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Exam 4
SA Resp Tx
62
Veterinary Medicine
Professional
04/10/2017

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Cards

Term
When do we intubate & ventilate?
Definition
-cardiopulmonary arrest
-severe hypoventilation
-severe hypozemia
Term
What is the emergent tx for resp dz?
Definition
-minimal handling
-oxygen
-mild sedation: butorphanol or ace
-fast-acting bronchodilator
-short-acting corticosteroid
-diuretc
-thoracocentesis
Term
What is the goal of O2 supplementation?
Definition
-inc FiO2 => inc PaO2 & SaO2 => inc O2 delivery
Term
What factors affect O2 delivery to tissue?
Definition
-oxygenation of blood
-Hemoglobin content of blood
-peripheral vasculatur
-CO
Term
What are some common indications for O2 supplementation?
Definition
-hypoxemia
-resp distress
-cardiac/resp arrst
-hypotension
-shock
-metabolic acidosis
-major surgery
-ead and spinal cord injury
Term
What are the methods of O2 supplementation?
Definition
-flow-by or face mask
-O2 cage
-nasal insufflation
Term
What are the advantages & disadvantages of flow-by or face mask O2?
Definition
-A: best for very short term use
-D: not accepted by all petients
Term
What are the advantages & disadvantages of O2 cage?
Definition
-A: control O2 level, temp, humidity
-D: not practical for too large of dogs
Term
What are the advantages of O2 supplementation?
Definition
-works for any size of patient
-usually well accepted
Term
What is an oxygen hood? Disadvantages?
Definition
-contructed E-collar & cellophange wrap
-D: become very hot & not accepted
Term
What are the general guidelines for oxygen supplementation?
Definition
-humidify O2 (exception is O2 hood)
-provide flow rates: 50-200 ml/kg/min
-w/ nasal insufflation do NOT exceed flow rates of 6L/min
Term
What are some complications of O2 supplementation?
Definition
-O2 toxicity: formation of O2 free radicals, lipidperoxidation, resp failure
Term
What O2 levels should we keep to avoid complications?
Definition
-long-term O2 mainained at less than or equal to 50% FiO2
Term
What are some resp indications for abx?
Definition
-bacterial rhinitis
-infectious tracheitis
-bacterial bronchopneumonia
-pyothorax
Term
When is parental admin of abx best?
Definition
-critically ill
-concurrent GI dz
Term
When is oral admin of abx best?
Definition
-stable
-healthy GI tract
-out-patient
Term
What are our empiric first choice abx for bacterial rhinits?
Definition
-Doxy
-Azithromycin
-Amoxicillin/clavulanic acid
Term
What is the common name for infectious tracheobronchitis? Etiology?
Definition
-kennel cough
-B. conrhiseptica, Mycoplasma sp, viral
Term
What are the empiric first choice abx for kennel cough?
Definition
-Doxy
-enrofloxacin
Term
How do we treat a mild, stable bacterial pneumonia?
Definition
-first gen cephalosporin
-Amoxicillin
Term
How do we treat a moderate, stable bacterial pneumonia?
Definition
-second gen cephalosporin
-amoxi/sulbactam +/- fluoroquinolone
Term
How do we treat a severe, unstable bacterial pneumonia?
Definition
-amoxi/sulbactam & fluoroquinolone
-2nd/3rd gen cephalosporin & fluoroquinolone
-meropenem or imepenem
Term
What abx do we empirically use to treat pyothorax?
Definition
-Filamentous and/or sulfr granules: actinomyces = penicillins OR nocardia = TMS, azithromycin, aminoglycosides, tetracylcines
-BS: potentiated penicillins, clindamycin + fluoroquinolones
Term
What are some commonly used antifungals?
Definition
-Itraconazole: oral
-Fluconazole: oral
-Terbinafine: oral
-amphotericin B: IV
-clotrimazole: topical
Term
What are some common etiologies of fungal rhinitis? Do they affect dogs or cats more frequently?
Definition
-Aspergillus or penicillium: dog >> cat
-Crypto: cat >> dog
Term
What are the common etiologies of fungal pneumonia? Do they affect dogs or cats more frequently?
Definition
-Histo: cat > dog
-Blasto: dog ? cat
-Coccidiosis: dog >> cat
-Crypto: cat > dog
-Aspergillus, systemic: dog >> cat
Term
Which abx do we use to treat fungal rhinitis?
Definition
=topical clotrimazole or enilconazole
+/- oral terbinafine
Term
How do we treat fungal rhinitis?
Definition
-oral itraconazole or fluconazole
Term
How do we treat fungal pneumonia?
Definition
-normally: oral itraconazole or fluconazole
-life-threatening: IV amphotericin B
Term
Which animals cannot use enilconazole for fungal rhinitis?
