W21 - Cystic Fibrosis Flashcards

1
Q

what is cystic fibrosis

A

a genetic autosomal recessive, systemic and multiorgan disease caused by defective ion transport

involves imbalance of fluid and electrolytes causing thick, sticky mucus and viscous secretions to accumulate in different organs

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2
Q

in what ethnicity is cystic fibrosis most common

A

caucasian

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3
Q

how deadly is cystic fibrosis

A

most lethal genetic autosomal recessive disease in the white population

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4
Q

What is cystic fibrosis caused by

A

mutation in a gene that encodes cystic fibrosis transmembrane conductance regulator

a chloride channel expressed in epithelial cells and other type of cells

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5
Q

what is autosomal mean

A

refers to any chromosomes other than the sex determining chromosomes

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6
Q

what does recessive mean

A

not expressed unless both copies are present

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7
Q

what does autosomal dominant mean

A

a gene on one of the non sex chromosomes that is always expressed, even if only one copy is present.

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8
Q

where is the CFTR located

A

apical membrane of secretory and absorptive epithelial cells of the pancreas, intestine, liver, airway, vas deferens and sweat glands + sweat glands.

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9
Q

What is the function of the CFTR protein

A

cyclic AMP dependent chloride channel, a bicarbonate channel and as a modulator of other ion channels

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10
Q

what does CFTR stand for

A

cystic fibrosis transmembrane conductance regulator

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11
Q

what is the CFTR

A

cloride channel expressed in epithelial cells that maintains

salt
fluid
pH homeostasis in various epithelial tissues

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12
Q

how do CFTRs form a pore

A

line up in parallel tail to tail forming a pore at its centre

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13
Q

What does NBD stand for

A

Nucleotide binding domain

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14
Q

what does RD stand for

A

Regulatory domain

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15
Q

Describe the role of NBD + RD in the channel

A

NBD + RD are in the cytosol and the membrane domain form the pore of the channel. RD is phosphorylated by a cAMP dep kinase, NBDs bind to and hydrolase ATP providing energy to open and close the pore.

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16
Q

what is the major NBD + RD function

A

regulating chloride conductance

17
Q

What symptoms exist of pulmonary disease

A
copious sputum production 
persistent cough
reduced lung function 
inflammation and tissue damage
chronic airway infections
18
Q

what is the main cause of morbidity and mortality of CF

A

chronic lung disease

19
Q

what are 2 forms of pancreatic dysfunction

A

exocrine pancreatic insufficiency - impaired enzyme secretion from pancreas and malnutrition

endocrine pancreatic insufficiency - cf related diabetes mellitus

20
Q

what effect does CF have on pancreatic secretions and the pancreas itself

A

pancreatic secretions have lower fluid volumes and increased acidity within the pancreatic lumen which leads to precipitation of the protein rich secretions which can cause plugging of small ducts and obstruction. Meaning more damage to pancreas.

21
Q

what is Meconium ileus

A

20% of babies with CF have this, it is a condition where the content of the newborn child’s bowel (meconium) is extremely sticky and causes the bowel to be blocked at birth.

Meconium ileus is a bowel obstruction that occurs when the meconium of child intestine is even thicker and stickier than normal.

22
Q

What are some gastrointestinal symptoms

A

thickened intestinal secretion, malabsorption, malnutrition, decreased gut motility. Salty tasting skin. Congenital absence of the vas deferens

23
Q

what can result from a mutation of the CFTR

A

reduce transcription or translation

affect traffinking to surface

accelerate protein turnover

causes loss of protein

24
Q

what are two ways in which we test for CF

A

blood test in new borns

sweat test in child / adult

25
Describe the pathophysiology of CF
CFTR gene defect Defective ion transport - lower chloride transport - higher sodium absorption - higher h20 absorption airway surface liquid depletion defective mucociliary clearance mucus obstruction infection inflammation
26
At what point in the pathophysiology can we try and manage
Potentiators and correctors can be used at airway surface liquid depletion mucoactives and physiotherapy can be used at mucus obstruction immunomodulatory therapy, antimicrobial
27
what are mucoactives
increase the ability to expectorate sputum and or decrease mucus hypersecretion
28
What are the 4 types of mucoactives
expectorants (induce cough or increase the volume of secretions) mucolytics (reduce the viscosity of mucus) mucokinetic drugs (increase the mobility and transportability of mucus) mucoregulators (control the process of hypersecretion)
29
what is an example of first line mucoactives
inhaled recombinant human DNase I degrades DNA
30
What is ivacaftor (kalydeco)
conductance regulator potentiator for CFTR channel with a G551D A "missenge" gating mutation. Ivacaftor increases the time the mutated CFTR is open, allowing chloride ions to flow through. This action partially normalises the consistency of mucous and digestive juices in cystic fibrosis.
31
what is lumacaftor
channel corrector
32
what is a channel corrector
acts as a protein folding chaperone, aiding the conformational stability of the mutated CFTR protein.
33
what is the purpose of chest physiotherapy
to augment clearnace of tenacious airway secretions Help postural drainage and percussion in varied positions that help draining mucus, chest is clapped and vibrated to help dislodge mucus to large airwayts
34
what is postural drainage
positions to help drain mucus