Respiratory Flashcards
1
Q
What is the goal of Arterial O2 sats?
A
> 94% (healthy patient)
COPD 88-92%
2
Q
What is the goal for Arterial O2 tension (PaO2/partial pressure in vasculature)?
A
80mmHg
3
Q
What is the PaO2/FiO2 ratio in the vented patient?
A
Goal of 400-500
4
Q
What is the calculation for Alveolar-arterial gradient?
A
2.5+0.21 (RA) x AGE
4
Q
What is the Alveolar-aterial gradient?
A
O2 in the alveoli (PAO2)
VERSUS
O2 dissolved in the plasma (PaO2)
5
Q
The Alveolar-arterial gradient increases with
A
An increase in FiO2
6
Q
What does the oxyhemoglobin Dissociation Curve tell us?
A
The correlation between saturated HGB with partial pressure
7
Q
What causes a LEFT shift on the oxyhemoglobin dissociation curve?
A
LOW temp/DPG
LESS O2 delivery to TISSUES
ELEVATED pH & Affinity (O2)
FETAL
“Meth” “LEFT”
8
Q
What causes a RIGHT shift on the oxyhemoglobin dissociation curve?
A
REDUCED O2 affinity
INCREASED O2 delivery, DPG, H+ & Temp
More acidic
9
Q
When HGB has a high affinity for O2
A
It will hold on to it
10
Q
Hypoxemia is low O2 in the
A
Blood
11
Q
Hypoxia is low O2 in the
A
Tissues
12
Q
Hypoventilation will cause what issues?
A
Increase in PaCO2 & PACO2
Decrease in PAO2 & diffusion
13
Q
How can hypoxemia be corrected?
A
Small increases in FiO2
14
Q
Ventilation is….
Oxygenation is….
A
Co2 out
O2 in
15
Q
Examples of Low flow
A
NC
Simple face mask
Face tent
NRB
16
Q
Examples of High Flow
A
HFNC
Venturi Mask
Neb
Non-invasive/invasive vent (mechanical)
17
Q
What is the FiO2 & LPM of venturi & trach collar?
A
FiO2= 0.24-0.6
LPM= 2-15
18
Q
What is the FiO2 & LPM of NC?
A
FiO2= 0.24-0.4
LPM= 1-6
19
Q
What is the FiO2 & LPM of simple mask?
A
FiO2= 0.35-0.55
LPM= 5-10
20
Q
What is the FiO2 & LPM of NRB?
A
FiO2= 0.80-0.95
LPM= 10-15
21
Q
FiO2 will increase by what percent per liter of O2?
A
4%
22
Q
NRB is ideal for
A
Severely hypoxic, but ventilating well
23
Q
Venturi is good for
A
COPD
24
Pre-oxygenation is known as
Denitrogenation
25
When we pre-oxygenate, our reserved is increased by
1.5-4L
26
What is the 2nd biggest reservoir of O2 besides the plasma?
FRC, which is the lung volume held after exhalation
27
What is the targeted end tidal O2?
90%, but most likely 88-92%
28
Where should FiO2 be to prevent hyperoxia?
40-50%
29
Hyperoxia can cause
Pulmonary/CNS/Ocular toxicity
Pro-inflammatory & cytotoxic effects
30
Will an increase in FiO2 help a patient hemmoraging?
NO
31
In HOTN, 100% O2 will cause
A reduce in SV & CO through an increase in SVR
32
100% O2 in cardiac ischemia can increase
Coronary vasoconstriction
33
100% O2 in cerebral ischemia can cause
A decrease in CBF
34
What system controls the airway?
PSNS by affecting the size, gland activity & microvasculature
35
What receptors are on the airway smooth muscle?
Adrenergic & an abundance of Beta 2 receptors (postgang/cholinergic)
36
SNS has this effect on airway smooth muscle
Indirect control
37
The NANC has this influence on smooth muscle tone
Direct
38
The NANC has a role in
The inflammatory process
39
What cells cause bronchoconstriction?
Histamine
Prostaglandin D2 & F2
Leukotrienes C4, E4 & D4
Platelet activating factor
Bradykinin
40
What preganglionic and postganglionic receptors are involved in PSNS influence?
Vagus pregang
Cholinergic postgang
41
How does contraction occur in the airway smooth muscle when the PSNS system is activated?
Vagus pregang--> Cholinergic post gang-->
ACh-->M3-->Gq (stimulatory)
Phospholipase C--> Increased IP3
SR releases Ca+-->MLCK activated
42
Which C fibers cause bronchoconstriction?
Sub P
NKa
Calcitonin gene related peptide
43
Catecholamine release can
Bind Beta-2 receptors indirectly through the SNS
44
Beta 2 during SNS activation will
Inhibit the release of ACh by causing hyperpolarization and stimulating adenyl cyclase, which increases cAMP & causes smooth muscle relaxation
45
cAMP in the smooth muscle will cause
Relaxation
46
Beta 2 stimulated which G protein?
