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Vuck Path/Pharm Test 5 Oxygenation
oxygenation
133
Pathology
Professional
02/10/2012

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Term
Volume of conduction zone dead space.
Definition
15 ml; anatomic and physiologic
Term
Surfactant
Definition
lipoprotein that lines the surface of the alveoli and reduces surface tension.
Term
Type I epithelial cells:
Definition
Gas exchange
Term
Type II epithelial cells:
Definition
Cuboidal cells make surfactant
Term
Vasoconstriction, blood clot, and fat emboli in pulmonary circulation all result in
Definition
decreased oxygenation.
Term
What happens to pulmonary capillaries during inflammatory process?
Definition
They become leaky, resulting in interstitial edema in lung.
Term
O2 transport measured by arterial blood gas (ABG)
Definition
98% of O2 carried in the blood in bound to Hb
3% of O2 is dissolved in the blood
-Partial pressure of air entering alveoli (PO2)
-Solubility of O2
Term
Identify the factors in oxygen transport to the cells of the body.
Definition
Factors that impede gas exchange
1. Impaired circulation: Clot or emboli (blood/fat)-impairs blood flow (PE )
2. Fluid shifts
3. Exudates from inflammation
Term
Describe the oxyhemoglobin association disassociation curve.
Definition
Sigmoidal shape, steep incline, plateaus around 80 - 90 as oxygen attached to hemoglobin is saturated.

We
Term
What factors affect the oxyhemoglobin curve?
Definition
pH: body will give up or hang on to more O2 in hg

in certain disease conditions in states O2 is more tightly bound to Hg than in others.
Term
What are the implications of acidosis, alkalosis, and temperature with respect to the Oxyhemoglobin curve, PO2 and respiratory rate.
Definition
In an acidotic state your body will unload O2; in alkalosis you hang on. You may not want to correct pH to normal because you want their body to give up the O2.
Term
Factors that impeded gas exchange
Definition
Impaired circulation
-Clot or emboli (blood/fat)-impairs blood flow (PE )
Fluid shifts
Exudates from inflammation (pus, as in bacterial pneum)
Term
Describe lung volumes and capacities.
Definition
Tidal volume (TV)-inspired/expired nl breath
Residual vol (RV)-vol after max expiration; cannot be measured by spirometry
Expiratory reserve vol (ERV)-expired after TV expired
Inspiratory reserve vol (IRV)-inspired above & beyond TV

Total lung capacity (TLC)-sum of 4 vols; maximal inspiration
Vital capacity (VC)- max vol exhaled after max air inspired
Functional residual capacity (FRC)-vol after expiration during quiet breathing
Inspiratory capacity (IC)-max voly inspired after expiration quiet breathing
Term
Compare and contrast restrictive vs. obstructive diseases in term of defining characteristics and pathology.
Definition
Term
What corresponding changes would you expect to see on an ABG in terms of PO2, PCO2? Describe how these parameters change with age.
Definition
Term
Define pneumonia.
Definition
Inflammatory reaction in the alveoli and interstitium caused by an infectious agent
Community acquired (CAP)
Hospital acquired (VAP)
Term
Differentiate between community-acquired and ventilator-acquired pneumonia.
Definition
term used to describe one of several diseases in which individuals who have not recently been hospitalized develop an infection of the lungs (pneumonia).

is a sub-type of hospital-acquired pneumonia (HAP) which occurs in people who are receiving mechanical ventilation. VAP is not characterized by the causative agents; rather, as its name implies, definition of VAP is restricted to patients undergoing mechanical ventilation while in a hospital.
Term
Pneumonia: causes
Definition
Aspiration of oropharyngeal secretions composed of normal bacterial flora or gastric contents (25%-35%)
Bacteroides, fusobacterium
Inhalation of contaminants
Virus
Mycoplasma

Contamination from the systemic circulation
Bacterial
Gram positive
Staphylococcus
Streptococcus
Bacterial
Gram negative
Haemophilus influenzae
Klebsiella
Pseudomonas aeruginosa
Serratia marcescens, Escherichia coli, Proteus spp
Term
Pneumonia: clinical manifestations
Definition
Severity of disease and patient age cause variation in symptoms
Crackles (rales) and bronchial breath sounds over affected lung tissue
Chills
Fever
Cough, purulent sputum

