Quiz 4 - Lung, Renal, Blood Flashcards
What is atelectasis?
inadequate expansion or collapse of the air spaces
What are the causes of atelectasis?
obstruction (aspiration), compression (pneumothorax), contraction (pleural fibrosis)
What is ARDS?
Acute respiratory distress syndrome
it is a progression of acute injury (either physical or chemical)
What causes the damage to the airway in ARDS?
the inflammatory response of neutrophils and fluid accumulation
What is COPD?
Chronic obstructive pulmonary disease
Examples include: emphysema, asthma, chronic bronchitis, bronchiectasis
What is the main cause of COPD?
smoking
What is emphysema?
type of COPD
destruction of elastic fibers in alveolar walls and permanent enlargement of the airspaces
What are the main causes of emphysema?
smoking, alpha-1 antitrypsin deficiency (imbalance of the protease and the anti-protease activity), and air pollution
What are some symptoms of emphysema?
barrel chested due to attempt at compensation and inability to fully exhale
dyspnea with cough and wheezing
What is pneumothorax?
air pockets into the pleural spaces causing collapse of the lungs
can result from ruptured bullous emphysema
What is chronic bronchitis?
type of COPD
persistent cough for 3+ months in 2 consecutive years
“blue bloaters”
Reid index = proportion of depth of mucosa that is composed of mucous glands…if >0.4, this suggests chronic bronchitis.
What are the main causes of chronic bronchitis?
smoking
air pollution
What is bronchiectasis?
obstruction of the bronchi
destruction of elastin and muscle in the bronchial walls
hypersecretion of mucus
What are some causes of bronchiectasis?
obstruction of the bronchi
persistent necrotizing infections (pneumonias)
microorganisms (staph, TB) that cause hypersecretion of mucus
cystic fibrosis
What are some symptoms of bronchiectasis?
persistent, foul-smelling cough
coughing up blood
hypoxemia
What is asthma and its symptoms?
Reactive airway disease narrowing of the airway hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy shortness of breath with chest tightness wheezing precipitated by the vagal nerve occurs in younger populations
What is atopic vs. non-atopic asthma?
atopic - allergic reaction
non-atopic - not allergy related (may be familial) and the cause is unknown.
What is restrictive lung disease and what are some examples?
Diseases that make it difficult to inhale; results from pleural fibrosis or chest wall abnormalitis; gas exchange is imparied by thickened septal walls; air movement is impaired by an inability to inhale/expand the lungs.
Fibrosing lung diseases occupational lung diseases sarcoidosis hypersentivity peumonitis iatrogenic causes (chemotherapy, radiation exposure, contamination in iv solutions used by drug abusers)
What are fibrosing lung diseases?
type of restrictive lung disease
associated with collagen vascular diseases such as RA
can lead to left sided heart failure
What are occupational lung diseases?
type of restrictive lung disease
mineral-dust induced (coal workers)
silicosis, asbestosis (can lead to mesothelioma - cancer of the pleural)
What is sarcoidosis?
type restrictive lung disease abnormal connective tissue and reduced elastic properties multi-organ involvement immune-related disease lethal in ~10% of cases
What is hypersensitivity pneumonitis?
caused by mold or animal products (dander and feces)
What is hemoptosis?
coughing up blood
seen in most diseases that cause sever coughing
What is a pulmonary embolus?
clot that from deep veins in the leg that can cause occlusion of the main pulmonary artery
obstruction of blood flow can lead to right heart failure
What are some causes/predisposing factors of a pulmonary embolus?
prolonged bed rest, surgery, congestive heart failure, hypercoagulability state
What causes of pulmonary hypertension?
recurrent thromboemboli, heart disease, chronic lung disease
cor pulmonale - right ventricular failure as a result of pulmonary hypertension
What is a cause of diffuse alveolar hemorrhage?
autoimmune responses.
In vascular lung diseases, how is gas exchanged impaired?
obstructed or thickened vessels
alveolar hemorrhage
In obstructive lung diseases, is gas exchange through septal walls impaired?
NO
air movement is impaired by the inability to exhale.
T/F - For lung infections, the type of microorganism responsible is the same, independent of location.
False
Hospital acquired pulmonary infections…
are a nosocomial infection, usually in patients with severe underlying illness.
Walking or Community pneumonia symptoms include…
low-grade fever (acute onset with chills), productive cough, general malaise but still able to function at school or work
most are bacterial in nature
What is the cause of tuberculosis?
mycobacterium tuberculosis
acid fast mycobacterium associated with Ghon complexes.
