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PP&T 3 test 3
respiration
207
Pathology
Professional
05/10/2011

Additional Pathology Flashcards

 


 

Cards

Term
what types of pulmonary function tests are there and what to they assess
Definition

  1. peak expiratory flow- flow rate
  2. spirometry- lung volumes & rates
  3. bronchoprovocation- airway reactivity (hyperresponsiveness)
  4. plethysmography- lung volume
  5. puls oximetry/diffusion capacity testing & arterial blood gases- gas exchange

Term
how is peak expiratory flow rate measured
Definition
liters per minute
Term
when does peak expiratory flow rates max 
Definition
at around 35
Term
what are peak expiratory flows based on
Definition
age, sex, height, race (effort dependent)
Term
what time of day will the peak expiratory rate be lowest
Definition
typically in the morning
Term
[image]
Definition
[image]
Term
what is tidal volume
Definition
 normal breathing
Term
what is total lung capacity
Definition
volume in lungs after max inspirtion
Term
what is vital capacity
Definition
maximal volume exhaled after full inspiration
Term
what is residual volume
Definition
volume remaining after maximal expiration
Term
what is restriction
Definition

reduced pulmonary function due to chest cavity size or lung size; limited lung expansion

Term
define obstruction
Definition
expiratory and/or inspiratory resistance to airflow (they get the air in but can't get it out)asthma, COPD
Term
what is spirometry
Definition
measurment of air movement patterns during controlled ventilatory maneuvers
Term
what is the key of spirometer
Definition
you must have reproducabale values (within .15l)
Term
what is the FEV1 in a spirometry
Definition
the forced air put in one second
Term
[image]
Definition
[image]
Term
what is forced mid expiratory flow and what may it help see
Definition
is is the air forced during the middle 50% of expiration and reflects medium/small airways is not dependent on effort and may reflect early obstruction
Term
[image]
Definition
[image]
Term
what is extrinsic asthma
Definition
asthma with external causes
Term
when giving albuterol for obstruction there must be what % increase and what volume to be reversable
Definition
12% and 200cc
Term
define asthma
Definition

Chronic inflammatory disorder of the airway with variable, recurring symptoms, obstruction, inflammation and hyperresponsiveness (and is reversable with drugs or spontaneously)

Term
what inflammatory cells are involved in asthma
Definition

  1. neutraphils (typically in severe cases)
  2. eosinophils, lymphocytes
  3. mast cells
  4. epithelial cell injuryy

Term
what are some majors changes in asthma (causes of obstruction)
Definition

  1. airway smooth muscle constricts
  2. inflammation leading to tissue edema causing the airway to shrink
  3. mucus (small amount but blocks the allready narrowed airway)
  4. over time collagen will deposit thickening the basement membrane
  5. vascular dilation of the eipithelial layer

Term
what are some things that contribute to asthma
Definition

allergic and non-allergic triggers

inflammatory cells

inflammatory mediators

airwat cells and tissues

IgE

Term
what are the three major effects of asthma
Definition

inflammation

airway construction

airway hyperresponsiveness

Term
what does airway obstruction in asthma result from
Definition

Bronchoconstriction (smooth muscle contraction)
Tissue edema of bronchial wall
Mucus
Airway remodeling
Smooth muscle hypertrophy and hyperplasia
Check Valve Respiration (also occurs in COPD

Term
airway inflammation in asthma contributes to what in asthma
Definition

Airway hyperresponsiveness
Airflow obstruction, including:
Acute bronchoconstriction
Airway edema
Mucus plugs
Airway wall remodeling
Respiratory symptoms and disease chronicity

Term
what are the major features of asthma
Definition

mast cell activation

inflammatory cell infiltration

eosinophils

B lymphocytes/TH2-like cells

macrophages

tissue edema

neutrophils (typically in death)

denuded airway epithelium (sloughing)

airway remodeling

Term
talk about eosinophils role in asthma
Definition

–contains inflammatory enzymes
Generate leukotrienes
Express many pro-inflammatory cytokines
Increased #s correlate with severity
steroids will reduce circulating and airway eosinophils