Viral
-Upper respiratory prodrome
Fever, cough, hoarseness, coryza accompanied by wheezing/rales
Term
Pneumonia: risk factors
Definition
Term
Describe the pathological changes related to pleural effusion and pneumothorax.
Definition
Term
Normal ABG
Definition
pH (7.35 - 7.45)
Measurement of acidity or alkalinity, based on the (H+) ions present.
PaO2 (80- 100 mm Hg)
partial pressure of oxygen that is dissolved in arterial blood
SaO2 (95% -100%)
arterial oxygen saturation
PaCO2 (35 - 45 mm Hg)
amount of carbon dioxide dissolved in arterial blood
HCO3 (22 - 26 mEq/liter)
calculated value of the amt of bicarbonate in the bloodstream
Term
Hyperventilation:
Definition
a state in which there is an increased amount of air entering the pulmonary alveoli (increased alveolar ventilation), resulting in reduction of carbon dioxide tension and eventually leading to alkalosis.
Term
Hypoventilation
Definition
: a state in which there is a reduced amount of air entering the pulmonary alveoli.
Term
Hypoxemia
Definition
: below-normal oxygen content in arterial blood due to deficient oxygenation of the blood and resulting in hypoxia.
Term
Hypoxia
Definition
: reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood.
Term
Asthma
Definition
Obstructive
reversible airway obstruction, airway inflammation, and increased airway responsiveness associated with cough, wheezing, etc.

Reverses spontaneously or with treatment
Term
Emphysema
Definition
Obstsructive
Term
Pneumonia
Definition
Restrictive
Term
Pneumothorax
Definition
Restrictive

Pneumothorax is a circumstance in which air gets in the pleural space (membrane space between the pleural linings of the lung and the thoracic cavity).
Term
Pleural effusions
Definition
Restrictive
thoracentesis to drain
A pleural effusion is an excess accumulation of fluid in the pleural space around the lungs.
Term
Mr. Worried is a 52-year-old widow who comes to ED C/O of shortness of breath and tingling in fingers. He is tachypneic (respirations are shallow and rapid). He denies diabetes; blood sugar is normal. There are no EKG changes. He has no significant respiratory or cardiac history. He takes a history of anxiety attacks for which he takes medication.
ABG results are:
pH= 7.48
PaCO2= 28
HCO3= 22
PaO2= 85
Definition
pH (7.5) little low
PaCO2 (35 - 45) low
HCO3 borderline low-normal
PaO2 (95) low

Blowing off his CO2 (his acid) expect he will be alkalotic; Anxiety attack, breathe into paper bag. Would NOT do this if he has chronic CO2 retention.
Term
198% of all adults in the U.S. (43 million)
Definition
smoke cigarettes
Term
Single greatest cause of disease and premature death in U.S. today
Definition
Tobacco
Term
Limbic Reward System
Definition
frontal cortex releases dopamine, reward pathway, nucleus accumbens, libic system, VTA (ventral tegmental area)
Term
Nicotine binds to nicotinic acetylcholine receptors (nAchR) in the ventral tegmental area
Definition
Acetaldehyde keeps the nicotine from breaking down--extending reward

works more in adolescents than in adults (both longer and intensified)
Term
Varenicline (Chantix)
Definition
works on alpha 4-beta 2 nicotinic acetylcholine receptors

nicotine mainly works on the alpha 4-beta 2 and alpha 4-beta 7
Term
Pathophysiologic consequences of tobacco smoke exposure
Definition
tissue destruction contributing to lung disease
cellular changes contributing to heart disease and cancer
cellular and molecular reinforcing effects leading to dependence
changes leading to dependence contribute to systemic disease
Term
Systemic inflammation and oxidative stress
Definition
caused by acute and chronic smoke exposure
Term
C-reactive inflammatory protein may remain elevated for up to ___ years after quitting.
Definition
20
Term
Approach to Smoking Treatment
Definition
View as chronic health condition, requiring multiple interventions
5 As (ask, advise, assess, assist, arrange)
Counseling
Pharmacotherapy
Term
5 Rs
Definition
relevance
risk
rewards
roadblocks
repetition
Term
Combination of counseling and medication is more effective than either alone. T or F
Definition
T
Term
First line agents
Definition
Nicotine replacement (patch, gum, inhaler, nasal spray, lozenge)
Bupropion (Zyban)
Varenicline (Chantix)
Term
Second line agents
Definition
Nortryiptyline
Clonidine
Term
PHSG
Definition
Public Health Service Guidelines
Term
Bupropion SR (Zyban)
Definition
antidepressant
MOA unknwn, but alleviates nicotine withdrawal
makes cigs taste bad
Set quite date 2 weeks out, add patch on date
Insomnia, dry mouth dizziness,
Contraindicated in h/o seizure or any MAO inhibitor med
No taper needed
Term
Varenicline (Chantix)
Definition
alpha-4, eta-2 receptor partial agonist
start 1 wk prior to quit date
decrease dose in renal impairment
monitor mood, behavior, suicidal ideation
Nausea, insomnia, vivid dreams
black box warning for suicide
Term
Smokeless Tobacco (SLT)
Definition
chewing tobacco, snuff, lozenge, sticks, strips, tablets, Snus

