RESPIRATORY: 612 - 613 Flashcards
What is a pleural effusion?
Excess accumulation of fluid between the 2 pleural layers
What are the 2 pleural layers?
Visceral (inner) and parietal (outer)
What is the major problem with a pleural effusion?
Restricted lung expansion during inspiration
What are the three types of pleural effusion?
- Transudate
- Exudate
- Lymphatic
Is protein content higher in transudate or exudate? How can you tell?
Exudate - it’s cloudy
What are 3 causes of transudate pleural effusion?
- CHF
- Nephrotic syndrome
- Hepatic cirrhosis
What are 4 causes of exudate pleural effusion?
- Malignancy
- Pneumonia
- Collagen vascular disease
- Trauma
What do exudate pleural effusions increase the risk of?
Infection
What is a cyclothorax?
Another name for lymphatic pleural effusion
What is the underlying cause of lymphatic pleural effusion?
Injury to thoracic duct wither from trauma or malignancy
Describe the findings in a cyclothorax.
Milky fluid and increased triglycerides
What is a pneumothorax?
Accumulation of air in the pleural space
How does a pneumothorax present?
All on affected side:
- Unilateral chest pain and dyspnea
- Unilateral chest expansion
- Decreased tactile fremitus
- Hyperresonance
- Diminished breath sounds
What are the two types of pneumothorax?
- Spontaneous
2. Tension
Describe the trachea’s position in spontaneous vs. tension pneumothorax.
Spontaneous - deviates to the affected lung (collapsed portion of lung)
Tension - deviates away from the affected lung (trapped air)
What is the difference between spontaneous vs. tension pneumothorax?
Both have accumulation of air in the pleural space but in a tension pneumothorax, air cannot EXIT that space
Describe the classic scenario for the spontaneous pneumothorax.
Tall, thin, young males who have rupture of an apical bleb
What are 2 settings in which tension pneumo’s are common?
- Trauma
2. Lung infection
What is the mechanism of action of H1 blockers?
Reversible inhibitors of H1 histamine receptors
How many generations of H1 blockers do we have?
2
Name three 1st generation H1 blockers.
- Diphenhydramine
- Dimenhydrinate
- Chlorpheniramine
Names contain “-en/-ine” or “-en/-ate”
What are the clinical uses for 1st generation H1 blockers?
Allergy, motion sickness, sleep aid
What are the toxicities for H1 blockers?
Sedation, antimuscarinic, anti-alpha-adrenergic
Name four 2nd generation H1 blockers.
- Loratadine
- Fexofenadine
- Desloratadine
- Cetirizine
Names usually end in “-adine”
What are 2nd generation H1 blockers used for?
Allergy
How do the toxicity of 2nd generation H1 blockers compare to those of 1st generation and why?
Far less sedating than 1st generation because of decreased entry into the CNS
What is guaifenesin?
Expectorant - thins respiratory secretions
How does guaifenesin affect the cough reflex?
Does NOT suppress cough reflex
Describe the mechanism of action of N-acetylcysteine.
Mucolytic
What are 2 specific uses for N-acetylcysteine?
- Loosen mucus plugs in CF patients
2. Antidote for acetaminophen overdose
What is dextromethorphan?
Synthetic codeine analog that is antitussive (antagonizes NMDA glutamate receptors)
What effect can dextromethorphan have if used in excess?
Opioid
What can be given for dextromethorphan overdose?
Naloxone
Describe the mechanism of pseudoephedrine and phenylephrine.
Sympathomimetic alpha-agonistic
Reduce hyperemia, edema, and nasal congestion
Also open obstructed eustachian tubes
What drug can be used illicitly to make methamphetamine?
Pseudoephedrine
What are pseudoephedrine and phenylephrine used for?
Nonprescription nasal decongestants
What are the toxicities of pseudoephedrine and phenylephrine?
Hypertension
Pseudoephedrine can also cause CNS stimulation/anxiety
