PHCP - Module 1 Flashcards by Xei Lee

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laryngopharynx

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Windpipe

Trachea

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Contains upper, middle, lower lobe

Right Lung

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Contains upper and lower lobe

Left Lung

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Final destination of inhaled cells
No smooth muscles

Alveoli

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Thin epithelial cell

Pneumonocytes

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AKA Hay Fever

Allergic Rhinitis

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It involves inflammation of nasal mucous
membranes in sensitized individuals when
inhaled allergenic particles contact mucous
membranes and elicit a response mediated by
immunoglobulin E (IgE).

Allergic Rhinitis

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Mediators of immediate
hypersensitivity include :

histamine, leukotrienes,
prostaglandin, tryptase, and
kinins.

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Dark circles under the
eyes

allergic shiners

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Determines whether rhinitis is caused by immune response to allergens.

Allergy testing

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Commonly used Allergy testing

Immediate-type hypersensitivity skin tests

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safer and more generally
accepted than intradermal testing, which is usually
reserved for patients requiring confirmation.

Percutaneous testing

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can detect IgE antibodies in the blood that are specific for a given antigen, but it is less sensitive than percutaneous tests.

radioallergosorbent test (RAST)

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most effective first-line drug treatments for Rhinitis

– Nasal corticosteroids with or without oral or nasal antihistamines
-Oral antihistamines plus oral decongestants (eg, a
sympathomimetic such as pseudoephedrine)

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Less effective alternatives include

nasal mast cell stabilizers (eg, cromolyn) given 3 or 4 times a
day,
nasal H1 blocker azelastine 1 to 2 puffs twice a day, and
nasal ipratropium 0.03% 2 puffs every 4 to 6 hours, which
relieves rhinorrhea.

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A chronic allergic disorder characterized by
episodes of severe breathing difficulty,
coughing, and wheezing using the air passage
to narrow & causes shortness of breath.
* These episodes are usually reversible, either
spontaneous or with treatment.
* The inflammation is due to bronchia hyper
responsiveness to a variety of stimuli

Asthma

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Occurs 6-9 hours after allergen provocation
– Involves the activation of eosinophils, T lymphocytes,
basophils, neutrophils and macrophage

Late phase inflammatory reaction

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Migrates to the airways and release inflammatory
mediators (leukotrienes and granule proteins) cytotoxic
mediators and cytokines

EOSINOPHILS

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Release cytokines from type 2 T-helper cells that mediate
allergic inflammation.( IL-4, IL-5 and IL-13)
– Type 1- T- helper produces IL-2 and Interferon gama that
are essential for cellular defense mechanism

T- lymphocytes

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Release of histamine, eosinophil and neutrophil chemotactic factors, leukotriene C4, D4 and E4,
prostaglandin and platelet activating factors.

Mast Cell degranulation

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capable of inducing smooth muscle
constriction and bronchospasm and may play a role in
mucosal edema and mucus secretion.

Histamine

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release a number of inflammatory mediators including
PAF and leukotrienes B4, C4 and D4
– 5 lipoxygenase pathway of arachidonic acid metabolism
– Produce Cysteinyl leukotrienes C4, D4 and E4
Released during the inflammatory process in the lungs and causes
bronchospasm, mucus secretion and airway edema

Alveolar macrophages

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Releases eicosanoids, peptidases, matrix proteins, cytokines and nitric oxide

Bronchial epithelial cells

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– Expectorated mucus from patients with asthma are:

highly viscous

Characterized by episodic dyspnea with wheezing – Coughing particularly at night – These often occurs during exercise – Other signs: * Expiratory wheezing on auscultation * Dry hacking cough * Signs of atopy (Allergic rhinitis or eczema)

Chronic Asthma

During vigorous exercise, pulmonary functions (FEV1) in patients with asthma increase during the first few minutes but then begin to decrease after 6 to 8 minutes

EXERCISE-INDUCED BRONCHOSPASM

Type of asthma which may be worse when the air is cold and dry

Exercise-induced asthma

Type of asthma triggered by workplace irritants such as chemical fumes, gases or dust

Occupational asthma

Type of asthma triggered by particular allergens, such as pet dander, cockroaches or pollen

Allergy-induced asthma

is the volume of air that can forcibly be blown out after full inspiration, measured in liters. -most basic maneuver in spirometry tests

FVC: Forced vital capacity (FVC)

the volume of air that can forcibly be blown out in one second, after full inspiration. Values of between 80% and 120% of the average value are considered normal.

