Respiratory - EMILY

Question 1

What comprises the mucociliary apparatus?

Answer 1

Ciliated cells and goblet cells that line the the conducting portion of the tracheobronchial tree

Question 2

What is the site of airway constriction and dilation?

Answer 2

Bronchioles and terminal bronchioles because they are made of smooth muscle and no cartilage

Question 3

What disappears in the transitional zone of the resp system?

Answer 3

Cilia and goblet cells

Question 4

What are the therapeutic goals of treating allergies/inflammation?

Answer 4

-Decrease inflammation
-Improve mucociliary clearance
-Promote gas exchange

Question 5

What kinds of drugs are used to treat allergies/inflammation?

Answer 5

-Steroids*
-Expectorants and mucolytics
-Bronchodilators

Question 6

What type of drug is used to treat pulmonary edema and why?

Answer 6

Diuretics; reduces fluid content in lungs to improve gas exchange

Question 7

What kind of drugs are used for treating coughing?

Answer 7

-Cough suppressants (antitussives)
-Expectorants and mucolytics
-Steroids

Question 8

What type of drug would be used to treat exercise-induced pulmonary hemorrhage?

Answer 8

Diueretics

Question 9

What kinds of drugs could be used to treat pneumonia?

Answer 9

-Antimicrobials
-Steroids/NSAIDS
-Expectorants and mucolytics
-Bronchodilators

Question 10

What are the 3 main type of drugs used to treat respiratory conditions?

Answer 10

-Antitussives
-Expectorants and mucolytics
-Bronchodilators

Question 11

What are the primary uses of cough suppressants in vet med?

Answer 11

-Tracheal collapse (dogs)
-Kennel cough (dogs)
-Cough suppression during diagnostic procedures (horses)

Question 12

What are the 4 drugs commonly used to suppress coughing and what are they?

Answer 12

-Butorphanol (opioid)
-Codeine (opioid)
-Hydrocodone (opioid)
-Dextromethorphan (opioid derivative)

Question 13

How is the cough reflex triggered?

Answer 13

Afferent pathways in the vagus nerve are stimulated and trigger the cough center in the medulla which stimulates respiratory muscles for coughing

Question 14

What do antitussives do to the cough center in the medulla?

Answer 14

They make it less sensitive so it’s less likely to be activated

Question 15

When should you NOT give an antitussive?

Answer 15

If the cough is productive (animal swallows after coughing). This could reduce helpful clearance of mucous and stuff which would be bad

Question 16

What is the safest antitussive product for use in cats long-term?

Answer 16

Dextromethorphan. It does not act on opioid receptors so it is not physically addictive

Question 17

What do expectorants do?

Answer 17

-Increase bronchial secretions
-Enhance mucociliary clearance
-Promote productive cough

Question 18

What do mucolytics do?

Answer 18

Break down mucous secretions

Question 19

Which 3 drugs are mucolytics?

Answer 19

-Acetylcysteine
-Dembrexine (sputolysin)
-Guaifenesin

Question 20

Which 2 things are expectorants?

Answer 20

-Saline expectorants
-Volatile oils

Question 21

How does acetylcysteine work?

Answer 21

The free sulfhydryl group on the drug breaks down disulfide bonds in mucoproteins

Question 22

What are two situations where acetylcysteine could be used?

Answer 22

1. Infused into gutteral pouch of horses to break down chondroids (mucous concretions)
2. Enema in foals for refractory meconium impactions

Question 23

What can acetylcysteine be given IV for?

Answer 23

Treating toxicities to acetaminophen and xylitol

Question 24

What can happen in some patients if acetylcysteine is given in the inhaled version?

Answer 24

Can induce hypersensitivity reactions and bronchoconstriction in some patients

Question 25

What does dembrexine (sputolysin) do?

Answer 25

Alters the viscosity of mucous to make it easier to clear

Question 26

How is dembrexine (sputolysin) given?

Answer 26

Orally administered so it has systemic effects. May also have some antitussive effects

Question 27

What is dembrexine (sputolysin) used to treat?