Term
explain lymphocytes imbalance and what it is related to in asthma
Definition

Shift toward TH2 (or reduced TH1)
Related to:
Eosinophilic inflammation
Hyperresponsiveness
Airway remodeling

Term
explain mast cells in asthma
Definition
activation releases bronchoconstrictor mediators:  histamine, cysteinyl leukotrienes, prostaglandin D2, sensitized by allergen binding (IgE receptors) and osmotic changes (EIB
Term
explain dendritic cells role in asthma
Definition

Interact with allergens at airway surface
Migrate to regional lymph nodes to interact with regulatory cells and stimulate TH2 production

Term
describe chronic asthma
Definition

persistent cell damage and ongoing repair resulting in airway abnormalities which may become permanent

Term
describe subacute asthma
Definition
recruited and resident cells are activated, resulting in more persistent inflammation
Term
describe early asthmatic response
Definition

Onset minutes, duration up to 2 hours
Allergen exposure - immediate obstruction
Bronchoconstrictor mechanisms important
Mast cells degranulate, releasing histamine, leukotrienes, and prostaglandins

Term
describe late asthmatic response
Definition

Present in 50% of adult asthmatics
Onset 6-8 hours, duration days to weeks
Obstruction associated with increased airway reactivity which may persist several weeks or longer following a single allergen exposure
Primarily inflammatory
increased numbers of eosinophils (can cause airway injury and alter epithelial function)
lymphocytes and macrophages, secrete cytokines (up regulate inflammatory cells, cause growth of mast cells, and may activate other cells)
Neutrophils in severe disease
Associated with increased airway reactivity and cellular infiltrate in airways

Term
what is the busiest time for asthma
Definition
fall when people are crowding (children in school) due to viruses
Term
what can stimulate hyperresponsiveness
Definition

Physical changes
Chemical and environmental irritants
Pharmacologic agents
Allergens
Viral infection (epithelial damage through IgE production against viral antigen and enhanced mediator response)
Cold air, exercise

Term
what are the mechanismsa of hyperresponsiveness
Definition

airway inflammation (major) dysfunctional neuroregulation

structural changes

 

Term
what causes exercise induced bronchospasms
Definition
increased respiration and mouth breathing means cooler unfiltered air causing an increase in leukotrienes
Term
what is chronic bronchitis
Definition
chronic productive cough for three months in two successive years (other causes are ruled out)
Term
what is emphysema
Definition
abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls without fibrosis
Term
is COPD reversible with bronchiodialotrs
Definition
only 1/3 can reverse (must recover 12% and at least 200cc) where as 2/3 do not reverse
Term
for the most part mortality rates of other diseases have been going down how about COPD
Definition
COPD mortalitiy has increased by 163%
Term
what are risk factors for COPD
Definition

cigarette smoke

occupational dust/chemicals

environmental tobacco smoke

inddor outdoor air pollution

infections

genes nutriotin

age

socio-economic status

air way remodeling

Term
how do noxious particles and gases lead to COPD
Definition
cause lung inflammation which creates oxidative stress or proteinases leading to COPD
Term
check valve respiration occurs in asthma and COPD what is this
Definition
tracheobronchial tree widens and lengthens during inspiration this can lead to air trapping especially if bronchioles are filled with mucus
Term
what is pathologic features of bronchitis
Definition

shit ton of mucus enlargement of mucus secreting glands

Hypertrophy of bronchial mucus glands
Hyperplasia of mucus secreting bronchial glands and mucosal goblet cells

Term
in COPD what role do cholinergic factors play
Definition
it appears to be a large role since treatment is mainly anticholinergic and works much better then they do in asthma
Term
what is a key difference in bronchitis then asthma in terms of the cells involved
Definition
the main player in bronchitis are the neutrophils (these occur in asthma typically at death)
Term
what are some features of chronic bronchitis
Definition

mucousal rigidity/thickening

increased muscle tone

scarring of bronchial wall

ciliary loss

obstruction (leading to air trapping)

