Respiratory Flashcards
______: chronic inflammatory disease of the bronchial tubes and lung tissue
airway changes:
the muscles surrounding the bronchial tubes ______, airways _____
- the lining of the airway becomes ______ and _____
-there is an increase in ____ production
asthma
constrict, narrow
inflamed, swollen
mucus
asthma triggers
- respiratory infections - ____, _____
- ______ - pollens, dust mites, animal dander
- ______
- work stimuli - ____, farmers hay ____
- ________ - cold air, tobacco smoke
- emotions - _____ & ____
- exercise - especially in ____ ____ climate
- drugs/preservatives - ___, ____
viral, pneumonia allergens GERD flour, mold environment anxiety, stress cold, dry ASA, sulfites, beta blockers
signs and symptoms
-use of accessory muscles
(_______, _____ intercostals, and _____ muscles of the neck)
-__________ pulse (weak during _______ and strong at _______)
-over inflation of the ____
-___ color of skin and nails may indicate cyanosis
-responds to standard treatment with _______ and
____
-___________: mortality rate 70%
sternocleidomastoid, external, scalene paradoxical inspiration expiration chest blue bronchodilators, steroids status asthmaticus
asthma
clinically: recurrent episodic bouts of ______
two phases
-acute-phase (________) response
-within a few minutes to ______ challenge
-________, ________, ________, ______-
-lasts a few hours
late-phase response (_______)
- ______ wheeze, hyper-responsiveness
- occurs in _ to _ last up to 12 to 24 hours
bronchospasm immediate bronchospasm, SOB, chest tightness, wheezing inflammation chronic 2,6
immediate (acute) phase bronchial smooth muscle constriction -mediator release from sensitized \_\_\_\_ cells and other immunologic reponses -\_\_\_\_\_\_\_\_; eosinophil chemotatic factors -\_\_\_\_\_\_\_\_\_- (LTB4, LTC4, LTD4, LTE4) -\_\_\_\_\_- is a chemo-attractant -\_\_\_\_\_\_\_, neutral \_\_\_\_, \_\_\_\_\_\_\_\_\_ (D2) -\_\_\_\_\_\_ with treatment -short term relief with \_\_\_\_\_\_\_ -\_\_\_\_\_\_\_ may help in allaying symptoms
mast histamine leukotrienes LTB4 tryptase proteases reversible prostaglandins bronchodilators oral steroids
late phase response
-peak within ___ hours and may last for ____ hrs
-chronic inflammation characterized _________
-mast cells, lymphocytes, GM-CSF (granulocyte, macrophage
CSF)
-release of _______ (IL4, IL5, IL9, 130, TNF, TGF) which activate ________ & _______
4-8, 12-24
cellular infiltration
cytokines
eosinophils, neutrophils
goals of asthma therapy
- prevent troublesome symptojms: cough, breathlessness in night, am, after exercise
- _______ normal lung func tion
- maintain normal activity
- prevent recurrent ________/hosp
- optimal ____ therapy w no side effects
maintain
exacerbations
drug
quick-relief (rescue) medications: -agents that directly relaxes bronchial smooth; prompt \_\_\_\_\_ of acute airflow obstruction -SABA (short acting beta agonist) -\_\_\_\_\_\_\_\_ (ventolin); \_\_\_\_\_\_\_\_ anticholinergics -\_\_\_\_\_\_\_\_ (Atrovent); \_\_\_\_\_\_\_\_ (spiriva) corticosteroids -\_\_\_\_\_\_\_, prednisone, triamcinolone
reversal albuterol, terbutaline ipratropium tiotropium fluticasone
pharmacologic agents for asthma
long-term control (controller) medications
-__________, inhaled - beclomethasone, budesonide, fluticasone
-______ (________) - salmeterol (serevent), formoterol; salmeteral/flunisolide
(Advair)
-__________ inhibitors
zileuton (Zyflo)
- ________ stabilizer (also inhibits eosinophi; recruitment)
cromolyn (gastrocom); nedocromil (alocrif)
-________ - theophylline
-________ - omalizumab (xolair)
corticosteroids LABA (long acting beta 2 agonist) leukotriene receptor antagonist (LTRA) 5-lipoxygenase inhibitors mast cell stabilizer methylxanthines immunomodulators
types of asthma
- _______ - patients with episodic illness with extended symptom-free periods
- _____ or ____ - daily symptoms or symptoms several times/week without extended symptom free periods
- _____ - daily symptoms during an allergy season (also referred to as seasonal asthma)
intermittent
persistent/chronic
allergic
status asthmaticus
- acute ____ asthma
- life threatening emergency
- requires rapid, and aggressive treatment
immediate treatment
- activate office emergency protocol
- oxygen by ____
- humidified air to help _____ mucus
- _____
- patients will require hospitilization
SEVERE
mask
liquefy
albuterol
symptoms of poorly controlled persistent asthma
- waking up at night >_/month
- refilling albuterol (ventolin) > __ time a month
- _______ bronchoconstriction
- missing _____
- missing ___
- _______
2 1 excercise induced school work hospitilization
quick relief medication reliever/rescue
- non-selective beta 2 agonist: _______, _________
- short acting beta2-agonists: ________, _______
- _________
- _____________
epinephrine, isoproterenol
terbutaline, albuterol
anticholinergics
systemic corticosteroids
beta 2- agonists (albuterol)
- relax airway smooth or relieve _______
- used for treatment of ______ episodes of bronchospasm and prevention of _______ d asthma
- for acute asthmatic attack
- ________
- _______ (ma huang)
- __________
bronchospasm intermittent exercise induced epinephrine ephedrine isoproterenol
beta-2 agonists -beta-adrenoceptor agonists mechanism of action -stimulate \_\_\_ receptor \_\_\_\_\_\_\_\_\_\_ coupled receptor system -activate \_\_\_\_\_\_\_\_ -increase \_\_\_ -protein \_\_\_\_\_\_\_ activation -inactivation of \_\_\_\_\_\_\_ kinase -results in bronchodilator response by relaxation of bronchial smooth muscle
b2 G protein adenylyl cyclase cAMP kinase A myosin light chain
