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Complexities of Health and Illness > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Upper respiratory system is composed of?

A
  • nose - sinuses - pharynx - larynx - trachea
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2
Q

Components of the conducting zone

A
  • nasopharynx - oropharynx - larynx - trachea - left and right bronchus - secondary bronchi - tertiary bronchi - bronchioles - terminal bronchioles - respiratory bronchioles
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3
Q

Most common upper respiratory disorders

A
  • viral Upper Respiratory Tract Infections (common cold) - influenza (the flu) - can lead to pneumonia, sinusitis and middle ear infections - Rhinitis, inflammation of the nasal cavities - sinusitis - pharyngitis (viral) - tonsilitis (bacterial) - strep infection can lead to glomerulonephritis (kidney) or rheumatic fever (heart) - epiglottitis (usually viral, uncommon but an emergency as blocks the airway) - laryngitis (usually viral, swollen vocal cords) - pertussis (whopping cough) - epistaxis (nose bleeds - trauma, cocaine abuse, underlying health disorder)
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4
Q

Symptoms forming from inflammatory response

A
  • swollen mucous membranes - nasal congestion and secretions - headache, fever, general malaise
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5
Q

Components of the respiratory zone

A
  • alveoli - alveolar ducts
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6
Q

What main viruses cause URTIs?

A
  • rhinovirus - adenovirus - coronavirus - parainfluenza virus - respiratory syncytial virus (RSV)
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7
Q

Manifestations of the flu

A

Respiratory ■Coryza (runny nose) ■ Cough, initially dry becoming productive ■ substernal burning ■ sore throat Systemic ■ fever and chills ■ malaise ■ muscle aches fatigue

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8
Q

Manifestations of tonsilitis and pharyngitis

A

Local ■ sore throat ■ Possible dysphagia and ear pain ■ Tender, swollen anterior cervical lymph nodes ■ Hoarse voice ■ Red, swollen pharyngeal mucous membranes and/or tonsils ■ Possible visible exudate on pharyngeal membranes and/or tonsils General ■ fever ■ general malaise ■ Arthralgia, myalgia

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9
Q

Drugs to treat colds

A
  • as usually viral, antibiotics are ineffective.
  • Codeine and pholcodine to treat non-productive coughs
  • anticholinergics reduce nasal discharge
  • expectorants bring up mucus and other material from the lower respiratory tract
  • mucolytics thin mucus
  • antihistamines reduce sneezing and runny nose
  • antipyretic analgesics (commonly, paracetamol)
  • sympathomimetic decongestants open the nasal passages by shrinking blood vessels in the mucus membrane of the nose
  • demulcent (soothing) liquids, flavouring and sweetening agents, and alcohol
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10
Q

Structures of the lower respiratory system

A
  • bronchi - lungs - alvioli - ribs - pleura - inter-costal muscles
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11
Q

Structures of the respiratory zone (where gas exchange takes place - aka parenchyma)

A
  • respiratory bronchiles - alveolar ducts - alvioli
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12
Q

What is the carina?

A

the area between the bronchi at the end of the trachea, with sensitive nerves that cause bronchospasm or coughing

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13
Q

What are the two layers of the pleura?

A
  • visceral - envelops the lungs - parietal - lines the thoracic cavity - pleural cavity between the two; negative pressure to maintain lung inflation and filled with fluid to lubricate
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14
Q

Respiratory volume and capacity are affected by?

A
  • age - gender - weight - health status (disease, injury)
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15
Q

What happens during inspiration?

A

diaphragm contracts and flattens rib cage elevates, intra pulmonary pressure decreases and air rushes in.

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16
Q

What happens during expiration?

A

Expiration - diaphragm relaxes, ribs descend and intrapulmonary pressure rises and air flows out.

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17
Q

What are the major inter-costal muscles involved in breathing?

A
  • scalenus muscles - serratus - transversus thoracis - sternocleidomastoid - pectoralis minor - rectus abdominus
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18
Q

What is tidal volume(TV)?

A
  • the volume on regular inspiration ~500mL
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19
Q

what is inspiratory reserve volume (IRV)?

A

The amount of extra air you can take in after tidal inspiration ~3000mL

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20
Q

What is expiratory reserve volume(ERV)?

A
  • the amount on top of tidal volume that you can breathe out in forced expiration ~1200mL
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21
Q

what is inspiratory capacity?

A

TV+IRV ~3500mL

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22
Q

what is vital capacity?

A

TV+IRV+ERV ~4000 - 5000mL

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23
Q

What is residual volume (RV)

A

the amount of air remaining in the lungs after full exhalation ~ 1200mL

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24
Q

What is functional residual capacity?

