Scenario 3

Question 1

What is exacerbation?

Answer 1

exacerbation may refer to an increase in the severity of a disease or its signs and symptoms. For example, an exacerbation of asthma might occur as a serious effect of air pollution, leading to shortness of breath.

Question 2

What is exacerbation?

Answer 2

exacerbation may refer to an increase in the severity of a disease or its signs and symptoms. For example, an exacerbation of asthma might occur as a serious effect of air pollution, leading to shortness of breath.

Question 3

What is dyspnoea?

Answer 3

dyspnoea is an unpleasant sensation of uncomfortable, rapid or difficult breathing. People say they feel puffed, short of breath or winded. Your chest may feel tight and breathing may hurt.

Question 4

What is COPD?

Answer 4

COPD stands for chronic obstructive pulmonary disease. This is the name used to describe a number of conditions including emphysema and chronic bronchitis. Emphysema affects the air sacs in your lungs (alveoli), and chronic bronchitis affects your airways (bronchi).

Question 5

What is Emphysema?

Answer 5

This is enlargement of the air spaces distal to the terminal bronchioles leading to destruction of their walls

Question 6

What’s the pathophysiology of emphysema?

Answer 6

The elastin of the alveolar walls is destroyed so that the lungs lose their elastic recoil. Expiration becomes difficult and air becomes trapped in the alveoli. This may cause alveoli to rupture and form bullae which may rupture causing pneumothorax. Airways become scarred and fibrotic. Gas exchange is reduced, residual volume rises and lung function deteriorates.

Question 7

What does ipratropium bromide (0.5mg) do?

Answer 7

It is an anticholinergic bronchodilator (muscarinic receptor antagonist) blocks parasympathetic nerve reflexes that cause the airways to construct so allow he air passages to remain open. The muscarinic agonists bind to the receptors on smooth muscle cell so smooth muscle relaxes so lumen enlarges so dyspnoea and bronchospasm are reduced.

Question 8

What salbutamol 5mg? (B2 Agonist)?

Answer 8

Salbutamol works by acting in receptors in the lungs called beta 2 receptors. When salbutamol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to become open. Also it is believed that salbutamol increases cAMP production by activation adenylate Cyclase and the actions of salbutamol are mediated by cAMP, increased intracellular cyclic AMP increases the activity of cAMP dependent protein kinase A, which lowers intracellular calcium concentrations and lower calcium concentrations means smooth muscle. In addition salbutamol inhibits the release of bronchi constricting agents from mast cells which inhibits micro secular leakage and enhances mucocilliary clearance

Question 9

Side effects of salbutamol

Answer 9

Tachycardia, headache asking, muscle cramps, mouth and throat irritations

Question 10

Explain Mrs Barnes dyspnoea in terms of her underlying pathophysiology.

Answer 10

Smoking causes inflammation of airways - so oedema of airway walls - so narrowed by of lumen and wheezing - so obstruction to airflow which means less has moved per inspiration/exhalation.

Question 11

Explain Mrs Barnes productive cough in terms of her underlying pathophysiology?

Answer 11

Smoking irritates and increased activity of mucus-secreting goblet cells and damages ever epithelial cells cillia. So excess secretion of mucus - mucus is a extra sticky - ciliary escalator ineffective - so productive cough

Question 12

Explain Mrs Barnes Pyrexia in therms of her underlying pathophysiology?

Answer 12

Mucus traps and enables he multiplication of bacteria -so acute lower repiratory Tract infection develops- infection/ leucocyte activity produce chemicals eg histamine/leucotrienes/cytokines. Some of this means the pyrogens and prostaglandins reset the hypothalamuss temperature gauge to a higher reading - so core temp rises which means Pyrexia

Question 13

Discuss the problems which might arise from amoxicillin therapy?

Answer 13

Most bacteria lives in our digestive tract act and perform a variety of functions including competing with other potentially harmful bacteria. Broad spectrum antibiotic therapy can damage and disrupt intestinal bacterial activity which may lead to an infections e.g. The multiplicative of pathogenic bacteria such as clostridium difficile (normally present in the guy) If this occurs it can lead to painful abdominal cramps and diarrhoea which may lad to colicky pin, dehydration, electrolyte loss, fever and weight loss goals

Question 14

Side effects of amoxicillin

Answer 14

Could have diahrea, would be a sign of c-diff. Blood in urine, nausea and dark urine I

Question 15

Side effects of ipratropium

Answer 15

Blood in urine, painful to urinate, need to urinate more frequently

Question 16

Side effects of salbutamol

Answer 16

Tremor, headaches, tachycardia.

