Pulmonary Flashcards
what controls respiration?
1) . medullary rhythmic center
2) . Vagal input from lungs
3) . ABGs
effect of PNS on respiration?
produces mainly bronchoconstriction and mucus secretion
effect of SNS on respiration?
beta-2 receptors relax smooth muscles, increase mucocilliary clearance
what is a healthy V/Q ratio?
0.8
Ventilation to perfusion ratio
difference between volumes and capacities in the lungs?
capacities are when you add volumes up/together
drugs that can be used to treat respiratory tract irritation & control of secretions
1) . Decongestants
2) . Antitussives
3) . Antihistamines
4) . Mucolytics
5) . Expectorants
what do decongestants do?
counter mucous discharge from upper respiratory tract (nasal stiffness)
decongestants MOA
usually alpha-1 adrenergic agonist –> causes vasoconstriction –> reduces blood flow = “dry up” mucosal tracts
what do antitussives do?
used to suppress cough (dry unproductive cough)
Antitussives MOA
decrease afferent nerve activity or decrease cough center sensitivity
Antitussive drugs can include what?
Codeine and antihistamines
What are antihistamines used for?
to manage respiratory allergic responses to seasonal allergies
general MOA for antihistamines
act on nasal mucosa H1 receptor
what do H1 receptors blockers do?
reduce nasal congestion, mucosal irritation, and cough by reducing secretions
difference between 1st and 2nd generation antihistamines
1st generation cross the BBB which results in more drowsiness
general AEs for antihistamines
dry mouth, sore throat, cough, nausea, HA, diarrhea, and nervousness
Mucolytics MOA
split disulfide bonds –> decreases viscosity of respiratory secretions making it easier to clear mucus from the airway
what do expectorants do?
facilitate the production and ejection of mucus.
issues with cold remedies and hypertension
decongestants can mimic effects of increased sympathetic activity, thus hypertensive individuals should avoid them
COPD is an umbrella term for what conditions?
1) . emphysema
2) . chronic bronchitis
3) . asthma
what is emphysema?
pathologic accumulation of air in the tissues, particularly in the lungs
pathophysiology of emphysema?
alveoli are damaged and create large air spaces which reduce the SA for gas exchange.
clinical manifestations of emphysema
1) . barrel chests
2) . clubbed fingers
3) . tachypnea
4) . marked exertional dyspnea
5) . hypertrophied neck muscles
6) . anxiety related to dyspnea or fear of dyspnea
what is chronic bronchitis?
inflammation of airway and irritation that results in excess mucus production
hallmark of chronic bronchitis?
very productive cough that lasts for at least 3 months for 2 consecutive years
clinical manifestations of chronic bronchitis
1) . SOB
2) . persistent cough
3) . prolonged expiration
4) . recurrent infection due to increased mucus in airways
5) . late effects include pulmonary hypertension
goals of trx for COPD
reduce airway edema secondary to inflammation and bronchospasm
how to achieve trx goals for COPD
1) . facilitate the elimination of bronchial secretions
2) . prevent and treat respiratory infections
3) . increase exercise tolerance
Drug classes used to treat COPD
1) . Bronchodilators
2) . Anti-inflammatory
3) . Antibiotics
Types of Bronchodilators
1) . inhaled beta agonists
2) . inhaled antimuscarinics
MOA of inhaled beta-agonists
agonize beta-2 receptors –> increase bronchodilation
suffix for inhaled beta-agonists
-terol
what are SABAs?
short acting beta-agonists
what are SABAs used for?
acute exacerbations, works within 5 minutes and lasts 4-6 hours
what are LABAs?
long acting beta-agonists
what are LABAs used for?
chronic managements, 12-24 hour duration, must be dosed once or twice daily
AE for inhaled beta-agonists
generally well tolerated. AE can include: tachycardia, tremor, hypokalemia
MOA for Inhaled antimuscarinics
primarily bind M3 in airway smooth muscle which antagonizes ACh actions at those sites resulting in bronchodilation
what are SAMA/LAMAs?
short/long acting antimuscarinics
AE for inhaled antimuscarinics?
generally well tolerated other than dry mouth
Anti-inflammatory drugs used to treat COPD
1) . inhaled corticosteriods (-asone or -sonide)
2) . PDE-3 inhibitor
typical use for ICS?
acute exacerbation of COPD or more severe disease
ICS AEs?
oral candidiasis (prevent by rinsing mouth)
MOA for PDE-3 inhibitor
decrease breakdown of intracellular cyclic AMP –> decreases inflammation
when would PDE-3 inhibitors be used?
when a pt has a more severe COPD case, this drug is used in to the hopes to decrease the amount of exacerbations
what is asthma?
reversible obstructive lung disease characterized by inflammation and increased smooth muscle reaction of the airways to various stimuli
types of asthma?
1) . extrinsic
2) . intrinsic
3) . exercise-induced
4) . asthma associated with COPD
Asthma Pathogenesis?
