Respiratory Flashcards

Terms Definitions
atropium
M3 blockers
Q. class Asmanex
Corticosteroid
Zileuton
Leukotriene Synthesis Inhibitorinhibits LOX enzyme
Q. class Maxair
Beta adrenergic
Ipratropium:
Use
Mechanisms
Asthma: A muscarinic antagonist
-Competitive block of muscarinic receptors
-Prevents bronchoconstriction
Inhibits phospholipase A2 enzyme
Glococortocoids
Q. class Racemic epi
Beta adrenergic
Q. Xopenex's method of administration
SVN
Bronchoconstriction:
Promoters
Inhibiters
Promoted by ACh & Adenosine
Inhibited by Theophylline & muscarinic antagonists
Theophylline, theobromine, and caffeine are part of what drug family that is used to treat asthma? What are the pharmacologic effects of theophylline?
Methylxanthines.
Pharmacologic effects: relax bronchial smooth muscle, decrease histamine release, stimulate ciliary transport of mucus, stimulate medullary respiratory center.
Atropine/Ipratropium Bromide
Properties - block muscarinic receptors thereby inhibiting aceycholine-induced bronchoconstriction.
Indications - in asthma pts unresponsive to adrenergic agents and methylxantihines. bromidey is often used in COPD because it also reduced secretions.
SE, Tox - drowsiness, sedation, dry mouth, blurred vision, urinary retenion, constipation. not as pronounced with ipratropium because it does not cross the BBB.
Salmeterol
Properties - β2 selective. longer actinging.
Indications - asthma prophylaxis.
Salmeterol
Use
Adverse effect
Beta 2 agonist
Asthma: long-acting agent for prophylaxis
Adverse: tremor, arrythmia
ADR of Glucocorticoids
minimalDysphonia (voice issues)Oral candidiasis
xanthine with low therapeutic magin and dual MOA
THEOPHYLINE
Q. class Symbicort
Combo beta adrenergic and corticosteroid
Q. Symbicort is...
Budesonide (steroid) and
Formoterol which is a long-acting bronchodilator
ADR of Xantines
causes alertness, tremors. CVS effects- stimulates CVS, Increases heart rate, + ve chronotropic. (narrow ther. margin) Weak diuretic effect ( Increases GFR and Reduces tubular reabsorption
Ephedrine
Properties - stimulates both α and β receptors and increases the release of NE. vasoconstriction/cardiac stimulation --> increase pulse pressure. CNS stimulant. Rapidly absorbed PO. Compared to epi - longer duration of action, more central effects, lower potency.
Indications - chronic asthma (rarely used now), mydratic (aqueously).
SE, Tox - CNS stimulation, increased PVR.
Q. Symbicort's Side Effects
Combination corticosteroid and beta adrenergic
Q. Xopenex's side effects
same as all beta-2
Adrenergic drugs
What are the short acting beta-2-adrenoreceptor agonists? What are they used to treat?
Albuterol, levalbuterol, metaproterenol, pirbuteol.
These drugs are used for the treatment of the acute bronchoconstriction of asthma by relaxing bronchial smooth muscle.
Fine tremors (of the fingers of the hand) Palpitations Dizziness Restlessness Agitation
FDRAP
Q. Symbicort is used for
Long term maintenance for asthma
ADR of leukotriene Modulators
raise in the liver enzyme level
Q. Name the 9 Corticosteroids
Asmanex Azmacort Flovent HFA Pulmicort Aerobid QVAR Decadron Veramyst Omnaris
What is an antitussive?
Medicine used to inhibit or suppress coughing.
Q. Pulmozyme's Dosage & Frequency
SVN Single use ampule daily
2.5 mg drug in 2.5 clear, colorless solution
When is nedocromil sodium used in place of cromolyn sodium?
Nedocromil is more effective in blocking bronchospasm induced by exercise or cold air.
Q. TOBI's doseage
ready to use ampule of 300 mg in 5 mL of solution bid for 28 days on then off
Q. Survanta mode of administration
ET tube & bag and turn baby as you give ¼ of dose
-pnea
breathing
ox/o
oxygen
adenoid/o
adenoids
-a
lack of
atel/o
incomplete, imperfect
N
MAST-CELL STABILIZERS
slower breathing
Bradypnea
anthrac/o
coal, coal dust
Types of Pneumothorax
Closed
Open
Tension
Hemothorax
Chylothorax
Pleural effusion: Milky
Triglycerides
Apena
temporary absence of breathing
Antitussives
relieve or suppress coughing
Asthma drugs
Methylxanthines
Theophylline-likely causes bronchodilation by inhibiting phosphodiesterase, thereby decreasing cAMP hydrolysis. Usage is limited becauseof the narrow therapeutic index (cardiotoxicity, neurotoxicity).