8.1 million Americans, increasing use in youth
Term
Obstructive lung disease: airway obstruction
Definition
inability to fully exhale; hyperinflation

asthma, COPD, cystic fibrosis
Term
Restrictive lung disease
Definition
extrapulmonary, pleural or paenchymal resp disease that restricts lung expansion

decr lung compilance, stiff, small lungs, decr lung volume, incr work of breathing; oxygenation and ventilation abnormalities
Term
Certified Smoking Cessation Specialist
Definition
Mayo Clinic
Term
Restrictive Lung Diseases
Definition
Interstitial LUng Disease (ex, idiopathic pulmonary fibrosis)
Sarcoidosis
Obesity
Scoliosis
Neuromuscular disease

treated with oral steroids
Term
Remodeling
Definition
basement membrane thickening that becomes permanent scarring; irreversible
Term
Causes of asthma
Definition
involves the interplay between host factors (particularly genetics) and environmental exposures that occur at a crucial time in the development of the immune system
Term
Hygiene Hypothesis
Definition
Imbalance between Th1 and Th2 in the origins of asthma

exposure to infection, country living protects against asthma
Term
asthma environmental factors
Definition
airborne allergens (house dust mite, altemaria)
viral respiratory infections
Term
FVC
Definition
forced vital capacity: max volume of air that can be exhaled during a forced maneuver
Term
FEV1
Definition
forced expired volume in one second: volume expired in the 1st sec of maxima expiration after a maximal inspiration. T his is a measure of how quickly the lungs can be emptied.
Term
FEV1/FVC
Definition
FEV1 expressed as a percentage of the FVC, gives a clinically useful index of airflow limitation
Term
asthma and the arachidonic acid metabolism pathway
Definition
aspirin can block prostaglandins, pushing the entire pathway over to the leukotrienes, resulting in increased inflammation. Cingulair blocks the leukotrienes
Term
Cingulair
Definition
block leukotrienes on 5-lipoxygenase, leukotrienes side of archidonic acid pathway
Term
2 types of asthma medications
Definition
controllers (of inflammation, ex corticosteroids)
relievers (beta-2 agonist)
Term
long-terms asthma control medications
Definition
ICS
combo long-acting beta 2 agonists (LABA) + inhaled ICS (always used together)
leukotriene modifiers
mast cell stabilizers
theophylline
Term
short-acting (quick relief) asthmas medications
Definition
short-acting beta 2 agonists (SABA)
lpratropium bromide
systemic corticosteroids (oral, IC, SC)
Term
COPD is 3rd leading cause of death in U.S. T or F
Definition
T
Term
COPD definition
Definition
preventable and treatable lung disease with extra-pulmonary effects that may contribute to severity in individual patients; airflow limitation that is not fully reversible; usually progressive and associated with abnormal inflammatory response to noxious particles or gases; exacerbations and co-morbidities contribute to severity; get flu shots! good handwashing, etc.
Term
clinical features of COPD
Definition
indolent, progressive
DOE, productive cough, wheeze
Term
2 COPD phenotypes
Definition
ephysemic: makes holes in the alveoli
chronic bronchitis: injured mostly the airways