Gs, which increases cAMP, which also created hyperpolarization, leading to HYPOKALEMIA
47
In the NANC system, what is inhibitory & what is excitatory?
Inhibitory- Nitric Oxide & Vasoactive Intestinal Peptide
Excitatory- Sub P & NKa
48
M2 involves which G protein?
Gi, which inhibits adenyl cyclase, leading to NO increase in cAMP, causing constriction
49
Asthma will cause these changes
Hyper-irritability
Airway remodeling
Mucous
Hypertrophy
Angiogenesis
Decrease in diameter & airflow
Increase in resistance
50
What are the long term effects of Asthma?
Epithelial damage
Submucosal edema
Mucous secretion/plugging
Increase in vascular permeability
Vasoconstriction
51
Definition of COPD
Chronic Obstructive Pulmonary disease where expiratory airflow limitations are NOT fully reversible
52
COPD can be classified as
Emphysema
Chronic Bronchitis
53
Characteristics of Emphysema
Parenchymal destruction
Loss of elastic recoil & structural integrity
54
Characteristics of Chronic Bronchitis
Small airway narrowing & inflammation
Mucous
55
COPD will cause
Bronchial inflammation
Fibrosis & narrowing
Goblet cell metaplasia
Mucous hypersecretion
Alveolar destruction (emphysema)
Decrease in elastic recoil & airflow
increased resistance
56
Patients with COPD often
Air-trap
Hyperinflate
57
What can be causing a bronchospams?
Anaphylaxis to ABX or NMB
Mechanical?
Histamine release (atracurium, meperidine or morphine)
Hyperactive airway
58
What will you see with a bronchospasm?
Increase in peak airway pressures (Early)
Decrease in tidal volume (early)
Capnography changes (early)
Changes in SaO2 & PaCO2
59
What will you feel or hear with a bronchospasm?
Difficult to bag
Wheezing
60
What is a poor indicator of airway obstruction?
Wheezing
61
Increased levels of cAMP cause
Inhibition of MLCK
62
What are examples of Inhaled short acting Beta 2 agonists?
Albuterol
Levalbuterol
63
What are examples of inhaled long acting Beta 2 agonist?
Salmeterol
Formoterol
64
What are examples of IV Beta agonists? Think IV SET
Salbutamol
Epinephrine
Terbutaline
65
Beta agonists will cause dilation & relaxation. They will also cause
Decrease in diastolic pressure 9SVR)
Hepatic glycogenolysis
Pancreatic release of glucagon
Stimulates Na/K ATPase (hypokalemia)
66
What are the systemic side effects of Beta agonists?
Tremor
Tachycardia
HYPERglycemia
HYPOkalemia
HYPOmagnesium
Decrease in PaO2 (by vasodilating poorly vented areas=shunting)
67
Careful giving Beta. 2 agonists to
Cards
DM
Hyperthyroid
Diuretic
Digoxin
68
Albuterol has some
Beta 1 activity
69
What is airway onset of albuterol?
5-10min
70
What is the PO inhaler onset of albuterol?
15-30min
71
What is the duration of albuterol?
4-6 hours
72
What is the acute dose of albuterol?
4-8 puffs Q20min
90mcg/puff
73
Epi has both
Beta 1 & Beta 2 effects
74
What is the dose of Racemic EPI
0.5mL of 2.25% in 4mL NS
Improvement in 20-30min
Monitor of systemic effects
75
Vasoconstriction in tracheal mucosa
Relieves edema
76
Muscarinic Antagonists (anticholinergics) block
ACh from binding M3, which binds to Gq, cascading with Phospholipase C, increasing the formation of IP3, causing constriction
77
Which Muscarinic Antagonists (anticholinergic) is inhaled & long acting?
Tiotropium
78
Which Muscarinic Antagonists (anticholinergic) is inhaled & short acting?
Ipratropium (tx COPD)
79
Which Muscarinic Antagonists (anticholinergic) are given IV?
Atropine (crosses BBB)
Glycopyrrolate
80
Anticholinergic side effects?
Tachycardia
Dry mouth
Blurred vision
Mydriasis
Urinary retention
Tremors
81
What is the example of Methylxanthines?
Theophylline
82
What are the 2 MOA of Theophylline, a Methylxanthine?
Phosphodiesterase Inhibitor (increased cAMP)
Blocks Adenosine 2B receptor
83
What are the side effects Theophylline, a Methylxanthine?