Answer 27

Horses: RAO, IAD, pneumonia Dogs: Otitis media with effusion (mucous plug in middle ear)

Question 28

What is guaifenesin?

Answer 28

Primarily a muscle relaxant, but also an expectorant/mucolytic

Question 29

How does guaifenesin work?

Answer 29

-Affects respiratory secretions via parasympathetic mechanisms stimulated by gastric mucosal irritation -Enhances mucociliary apparatus function

Question 30

The _______ of a tube is much MORE important than its _______ in determining resistance to airflow

Answer 30

Radius; length

Question 31

Bronchioles consist of:

Answer 31

Smooth muscle only!!

Question 32

Bronchiolar smooth muscle innervation is primarily _______________

Answer 32

Parasympathetic

Question 33

What are the primary receptors in bronchiolar smooth muscle?

Answer 33

M3 (muscarinic/cholinergic)

Question 34

Stimulation of M3 receptors in the bronchioles will cause:

Answer 34

Bronchoconstriction

Question 35

What other receptors are also present in bronchiolar smooth muscle?

Answer 35

beta-2 receptors

Question 36

Stimulation of beta-2 receptors in bronchiolar smooth muscle will cause:

Answer 36

Bronchodilation

Question 37

What are effective bronchodilators?

Answer 37

Anticholinergics (muscarinic antagonists)

Question 38

Anticholinergics will prevent what?

Answer 38

Parasympathetic bronchoconstriction

Question 39

What are 3 anticholinergic drugs that are bronchodilators?

Answer 39

-Atropine -Glycopyrrolate -N-butylscopolamine bromide (Hyoscine butylbromide)

Question 40

What are 2 drugs that are beta-2 agonists?

Answer 40

-Clenbuterol -Albuterol/salbutamol

Question 41

What are 3 methylxanthines that cause bronchodilation?

Answer 41

-Aminophylline -Theophylline* -Caffiene

Question 42

Beta-2 agonists are Broncho-__________

Answer 42

Dilators

Question 43

Epinephrine is also a bronchodilator. What kind of drug is it?

Answer 43

Non-selective adrenergic agonist

Question 44

What is salbutamol/albuterol usually given as treatment for?

Answer 44

Asthma in horses and cats - generally for acute treatment

Question 45

Salbutamol/albuterol is a _______-acting bronchodilator

Answer 45

Short

Question 46

Why is salbutamol/albuterol given in an inhaled form?

Answer 46

-Rapid onset of action -Reduced risk of adverse effects and drug interactions

Question 47

Why shouldn't salbutamol/albuterol be given for extended periods?

Answer 47

-Tolerance can occur (tachyphylaxis) -May be pro-inflammatory in cats

Question 48

Clenbuterol should NOT be given to which animals?

Answer 48

FOOD ANIMALS!!

Question 49

Clenbuterol is labelled for what?

Answer 49

Management of airway obstruction due to respiratory disease in horses (RAO, IAD)

Question 50

Clenbuterol must be combined with ____________ __________ to achieve desired effects

Answer 50

Environmental changes

Question 51

Clenbuterol is usually given as an adjunctive treatment with what other type of drug?

Answer 51

Steroids (inhaled or systemic)

Question 52

When does the maximum benefit of clenbuterol usually occur?

Answer 52

After 14 days of administration

Question 53

What can occur within 21 days of continuous administration of clenbuterol in horses?

Answer 53

Tachyphylaxis

Question 54

What is the most commonly used inhaled nasal steroid?

Answer 54

Fluticasone

Question 55

What is ciclesonide?

Answer 55

A steroid pro-drug used in the treatment of equine asthma

Question 56

What are the drug classes that can cause respiratory depression?

Answer 56

-General anesthetics -Opioids -Benzodiazepines

Question 57

What is doxapram?

Answer 57

A drug with specific respiratory stimulatory effects on the CNS

Question 58

What is a useful but controversial use of doxapram?

Answer 58

Using it to stimulate respiration in apneic neonates

Question 59

Doxapram _________ respiratory rate and volume, but arterial PaO2 may not __________

Answer 59

Increases; increase