80% of COPD patients have both types of damage
occasionally, a patient will have almost exclusively one or the other
Term
What percentage of smokers develop COPD?
Definition
15%--big genetic component
Term
alpha-one antitrypsin
Definition
protein synth in liver, secreted in blood stream

neutralizes neutrophil elastase in the lung interstitium and protects lung parenchyma from breakdown
Term
Chronic Bronchitis
Definition
chronic cough or mucus production for at least 3 mos in 2 successive years when other causes have been excluded
Term
V/Q mismatch
Definition
ventilation-perfusing mismatch:

lower ventilation: perfusing

treat with low-flow O2
Term
Shunt
Definition
pus, water, blood, analectasis

alveoli filled with one of above

need high-flow O2
Term
ARDS
Definition
acute respiratory distress syndrome

pulmonary edema, shunt problem

need high-flow O2
Term
Clubbing in a smoker . . .
Definition
think about lung cancer until proven otherwise
Term
Bronchodilators in Stable COPD
Definition
Short & long-acting aticholinergics (SAMA & LAMA), short-actig beta agonists (SABA) and long-acting beta-agonists (LABA)
Term
dyspnea
Definition
shortness of breath
Term
cough
Definition
sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes. The cough reflex consists of three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.[1] Coughing can happen voluntarily as well as involuntarily.
Term
hemoptysis
Definition
expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g., in tuberculosis or other respiratory infections or cardiovascular pathologies).
Term
hyperpnoea
Definition
increased depth of breathing when required to meet metabolic demand of body tissues, such as during or following exercise, or when the body lacks oxygen (hypoxia), for instance in high altitude or as a result of anemia.
Term
cyanosis
Definition
the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of
Term
ventilation vs respiration
Definition
air in and out of alveoli in 2 stages (inspiration and expiration)

process by which the chemical energy of "food" molecules is released and partially captured in the form of ATP. : aerobic (oxygen in mitochondria) or anaerobic respiration produces carbon dioxide
Term
kyphosis
Definition
also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae (upper back).
Term
scoliosis
Definition
side to side curvature of the spine
Term
atelectasis
Definition
the collapse or closure of alveoli resulting in reduced or absent gas exchange.
Term
fibrosis
Definition
the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process.
Term
ARDS
Definition
Adult Respiratory Distress Syndrome

In ARDS, infections, injuries, or other conditions cause fluid to build up in the air sacs. This prevents the lungs from filling with air and moving enough oxygen into the bloodstream.
Term
TV
Definition
Tidal volume (TV)-inspired/expired nl breath
Term
RV
Definition
Residual vol (RV)-vol after max expiration; cannot be measured by spirometry
Term
ERV
Definition
Expiratory reserve vol (ERV)-expired after TV expired
Term
IRV
Definition
Inspiratory reserve vol (IRV)-inspired above & beyond TV
Term
TLC
Definition
Total lung capacity (TLC)-sum of 4 vols; maximal inspiration
Term
VC
Definition
Vital capacity (VC)- max vol exhaled after max air inspired
Term
FRC
Definition
Functional residual capacity (FRC)-vol after expiration during quiet breathing
Term
IC
Definition
Inspiratory capacity (IC)-max voly inspired after expiration quiet breathing
Term
pneumothorax
Definition
abnormal collection of air or gas in the pleural space that separates the lung from the chest wall, and that may interfere with normal breathing.
Term
pleural effusion
Definition
excess accumulation of fluid in the pleural space around the lungs


two major types of pleural effusion:
Transudative effusions, where the excess pleural fluid is low in protein; and
Exudative effusions, where the excess pleural fluid is high in protein.
Term
Asthma and Th1 and Th2 imbalance
Definition
downregulation of Th1 (immune response that fights infection) and domination of Th2 (expression of allergic diseases and asthma)
Term
spirometry measures how ___ and how ____ air you breathe ___ .
Definition
fast; much; out
Term
asthma triggers
Definition
ASA
sulfites
stress
illicit drug use
beta blockers
Term
Inhaled Corticosteroids block before or after arachidonic acid?
Definition
before
Term
Risk of COPD should be considered starting at ___ pack/year history
Definition
10
Term
COPD Systemic Effects
Definition
Cachexia
Osteopenia
O2-related cognitive impairment and depression
venous thromboembolism
pulmonary hypertension
hormonal abnormalities
Term
Pharmacotherapy in Stable COPD
Definition
Short-acting Bronchodilators
Long-acting Bronchodilators
Anti-Inflammatory Corticosteroids
Term
Short-acting inhaled bronchodilators
Definition
Beta-agonists sympathomimetics:
Albuterol
Levalbuterol
Pirbuterol