 

Term
when yo u get inflammation in COPD where does it take place
Definition
small airways
Term
what is the main issue with COPD
Definition
smoking
Term
what are the big players in COPD (cellular level)
Definition

ALv macrophage

epithelial cells (slough off)

Cd8 cell (TC1)

neutrophils

Term
what causes exacerbations
Definition

80% due to infections

20% non-infections environmental noncompliance with drugs

Term
why does smoking cause all these lung problems
Definition

  • activates macrophage, which recruite neutraphil, which then secretes elastin causing elastse to degrades elastin causing the emphasemia pic
  • another path is smoking releases oxidents and free radicals, (the macrophage causes a releases of H2O2), bothe od the prior two will lead to oxidazes of alpha antitrypsin which inhibits elasatase

 

Term
what are the two types of emphasemia
Definition

centrilobular

panlobular (senile emphysema)

Term
describe centrilobular emphasema
Definition

iniitially more the alveolar are preserved till the fenestrationis enlarge (these fenestrations develop in the walls initially

more common in men and is usually associated with chronic bonchitis

Term
describe panlobular emphysema
Definition

  • this is the distal destruction  (aveoli's)
  • os the end stage centilobular disease
  • may not be true emphysemia since no clinical loss of impaired lung
  • is not common, but is charecteristic of primary emphesema

Term
describe the pathology of emphysema
Definition

Increased airway resistance
Reduced diffusing capacity
Increased ratio of residual volume/total lung capacity
Often find metaplasia of squamous tissue and/or neoplasia of tracheobronchial epithelium AND all of the changes in CB
Fibrous thickening of alveoli, pulmonary arterioles, and small arteries
Reduced surface tension, so as pressures in alveoli > bronchioles during exhalation, result in airway collapse

Term
whats ia bleb
Definition
an alveoli that is rutured into the subpleural space (can result in pneumothorax)
Term
what is bullae
Definition
air filled spaces >1cm due to check valve alveolar obsturction (air in and trapped)
Term
what causes Blebs and bullae
Definition

Collagen or elastic tissue degeneration
Vascular obliteration with ischemic tissue
Lung tissue antibodies
Reduced defense mechanisms due to smoking, infection, pollution

Term
what is alpha-1-antitrypsin deficiency
Definition

  • this is a genetic disorder, where 1/3 patients will develop emphysema as young adults (still needs concomitant factors)
  • causes inhibition of neutrophil elastase

Term
what is the usual cause of mortality in COPD
Definition

infection

right sided heart failure (Cor pulmonale)

ulcer

pneumothorax

arrhythmia

Term
what are some results of chronic hypoxia
Definition

stimulation of RBC synthesis

coma

altered behavior

seizures

Term
what are the values of COPD 1 mild
Definition

FEV1/FVC < 70%

FEV1 > 80% predicted

Term
what are the values of COPD 2 moderate
Definition

FEV1/FVC < 70%

50% < FEV1 < 80% predicted

Term
what are the values of COPD 3 severe
Definition

FEV1/FVC < 70%

30% < FEV1 < 50% predicted

Term
what are the valuse of COPD 4 severe
Definition

FEV1/FVC < 70%

FEV1 < 30% predicted

OR

< 50% WITH Chronic Respiratory Failure

Term
in asthma airway narrowing is controlled by
Definition

(1) contraction of bronchial smooth  muscles

  (2) edema

  (3) mucus hypersecretion

 


Term
Drugs will focus on what two major areas
Definition

inflammation

bronchospasm

Term
what does a reliever do in asthma
Definition
a reliever will help smooth muscle bronchospasm
Term
where does a controller work in asthma
Definition
a controller will work to reduce inflammation
Term
in athma what happens to cause the early reaction
Definition
in early reaction cause can be histamines from mast cells can constrict the smooth muscle as well as allergins effecting T lymphocytes
Term
what happens in late phase asthma
Definition
eosinophils and possible (rarely neutorphils)
Term
in early phase asthma what are the mainoutcomes
Definition

mucous production

bronchoconstriction

Term
in late phase asthma what is the ultimate issue
Definition
inflammation causing- edema, airway injusry, imparied ciliary clearance, reduced air flow, air way hyperreactivity
Term
what causes stimulation vagal response
Definition
inhaled irritenats cause this neurogenic inflammation)
Term
what are symptoms of asthma
Definition

coughing
     shortness of breath
     chest tightness
     wheezing
     dyspnea (difficulty breathing out

