Respiratory Flashcards
What does the URT consist of?
Nose and Nasal cavities
paranasal sinuses
pharynx
larynx
What does the LRT consist of?
Trachea
bronchi and smaller bronchioles
lungs and alveoli
What is the role of the nose and nasal cavities?
Provide airway for respiration
Moistens and warms air
filters inhaled air
contains olfactory receptors
involved in speech
T or F. The nose is the most effcient way to get air?
False, the mouth is but, mouth gives much less moisture and less filtering.
Describe the Paranasal sinuses and its possible functions?
Air containing cavities in the skull, lined with mucous membrane
Decrease weigth of skull, increases resonance of voice, bufer agaisnt facial trauma, insulates sensitive structures from rapid temperature fluctuations, humidifies and heats air, imunological defense
What are the tonsils?
Immunocompetent organ first line of defence
What is pleurisy?
Inflammation of the pleura
What is the effect on the alveoli for COPD?
Nothing, alveoli themselves are not affected
What is the affect on the alveoli in emphysema?
Thinning of walls, less elastic, air traping leading to alveoli destruction
What is poor compliance?
Problem getting air in, restrictive disease
What is poor elasticity?
Air can get in but air trapping from poor gas exchange occurs
What is the effect of lower oxygen?
Higher BP, restriction
What is the conducting system?
All sites involved in conducting air into the lungs
What are the respiratory zones?
Where gas exchange occurs
What is plmonary ventilation?
Inspiration and expiration
WHat is external respiration?
lungs
What is internal respiration?
Tissues taking up oxygen
What does V/Q = 0 indicate?
blocking of airflow from lugns to alveoli, pressure not enough
what does V/Q = infinity indicate?
blocking blood flow, ventilation is good but perfusion not enough
WHat does any mismatch of V/Q cause?
hypoxemia
Normal breathing
eupnea
breathing that stops at night
apnea
shortness of breath
dyspnea
rapid breathing
tachypnea
forced inhalation using external muscles
costal breathing
deep breathing using abdominal muscles
Diaphragmatic breathing
What is type 1 respiratory failure?
Inability of lungs to preform adequate gas exchange, oxygen saturation falls below 90%, CO2 levels remain normal or can be low
Potential causes of type 1 respiratory failure?
lung disorder, pneumonia, pulmonary edema, fibrosis, embolism, hpyertension
What is type 2 respiratory failure?
ventilatory failure; occurs when breathing is not suffeceint to rid the body of CO2. Leads to hypercapnia
WHat is an obstructive disease FEV1/FVC look like
Low FEV1/FVC, normal FVC.
FEV1 lower b/c cannot breath out air quickly but with sustained effort will be able to breathe out all air to maintain a normal FVC
What is a restrictive disease FEV1/FVC look like?
normal FEV1/FVC ratio but low FVC.
WHat is FEV1?
forced expiratroy volme in 1 second
What is FVC?
forced vital capacity
WHat FEV1/FVC is diagnostic of asthma?
<0.7
What are cardinal symptoms of COPD?
dyspnea, chronic cough, sputum production
MOA of short-acting beta-adrenergic agonists? Drugs?
Bind to B2 receptors in lung causing hyperpolarixation f Ca activated K channels in airway, stimulation of ATP –> cAMP –> removal of calcium from muscle
Secondary MOA:
Reduces mediator release from mast cells
Reduces microvascular leakage after exposure to mediators
Enhances mucociliary clearance
Reduces neurotransmission of cholinergic nerves
Most used agent, rescue medication
Salbutamol and Terbutaline B2 selective, Epinepherine is non-selective
Side effects of SABAA?
tachycardia
palpitations
dizziness
termor
–> tolerance typically develops these side effects
MOA of short-acting muscarinic antagonists? drugs?
Ach in lungs causes bronchoconstriction and increased mucous secretiong; increases states of inflamation –> Ipratropium competitve antagonist of endogenous ach at muscarinic receptors
Inhbits M3-Gq-PLC-IP3-CA2+ pathway
not coomonly utilized in asthma
add-on during asthma attacks
rescue medication
Ipratropium
Side effects of SAMA?
Cough
headache
dizziness
dry mouth
DI with anti-cholinergic load
MOA of inhaled steroids? Drugs?
bind to glucocorticoid receptors, move into nucleus, inhibit histone acetyltransferase and increase histone deacetylase 2
HAT acetylates inflammatroy proteins, HDAC2 deacetylates inflammatory proteins
Beclomethasone, fluticasone, budesonide, mometasone, ciclesonide
First line controller medication
Side Effects of steroid?
oral thrush
hoarseness of voice
longterm high dose:
adrenal supresson
increased glucsoe elvels
pneumonia
osteoporosis
DI with desmopressin can lead to hyponatremia risk
Long-acting beta-adrenergic agonists details? Drugs?
Common controller medications
added after coticosteroid
less rapid acting than short-acting agents but last longer
same MOA, SE, and DI as SABA
Salmeterol, Formoterol
What is unique about Formoterol?
Actually works veru quickly, can be used as both a reliever and controller
MOA of Leukotriene receptor antagonist? Drug?
Cysteinyl-leukotriene receptors cause mucous secretion, bronchoconstrition and eosinophil recruitment when activated
ANtagonize the receptor and prevent these effects
Montelukast
Used in very mild asthma as an ORAL controller medication
Side Effects of LRAs?
Minimal; no DIs
Describe theophylline
Rarely used
Oral last-line controller medication
difficult dosing
Bronchodilation via:
- inhibiton of phosphodiesterase –> increase cAMP
- atangonizes adenosine receptors
- increases interleukin 10 levels
- preventin creation of pro-inflammatory mediators
Side effects of Theophylline?
Tachycardia
Arrhythmias
Significant GI
DI with 3A4 substrate and 1A2 substrate
Describe Biologics.
Injectable gents targeting alergic response or inflammatory mediators
last-line use
includes:
MAB’s
Omalizumab –> inhibits IgE
Mepolizumab, reslizumab, benralizumab inhibits interleukin -5
Dupilumab –> inhibits interleukin 4 and 13
Describe use of SABA’s and LABA’s in COPD
Same agents as asthma
slightly less effective than SAMA and LAMA in COPD
given scheduled rather than prn
Describe SAMA and LAMA in COPD
used more than SABA and LABA
SAMA same drug (ipratropium)
LABA drugs include:
tiotropium
aclidinium
glycopyrronium
umeclidinium
DEscribe inhaled steroid in COPD
Same agents as asthma
Main difference is they are utilized in end stage of COPD
Main therapies of COPD? Severe? excerbations? rare?
- SABA and LABA
- SAMA and LAMA
Severe: - inhaled coticosteroids
Exacerbations: - oral steroids
- antibiotics
Rarely used: - Theophylline (methylxanthines)
Categorize asthma treatments in Releiver, controller, exacerbations, and novel therapy.
Reliever: SABA and SAMA
Controller: ICS, LABA, LTRAs, theophylline
Exacerbations: orla steroids
Novel therapy: biologics