Anticholinergics:
Ipratropium
Term
Long-acting inhaled bronchodilators
Definition
Beta-agonist sympathomimetics:
Sameterol
Formoterol
Arformoterol
Indacaterol

Anticholinergics:
Tiotropium
Term
Corticosteroids
Definition
Combination:
Sal + Fluticasone
For+Budesomide
Term
Combination short acting inhaled bronchodilator
Definition
ipratropium bromide and albuterol
Term
Combination short acting inhaled bronchodilator
Definition
ipratropium bromide and albuterol
Term
Beta 2 adrenergic agonists
Definition
bind to transmembrane receptor protein, activates cAMP, ultimately relaxing airway smooth muscle
Term
SABA
Definition
Albuterol
Pirbuterol
Levalbuterol
Term
LABA
Definition
Salmeterol
Formoterol
Term
Beta agonist adverse effects
Definition
tachycardia
arrhythmias
dizziness
tremors
hypokalemia
nausea
decrease in arterial PO2
Term
LABA Black Box Warning
Definition
fatal asthma attack on Severent; always give with an inhaled corticosteroid (ICS)
Term
short-acting anticholinergics
Definition
Term
long-acting (24 hrs)
Definition
Tiotropium (Spiriva); blocks M1 and M3 only, not M2
Term
side effects of anticholinergics
Definition
dry mouth
blurred vision (if sprayed in eyes)
worsening glaucoma
if prostate issue, urination problems
Term
Methylxanthines (Theophylline)
Definition
MOA unknown, increases cAMP

oral, add-on therapy

many drug-drug intreactions, low dose due to toxic adverse effect
Term
Theophylline Side Effects (dose related)
Definition
headache
tremor
insomnia
diarrhea
hypokalemia
hypercalcemia
gastroesophageal reflux
nausea
tachyarrhythmias
Term
antihistamines
Definition
histamine blockers (antagonists)
H1 receptors (smooth muscle response)
H2 receptors (histaminic stimulation of gastric acid)
Term
First generation H1 receptor antagonists
Definition
strong sedative effects (tolerance develops), cross blood-brain barrier, hepatic enzyme induction

Diphenhydramine (Benedryl)
Hydroxyzine (Atarax)
Chlorpheniramine (Chlor-Trimeton)
Promethazine (Phenergan)
Term
2nd gen H1 receptor antagonists
Definition
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratidine (Claritin)
Desloratadine (Clarinex)
Term
3rd gen H1 receptor antagonists
Definition
levocetrizine (Xyzal)
Term
Intranasal antihistamine
Definition
azelastine HCL (Astepro)
Ciclesonide (Omnaris)
Azelastine (Astelin)
Olopatadine HCL (Patanase)
Term
MOA 2nd and 3rd gen H1 receptor antagonists
Definition
reversible competitive antagonism at H1 receptor
interfere w/mediator relase from mast cells (inhibit Ca++ influx and release)
Inhibit late-phase allergic rx of leukotrienes or prostaglandins or produce anti-platelet activating factor effect
Term
Inhaled Corticosteroids
Definition
Treat airway inflammation

Potentiate effects of beta-agonists

Decrease beta-agonist tachyhylaxis
Term
Corticosteroids treat airway inflammation by
Definition
inhibiting cytokine and mediator release
attenuating mucus secretion
decreasing microvascular permeability
Term
Oral vs IV corticosteroids
Definition
Oral prednison as effective as IV methylprednisolone (and less expensive)

IM use in acute asthma
Term
Side Effects of Oral Corticosteroids
Definition
decreased bone density
cataracts
high blood sugar
Term
Combo ICS and LABA
Definition
inhaled corticosteroid + long-acting beta agonist

Advair: fluticasone + salmeterol
Symbicort: budesonide + formoterol
Dulara: mometasone + formoterol
Term
Low dose ICS + LABA more effective than increased dose ICS alone?
Definition
Yes!
Term
Leukotriene receptor antagonists
Definition
Zafirkulast (Accolate) - oral
Montelukast (Singulari) - oral
compretitive inhibitor of CyslT1 receptor (lipoxygenase side of arachidonic acid metabolism pathway)

add-on therapy
nasal symptoms
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