What are some characteristics of Tb?
usually affects the lungs, but can affect other organs
flourishes in crowded, impoverished areas
non-contagious in periods of dormancy
problems with multi-drug abx resistance
forms necrotizing granulomas (caseating)
associated with HIV infections
Miliary Tb = organisms break off and spread throughout the body
Pulmonary fungal infections…
differ across the country and are usually seen in individuals that are immune-suppressed.
95% of primary lung cancers are…
carcinomas (as opposed to sarcomas, etc.)
What are the most common types of primary lung carcinomas?
adenocarcinoma
squamous cell carcinoma
What is the most aggressive type of lung carcinoma?
small cell (oat cell) carcinoma
Which risk factor puts a person at 55x the risk for developing lung cancer?
smoking
Lung cancers frequently spread to which site?
the brain
T/F - Carcinoma of the lungs is the 2nd leading cause of cancer death world-wide.
False - its THE leading cause of cancer death world wide.
What are the common triggers of asthma?
hyper-responsiveness to triggers fluid secretions increase infections allergens excessive exercise cold temperatures tobacco some drugs stress
Prevalence of asthma
F > M
children > adults
can progress to COPD in adults
What are some dental considerations for the asthmatic patient?
mouth breathers –> xerostomia
steroid inhalers –>irritate back of mouth
remind patients to bring inhaler and medicate before appointment.
Properties and uses of “relievers” for asthma medication
early treatments short-acting or rescuers rapid bronchodilators (within minutes) used for less severe cases of asthma (intermittent asthma) typically beta-2 agonists given at minimum doses and frequencies to avoid tolerance
albuterol
beta-2 agonist
“reliever”
rapid onset and 4-6 hr effects
MOA = directly relaxes airway smooth muscle and causes bronchodilation; also decreases microvascular leakage
salmeterol
beta-2 agonist
“reliever”
slower onset than albuterol, 12 hr effectiveness
MOA = directly relaxes airway smooth muscle and causes bronchodilation; also decreases microvascular leakage
Properties and uses of “controllers” for asthma.
taken regularly for long-term stable control
often have more side effects
inhaled corticosteroids are the drug of choice for moderate to severe asthma
often combined with beta-2 agonists
NOT for rescue
for routine use
fluticasone
inhaled steroid
MOA = anti-inflammatory effects reduce bronchial reactivity
side effects = nose bleeds; sores in nose, mouth, and tongue that don’t heal; increased oral infections (candidiasis)
[oral steroids such as prednisone are last resort]
Theophylline
methylxanthine drug (tablet or inhaler) MOA = phosphodiesterase inhibitor that increases cAMP and relaxes airway smooth muscle side effects = headaches, nausea, anxiety, sleep problems uses = add-on controller; monotherapy for mild asthma; combined with corticosteroids to reduce steroid doses and side effects.
Ipratropium
anti-muscarinic
MOA = reverses the contraction of smooth muscle and reduces mucous secretions from vagal activity
uses = back-up to beta-2 agonists
slow onset
Montelukast
“Singulair”
leukotriene modifier
MOA = block leukotriene-binding receptor
uses = for prophylaxis and for patients that have trouble with inhaled therpaies
Cromolyn
inhibits releases of inflammatory mediators such as histamine
for prophylactic use only
Omalizumab
monoclonal antibodies
inhibit IgE binding to mast cells preventing the release of inflammatory mediators
very expensive
only for severe non-responsive asthma
Tiotropium bromide
“Spireva”
Treatment of COPD
long-acting bronchodilator
Pharmacological treatments of COPD include
- tiotropium bromide - long-acting vasodilator
- salmeterol - longer acting beta-2 agonist
- Theophylline + glucocorticoids
Typically, responses are not as good as with asthma.
Oseltamivir
“Tamiflu”
MOA = prevents separation of virus particle from cell receptors –> stops viral spread; early treatment is essential
decreases duration by 1-2 days and reduces severity
effective for both influenza A & B.
Symptoms of allergic reactions include…
ithcing, hives, sneezing, wheezing, difficulty breathing
What causes an allergic reaction?
contact with allergens
release of histamine from mast cells and basophils leads to (1) contraction of pulmonary smooth muscles (2) dilate blood vessels –> lower blood pressure (3) increased permeability of vessels (4) increase gastric secretion
