?

A

Prostaglandins and thromboxanes are produced aiding inflammation and amplification

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15
Q

Which leukotriene is over produced in asthma?

A

LTD4

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16
Q

What is the effect of overproduction of leukotrienes in asthma?

A
  • Trigger contraction and proliferation of smooth muscle
  • Cause eosinophil influx (which release cationic proteins damaging epithelial cells)
  • Increases mucus secretion, but decreased transport
  • Oedema
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17
Q

Leukotriene receptor antagonists are used in asthma, name one that is used to bind to LTD4?

A

Montelukast

taken orally

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18
Q

What is anti- IgE and what is the name of one key form in relation to asthma called?

A

Monoclonal antibody

Omalizumab

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19
Q

OmalizumB has what effects?

A

Binds strongly to IgE inactivating it
Prevents pro-inflammatory mediators being released from basophils and mast cells
Boosted every 2-4 weeks via injection

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20
Q

Name two anti- IL5 drugs

A
  1. Mepolizumab

2. Reslizumab

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21
Q

How does anti- IL5 therapy work?

A

Th2 cells produce IL-5 in the immune response aiding eosinophilic inflammation in asthma
The use of anti- IL5 therapy is that eosinophilic inflammation is much reduced

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22
Q

Name 2 LABAs

A
  1. Formeterol

2. Salmeterol

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23
Q

What are the three different types of muscarinic receptors?

A
  1. M1 - enhance cholinergic reflex
  2. M2 -inhibit acetylcholine release
  3. M3 - mediate bronchoconstriction and mucus release
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24
Q

Muscarinic antagonists inhibit which type of muscarinic receptor ?

A

M3

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25
Q

Name a SAMA

A

Ipratropium

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26
Q

Name two LAMAs

A
  1. Tiotropium

2. Glycopyrronium

27
Q

Methylxanthines act as ______ and also ______

A

Bronchodilators

Anti-inflammatory drugs

28
Q

Name and example of a methylxanthine

A

Thophylline

29
Q

What is the function of phosphodiesterase 4 enzymes?

A

Hydrolyse cAMP

30
Q

What is the overall function of PDE4 inhibitors?

A

Prevent cAMP hydrolysis allowing high levels of cAMP in cells
Bronchial smooth muscle will become relaxed

31
Q

PDE4 inhibitors are for use only in ____

A

COPD

32
Q

Give an example of a PDE4 inhibitor

A

Roflumilast

33
Q

Why are PDE4 inhibitors used infrequently ?

A

Side effects such as nausea, diarrhoea and headaches

34
Q

What are mucolytics

A

Drugs which reduce the viscosity of mucous and reduce inflammation

35
Q

Give two examples of mucolytics

A
  1. Carbocisteine

2. Erdosteine

36
Q

Ina n acute asthma attack what treatment is given?

A
  • Oral prednisolone (40mg)
  • At least 60% oxygen aim for 94- 98% SpO2
  • Nebulised salbutamol
37
Q

What are some treatment methods for COPD?

A
  • Smoking cessation
  • Immunisation
  • Pharmacotherapy
  • Oxygen
  • Increase exercise
38
Q

Name two LAMAs

A
  1. Titanium

2. Aclidinium

39
Q

Name two LABAs

A
  • Olodaterol

- Formeterol

40
Q

Name an ICS for COPD use

A

Beclometasone

41
Q

Which antibiotic may be used for COPD?

A

Azithromycin

also amoxicillin and doxycycline

42
Q

How is acute COPD treated?

A
  • Nebulised high dose salbutamol and ipratropium
  • Oral prednisolone
  • Antibiotic (amoxicillin/ doxycycline) if infection
  • 24-28% O2
  • Non- invasive ventilation
43
Q

Which external factors can cause lung restrictions?

A
  1. Skeletal causes ( broken ribs, kyphoscoliosis)
  2. Muscle Weakness (intercostal/ diaphragmatic)
  3. Obesity (due to compression)
44
Q

What are the effects of lung compression from external sources?

A
  1. Reduced partial pressure of oxygen
  2. Reduced partial pressure of carbon dioxide
  3. Reduced lung volumes
  4. Hypoxia
45
Q

What is DPLD?

A

Diffuse parenchymal Lung Diseas
Interstitial lung disease
An umbrella term for lung diseases affecting the interstitium

46
Q

What is the interstitium of the lungs?

A

The space and tissues surrounding the alveoli

47
Q

What are the three main categories for ILD( interstitial lung disease)?

A
  1. Those with a known cause
  2. Those with an unknown cause( isopathic)
  3. Those associated with systemic disease
48
Q

Why may hypoxia occur at a thickened alveolar/ arteriolar barrier?

A

Carbon dioxide is ver soluble and easily diffuses across so can be blown off
Oxygen will not be able to pass the barrier into the blood as easily potentially leading to hypoxia

49
Q

Give two different causes for ILD

A
  1. LVF- fluid in alveolar lumen due to a raised pulmonary venous pressure
  2. Sepsis, adult respiratory distress syndrome damage, altitude sickness- Non- cardiac pulmonary oedema
50
Q

What is consolidation in the lungs?

A

Fluid within areas which there normally is not any fluid

51
Q

What can cause consolidation on a CXR?

A
  1. Pneumonia
  2. PE
  3. Alveolitis
  4. cryptogenic pneumonia (not infectious)
52
Q

What is alveolitis?

A 
This is the infiltration of inflammatory fluid into the alveolar walls 
It can be caused by:
- Drugs
- Toxic gases
- Fibrosing alveolitis
- Autoimmune disease
53
Q

What is pneumoconiosis?

A

Dust disease
Restrictive lung disease that can be either fibrogenic (asbestosis, silicosis) or non- fibrogenic (siderosis (due to iron), stenosis, baritosis (due to barium))

54
Q

What is carcinomatosis?

A

Body-wide spread of cancer and can contribute to DPLD

55
Q

How do eosinophils contribute to DPLD?

A

They occur alongside all sides of inflammation which is present in DPLD

56
Q

Symptoms of DPLD?

A
  • Breathlessness
  • Cough (without wheeze- no obstruction)
  • Finger clubbing
  • Lung crackles (inspiration)
  • Central cyanosis
  • Pulmonary fibrosis (chronic inflammation)
57
Q

How is FEV1 affected in DPLD?

A

It is reduced

58
Q

How is FVC affected in DPLD?

A

It is reduced

59
Q

What happens to the FEV1/ FVC ration in DPLD?

A

It remains normal as both variables decrease in proportion

60
Q

Aside from FEV1 and FVC what are the three main checks which must be covered for diagnosing DPLD?

A
  1. Arterial oxygen saturation (should be lowered in DPLD)
  2. CXR (bilateral consolidation is common)
  3. Presence of antibodies (caused by infection)
61
Q

How is DLPD treated?

A
  1. Cause is removed
  2. Inflammation is treated
  3. Oral prednisolone (systemic corticosteroids )
  4. ICS - if oral fails
  5. Oral azathioprine (immunosuppressor)
  6. Anti-fibrotic drugs (pirfenidone, ninetdanib)
  7. Oxygen (if hypoxic)
  8. Lung transplant- end stage disease
62
Q

In asthma, FVC is ____ but FEV1 is _____

A

Normal

Reduced

63
Q

What type of graph can help diagnose lung conditions?

A

Flow volume curve

64
Q

How does peak expiratory flow rate differ between obstructive and restrictive when compared to a normal result?

A

Obstructive - reduced

Restrictive - normal

Respiratory (12 decks)

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