A

ERV+RV ~1800 - 2400mL

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25
Q

What is total lung capacity?

A

TV+IRV+ERV+RV ~5500 - 6000mL

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26
Q

What are the 4 steps of gas transport?

A
  • ventilation of the lungs - diffusion in the lungs - perfusion in the lungs - diffusion in the tissues
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27
Q

What is V/Q?

A
  • the ventilation-perfusion ratio - should be about 0.8 (more perfusion than ventilation)
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28
Q

What is the oxyhaemoglobin dissociation

A
  • allows for more oxygen to be delivered to the cells when needed - right shift (reduced affinity) on increased temp, increased H+ encourages oxygen to detach from haemoglobin - left shift on decreased temp, decreased H+, increased CO encourages oxygen to remain linked to haemoglobin
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29
Q

What are the normal values for ABGs?

A

pH - 7.35 to 7.45 PaCO2 - 41 - 51 mmHg PaO2 - 80-100mmHg HCO3 - 22 - 26 mmol/L Base excess - +2.0 to -2.0 mmol/L SaO2 - 95-100%

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30
Q

Major lower respiratory disorders

A

Obstructive

  • asthma
  • Bronchiectasis
  • COPD *emphysema * bronchitis

Restrictive

  • acute respiratory distress syndrome (ARDS) Infections
  • Pneumonia

Cancer

  • Lung Cancer

Cystic Fibrosis (leads to mucus plugging, chronic inflammation and chronic infection)

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31
Q

What are the characteristics of obstructive pulmonary disease?

A
  • airway obstruction that worsens with expiration - common clinical manifestations: dyspnoea and wheezing, decreased FEV1, chronic fatigue - mismatched V/Q ratio
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32
Q

What is asthma?

A
  • hyper-responsive airways
  • often reversible with treatment, but can become chronic inflammation of the airways
33
Q

What is the pathophysiological pathway of asthma leading to respiratory failure?

A
34
Q

What are the drug groups for asthma management?

A
  • Relievers

* short or long-acting beta-agonists (aka adrenergic stimulants. eg. salbutamol, terbutaline)

* anticholinergics (bronchodilators; eg. Ipratropium, tiotropium bromide)

* theophyllines (aka mathylxanthines)

  • controllers

* long-acting beta-agonists (eformoterol fumarate dehydrate, salmeterol xinafoate)

  • preventers

* corticosteroids (eg ciclesonide, fluticasone propionate, budesonide)

* cromones (aka mast cell stabilisers; eg cromolyn sodium and nedocromil)

* leukotriene receptor agonists (montelukast)

* anti IgE antibody

35
Q

What is the pathophysiological pathway for COPD?

A
36
Q

Medication management of COPD?

A
  • Broncho-dilators
  • Indacaterol
  • Cortico-steroids
  • Anti-mucolytics
  • Influenza vaccine
  • Oxygen
37
Q

What is restrictive pulmonary disease?

A
  • Less common in Australia compared to obstructive
  • Different pathology but many similar clinical manifestations
  • Lung tissue compliance decreases
  • Increased respiratory effort
  • Decreased lung volume and tidal volume
  • Different causes
  • Intrinsic (asbestosis, acute respiratory distress syndrome)
  • Extrinsic (neuromuscular diseases)
38
Q

What is Acute Respiratory Distress Syndrome?

A
  • A syndrome characterised by
  • Acute lung inflammation
  • diffuse alveolar-capillary disease
  • Pulmonary oedema and severe hypoxaemia
  • Often as a result of other serious disorders
  • Sepsis,
  • burns,
  • pneumonia aspiration,
  • overdose
  • poisoning
  • Due to oedema and collapsing alveoli, Lung compliance decreased and breathing effort increased
  • Often escalates to body-wide inflammatory response and multi-organ failure
39
Q

What is the pathophysiological pathway of ARDS?

A
40
Q

Medications to treat ARDS:

A
  • Oxygen
  • Nitric oxide
  • Artificial surfactant
41
Q

What are the most likely reasons for lower airway infectious pulmonary diseases?

A
  • immunocompromise
  • unrelated medical problems
  • post-surgery
  • forced bedrest
  • smoking
42
Q

What is the pathophysiological pathway for pneumonia?

A
43
Q

What are the main clinical manifestations of pneumonia?

A

Rapid onset of:

  • fever
  • chills
  • either productive (reddish or purulent green) or dry cough
  • dyspnoea, hypoxaemia
  • adventitious breath sounds
44
Q

What are the main medications used for pneumonia?

