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The patient (Y2-2) > Respiratory anatomy and disease > Flashcards

Respiratory anatomy and disease Flashcards

1
Q

Parasympathetic nerves cause bronchoconstriction and mucus secretion via the release of ACh which acts on which receptors?

A

M3 receptors

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2
Q

What is the effect of blocking M2 receptors that are present on nerve terminals?

A

M2 receptors reduce the release of ACh by a feedback mechanism - so blocking them would lead to an increase in ACh

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3
Q

There is no sympathetic innervation of human airway smooth muscle. True or false?

A

True

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4
Q

How does ACh acting via M3 receptors cause muscle contraction?

A

Releases from vagus nerve
stimulates Gaq which stimulates IP3 and leads to increase in intracellular calcium
Ca2+ interacts with calmodulin to form a complex which can activate MLCK. The kinase phosphorylates myosin -> contraction

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5
Q

How does activation of B-receptors via adrenaline and noradrenaline cause muscle relaxation?

A

Binding activates Gas which stimulates adenylyl cyclase leading to increased production of cAMP
cAMP activates PKA which phosphorylates several proteins - all act to reduce intracellular calcium
Less calcium so less MLCK activity so less myosin phosphorylation -> relaxation

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6
Q

Which inflammatory cell is involved in asthma?

A

eosinophils

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7
Q

which inflammatory cell is involved in COPD?

A

neutrophils

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8
Q

What causes the immediate phase in allergic asthma?

A

the spasm of bronchial smooth muscle

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9
Q

What are some of the disadvantages of B-agonists?

A

Receptor desensitisation
Receptor down-regulation
Refractory bronchoconstriction

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10
Q

What are the advantages of xanthines in the treatment of asthma?

A

increase endogenous cAMP
enhance B2 agonist effects
antagonists at adenosine receptors

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11
Q

Where are PDE4 found?

A

Airway smooth muscle

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12
Q

What are the disadvantages of xanthines?

A

less effective than B-agonists
stimulate the heart
stimulatory effect on CNS - increased alertness, tremor
small therapeutic window

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13
Q

What phosphorylates MLC?

A

MLCK

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14
Q

What dephosphorylates MLCK?

A

MLC phosphatase

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15
Q

The amount of muscle contraction is dependent on what?

A

The degree to which myosin is phosphorylated

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16
Q

Which 2 G proteins can M3 receptors couple to?

A

Gaq

G12

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17
Q

Is ipratropium bromide short acting or long acting?

A

short-acting muscarinic antagonist

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18
Q

What are the advantages of antimuscarinic bronchodilators?

A

reduce mucus secretion

useful as add-on therapy in life-threatening asthma

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19
Q

What are analeptics and name one.

A

Doxapram - they are respiratory stimulants for use in ventilatory failure

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20
Q

What causes pneumothorax?

A

Injury to the chest and air enters as a result

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21
Q

What disease may cause spontaneous pneumothorax?

A

emphysema

pneumonia

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22
Q

How can pneumothorax be treated?

A

if minor - monitor by xray, absorption of air

if large - surgery to repair puncture

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23
Q

What is tidal volume defined as?

A

The volume of air breathed in and out - in a healthy adults 500ml

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24
Q

What is meant by vital capacity?

A

the greatest volume of air that can be expelled from the lungs after a deep breath in

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25
Q

What is residual volume?

A

The air left in the lungs after forcing it out

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26
Q

What is minute ventilation and what is the equation?

A

The amount of air inhaled/exhaled in a minute

tidal volume x respiratory rate

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27
Q

What is alveolar ventilation and what is the equation for it?

A

The amount of gas that reaches the alveoli per breath

(tidal volume - dead space) respiratory rate

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28
Q

Gaseous exchange takes place in the dead space. True or false?

A

False

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29
Q

What is meant by FVC?

A

Forced vital capacity - maximum volume exhaled

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30
Q

What is meant by FEV1?

A

Forced expiratory volume in 1 second

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31
Q

What effect does obstructive lung disease have on FEV?

A

FEV is reduced

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32
Q

What effect does obstructive lung disease have on FEV/FVC?

A

< 80%

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33
Q

What effect does obstructive lung disease have on FVC?

A

Normal

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34
Q

What effect does restrictive lung disease have on FEV?

A

reduced

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35
Q

What effect does restrictive lung disease have on FEV/FVC?

A

> 80%

36
Q

What effect does restrictive disease have on FVC?

A

reduced

37
Q

What is meant by lung compliance?

A

The ease of expansion of the lungs and thorax

38
Q

In healthy individuals, what happens to lung volume when there is an increase in transpulmonary pressure?

A

When there is an increase in pressure, there is an increase in lung volume

39
Q

In patients with emphysema, what happens to lung volume when there is an increase in pressure?

A

A small increase in pressure will lead to a large increase in lung volume - because there is a lot of stretch but no recoil

40
Q

In patients with oedema or fibrosis, what effect will an increase in pressure have on lung volume?

A

there is low compliance - when pressure is applied, there is only a very small increase in lung volume

41
Q

Where are central chemoreceptors located?

A

brain stem medulla

42
Q

Where are peripheral chemoreceptors located?

A

aortic bodies

carotid bodies

43
Q

What are the aims of treatment for chronic asthma?