GI upset
HA
Restlessness
Seizures
Arrhythmias
Death
Toxic >20mcg/mL
84
Corticosteroids effects
DNA transcription & proteins
85
Glucocorticoids increase
Beta 2 receptors
86
Glucocorticoids decrease
Inflammatory cells
Mucus Secretion
Cytokine
Leak
87
Steroid & beta agonist combination therapy is reserved for
COPD
88
What are the combo drug examples of corticosteroids & beta 2 agonists?
Fluticasone/Salmeterol
Budesonide/Formoterol
89
What are examples of Corticosteroids used to treat respiratory problems?
Fluticasone
Mometasone
Methylprednisolone...
90
What are the side effects of corticosteroids?
Infection
HYPERglycemia
HTN
Adrenal Suppression
Psychosis
Ulcer
Osteoporosis
Increased IOP
91
What are examples of Leukotriene Modifiers?
Montelukast
Zileuton
92
What is the MOA of Leukotriene Modifiers?
Blocks Leukotriene receptors
Blocks conversion of arachidonic acid to leukotrienes
93
What are the examples of Mast cell stabilizers?
Cromolyn Sodium
Nedocromil
94
What is the MOA of Mast cell stabilizers?
Blocks mast cell degranulation
Blocks release of histamine, bronchoconstriction, mucosal edema & mucous secretion
95
Which medications DO NOT decrease bronchomotor tone?
Desflurane
Nitrous Oxide
96
Which channels are sensitive to anesthesia?
T-type Ca+ channels
97
Beta 2 are bound to...
Alpha 2 are bound to...
Beta-Gs
Alpha- Gi
98
What is bound to Gq?
Alpha 1
ET-A
M3
99
What happens when Alpha1, ET-A & M3 are bound to Gq proteins?
IPs increases, increasing the release of intracellular Ca+= constriction
100
Activated Ca+ in the endothelial cell will eventually lead to
Vasodilation
101
What is the pathway of cGMP?
Ca+-->NOS-->L-arg-->NO
Activation of guanylyl cyclase--> GTP to cGMP= relaxation
102
cGMP activates
MLCP, which breaks down myosin light chains
103
What is the mean pulmonary artery pressure?
>20-25mmHg
104
Increased Pulm vascular resistance
>2 Woods units
105
Normal mean PAP
12 (or less than 20)
106
Normal PVR
Anything <2
107
What is the pathology of PH?
Decreased NOS & prostacyclin
Increase in thromboxane & endothelin-1
108
When dealing with PH, it is important to avoid
PVR
Hypothermia
Ketamine
Nitrous Oxide
Acidosis
Lrg decreases in SVR
109
What should be used in the management of PH?
Vasopressors intra-op for HOTN
Etomidate
Opioids
Low volatile agents
110
In PH, there is a decrease in
The blood flow to the right side
111
What is the main treatment for acute PH?
Inhaled Nitric Oxide
112
Inhaled Nitric Oxide activates
Guanyl cyclase to increase cGMP
113
Inhaled Nitric Oxide reduces
Shunt fraction
114
IV Nitric oxide causes
Vasodilation everywhere, which can lead to perfusion of poorly vented lungs, which will increase the shunt and decrease PaO2, PVR & SVR (hypoxemia)
115
Nitric Oxide will cause
Vasodilation
Bronchodilation
Anti thrombotic/inflammatory/proliferation
116
What are examples of Phosphodiesterase Inhibitors?
Milrinone (PDE3/cardiac)
Sildenafil (PDE5/lungs)
Tadalafil (PDE5/lungs)
117
What is the MOA of Phosphodiesterase Inhibitors?
Increases & prevents the breakdown of cGMP & cAMP
Targets Nitric Oxide pathway
Ca+ levels are decreased
Inhibits Phosphodiesterase enzymes
118
PDE5 side effects
HA
Nasal congestion
Dyspepsia
Flushing
Priapism
119
PDE-4 side effects
HA
Nausea
Diarrhea
120
PDE3 side effects
V Arrythmias
HA
HOTN
121
What are examples of Endothelin Receptor Antagonists?
Bosentan
Ambrisentan
122
What is the MOA of Endothelin Receptor Antagonists?
Blocks ET-A &/or ET-B
Decreases smooth muscle cell proliferation
123
Endothelin Receptor Antagonists side effects
Related to vasodilatory properties
Flushing
HA
HOTN
124
What is the MOA of Prostacyclin derivatives/ Prostaglandins?
Increases PGI2 to target IP receptors
Relaxes vascular smooth muscle
Inhibits muscle cell growth 7 PLT aggregation
125
126
127
Prostacyclin derivatives/ Prostaglandins improves
Oxygenation
128
Prostacyclin derivatives/ Prostaglandins drug examples
Prostacyclin
Epoprostenol (inhaled)
Iloprost (inhaled)
Trepostinil (inhaled)
Remodulin (IV)