A
  • Pneumococcal vaccination (prevent)
  • Treat cause (antibiotics, antifungals)
  • Broncho-dilators
  • anticholinergic drugs
  • antimucolytic
  • Oxygen support
45
Q

Medications for lung cancer

A
  • Chemotherapy (Doxorubicin, vincristine)
  • radiotherapy, surgery
  • Broncho-dilators
  • Analgesics
  • Oxygen
46
Q

What are the two primary variables used to determine lung volume and flow changes

A
  • the forced expiratory volume in the first second of exhalation; abbreviated to FEV1
  • the forced vital capacity (FVC), or the maximal amount of air that can be forcibly expelled from the lungs in one breath
  • FEV1 / FVC ratio should be greater than 70%
47
Q

What are the three types of ling receptors that send impulses from the lungs to the dorsal respiratory group?

A
  • irritant receptors (cause bronchoconstriction, increase in ventilatory rate)
  • stretch receptors (size and volume of the lungs)
  • J-receptors (cause shallow breathing, hypotension, bradycardia)
48
Q

What is forced expiratory volume (FEV1)?

A

The amount of air that can be forcibly exhaled in 1 second

49
Q

What is forced vital capacity (FVC)?

A

The amount of air that can be exhaled forcefully and rapidly after maximum air intake

50
Q

What is minute volume (MV)?

A

the total amount or volume of air breathed in 1 minute.

51
Q

What are the two pressures normally present in the thoracic cavity?

A
  • Intrapulmonary pressure - within the alveoli of the lings
  • Intrapleural pressure - within the pleural space (always less than intrapulmonary pressure
52
Q

What is the difference between chronic bronchitis and emphysema, the two diseases usually present in COPD?

A

Chronic bronchitis consists of airway inflammation and remodelling (hypersecretion of mucus and chronic productive cough) whereas emphysema is the destruction of alveolar tissue and decrease in elastic recoil.

53
Q

Treatments for the respiratory symptoms of cystic fibrosis

A
  • techniques to promote mucus clearance, such as:
    • chest physical therapy
    • positive pressure devices
  • bronchodilators
  • aerosolised DNase which liquefies mucus
  • inhaled mucolytics such as hypertonic saline and mannitol
54
Q

Types of lung cancer

A
  • squamous cell carcinoma
  • adenocarcinoma
  • large cell carcinoma
  • small cell carcinoma
55
Q

Conditions caused by pulmonary alterations

A
  • Pulmonary oedema (excess water in the lungs)
  • Hypoxaemia (reduced oxygenation of arterial blood)
  • Hypercapnia (increased carbon dioxide in the arterial blood)
  • Acute respiratory failure
  • Atelectasis (the collapse of lung tissue)
  • Pneumothorax (the presence of air or gas in the pleural space)
  • Pleural effusion (the presence of excess fluid in the pleural space)
  • Empyema (infected pleural effusion) - the presence of pus in the pleural space
  • Aspiration (the inhalation of fluid and solid particles into the lung)
56
Q

Signs and symptoms of pulmonary alterations

A
  • Dyspnoea
  • Cough
  • Hypoventilation and hyperventilation
  • Abnormal breathing patterns
  • Haemoptysis
  • Cyanosis
57
Q

Diagnostic tests for pneumonia

A
  • history and physical examination
  • Chest X-ray
  • CT scan
  • Sputum Gram stain
  • Sputum culture and sensitivity
  • Full blood count
  • Serology testing
  • Pulse oximetry
  • Arterial blood gases
  • Fibre-optic bronchoscopy
58
Q

Common asthma triggers

A
  • Environmental allergens (often small glycoproteins, e.g. dust mites, animal dander, pollen, fungi) Cigarette smoking
  • Pollution
  • irritants (fumes from volatile compounds, e.g. cleaning agents, glues, paints)
  • Respiratory tract infections
  • medications (aspirin, non-steroidal anti-inflammatory drugs, beta-blockers)
  • Physical factors (exercise, changes in temperature)
  • gastro-oesophageal reflux
  • Emotional stress
  • occupational exposure to organic compounds
  • food additives
59
Q

manifestations of acute asthma

A
  • dyspnoea
  • tachypnoea
  • tachycardia
  • chest tightness
  • wheezing
  • cough
  • anxiety
60
Q

