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pulmonary Flashcards

1
Q

ventilation influences

A

pressure gradient, chest wall compliance, airway obstruction, rib fractures, pressure gradient, nerve innervation problems, muscle weakness

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2
Q

compliance

A

how easy the lungs can inflate; can be a chest wall issue or a lung issue

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3
Q

conditions that decrease chest wall compliance

A

obesity, kyphosis and scoliosis

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4
Q

conditions that decrease lung compliance

A

atelectasis (lung collapse), pneumonia, pulmonary edema

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5
Q

chemoreceptors

A

in CNS and PNS; measure blood oxygen or Co2 and control respiration based on levels

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6
Q

central chemoreceptors measure

A

Co2 and pH of cerebrospinal fluid

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7
Q

peripheral chemoreceptors measure

A

oxygen in arterial blood

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8
Q

hypoxemia

A

reduction of O2 in arterial blood to <60 mmHg; symptoms: agitation, euphoria, impaired judgement, hypoTN, bradycardia, cyanosis

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9
Q

hypoxemia compensatory mechanisms

A

SNS activates to try and inc. CO; acute hypoxemia: peripheral chemoreceptor stimulation –> inc. sympathetic outflow –> acute BP changes

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10
Q

hypercapnia

A

increased CO2 levels in arterial blood (>50 mmHg); causes respiratory acidosis; symptoms: inc. respiration, dec. nerve activity (carbon dioxide narcosis), dec. muscle contraction; vasodilation

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11
Q

antitussives

A

dextromethorphan (robitussin); CNS effect; suppress cough reflex; acts on medullary cough center in brain; don’t give if head injured or if cough is needed to ensure airway

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12
Q

dextromethorphan (robitussin)

A

antitussive; don’t give if head injured or if cough is needed to ensure airway

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13
Q

decongestants

A

usually adrenergics/sympathomimetics; decrease secretions by vasoconstriction (mimics SNS); shrink swollen membranes and open passages; can be oral, topical nasal spray, or topical nasal steroids

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14
Q

pseudoephedrine (sudafed)

A

oral decongestant; adrenergic; dec. nasal congestion and earache pain; caution when combined with other adrenergics, cardiac pt, HTN, or hyperthyroid pt; may rebound, limit use to 3-5 days

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15
Q

phenylephrine (coricidin)

A

topical nasal decongestant spray; OTC; local effect; monitor for rebound, limit use to 3-5 days; watch for nasal ulceration from constricted nasal vessels; caution w/ glaucoma (increases eye pressure)

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16
Q

fluticasone (flonase)

A

topical nasal steroid decongestant; anti-inflammatory effect; dec. systemic allergy symptoms; takes time to see full effect(weeks), must use every day; monitor for candida (fungal) infection, avoid illness exposure (dec. inflammatory response)

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17
Q

guaifenesin (mucinex)

A

expectorant; increase productive cough, dec. viscosity and adhesiveness of secretions; monitor for GI effects (GI mucous); assess why they’re taking it to make sure it’s not covering a bigger issue

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18
Q

diphenhydramine (benadryl)

A

antihistamine; directly compete with histamine for specific receptor sites; manage seasonal allergies, reactions, motion sickness, and sleep disorders; thickens bronchial secretions (caution in pt. w/ respiratory disease); monitor anticholinergic effects; can have opposite effect in kids (hyperactivity)

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19
Q

antihistamine properties

A

antihistaminic, anticholinergic, sedative, antipruritic (anti-itch)

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20
Q

acetylcysteine (mucomyst)

A

mucolytic; breaks up and liquifies mucous in high risk respiratory pts.; monitor GI; use a separate nebulizer form other meds (forms precipitate when mixed)

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21
Q

first line respiratory drug

A

topical nasal decongestants (to avoid systemic effects)

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22
Q

asthma

A

reversible airway obstruction

23
Q

COPD

A

chronic obstruction of airways; emphysema (alveoli damage) mixed with chronic bronchitis (inflammation/mucous)

24
Q

extrinsic (atopic asthma)

A

a type I hypersensitivity reaction (inc. IgE synthesis); allergens like dust, mold, and pollen; mast cells release inflammatory mediators; acute response within 10-20 mins; late-phase response from airway inflammation (4-8 hours)