FEV1

the ratio of FEV1 to FVC. – In healthy adults this should be approximately 70–85% (declining with age)

FEV1/FVC (FEV1%)

B2RA w/ some B1 activity ADE: Tremors, Nervousness in 2-6yrs old

Albuterol sulfate (Proventil HFA, Ventolin HFA, ProAir HFA)

B2RA w/ some B1 activity Attractive choice in tx of acute symptoms in younger children

Pirbuterol (Maxair Autohaler)

B2RA w/ some B1 activity Effective in smaller doses. fewer ADE

Levalbuterol (Xopenex)

Anticholinergic INH secretions from serous and seromucous glass lining the nasal mucosa

Ipratropium (Atrovent)

Anticholinergic + B2 little effect on cardiac muscle contractility

Ipratropium + Albuterol (Combivent, DuoNeb)

Corticosteroid, Oral decreases inflammation bu reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity

Prednisone (Deltasone, Orasone) Methylprednisone (SoluMedrol, Medrol) Prednisolone (Pediapred, Prelone, Orapred)

Long-Acting B2 Bronchial Smooth muscle relaxation

Formoterol (Foradil, Performist) Salmeterol (Serevent)

Long-Acting B2 Increased intracellular cyclic AMP

Arformoterol (Brovana)

Corticosteroid. -Elicit local anti-inflammatory effects to respiratory effect

Mometasone

Corticosteroid. Potent anti-inflammatory activity

Fluticasone

Corticosteroid. INH multiple types of inflammatory cells

Budesonide

B2 Agonist elicit bronchial smooth muscle relaxation

Formoterol

Long-Acting B2 Agonist bronchial smooth muscle relaxation

Salmeterol

Symbicort

Budenoside/Formoterol

Dulera

Mometasone/Formoterol

Advair

Salmoterol/Fluticasone inhaled

INH 5-lipoxygenase INH Leukotriene formation

Zileuton

Methylxanthines Directly relaxes smooth muscle of resp tract

Theophylline (Theo-24, Theocron, Uniphyl)

Mast Cell Stabilizer INH release of histamine, leukotrienes, and other mediators

Cromolyn sodium (Intal)

Monoclonal Antibody Recombinant humanized monoclinal antibody

Omalizuyab (Xolair)

Corticosteroid, Inhalant aerosol inhaled indicated for maintenance treatment of asthma as prophylactic therapy

Ciclesonide (Alevasco)

Corticosteroid, Inhalant INH bronchoconstrictions mechanism

Beclomethasone (QVAR, Beclovent)

Corticosteroid, Inhalant Glucocorteroid, anti-inflam

Triamcinolone inhaled (Azmacort) Flunisolide (Aerobid, AeroSpan, Nasalide)

Leukotriene Receptor Antagonist selective competitive inh of LTD4 and LTE4 receptors

Zafirlukast (Accolate)

Leukotriene Receptor Antagonist blocks binding of leukotriene D4 to its receptor Advantage: chewable

Montelukast

* Airflow limitation that is NOT FULLY reversible with bronchodilators

COPD

As compared to asthma, ______ is associated with neutrophilic rather than eosinophilic inflammation.

COPD

is associated with chronic or recurrent excessive mucus secretion into the bronchial tree with cough that is present on most days for at least 3 months of the year for at least 2 consecutive years.

Chronic bronchitis

Permanent enlargement of the airspaces distal to the terminal bronchioles🡪 decreased alveolar spaces available for gas exchange🡪 1. loss of alveoli walls🡪 Decreased elastic recoil🡪 airway limitation.

Emphysema

Pink puffers

Emphysema

emphysema associated with smoking and typically most severe in the upper lobe

Centriancinar

involves central alveioli, distal and terminal bronchioles. Typically most severe in the lower lungs. Common in patients with HOMOZYGOUS ALPHA 1 ANTITRYPSIN

Panancinar

The most common etiologic factor is exposure to environmental

tobacco smoke

responsible for inhibiting several protease enzymes, including neutrophil elastase.

AAT

AAT is __________

α1-antitrypsin

MOST SIGNIFICANT SYMPTOM of COPD

Breathlessness

Blue Bloater

Chronic Bronchitis

Stage 0

at risk

Stage 1

Mild COPD

Stage 2:

Moderate COPD

Stage 3

Severe COPD

Stage 4:

Very Severe COPD

A drug used as an antidepressant. * Can markedly reduce nicotine cravings. * Though associated with an increased risk for seizures

Bupropion

a new agent became available to assist in tobacco cessation attempts. - a nicotine acetylcholine receptor partial agonist that has shown benefit in tobacco cessation. - Varenicline relieves physical withdrawal symptoms and reduces the rewarding properties of nicotine.

Varenicline