Main pulmonary vascular disorders

A
  • pulmonary embolism
  • pulmonary hypertension
61
Q

Primary causes of respiratory failure

A
  • airway obstruction (eg laryngospasm, foreign body aspiration, airway oedema
  • respiratory disease (eg asthma, COPD)
  • neurological causes (eg spinal cord injury, poliomyelitis, Guillain-Barre syndrome, drug overdose, stroke)
  • chest wall injury (eg flail chest, pneumothorax)
  • alveolar disorders (eg. pneumonia, pneumonitis, COPD)
  • pulmonary oedema (eg heart failure, ARDS, near-drowning)
  • ventilation-perfusion mismatch (eg pulmonary embolism)
62
Q

Conditions associated with the development of acute respiratory distress syndrome (ARDS)

A
  • shock (eg haemorrhagic shock, septic shock)
  • inhalation injuries (eg aspiration of gastric contents, smoke and toxic gases, near-drowning, oxygen toxicity
  • infections (eg Gram-negative species, viral pneumonia, pneumocystis carinii)
  • drug overdose (eg heroin, methadone, aspirin)
  • trauma (eg burns, head injury, lung contusion, fat emboli)
  • disseminated intravascular coagulation
  • pancreatitis
  • uraemia
  • amniotic fluid and air emboli
  • multiple transfusions
  • open heart surgery with cardiopulmonary bypass
63
Q

Indications for oxygen therapy

A
  • Used primarily to treat hypoxia and hypoxaemia (oxygen deficiency in arterial blood)
  • PaO2 less than 50mmHg may result in tissue hypoxia
  • Conditions that may decrease PaO2 include airway obstruction, hypoventilation or high altitude
  • Used as a carrier gas in anaesthetics
  • Treatment of cyanosis, shock, severe haemorrhage, cardiac and respiratory arrest, coronary artery occlusion
64
Q

adverse effects of oxygen administration

A
  • Oxygen toxicity
    • Exposure to 80% to 100% oxygen for prolonged periods
    • Inflammatory response à destruction of the alveolar membrane
  • Symptoms
    • ache or burning behind the sternum
    • respiratory distress with decreased vital capacity
    • nausea and vomiting
    • restlessness, tremors
    • twitching
    • paraesthesias
    • convulsions
    • a dry, hacking cough
65
Q

Info on salbutamol for asthma

A
  • Short acting β2 agonists
  • Rapid onset of action
    • 5-15 minutes onset
    • 1-2 hours peak
    • 3-6 hours duration
  • Adverse Effects – tremor, palpitations, anxiety, restlessness, headaches, muscle cramps, hyperglycaemia, tachycardia.
  • Adult dose – 1-2 inhalations (100mcg salbutamol per dose), second 1 minute after the first.
  • Can also be given via nebuliser, orally or parenterally.
66
Q

Info on Beclomethasone for asthma

A
  • Corticosteroid
  • Maintenance treatment and prophylaxis
  • Peak plasma levels – 3-5 hours after admin
  • Local adverse effects – dysphonia (changed voice), oropharyngeal candidiasis (oral thrush) and allergic reactions
  • Not useful in acute attacks
  • Typical adult dosage – 50-200mcg up to a max of 400mcg twice daily.
  • May be up to 2000mcg daily in severe persistent asthma
67
Q

Info for Salmeterol for asthma

A
  • aka Serevent
  • Long acting β2 agonist
  • Half-life 6-12 hours administered BD or daily.
  • Used in conjunction with inhaled corticosteroids
  • Side effects – pharyngitis and upper respiratory tract infections and headache.
  • Only be used when short or intermediate-acting drugs are unable to control the symptoms.
68
Q

Info for combination drugs for asthma

A
  • Combination of preventer (inhaled corticosteroid) and reliever/controller (long-acting β2 agonists).
  • Regular treatment when both drugs appropriate not for relief of acute symptoms.
  • Advantages – convenience, cost reduction, better control of asthma and regular use of low dose steroid.
    • fluticasone and salmeterol (Seretide)
    • budesonide and eformoterol (Symbicort).
69
Q

Information for inhaled corticosteroids for asthma

A
  • Useful in preventing asthma
  • Decrease the degranulation of mast cells and have a role in the synthesis of inflammatory mediators and new antibodies.
  • Administered via inhalation to reduce bronchial hyper-activity and minimise patho-physiological changes (oedema, excessive mucous)}Metered dose inhaler or nebuliser decreases incidence of systemic reactions.
  • Beclomethasone, fluticasone and budesonide
  • Does not act as a bronchodilator, may need to give bronchodilator first to increase the ability of corticosteroid to reach airways
70
Q

information for systemic corticosteroids for asthma

A
  • Used when inhaled medication cannot adequately control asthma
  • Prednisolone – short course
  • In an emergency can be given parenterally – IV hydrocortisone, dexamethasone
  • Can cause systemic adverse events – adrenal suppression, growth suppression, altered deposition of muscle, fat, skin, hair and bone, ocular changes, infections, mineralocorticoid effects and psychological disturbances
71
Q

What is an adrenal crisis?