Definition
-cats
Term
When is topical therapy contraindicated w/ fungal rhinitis?
Definition
-erosion of cribiform plate = access to brain
Term
What are the cure rates w/ topical therapy of fungal rhinitis?
Definition
-60-70% w/ first tx
-about 90% w/ multiple tx
Term
True or False: Absence of nasal discharge indicates cure of fungal rhinitis.
Definition
-FALSE
Term
What are some indications for corticosteroid tx of resp dz?
Definition
-feline asthma
-chronic bronchitis
-eosinophilic bronchopneumopathy
-lymphoplasmacytic rhinitis
-HW dz
Term
What are the two classes of bronchodilators? Examples of each?
Definition
-Methylxanthines: Theophylline, Aminophylline
-Beta-rc agonist: terbutaline, albuterol, epinephrine
Term
What are some common indications of bronchodilators?
Definition
-feline asthma
-chronic bronchitis
-bronchial collapse
-bronchopneumonia
Term
How do methylxanthines work?
Definition
-inh phosphodiesterase: relax smooth mm
-inh mobilization of Ca: inh smooth m contraction
-inh adenosine: inh bronchoconstrition
Term
What are the physiologic effects of methylxanthine?
Definition
-bronchodilation
-anti-inflam: inh mast cell degranulation
-improves mucociliary clearance
-strengthens resp mm: helps prevent m fatigue
Term
HOw do beta-rx agonists work?
Definition
-activate adenyl cyclace => smooth m relaxation = bronchodilation
Term
What are the physiologic effects of beta-rc agonists?
Definition
-bronchodilation
-anti-inflam: inh inflamm mediator release
-improves mucociliary clearance by dec secretion viscosity
Term
What are some side effects of beta agonsits & methylxanthines?
Definition
-CNS excitation
-GI distress
-tachycardia
-cardiac arrhythmia
-Beta-rc agonists: hypokalemia
Term
What are some contraindications for beta agonists & methylxanthines?
Definition
-cardiac dz
-seizure disorder
-hypertension
-hyperthyroid
-renal dz
-liver dz
-knwon hypersensitivity
Term
What are the two classes of antitussives? Give examples of each.
Definition
-Narcotics: hydrocodone, butorphanol, codeine
-Non-narcotic: dextromethorphan
Term
What are some indications for antitussives?
Definition
-tracheal/bronchial collapse
-tracheitis
-chronic bronchitis
-pulmonary fibrosis
Term
What is the best cough suppression?
Definition
-treat underlying dz
Term
What are the contraindications of antitussives?
Definition
-any productive cough: important physical defense
-bronchopneumonia
Term
What is our major mucolytic protussive? How does it work?
Definition
-N0acetyl-L-cystine (NAC)
-breaks mucoprotein disulfide bonds = improves mucociliary clearance and cough
-also a direct antioxidant
Term
How do we administer NAC?
Definition
-IV slowly
-PO is neutraceutical
-nebulization causes bronchoconstriction
Term
What are some common indications for NAC?
Definition
-bronchopneumonia
-chronic bronchitis
-non-cardiogenic pulmonary edema
-ARDS
Term
What are the advantages of inhalant therapy?
Definition
-deliver moisture or drug directly to airway
-quicker onset of action
-lower required doses: dec systemic SE
Term
What are the two delivery methods of inhalant therapy?
Definition
-nebulizer
-metered dose inhaler
Term
What does the final destination depend on?
Definition
-partical size: smaller size = deeper delivery
-breath characteristics: deeper breath = deeper drug deliver
Term
How do we maintain airway hydration?
Definition
-IV fluids
0nebulization
Term
What happens w/ airway dehydration?
Definition
-ciliary dysfuncition
Term
What are the indications for airway hydration?
Definition
-excess tracheal & bronchial secretions
-bronchopneumonia
Term
What is coupage? When do we do it?
Definition
-repeated, firm, thoracic percussion to improve clearance of debris
-done after nebulization
Term
What are the indications for coupage?
Definition
-bronchopneumonia
Term
What are contraindications for coupage?
Definition
-pulmonary abscess or bullae
Term
What are the various drugs we use for nebulization?
Definition
-abx
-bronhcodilators
-mycolytics
Term
Briefly describe the method of drug nebulization.
Definition
-use systemic dose
-dilute w/ sterile saline
-give over 20-30min
Term
What is MDI?
Definition
-suspension of drug in propellent w/ speciic amt of drug w/ eac actuation
-spacers are required
Term
What is the most commonly used MDI?
Definition
-fluticasone proprionate (corticosteroid): three different doses
-also use albuterol (can be repeated)
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