25
intrinsic (nonatopic) asthma
no allergic component; triggers like cold air, pollutants, stress, and exercise; in exercise neutrophils still appear (drs. don't fully know why); aspirin and NSAIDS can trigger
26
bronchial asthma
chronic inflammatory disease of the airways that causes periodic attacks of coughing, wheezing, shortness of breath, and chest tightness
27
asthma manifestations
wheezing, shortness of breath, chest tightness; symptoms more common at night
28
diagnosing asthma
test peak expiratory flow, give bronchodilator, retest expiratory flow; not diagnosed until >2 yrs old
29
asthma treatment
bronchodilators (B2 agonists, xanthines, anticholinergics); inhaled corticosteroids; mast cell inhibitors; leukotriene receptor antagonists; oxygen
30
beta 2 agonists
adrenergics, epinephrine, albuterol, salmeterol, formoterol
31
albuterol (proventil, ventolin)
short acting beta2 agonist; selective; common inhaler
32
salmeterol (serevent) and formoterol (foradil)
long acting beta2 agonist; selective; inhaler
33
catecholamine B2 agonist
ephedrine, epinephrine, isoproterenol; cannot be given orally; shorter acting
34
beta 2 agonist adverse effects
sympathetic NS effects, insomnia, restlessness, tremor, cardiac stimulation, bronchospasm rebound; caution in pt. w/ HTN
35
anticholinergics
bronchodilators; block action of ACh; not as effective as B2 agonists (used for pt. who can't tolerate B2 agonist)
36
ipratropium (atrovent)
short acting anticholinergic bronchodilator
37
tiotropium (spiriva)
long acting anticholinergic bronchodilator; not for acute asthma episodes
38
xanthines
cause smooth muscle relaxation in respiratory tract; inhibit release of slow-reacting substance or anaphylaxis and histamine; reduces bronchial edema; narrow safety margin (check blood levels); avoid caffeine; paradoxical effect in high levels (tachycardia, nausea, seizures)
39
aminophylline and theophylline
xanthines; treat asthma and COPD; must be used regularly to maintain levels; limit caffeine; take serum levels; monitor for tachycardia
40
corticosteroids
reduces inflammation; usually combined with bronchodilator; given IV during acute episodes, then weaned off orally
41
budesonide (pulmicort turbuhaler); fluticasone (flovent); beclomethasone (beclovent, vanceril)
inhaled corticosteroids; no systemic effect; compliance issues w/ pt. stopping them when symptoms go away; rinse mouth after use to prevent fungal infection; bronchodilator and then steroid (lets steroid reach deeper in lungs)
42
antileukotrienes (leukotriene receptor antagonists)
prevent leukotrienes from attaching to receptors on cells in the lungs and circulation; for prevention and chronic treatment of asthma, not for acute attacks
43
leukotrines
substances released by mast cells when a trigger starts a series of chemical reactions in the body; cause inflammation, bronchoconstriction, and mucous production (coughing, wheezing, SOB)
44
montelukast (singulair)
antileukotriene; prevent and treat chronic asthma; assess HA, NVD, liver function tests, and myalgia (muscle pain)
45
#1 risk factor for COPD
smoking
46
genetic defect causing COPD
deficiency of alpha 1 anti-trypsin; normally prevents enzymatic destruction of lung tissue, deficiency causes alveolar wall destruction and dec. lung elasticity
47
goblet cells
mucus producing cells; hypertrophied in COPD --> more mucus production
48
COPD manifestations
sputum, cough, SOB, barrel chest, pursed lip breathing (to inc. lung pressure), use of accessory muscles
49
COPD pathophysiology
alveolar tissue destruction, inflammation and fibrosis of bronchial wall, chronic release of inflammatory cytokines, thickening and narrowing of bronchi, diminished airflow, air trapping, lung hyperinflation, hypertrophy of goblet cells
50
emphysema
increased neutrophils due to inhaled irritants; neutrophils in the alveoli secrete trypsin which breaks down and stiffens alveoli; dec. gas exchange sites; loss of elasticity--> air trapping and hyperinflation; SOB
51
"pink puffer" disease
emphysema (air trapping and pursed lip breathing)
52
chronic bronchitis
chronic irritation of major and small airways; inc. goblet cells (mucus hypersecretion); bronchiolar wall fibrosis; fluid retention and R sided HF; peripheral edema, productive cough, cyanosis
53
COPD treatment
smoking cessation (use nicotine patches); bronchodilators, beta agonists, anticholinergics, xanthines; steroids, antibiotics(prevent pneumonia); oxygen (pt. may resist)
54
pulmonary embolism
blood clot in a pulmonary artery obstructing blood flow to lung tissue; DVT is a risk factor; immobility and malignancy (cancer) are risk factors

pathopharm (7 decks)

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