A
  • Prolonged use of corticosteroids suppresses the normal hypothalamic-pituitary axis.
  • Leads to adrenal atrophy from lack of stimulation
  • Sudden cessation of medication, extreme stress (MVA, surgical procedure, massive infection) → adrenal crisis
  • Can result in → physiological exhaustion, hypotension, fluid shift, shock and even death.
  • Treatment – massive infusion of replacement steroids, constant monitoring and life support measures.
72
Q

Info on glucocorticoids

A
  • Anti-inflammatory action
    • –Stabilise lysosomal membranes and prevent neutrophil movement
    • –Suppresses virtually all the vascular and cellular events in the inflammatory response including wound healing and repair
    • –Inhibit many more mediators than NSAIDs
  • Immunosuppressant action
  • –Block production and release of cytokines and other mediators
  • –Interfere with integrated role of T and B lymphocytes, macrophages and monocytes
73
Q

info on Mineralocorticoids

A
  • Affect electrolyte levels and homeostasis
  • Increase sodium reabsorption in renal tubules, leading to sodium and water retention and increase potassium excretion
74
Q

Bronchodilators for COPD

A
  • Via inhaler with spacer or nebuliser
  • Salbutamol (short-acting β2 agonists)
  • Indacaterol (long-acting β2 agonists) – only used in long term management of COPD and often combined with a corticosteroid
  • Relax tight muscles
  • Quick relief from symptoms
  • No effect on inflammation
75
Q

Inhaled corticosteroids for COPD

A
  • Decrease inflammatory response
  • Inhaled budesonide/fluticasone
  • Slows respiratory decline
  • Prone to chest (and other) infections
  • Oral steroids may be required for severe exacerbation of symptoms
76
Q

oxygen therapy for COPD

A
  • Long term home oxygen
  • ~ 18 hrs per day to permanent
  • Meet certain criteria and requires a prescription
  • Likely to not relieve (though may reduce) breathlessness but ensures oxygen to vital organs
  • Demonstrated to reduce mortality
  • Safety precautions
  • Titrated to individual needs but often 2 LPM to 4 LPM
77
Q

Key drug groups for respiration

A

◆ BRONCHODILATOR DRUGS:

✛ Anticholinergics (muscarinic antagonists):
long-acting: tiotropium, aclidinium, umeclidinium, glycopyrronium bromide (glycopyrrolate)
short-acting: ipratropium
✛ β-adrenoceptor agonists:
long-acting (controllers): formoterol (eformoterol), salmeterol, indacaterol
short-acting: salbutamol, terbutaline (DM 26.2)
✛ Methylxanthines: aminophylline, theophylline (DM 26.3)

◆ DRUGS FOR RESPIRATORY TRACT INFECTIONS:

✛ Antivirals: amantadine, neuraminidase inhibitors: zanamivir, oseltamivir
✛ Cough suppressants: codeine, pholcodine (DM 26.5)
✛ Decongestants: xylometazoline (DM 26.1)
✛ Drugs for influenza: vaccines (DM 26.6)

◆ DRUGS FOR RHINITIS: Antihistamines, nasal corticosteroids
◆ EXPECTORANTS: dilutents: normal saline, water; irritant expectorants: guaifenisin
◆ MEDICAL GASES: carbon dioxide, nitric oxide, nitrous oxide, oxygen
◆ MUCOLYTICS: dornase alfa, bromhexine, acetylcysteine
◆ PROPHYLACTIC ANTIASTHMA DRUGS (PREVENTERS):

✛ Cromones (cromolyns): sodium cromoglycate, nedocromil
✛ Inhaled (gluco)corticosteroids: beclometasone (DM 26.4), budesonide, fluticasone, ciclesonide
other drug groups
✛ Leukotriene-receptor antagonists: montelukast
5-lipoxygenase inhibitors: zileuton
monoclonal antibodies: omalizumab, mepolizumab

◆ PULMONARY SURFACTANTS: beractant, poractant alfa

78
Q

What is the bicarbonate buffer equation?

A

CO2 + H2O ⇄ H2CO3 ⇄ HCO3− + H+

Complexities of Health and Illness (5 decks)

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