respi meds Flashcards
2 components of respi system
ventilation and gas exchange
what affects ventilation
airway patency ie diameter
active muscles
what affects gas exchange
- adequate number of alveoli
- no fibrosis of alveolar wall
what is ventilation
moving gas from outside to inside px
whhat is gas exchange
exchange gas with blood at alveoli
if the lungs are filled with air, what colour is the lungs on xray
radiolucent
costaphrenic recess/angle
first place where fluid collects in lungs if got problem
function of ribs
main function is not protection
it is changing the intrathoracic volume to increase vol for air to enter
number of lobes in right lung
3
main muscles of respi
inter/ext intercostal muscles
oblique
accessory muscles function in breathing
prim function is not breathing but if needed example got breathing problem/ times of stress then it can be activated to assist
type of diffusion of gas
simple passive diffusion
how might you tell a patient is experiencing breathing difficulties (related to accessory muscles)
gripping arms by the side
pectoral accessory muscles activated for breathing, arms cannot move
type1 vs type 2 respi failure
type 1 gas exchange
type 2 ventilation failure
type 1 respi failure cause
gas exchange failure
- fibrosis
- inadequate number of alveoli
- VQ mismatch
type 2 respi failure cause
- muscle problem
- airway patency narrow
symptoms and signs of respi probems
symptoms - cough, sputum, blood, wheezing, stridor, dyspnoea, pain
signs - chest movement, rate of resp, vocal resonance, percussion
what is the appearance of the sputum in respi failure
sticky thick mucus may be bloody
heart failure sputum difference -> white frothy
CF -> thick sticky
what could pain be caused by when breathing
fracture, pneumonia, inflammation in chest wall
what could blood in cough be caused by
tumour, TB
normal rate of respi (bpm)
12-15 breaths per minute
in normal ppl shld there be vocal resonance and percussion when using stethoscope?
yes u shld hear vocal resoncance, otherwise means there is consolidation of a solid/liquid
dull instead of resonant percussion is bad because might mean liquid r solid filling the lung
respi investigations types
sputum
CT scan
spirometry
PEFR
bronchoscopy
VQ scan using radioisotopes
3 types of respi drug administration
inhalation
IV
oral
drugs used for ventilation and drugs used for gas ex
ventilation = bronchodilators, anti inflammatory ie steroid and cromoglycate/leukotriene
gas exchange = oxygen
types of bronchodilators
- B2 agonist
- anticholinergic
difference between B2 agonist and anticholinergic?
B2 binds to B2 receptors in airway and causes bronchodilation
Anticholinergic inhibits muscarinic nerve and reduces mucus, relaxes tone of smooth muscle
what do Cromoglycate inhaler and Leukotriene tablet do?
They reduce inflammatory mediators, by preventing mast cell degranulation,
they are more preventative measures, to prevent release of chemical mediators in the bronchial walls that initiate asthma
Drugs that impair ventilation
- ** beta blockers**
- respiratory depressants like opioids or benzodiazepines (used in iv sedation, need to monitor respi rate)
- respi depressants reduce ventilation rate and causes smooth muscle relaxation
blue vs green B2 agnoist
blue short acting green long acting
most common bronchodilator
most commonly blue salbutamol (b2 agonist) for acute asthma attacks and
brown beclomethasone (corticosteroid) for preventative
Types of inhalers
- Meter dose
a. with or without spacer - Breath activated
a. spinhaler
b. turboinhaler - Nebuliser
a. gas bubbled through liquid
problem with meter dose
is that it fires all over oral pharynx and may cause local immunosuppression and sometimes candidiasis
why does long acting b2 agonist need to be taken with steroids
otherwise high risk of ACS
bronchitis vs Bronchiectasis
Bronchitis is an inflammatory disorder of the trachea and bronchial tubes. (mucus and infla)
Bronchiectasis is a disorder in which the bronchi widen and become destroyed due to infection. (damaged, scarred, thickened, widened, infection, cannot clear mucus, reduced dimeter, loss of normal lung structure )
Side effects of corticosteroids
adrenal suppression
candidiasis
osteoporosis?
