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pathopharm > pulmonary > Flashcards

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
Q

intrinsic (nonatopic) asthma

A

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
Q

bronchial asthma

A

chronic inflammatory disease of the airways that causes periodic attacks of coughing, wheezing, shortness of breath, and chest tightness

27
Q

asthma manifestations

A

wheezing, shortness of breath, chest tightness; symptoms more common at night

28
Q

diagnosing asthma

A

test peak expiratory flow, give bronchodilator, retest expiratory flow; not diagnosed until >2 yrs old

29
Q

asthma treatment

A

bronchodilators (B2 agonists, xanthines, anticholinergics); inhaled corticosteroids; mast cell inhibitors; leukotriene receptor antagonists; oxygen

30
Q

beta 2 agonists

A

adrenergics, epinephrine, albuterol, salmeterol, formoterol

31
Q

albuterol (proventil, ventolin)

A

short acting beta2 agonist; selective; common inhaler

32
Q

salmeterol (serevent) and formoterol (foradil)

A

long acting beta2 agonist; selective; inhaler

33
Q

catecholamine B2 agonist

A

ephedrine, epinephrine, isoproterenol; cannot be given orally; shorter acting

34
Q

beta 2 agonist adverse effects

A

sympathetic NS effects, insomnia, restlessness, tremor, cardiac stimulation, bronchospasm rebound; caution in pt. w/ HTN

35
Q

anticholinergics

A

bronchodilators; block action of ACh; not as effective as B2 agonists (used for pt. who can’t tolerate B2 agonist)

36
Q

ipratropium (atrovent)

A

short acting anticholinergic bronchodilator

37
Q

tiotropium (spiriva)

A

long acting anticholinergic bronchodilator; not for acute asthma episodes

38
Q

xanthines

A

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
Q

aminophylline and theophylline

A

xanthines; treat asthma and COPD; must be used regularly to maintain levels; limit caffeine; take serum levels; monitor for tachycardia

40
Q

corticosteroids

A

reduces inflammation; usually combined with bronchodilator; given IV during acute episodes, then weaned off orally

41
Q

budesonide (pulmicort turbuhaler); fluticasone (flovent); beclomethasone (beclovent, vanceril)

A

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
Q

antileukotrienes (leukotriene receptor antagonists)

A

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
Q

leukotrines

A

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
Q

montelukast (singulair)

A

antileukotriene; prevent and treat chronic asthma; assess HA, NVD, liver function tests, and myalgia (muscle pain)

45
Q

1 risk factor for COPD

A

smoking

46
Q

genetic defect causing COPD

A

deficiency of alpha 1 anti-trypsin; normally prevents enzymatic destruction of lung tissue, deficiency causes alveolar wall destruction and dec. lung elasticity

47
Q

goblet cells

A

mucus producing cells; hypertrophied in COPD –> more mucus production

48
Q

COPD manifestations

A

sputum, cough, SOB, barrel chest, pursed lip breathing (to inc. lung pressure), use of accessory muscles

49
Q

COPD pathophysiology

A

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
Q

emphysema

A

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
Q

“pink puffer” disease

A

emphysema (air trapping and pursed lip breathing)

52
Q

chronic bronchitis

A

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
Q

COPD treatment

A

smoking cessation (use nicotine patches); bronchodilators, beta agonists, anticholinergics, xanthines; steroids, antibiotics(prevent pneumonia); oxygen (pt. may resist)

54
Q

pulmonary embolism

A

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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