Resp

Question 1

A large number of thin-walled alveoli, forming an enormous surface area, which serve to maintain proper gas exchange

Answer 1

Lung parenchyma

Question 2

Parenchyma disease ex

Answer 2

Asthma & COPD

Question 3

What 3 ways does PNS influence airway

Answer 3

Airway caliber (diameter);
Glandular activity;
Airway microvascular

Question 4

______ nerve provides the preganglionic fibers

Answer 4

Vagus

Question 5

Preganglionic fibers synapse with postganglionic fibers in the?

Answer 5

Airway parasympathetic ganglia

Question 6

ACh activates the _______ receptor of postganglionic fibers of PNS to produce _______

Answer 6

M3; bronchoconstriction

Question 7

Anticholinergics can provide bronchodilation even in resting state b/c PNS produces a _______ of resting bronchomotor tone

Answer 7

Basal level

Question 8

How does SNS play direct role in airway muscle tone?

Answer 8

It doesn’t

Question 9

______ receptors are present on airway smooth muscle cells and cause bronchodilation via ______

Answer 9

B2; G mechanisms

Question 10

The ANS influences bronchomotor tone through what system?

Answer 10

Nonadrenergic Noncholinergic System (NANC System)

Question 11

What are the 2 main inhibitory transmitters thought to be responsible for airway smooth muscle relaxation

Answer 11

Vasoactive intestinal peptide (VIP) & NO

Question 12

What 2 main excitatory transmitters are shown to cause neurogenic inflammation, including bronchoconstriction?

Answer 12

Substance P & Neurokinin A

Question 13

Mainstay therapy for bronchospasm, wheezing, & airflow obstruction

Answer 13

Beta-adrenergic agonist

Question 14

Beta-adrenergic agonists used in clinical practice are:

Answer 14

Typically delivered via inhalers or nebulizers;
Beta 2 selective;
Divided into short and long acting therapies

Question 15

Short acting beta-2 agonist therapy is effective for rapid relief of?

Answer 15

Wheezing, bronchospasm, & airflow obstruction

Question 16

Long acting B2 agonists used as ______ providing improved lung function & reduction in symptoms and exacerbations

Answer 16

Maintenance

Question 17

MOA of short acting B2 agonist

Answer 17

Bind to receptor located on plasma membrane of smooth muscle cells, epithelial, endothelial, other airway cells.
Causes a stimulatory G protein to activate adenylate cyclase which converts ATP into cAMP causing smooth muscle relaxation

Question 18

Why does Salmeterol have longer duration?

Answer 18

Bc of a side chain that binds to B2 receptor & prolongs activation of receptor

Question 19

Why does Formoterol have longer duration?

Answer 19

Lipophilic side chain allows for interaction w/ lipid bilayer of plasma membrane allowing slow & steady release prolonging duration

Question 20

Long acting B2 agonists:

Answer 20

Prescribed when short acting is used >2 x in a week;
Combination w/ inhaled corticosteroids is effective in reducing symptoms, exacerbation, & improving lung function while minimizing dose of inhaled corticosteroid

Question 21

Systemic absorption of B2 causes tremors bc of ______ and tachycardia bc ______

Answer 21

Direct stimulation in skeletal muscle or vasculature

Question 22

In severe asthma, B2 may cause temporary reduction of PaO2 tension of 5 mmHg or more secondary to?

Answer 22

Vasodilation in poorly ventilated lung regions

Question 23

_______, _______, & ________ can occur with B2 agonist therapy but tend to decrease with regular use

Answer 23

Hyperglycemia, hypokalemia, Hypomagnesemia

Question 24

Tolerance of B2 is d/t?

Answer 24

B2 receptor down regulation

Question 25

Withdrawal of B2 agonist after regular use can produce?

Answer 25

Transient bronchial hyperresponsiveness (exaggerated bronchial restriction)

Question 26

Reserve long acting B2 for which pts

Answer 26

Poorly controlled on inhaled steroids alone or have symptoms perilous enough to warrant potential added risk

Question 27

Which adrenergic agonists can be given IV?

Answer 27

Epi, albuterol, terbutaline, salbutamol

Question 28

Use of ______ in COPD as maintenance and rescue therapy is standard tx

Answer 28

Anticholinergics

Question 29

_______ NOT used for maintenance therapy in asthmas, only for acute exacerbations

Answer 29

Anticholinergics

Question 30

M2 receptors located? Responsible for?

Answer 30

Postganglionic; limiting production of ACh and protect against bronchoconstriction

Question 31

What are M1 & M3 responsible for?

Answer 31

Bronchoconstriction & mucous production

Question 32

Inhaled anticholinergics target which muscarinic receptors?

Answer 32

M1 & M3

Question 33

Smooth muscle contraction form ACh binding to M1 or M3 is produced from increases in _____ or activation of ______

Answer 33

cGMP; G protein (Gq)

Question 34

Gq activates ______ to produce ____

Answer 34

Phospholipase C; inositol triphosphate (IP3)

Question 35

IP3 causes release of _____ from intracellular stores and activation of _____ causing smooth muscle contraction

Answer 35

Ca; myosin light chain kinase

Question 36

Which 2 anticholinergics are approved for obstructive airway dz

Answer 36

Ipratropium (Atrovent) & Tiotropium (Spiriva)

Question 37

Short acting. Commonly used for maintenance therapy for COPD. Can be used as rescue for COPD & asthma exacerbations. NOT recommended as routine management for asthma. Increases exercise tolerance

Answer 37

Ipratropium

Question 38

Only long acting anticholinergic available for COPD maintenance. Reduces resp failure, COPD exac & all-cause mortality

Answer 38

Tiotropium

Question 39

Inhaled anticholinergics are _____ absorbed

Answer 39

Poorly