SPACER recommended for every metered dose inhaler
most effective asthma treatment
corticosteroids
but be aware of the side effects like risk of fungal,bact,viral infctions, osteoporosis, adrenal suppression?
what is CF
recessive gene; genetic disease that causes Production of excess sticky mucus in various organs, but mainly lungs and pancreas
Defect of chloride ion channels (either opens abnormally or cannot open at all)
what mutation in CF
F508del mutation of CFTR gene on chromosome 7
Recessive gene
in CF sweat test, what ae we looking out for
Sweat test – higher chloride ion conc in sweat => most likely have CF
best test for CF
CFTR gene testing
symptoms of CF
Pulmonary infection (Staphylococci)
Coughing
Chest infections
Malnutrition due to pancreatic insufficiency
Poor weight gain
Prolonged diarrhoea
Asthma with clubbing and bronchiectasis
why would someone with CF have osteoporosis
Osteoporosis due to lack of vitamin D
Deficient in pancreatic enzymes, cannot absorb fat dependent vitamins (ADEK)
how is CF linked to diabetes and liver dysfunction
mucus to build up and block bile ducts in the liver. This prevents bile from leaving the liver, which causes inflammation and produces scarring. permanent scarring of the liver, called cirrhosis
The build-up of sticky mucus caused by cystic fibrosis can lead to inflammation and scarring of the pancreas. This can damage the cells that produce insulin and lead to high blood glucose (sugar) levels. As the pancreas can’t produce enough insulin, blood sugar levels may continue to rise.
tx for CF
physio therapy to drain excess mucus
medications
exercise to improve lung function and build bone mass
transplatn
meds used in CF
bronchodilators
antibiotics (but try not to overprescribe can cause ABR)
steroids
pancreatic enzyme replacement
nutritional supplements
**CFTR modulators **
stem cell therapy
CFTR modulators best used on which px
px with F508del mutation
is asthma reversible
yes REVERSIBLE airflow obstruction
what is asthma
Bronchial hyper reactivity, changes in bronchial walls restricting air flow in and out
Allergen -> T cell-> B cell-> IgE production-> mast cell degranulation -> histamine and leukotrienes -> bronchoconstriction, oedema and mucus secretion
1 Bronchial SM constriction
2 Oedema in mucosa
3 Mucus secretion into airway lumen
causes of asthma
unknown/
infections/
environmental stimuli like dust and smoke/
warm->cold air/
atopy ie hypersensitivity allergy
dental risk assessment for asthma patients
full medical history
severity
triggers to avoid
position patient in emergency
emergency drug kit
when to call ambulance
symptoms of asthma
Cough caused by mucus causing irritation
Wheeze
SOB
Diurnal variation **worse in overnight and early morning
More problems with exhaling than inhaling since there are muscles to support inhalation
what is biphasic response in asthma
early/acute
breathlesses wheezing
B2 agonists used
late
corticosteroids used to prevent the late response in severe acute asthma attacks
meds used for asthma
1 blue/green SA/LA bronchodilators B agonists
2 brown/purple/others LD/HD corticosteroids
For most severe asthama, given daily steroids
3 Regular montelucast
4 Pulsed oral steroid - prednisolone
leukotriene inhibitor
prevents mast cell degranulation
5 Monoclonal antibodies therapy
Look at the colour of their inhaler to help determine severity of their asthma
Blue and brown -> SA B2 agonist and LD corticosteroid
Green and purple -> LA B2 agonist and others (moderate to severe asthma)
types of lung tumours
Central tumours
Peripheral tumours
ALL ARE MALIGNANT
1 Small cell
2 Non small cell
- SCC (most common, centrally located, SMOKING biggest cause)
- Large cell
- Adenocarcinoma
causes of lung tumours
smoking,
genetics,
radiation,
chemicals,
pollution,
other lung diseases like COPD or pulmonary fibrosis
symptoms of lung cancer
Cough
SOB
Fatigue
Haemoptysis (blood stained sputum)
Pneumonia and repeated respi infections (occlusion of main bronchi)
Metastasis
dysphagia
SVC obstruction
Recurrent laryngeal nerve palsy -> hoarseness
how does lung tumours cause dysphagia and SVC obstruction
Central tumour compresses oesophagus and SVC as it passes the mediastinum
for svc obstruction, prevents blood retuning from upper part of body, oedema in arms head neck
when is lung tumours usually found
stage 3 and 4 which is too late, poor prognosis
Stage 3 involves both side of the bronchus
Stage 4 involves oedema, fluid, pneumonia, metastasis
what is sleep apnoea
Airway obstruction when sleeping
10sec or more
Muscle tone drops -> tongue falls back and blocks airways by occluding back of the pharynx
people with OSA experience a collapse of their airways during sleep. When this causes their breathing to completely stop or reduce to 10% of normal levels for at least 10 seconds, it is called an apnea.
sleep apnea px are at risk of what?