A

Control symptoms
prevent exacerbations
no need for rescue meds
achieve best possible lung function tests

44
Q

Name a SABA

A

Salbutamol

45
Q

Name a LABA

A

Salmeterol

46
Q

What type of inhaler is salmeterol?

A

Controller

47
Q

What type of inhaler is salbutamol?

A

Reliever

48
Q

Name an inhaler that is a preventer

A

Beclamethasone

49
Q

How does a nebuliser work?

A

Aqueous solution of drug is converted into a mist for inhalation through a mask or mouthpiece

50
Q

Is coordination needed when using a nebuliser?

A

no

51
Q

What are some of ADRs of B-agonists?

A

Fine tremor
Tachycardia
Hypokalaemia

52
Q

How is prednisolone administered?

A

Orally

53
Q

What is hydrocortisone and how is it administered?

A

Corticosteroid and is administered IV

54
Q

What are the four indications that show ICS should be used?

A

Had exacerbations of asthma in the past two years
Using an inhaled B-agonist more than 3 times/week
Symptomatic > 3 times a week
Waking 1 night per week

55
Q

Name two leukotriene antagonists that can be used in asthma treatment

A

Montelukast

Zafirlukast

56
Q

What is theophylline and how is it administered?

A

Methylxanthine administered orally

57
Q

Theophylline is a salt of aminophylline. True or false?

A

False - aminophylline is a salt of theophylline and can be administered orally/IV

58
Q

How does smoking have an effect on use of methlyxanthines?

A

Smoking increases clearance (and so reduces plasma levels) of methylxanthines - so a patient who smokes may need to have a higher dose for therapeutic effect

59
Q

Does obesity increase or decrease clearance of methylxanthines?

A

reduces clearance

60
Q

Name a cromone that can be used in asthma therapy.

A

Nedocromil

61
Q

What factors affect PEF?

A

Age
Sex
Height

62
Q

What does a PEF of <50% predicted indicate?

A

Acute severe asthma

63
Q

What is acute severe asthma determined by?

A

PEF < 50% predicted
Ability to talk
RR > 25
HR > 110

64
Q

What is the immediate treatment that is required for acute severe asthma?

A

oxygen at the highest possible conc: 40-60%
B-agonist nebuliser or multiple doses via spacer
Corticosteroid: 40mg prednisolone or 100mg hydrocortisone IV

65
Q

What does step 1 BTS/SIGN guidelines for adults asthma state?

A

low dose ICS

66
Q

What does step 2 BTS/SIGN guidelines for adults asthma state?

A

Add LABA to low dose ICS (usually a combination inhaler)

67
Q

What does step 3 BTS/SIGN guidelines for adults asthma state?

A

Increase ICS to medium dose, continue LABA

consider trialling LTRA SR theophylline, LAMA

68
Q

What does step 4 BTS/SIGN guidelines for adults asthma state?

A

Increase ICS to hgih dose and add a fourth drug:

LTRA, SR theophylline, B agonist tablet, LAMA

69
Q

What does step 5 BTS/SIGN guidelines for adults asthma state?

A

Continuous or frequent use of oral steroid

Consider other treatment to minimise use of steroid tablet

70
Q

COPD is curable. True or false?

A

False - treatable but not curable

71
Q

Sputum production is associated with asthma, not COPD. True or false?

A

False - COPD

72
Q

In diagnosis of COPD, what is airflow obstruction defined as?

A

FEV less than 80% predicted and post bronchodilatory FEV/FVC less than 70% predicted

73
Q

Male gender is a risk factor for COPD. True or false?

A

True

74
Q

Name 4 side effects of antimuscarinic drugs

A

Blurred vision
Urinary retention
Dry mouth
Constipation

75
Q

In treating COPD, what is the percentage of oxygen delivered?

A

24-28%

76
Q

What is the criteria for use of long-term oxygen therapy?

A

FEV < 35%

77
Q

Which vaccines are offered for COPD patients?

A

Annual influenza vaccine

Pneumococcal vaccine

78
Q

What are antibiotics given for in COPD?

A

Infective exacerbations

79
Q

Name a mucolytic that is used in COPD treatment

A

Carbocisteine

80
Q

What is hypercapnia?

A

CO2 retention

81
Q

What is cor pulmonale?

A

Right heart failure - usually due to COPD

82
Q

What is step 1 in BTS/SIGN child asthma?

A

Very low dose ICS or if child is under 5 LTRA

83
Q

What does step 2 in BTS/SIGN child asthma state?

A

Very low dose ICS and if child is under 5 add: LTRA

Very low dose ICS and if child is over 5 add LABA

84
Q

What does step 3 in BTS/SIGN child asthma state?

A

No response to LABA - stop and increase ICS to low dose
Response to LABA, but inadequate - Cont LABA, increase ICS to low dose
Response to LABA, but inadequate, cont LABA and ICS, and consider LTRA

85
Q

What does step 4 BTS/SIGN child asthma state?

A

Increase ICS to med dose and consider addition of fourth drug SR theophylline

86
Q

What does step 5 BTS/SIGN child asthma state?

A

Daily use of steroid tab
Maintain med dose ICS
Consider other treatment to reduce

The patient (Y2-2) (8 decks)

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