1) . abnormal airway response
2) . mediators cause thickening of airway walls and increased contractile response of bronchial smooth muscle
3) . mucous plug can become significant and block up the airways that are in spasm and swollen (traps air distally)
Clinical manifestations of Asthma
1) . sensation of chest constriction
2) . inspiratory and expiratory wheezing
3) . nonproductive cough
4) . prolonged expiration
5) . tachycardia and tachypnea
Goals for Asthma trx?
1) . decrease impairments
2) . decrease risk (prevent exacerbations, need for emergency care, prevent loss of lung function, decrease AE for therapy)
1st line (maintenance trx) for Asthma
1) . ICS solo
2) . LABAs only in combo with ICS
1st line trx for acute exacerbations of Asthma
PO ICS
Alternative trx for Asthma
1) . Leukotriene Modifiers
2) . Immunomodulators
3) . Cromolyn Sodium
4) . Methylxanthines
what are Leukotrienes?
released from mast cells eosinphils, they play a role in airway edema, smooth muscle contraction and inflammatory process
types of Leukotriene modifiers
1) . Leukotriene receptor antagonist (LTRA)
2) . 5-lipoxygenase inhibitor
MOA for LTRA
competitively antagonize leukotriene receptors
Types of Immunomodulators
1) . Anti-IgE
2) . Interleukin Antagonist
MOA of Anti-IgE?
binds IgE antibody –> prevents IgE binding to receptors on mast cells and basophils –> limits activation and release of allergic response mediators
AE of Anti-IgE
HA, injection site reactions; very rare anaphylactic allergic reactions
Interleukin antagonist MOA
monoclonal antibodies that binds interleukins results in decrease inflammatory response
Common interleukin antagonist AE
injection site reactions, HA, increase creatine kinase
What drugs are used for acute symptom relief and exacerbations of Asthma?
1) . SABAs
2) . SAMAs
3) . PO steroids
what is used for acute symptom relief and EIB?
SABAs. typically used up to 3 trx at 20 min intervals
when would SAMAs be used?
in combo with SABA in emergency care setting or as monotherapy if SABA not tolerated
when would PO steroids be used to treat Asthma?
moderate to severe exacerbations
what is a BPTs?
bronchial provocation test. Used to diagnose asthma in atheltes
What is cystic fibrosis?
gene defect that doesn’t allow Cl- to pass in and out of the plasma membrane of epithelial cells. More commonly known for its copious amounts of mucus but is a multi-system disease
CF complications
1) . CFRD
2) . bone disease
3) . liver disease
4) . lung transplants
CF trxs
1) . Bronchodilators
2) . CFTR modulators
3) . Mucolytics
4) . Anti-inflammatory
5) . Inhaled Antibiotics
6) . PO Antibiotics
7) . Nutritional support
Bronchodilators used in CF trx
may use LABAs for maintenance; SABAs used prior to chest physiotherapy
what is a CF trans-membrane regulator?
membrane protein and Cl- channel –> regulates sodium and water which helps keep mucous thin
how does CF effect CFTRs?
genetic mutations cause closing and/or narrowing of CFTR or prevents CFTR from getting to the cell surface
purpose of CFTR modulators
decrease risk of exacerbation, increase lung function and QOL
common AE for CFTR modulators
HA, GI issues, respiratory issue
less common AE of CFTR modulators
dizziness and hypertension
why are mucolytics used in trx of CF?
decrease risk of exacerbations, improve lung function and QOL
type of mucolytic used ideally?
hypertonic saline and dornase alfa
MOA of hypertonic saline?
increase salt in airways which draws more water into airways -> increases hydration of airway mucus secretions, increases mucucillary functions
MOA of dornase alfa (Pulmozyme)
cleaves DNA –> decrease mucus viscosity –> improved airflow
what is a red flag for a pt on dornase alfa?
chest pain -> merits an automatic referral to a physician
what is a red flag for a pt on dornase alfa?
chest pain -> merits an automatic referral to a physician
Anti-inflammatory used to trx CF
Chronic high dose ibuprofen if <18 years old - has been proven to slow the loss of lung function
Inhaled Antibiotics used to trx CF
1) . Tobramycin (Tobi)
2) . Aztreonam
when would an inhaled antibiotic be used chronically for CF trx?
if P. aeruginosa persistently present in cultures
prescription instructions for Tobramycin
nebulized 2-3x daily for 28 days on and then 28 days off
AE of Tobramycin (9)
voice disorder, HA, fever, respiratory issue, ototoxicity, pharyngolarngeal pain, cough, nasal congestion, wheezing
additional AE for aztreonam
fever
supplemental vitamins used for nutritional support in pts with CF?
Vitamins A, D, E, and K
what is PERT?
pancreatic enzyme replacement therapy
Therapeutic concerns with Anti-cholinergic drugs used to trx respiratory conditions?
dry mouth, HTN and tachycardia
Therapeutic concerns with steroids used to trx respiratory conditions?
1) . inhaled: oral candidiasis and thrush
2) . increased infection risk, HTN, Osteoporosis (muscle weakness, skin atrophy)
Therapeutic concerns with Beta-2 agonists used to trx respiratory conditions
tremor, trachycardia, hypokalemia, hyperglycemia, reduced exercise capacity