Increased risk of MI
do not get enough oxygen, continual periods of hypoxia
how to measure sleep apnoea
Measure with AHI
The apnea-hypopnea index (AHI) represents the average number of apneas and hypopneas you experience each hour during sleep.
Key to long term survival is to have lesser episodes per night
management of sleep apnea
1 Mandibular advancement appliance
2 CPAP – continuous positive airway pressure
NOT a ventilator , provides pressure to keep space between tongue and pharynx
3 Sleep apnoea positional therapy
what is COPD
COPD has damage both to the airways and the alveoli, so less ability to ventilate and gas exchange
Chronic bronchitis (inflammation and mucus) non reversible damage
Emphysema (destruction of alveoli, enlarged sacs, reduced SA for gas exchange) non reversible
Asthma component REVERSIBLE
causes of copd
Smoking
Pollution
Genetics
Age
Chemicals
Chronic bronchitis
Asthma
diagnosing copd
CAT = COPD assessment test
Exacerbation history
No. of symptoms
Spirometer
Airflow limitation
FEV
exacerbation of chronic obstructive pulmonary disease (COPD)
An acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of a person’s symptoms from their usual stable state
cause by infection (viral, bacterial) or
non infection (noncompliance with meds or environmental factors)
symptoms of copd
Productive chronic cough
Green sputum
SOB
Dyspnoea
Chest discomfort
Fatigue
Mucus
what can copd lead to
Heart failure
Pneumonia
ARDS (acute respiratory distress syndrome)
type 1 or 2 respiratory failure
how does copd lead to pneumonia
Chronic inflammation interferes with the body’s natural ability to clear and destroy bacteria that enter into the lung, leading to infection
ARDS
severe inflammation of the lungs causing fluid to leak into the BV in the airways
can be fatal
treatment for copd
Fundamental tx method is NON drug based
- Offer smoking cessation
- Flu vaccinations prevents infection
- Pulmonary rehabilitation (graded exercise programmes)
if they dont work then use inhalers (bronchodilators, steroids, oxygen)
when to use steroid in copd
Steroids if FEV<50% (used if there is significant airway inflammation)
what to watch for when using oxygen theraoy for copd
When using oxygen, make sure to watch respiratory rate because oxygen reduces body drive to breathe
***rmb that for asthma, can determine severity based on medication they use eg colour of inhaler
But for COPD, cannot assess severity based on their medications, every person is different
when to prescribe antibiotics to copd patients
ANTIBITOICS may be prescribed for severe COPD patients to use in the case of acute exacerbations
Dental implications for copd
Have oxygen in clinic
Be careful oxygen is flammable
Inhaled steroids candida risk
Use spacer for MDI inhalers
Smoking cessation advice
Smokers have increased oral cancer risk so should screen
Home oxygen therapy for COPD useful?
Effective if used 24h each day, significant increase in survival
Intermittent use of NO help -> low level hypoxia throughout the day make ACS events more likely (cvs risk of sudden death)
pinkpuffer and blue bloater are which type of respi failure?
pink puffer => type 1 (gas exchange failure)
blue bloater => type 2 (ventilation failure)
is pink puffer emphysema or chronic bronchitis?
emphysema
blue bloater -> chronic bronchitis
is type 1/2 respi failure hypoxaemia or hypercapnia
type 1-> pink puffer (hypoxaemia)
type 2-> blue bloater (hypercapnia)
Hypoxaemia
Hypoxaemia ie low oxygen (PaO2 <8kPa or SaO2 <90%)
Hypercapnia
Hypercapnia (PaCO2 >6.7kPa
CO2 retention due to ventilation failure)
symptoms of pink puffers
hyperventilation
pink because oxygenated
minimal cough
Reduced SA for gas exchange
Thickening of alveolar barrier
Diffusion abnormality
VQ mismatch
symptoms of blue bloaters
cyanosis
wheezing
productive cough chronic
purulent sputum
Exacerbations caused by oedema and mucus
is type 1 or 2 ACUTE respi failure
type 2
CO2 retention
blue bloater
ventilation failure
co2 cannot be expelled
Why and when is emergency supplemental oxygen supplied and not supplied to a patient in reference to COPD?
If the patient is Hypoxic (low blood oxygen), then oxygen can be given to patients suffering from acute COPD
however emergency oxygen cannot be used for patients with chronic COPD