 
Causes of Hypercapnia
Hypoventilation
Lung disease
Diminished consciousness
Exposure
NosePharynxTrachea--C ringsBronchi--O ringsBronchioles--loses cartilageTerminal bronchioles--loses goblets
Respiratory zone
Left and right
Secondary bronchi
External Nose
Visible includeshyaline cartilage platesnasal bones
Alveolar ventilation V.A
(VT - VD)Xf
rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals aid in what phase of breathing during exercise?
expiration
Causes of Pleurisy
Pneumonia
TB
Chest Trauma
Pulmonary infarction
Neoplasms
this anticholinergic is short-acting & therefore is usually admin'd 3-4x's/day
ipratropium/Atrovent
In low ventilation-perfusion states, blood bypasses the alveoli without gas exchange occurring. This is why it is sometimes called ________. This could be due to pneumonia, atelaectasis, a tumor, or mucus plug. All of which are ________.
ShuntingObstructions
Functional residual capacity
RV + ERV
Typically 500 mL
Inspiratory reserve volume
Midclavicular line location
middle of clavicle
Vestibule
just inside nareslined with stratified squamos epitheliumcontinous with skin
hypoxemia
deficiency of oxygen in the blood
IRV
Inspiratory Reserve Volume - volume entering lungs going from normal tidal inspiration to maximal forced inspiration.
Alveolar-arterial O2 difference
Normal alveolar-arterial O2 difference:
[(A-a)DO2]<10 mmHg.
External Naris
Nostrils; undersurface of external nose
both ventilation and perfusion are greater in what part of lung?
base
Causes of Metabolic Acidosis
DKA
Lactic Acidosis
Starvation
Severe diarrhea
Renal tubular acidosis
Renal failure
GI fistula
Shock
T/F Medicare pays for flu shots?
True
______ is a reversible airflow obstruction. When auscultating you should hear wheezing if this disease process is going on.
Asthma
Complications (long latency)*Bronchogenic carcinoma --> additive w/SMOKING*Mesothelioma --> NOT additive w/smoking
Signs of bronchial obstruction
critical
having unstable and abnormal vital signs and other unfavorable indicators
S-shaped curvature of thoracic and cervical spine
Scoliolis
Emphysema
an abnormal condition of the lungs marked by decreased respiratory function
leading cause of cancer related mortality
lung cancer
hamartoma
most common benign neoplasm in the lung. most common in older men
aspirate
take a foreign object into the airway
What is ACE2 Important?
ACE2 (Agntiotensin-Converting Enzyme)- ACE 2 and CD209L are functional SARS HCoV receptors-ACE2 knockout mice have lower yield of virus than wild type mice-Infection w/ SARS HCoV results in down-regulation of ACE2 and subsequent lung pathology-ACE2 has key protective role in acute lung injury
Intubation
putting a breating tube into the trachea by the way of the mouth, nose, or throat to provide an airway for breathing
this drug likely causes bronchodilation by inhibiting phosphodiesterase, thereboy decreasing cAMP hydrolysis
theophylline (a methylxanthine)
SaO2
The amount of oxygen bound to hemoglobin in comparison with the amount of oxygen the hemoglobin can carry
which class/meds are most effective for relieving acute bronchospasm?
short-acting B2-agonists:
metaproterenol (Alupent) &amp; abuterol (Proventil)
TB active infection
display symptoms, contagious, positive skin test
What scan is injected with radionuclide and takes 6 perfusion views: anterior, posterior, right & left lateral & 2 oblique views. If perfusion test is abnormal, cl inhales radioactive gas to see the ventilation of the lungs as gas makes it way in&out lung
V/Q scan
When palpating a person's chest, a sound called ______, or a crunching feeling under the skin caused by air leading into the subcutaneous tissue, may be felt from disease.
Crepitus
Hypoventilation
Reduced rate and depth of brreathing that causes an increase in CO2
Lung problems and tracheal deviation
Obstruction --> Toward
ventilation
breathing in and out occurs by changing the size of chest cavity
urinalysis
an examination of the urine to determine the general health of the body and, specifically, kidney function
tocolysis
Process of uterine relaxation to stop labor temporarily, mostly done by drugs
Patient position for lateral percussion
raise arms overhead
What organ is part of both the respiratory and digestive tracts?
