Pulmonary Flashcards
tracheal epithelial cell type in a smoker
ciliated columnar epithelium metaplasia to squamous
this is significant because sputum is no longer moved easily
Kartagener syndrome
defective dynein (walking along microtubules) leading to nonfunctional cilia at: respiratory tract sinuses eustachian tubes Fallopian tubes Flagella of sperm
Presents with: chronic infections infertility hearing loss situs inversus
suptum transversum
embryological origins for the diaphragm, converges with the pleuroperitoneal membrane
dorsal mesentery of esophagus
abdominal wall
at 4 months
causes of pulmonary HTN
primary- mutated bone morphogenetic protein receptor type II, which controls pulmonary smooth muscle proliferation
secondary:
COPD, sleep apnea, frequent thromboembolism, mitral stenosis, left- to- right cardiac shunts.
Bosentan mechanism
antagonist at endothelin 1 receptor decreases pulmonary vascular resistance, but can be hepatotoxic (monitor LFT)
Asthma meds
bronchospasm and inflammation beta2 agonists -albuterol, levalbuterol smooth muscle relaxation acute asthma exacerbation
nebulizer or inhaler
There may be mild beta1 agonist activity at high doses. Jitteriness, tachycardia, but this is less seen with levalbuterol
Salmeterol
long-acting, ppx, adverse effects: tremor, tachycardia
combine with inhaled steroid
Corticosteroids
decrease inflammation
- inhibit cytokine synthesis
- inhibit TNFa production
beta-2 agonists for mild intermittent asthma. If using more than 1-2 times per week, inhaled, oral, IV steroids
inh:
fluticasone, budesonide, beclomethasone
Systemic steroids
severe chronic asthma
or use in conjunction during
acute asthma exacerbation with inhaled beta2 agonists
oral or IV
pt may revert after steroids wear off. this is the basis for several days of treatment, followed by taper
Cromolyn
prevents release of mediators from mast cells. prevents bronchoconstriction and inflammation
used for prophylaxis only
ipratropium, tiotropium
muscarinic antagonists, block mACh receptors
decreased overall vagal (parasympathetic tone) in the lungs
smooth muscle relaxation leading to bronchodilation and decreased mucus production
zileuton
5-lipoxygenase inhibitor, blocks conversion of arachidonic acid to leukotrienes, responsible for PMN chemotaxis and bronchospasm
Zafirlukast and montelukast
prevent chemotactic and bronchospastic effects of LKED4 by blocking the zafirleukast receptor
zafirlukast in children over 2
montelukast approved for children over 5
can be used for allergic rhinitis
Methylxanthines (Theophylline)
Bronchodilation by inhibiting phosphodiesterase Very narrow therapeutic index leads to cardiotoxicity- tachycardia, hypotension antidote= beta blocker neurotoxicity- seizures
CYP450 metabolism
BLOCKS THE ACTIONS OF ADENOSINE
narrow therapeutic index, last resort drug
Expectorant- guaifenesin
loosen sputum
large doses
does not suppress cough reflex (hence destramethorphan)
expectorant- N- acetylcysteine
acetaminophen overdose, mucolytic that cleaves disulfide bonds within mucous glycoproteins
Prevents contrast- induced renal nephropathy (given before and after contrast)