Go to doctor with the rare side effects itching raised bumps on skin, dizziness, wheezing

Question 17

How does smoking effect emphysema

Answer 17

Smoking causes inflammation to alveolar walls
Destruction of some alveolar walls and elastin
So increased residual volume
Loss of elastic recoil
So exhalation more difficult
So over filling of alveoli and rupture
So reduced gas exchange

Question 18

Pharmacokinetics of salbutamol

Answer 18

Absorption: systemic absorption is rapid following aerosol administration. Also acts within 5 mins with peak 15-20 mins and overal duration 4-6 hours
Protein bound: 10 percent
Metabolised: hydrolysed by esterases in tissue and blood to the active compound colterol and conjuntively metabolised to salbutamol 4-0 sulphate in liver
Elimination: 72 percent urinated within 24 hours, 28 as unchange drug and 44 as metabolite
Half life: 1.6 hours

Question 19

Pharmacokinetics of amoxicillin

Answer 19

Absorbed rapidly

Distribution: most bodily fluids/ csf less than 1 percent / protein bound 20 percent

Metabolism: heptic metabolism accounts for 30 percent of most penicillins

Excreted 60 percent in 8 hours
Half life: 61.3 mins

Question 20

What’s a mcs microscopy, culture, sensitivity

Answer 20

Microscopy: stick under a microscope to see anatomical features eg size/shape/ pretence of flagella etc - helps to identify the cater gory of organ

Culture: put into a plate of growth medium and stick in warm place to growth and divide to make colonies. Gradually purify the cultures so that one plate contains only a culture of one particular organism

Sensitivity: place pure samples of the colony onto an agar plate containing discrete areas impregenated with various anti biotics - stick in warm and leave- any clear zone in an antibiotic will indicate the organism is sensitive to e.g it can be disabled or killed by that antibiotics

This means antibiotic would be given more rarely then resistance will become less common

Question 21

Pharmacokinetics of ipratropium bromide

Answer 21

Absorbed: rapidly
Protein binding: 10 percent
Half life 2 hours
Metabolised in liver
Excreted urine
Bioavailability 20 percent.

Question 22

Explain why Mrs Barnes salbutamol is dele over via an air driven rather than an oxygen delivered nebuliser

Answer 22

Airway obstruction due to inflammation and bronchospasm and destruction of alveolar elastin and resultant dilation of alveoli and increase in residual volume all reduce the amount of expired air leaving the lungs. This may lead to increase level of CO2 in the alveoli (increase pco2) because gases diffuse down a pressure. Increase pco2 may inhibit normal diffusion of co2 from the pulmonary capillaries into the alveol. This can lead to persistently raised co2 levels in blood in some COPD patients. Respiratory drive is normally stimulates by intermittently rising quantity of co2 in arterial blood (pco2) and resultant increasing acidity in cerebrospinal fluid. Co2 chemoreceptor receptors stimulated when there is a tempory rise in co2 and transmit nerve impulses to the respiratory centres which increases respiratory effort to correct imbalance. In COPD lung airways are narrowed and many other factors which less surface area for gas exchange. Result is blood co2 levels become persistently raised so chemorexeptors become dese-sensitised so they stop working. We also have got sensor cells that are stimulated by decreasing blood 02 levels and we don’t use these and although there is some doubt we think these short of blood 02 sensors keep the COPD patients breathing. If salbutamol delevierd in 02 then blood become rich O2 and short of 02 receptors stop working so no messages to breathe can send the patient to death.

Question 23

What is the progression of smoking

Answer 23

Airway inflammation - infection - increase mucus production - bronchospasm - permanent narrowing bronchi - worsening alveolar damage

Question 24

Why should she quit smoking?

Answer 24

Cigarette smoke and the chemicals released during smoking are irritants inhaled irritants result in airway inflammation

Inflammation increase size and number of mucus and goblet cells leading to hyper secretion of mucus
Inflammation also contributes to bronchial odema and increased airway resistance.
Cigarette smoke/ irritation also contributed to loss of elasticity in the alveoli.
This causes them to become brittle and enlarged
Over stretching may cause several air sacs to rupture forming bullae which decreases surface area