Pharynx
What beta-lactam antibiotics have anti-pseudomonal activity
Cefepime, meropenem, ciprofloxacin, levofloxacin, piperacillin/tazobactam
Viral pneumonias
pneumonia tends not to cause a productive cough; the inflammation is mostly interstitial and lymphocytic. Common organisms include influenza, respiratory syncytial virus (may be epidemic in children), adenovirus, parainfluenza, and others. Cytomegalovirus pneumonia occurs in immunocompromised patients (AIDS, transplants ...). Infected cells have abundant cytoplasm and large intranuclear “owl’s eyes” inclusions. Adeno virus - smudge nuclear inclusions. Hanta Virus - location plus hemorrhagic fevers that produce fever, myalgia, cough, and headache with rapid onset respiratory failure.
What galloping consumption means?
Galloping Consumption-->when there is dissemination of TB through the airways as apposed through lymphohematogenous (miliary)
When is Amphotericin B Used?
Amphotericin B-Use-Broad spectrum anti-fungal-initiation of anti-fungal therapy-Anti-fungal azoles used for maintenance
Ventilator
device used to assist in breathing or subtitute for patients breathing
at what level do the esophagus and vagus (2 trunks) perforate the diaphragm?
T10
Buffer
Substance that reacts to an acid or base to prevent a large change in pH
why are chest tubes inserted
pneumothorax, hemothorax, pleural effusion, post thoracotomy, post CABG, chylothorax
risk factors for cancer of the larynx
smoking, drinking
T/F it is important to  Check the physician's order with the type of delivery system and liter flow or percentage of oxygen actually in use.
True
People with COPD show a ______ sign, or a flattened diaphragm when looking on an x-ray.
Hoovers
When percussing the thorax, a normal sound would be _______, or a long low pitched hollow sound. _________ or _______ would indicate a disease process is occuring.
resonancehyperresonance, dullness
Explains ACE inhibitor side effect of cough
Residual volume
Lung secretions
He PAHKS the cah in Hahvahd yahd
Foul smelling sputum?
Anaerobic infection (requires pt to have teeth!). Also poor dental hygiene or lung abscesses, necrotizing pneumonia.
pulmonary veins
a vein conveying oxygenated blood from the lungs to the left atrium of the heart.
stethoscope
an instrument used to convey sounds in the chest or other parts of the body to the ear of the examiner
2nd rib location
locate sternal angle and move laterally
Function of Larynx
maintain an open passageway for air movementthyroid and cricoid cartilages
Goodpasture’s syndrome
Biopsy of the kidney rather than lung is preferred. Goodpasture's is a rare disease; Wegener's and related ANCA-associated vasculitis (see below) is the most common cause of a pulmonary-renal syndrome. Other vasculitis syndromes, autoimmune diseases like lupus, and infections must also be considered
Appearance of patient with eymphysema
barrel chest...well devoloped accesory muscles...suprasternal retraction
How do you tx Measles
Measles Tx:-vaccine available-give IG and VitA
What are si/sx of bronchiectasis?
hemoptysis, purulent sputum, recurrent infections, dilated airways
Primary Pulmonary Hypertension
Rare and potentially fatal disease. It is elevated pulmonary pressures resulting from an increase in pulmonary vascular resistance to blood flow
How are ABGs obtained?
Invasively: arterial catheter in the radial or femoral artery or arterial puncture
TB latent infection
causes no symptoms and is not contagious, positive skin test, can become active later
What O2 delivery system is the most accurate and pulls proportionate room air w/ oxygen?
Venturi Mask
If a person is diagnosed with pneumonia, WBC should be monitored. Also a chest x-ray would reveal ____ to _____ infiltrates. The pulse oximeter would show a reading of less than _____ and _____ cultures should be done before giving an antibiotic so as not
patchy to unclear95sputum
Hilar mas arising from bronchusKeratin pearlsIntercellular bridge
Think S. C.:*Sentral, Smoking*Cavitations, Keratin/bridges
Cryptogenic Organizing Pneumonia (COP or BOOP). Remember NO organized interstitial fibrosis or honeycomb lung!
Lymphocytic interstitial pneumonia has what as its causative disease? What separates from other interstitial pneumonias?
Enter your front text here.
Enter your back text here.
most common cause of a solitary lung nodule
old calcified granuloma
carbon dioxide (CO2)
gas produced by body cells when oxygen and food combine; exhaled through the lungs
Epidemiology, location, gross and microscopic anatomy of squamous cell carcinoma
Squamous Cell Carcinoma• Has the strongest relationship to smoking.• Usually arises around the hilus of the lung (segmental or subsegmental bronchus).•But peripheral tumors may be seen. •Begins as an area of in situ carcinoma.Gross Morphology-gray, white, firm w/ necrosis often in the center, star like at the edge; penetrating type (occlude the lumen); Creeping type (grow laterally along the bronchi)Histology:-keratinized cells w/ intercellular bridges and keratin pearls
Obstructive Lung disease (COPD)
Obstruction of air flow, resulting in air trappings in the lungs, PFTs--Decrease FEV1/FVC ratio (hallmark)
 
Types:
1. Chronic Bronchitis (Blue Bloater)--produces cough for greater htan three consecutive months in 2 or more years. Hypertorphy of mucous secreting glands in the bronchioles (Reid index >50%). Leading cause is smoking. FIndings: wheezing, crackles, cyanosis.
 
2. Emphysema (pink puffer)-enlargment of air spaces and decrease recoil resulting from destruction fo alveolar walls. Caused by smoking (centriacinar emphysema) and alpha-antitrypsin defiicency (panacinar emphysema and liver cirrhosis)-->increase elastase activity. FIndings: dyspnea, decrease breath soudns, tachycardia, decrease I/E ratio.
 
3. ASthma--bronchial hyperresponsiveness causes reversible bronchoconstriction. Can be triggered by viral URIs, allergens, and stress. Findings:  cough, wheezing, dyspnea, tachypnea, hypoxemia, decrease I/E ratio, pulsus paradoxus, Curschmann'sspirals, smooth muscle hypertrophy, mucous plugging.
 
4. Bronchiectasis--chronic necrotizing infection of bronchi-->dilated airways, purulent sputum, recurrent infections, hemoptysis. Associated with bronchial obstruction, CF, poor ciliary motility, Kartagener's syndrome.
what lung volume is associated with a positive airway pressure?
total lung capacity
Blue Bloater
Pt with blueish color of the lips and skin commonly seen in severe Chronic Bronchitis
what strength of dose of ICS is always used when possible to minimize adverse reactions
lowest dose
What are the Upper respiratory structures?
Noses, Submucosal glands, and Trachea.
If a patients Forced Vital Capacity and FEV1 are both significantly reduced than what does that indicate?
lung expansion is restricted.
Respiratory failure, neurologic impairment, petechial rash.
What is the risk of acquiring post-ARDS fibrosis?
Pulm edema involves increased hydrostatic pressure or dec oncotic forces, where ARDS involves capillary damage and inc permeability. Pulm edema -> transudate, ARDS -> exudate which clogs the lymphatic drainage.
With proliferation of type II pneumocytes in the exudative phase of ARDS/alveolitis, what is a marker of pulmonary fibrosis?
What occurs when someone has pneumonia?
Alveoli fill with fluid and/or cellsGas exchange is severely reduced
Apical tumors (usually non-small cell tumors)
Pancoast tumor: Tumor invades nerves in or near brachial plexus, causes pain & weakness of arm & hand. Horner syndrome: Tumor invades sympathetic chain or cervical stellate ganglion, causes ipsilateral ptosis (droopy eyelid), miosis (abnormal pupil constriction), enophthalmos (eye recedes in orbit), and anhydrosis (lack of sweating in affected side of face / arm). Less common complications: constrictive pericarditis or tamponade, esophageal symptoms
What are the four main respiratory centers?
DRG, VRG, PRG, Botzinger complex
What pathogens cause pneumonia in CF pts?
• Persistentcolonization – H. influenzae, S. aureus, P. aeruginosa, Burkholderiacepacia; also Aspergillus spp. • Exaggeratedinflammatoryresponse– From induction of Pseudomonas alginate synthesis?
What does Staphy aureus cause, and how is it infectious?
Staphyl aureus-gram-pos, coagulase pos.-produc a cell wall protein, protein A, which possesses antiphagocytic properties and has a high affinity for the Fc portion of certain immunoglobutlin subclasses-Viral Respiratlry infection (especially influenza A) may alter natural host defense and allow the develop of staphy pneumonia
What are 5 important products of your lungs?
1) surfactant
2) prostaglandins
3) histamine
4) ACE
5) kallikrein (activate brady)
what 3 classes of resp meds are bronchodilators?
- B2-agonists
- methylxanthines
- anticholinergics
____ is a long tube used for cl w/ long or extra-thick necks. Often called a "bull neck trach" because of the long distance from the skin to the trachea or the longer lenght of the trachea in large people.
Single-Lumen Tube
Oxygen diffuses from the air into the blood at the _____ to be ______ to the _______
AlveolitransportedCells of the body
What's the most common cause of pulmonary hypertension?
COPD (secondary, primary less common).
What are the histologic differences between bronchi and bronchioles?
No submucosal glands, cartilage, or goblet cells in bronchioles. Simple ciliated columnar epithelium in bronchioles vs pseudostratified respiratory epithelium in bronchi. Clara cells in the bronchioles.
Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii, PCP)
About a third of AIDS patients die of it, Prophylaxis with Bactrim or pentamidine is very useful. produces an extensive pneumonia with a foamy exudate filling alveoli. Fever, cough, and dyspnea are the major presenting signs and symptoms. The usual diagnostic method is bronchoalveolar lavage (BAL). Use GMS stain. Does not culture well.
What is the difference between Antigenic Shift & Drift?
Antigenic drift :Mutations of the m aglutinin and neuramidase allow the virus to escape host antibodies.• Antigenic shift: When RNA recombination of animal influenza virus segments occurs, making all humans susceptible.
Under what conditions would the O2-dissociation curve shift to the right?
1) high CO2
2) low pH
3) inc. temperature
4) 2,3-DPG (altitude)
5) inc. metabolic needs (exercise)
The nutritional considerations that promote healthy lungs is to include foods high in ___?
Foods high in zinc and vitamins A, B-complex, C and E
A form of COPD --> "Blue bloater"Affects bronchioles
Definition: Productive cough for >3 consecutive months in >2 years
How are transmitted voice sounds altered in the case of pneumonia? Fremitus?
Spoken and whispered words are louder and clearer (bronchophony). Ee's are heard as Ay's (egophony). Tactile fremitus is increased.
What test is used to diagnose Asthma or AHR?
Asthma or Airway Hyperresponsivness is measured thourgh METHACHOLINE-in asthmatics, doses below the cutoff cause an abnormally large decline in FEV1
what happens to the V/Q ratio with exercise? why?
approaches 1 - increased cardiac output &amp; vasodilation of apical capillaries
Give 3-4 causes of upper airway obstruction.
Tongue edema, Occlusion by the tongue, Laryngeal edema, Peritonsillar & pharyngeal abscess, Head & Neck CA, Thick secretions, stroke & cerebral edema, Facial, tracheal, or laryngeal trauma, aspiration, burns of head/neck, & anaphylaxis
1. Loss of alveolar tethering to keep airways open; 2. Mucus hypersecretion; 3. Mucosal inflammation + fibrosis;
What inflammatory cell types are responsible for early and late phase asthma?
A 35-year-old HIV positive male has had a previous bout of Pneumocystis carinii pneumonia and now has a CD4 lymphocyte count of 69/microliter. He is at LEAST risk for a pulmonary infection with: A Respiratory syncytial virus B Mycobacterium avium-comple
RSV is most often an infection of children. In general, pulmonary viral infections are not increased significantly with AIDS.
Who is at risk for RSV LRTI?
Who is at risk for RSV LRTI?• Infants • Infants and children with underlying heart or lung disease, i.e, congenital heart disease, BPD.• Infants born • Immunocompromised persons (immune def, malignancy).• Significant asthma at any age.• Elderly in nursingh omes. • Elderly patients with chronic pulmonary disease.
Between the lower and upper lungs which is more likely to be compromised, so there is a mismatch of ventilation in the upper regions?
Lower lungs are more likely to be compromised than upper lungs, so there is a mismatch of ventilation & perfusion in the upper regions
Central - small cell CA and squamous cell CA.Peripheral - adenocarcinoma, large cell CA.
What are the most common presenting symptoms of lung cancer?
what type of cell proliferates during lung damage?
type II - serve as precursors to type I cells and other type II cells
Superior Vena Cava Syndrome is due to obstruction of the SVC by what? What is the symptom? How can it be relieved?
A lung cancer mass impinging on the SVC causing upper extremity and facial engorgement (turning red), relieved by raising the right arm.
A 55 year old male with a long history of smoking has recently experienced an episode of hemoptysis along with his usual cough. He has a sputum cytology examination performed that demonstrates the presence of atypical cells with hyperchromatic nuclei and
Both squamous cell and oat cell carcinomas tend to be central in location.A
What phase of sleep is apnea most likely to occur in?
REM due to the decrease in FRC and tidal volume.
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