Term
what drug classes are used to treat asthma
Definition

beta 2 agonists

corticosteroids

methylzanthine

cromolyn

muscarinic antagonist

monoclonial antibodiea

leukotriene modifiers

Term
how much of an inhaled drug gets to the lungs
Definition
about 10-20% inhaled with the rest getting swallowed
Term
what do beta 2 agonists do in asthma
Definition

reverse   bronchoconstriction irrespective of the contractile agent]

  thus, most effective & most widely used

Term
how do non selective beta agonists work in asthma and one example
Definition

ØRelax airway smooth muscle

 

ØIncrease mucociliary transport

 

ØInhibit release of bronchoconstrictors from mast cells, eosinophils   basophils, neutrophils, lymphocytes (rapid desensitization occurs)

epinephrine

Term
what is the mechanism of action for beta 2 agonists
Definition
acts at adenylyl cyclase to increase cAMP with will increase Ca extrusion thus causing smooth muscle relaxation (bronchialdilation)
Term

aside from beta two agonists what is another way to increase cAMP to cause bronchodilation

 

Definition
use a drug like theophylline which is methyzanthine that will inhibit phosphidiesterases (these breakdown cAMP)
Term
what are the short acting beta 2 blockers used in asthma
Definition

albuterol

biolterol

pirbuterol

terbutaline

bronchodilation for 4-8 hrs

Term
whata re the long acting beta 2 agonists for asthma
Definition

formoterol

salmeterol

bronchodilation >12h

Term
what are the non-selective beta agonists for asthma
Definition

isoproterenol

metaproterenol

isoetharine

Term
regular use of beta agonists leads to tolerance what aspect of asthma is this the greates in
Definition

tolerance may affect b receptors on mast cells & lymphocytes   more than in bronchiolar smooth muscle;

     thus, lack of significant chronic antiinflammatory effects

Term
what is the 1st choise for acute symptomatic relief of asthma
Definition
short acting beta 2 agonists (used PRN)
Term
if you have to use a beta 2 agonist more then twice a week this means what
Definition
inadequate control of asthma
Term
for maintence treatmeant of asthma what do you use
Definition
long acting beta agonists typically with corticosteroids
Term
what is the mechanism of the long acting beta agonist morbidity
Definition

 

Negative feedback with beta agonist use
Internalization of receptors and downregulation
Regular use increases bronchial hyperreactivity despite maintenance of some degree of bronchodilatation
These effects may worsen control without increased symptoms

 

Term
what are the three main methylxanthine drugs
Definition

theophylline

thebromine

cafeine

Term
what is the mechanism of action for methylzanthine
Definition

inhibits phosphodiesterase4

blocks adenosine (adenosine can produce bronchoconstriction)

Term
how does adenosine produce bronchoconstriction
Definition
 release of prostaglandins leukotrienes and histamines
Term
what is the therapeutic index for theophylline and when would you use it in asthma patients
Definition

the range 10-20 ug/ml

and you would use this in a patient who has poorly controlled symptoms

Term
what are the muscarinic antgonists
Definition

Ipratropium bromide (Atrovent) – short acting    

Tiotropium (Spiriva) – 24 hr duration of action

Term
what is a COPD drug that inhibits PDE4
Definition
roflumilast (dailiresp) (typically used with spiriva for mainantece)
Term
the non selective muscarinic antagonists is actually selective for
Definition
M1 and M3
Term
how does the muscarinic antagonist work in asthma (approved for COPD)
Definition

Affects bronchoconstriction caused by p-symp stimulation

  (occurs in asthma produced by irritant stimuli

  and allergy) ----  M3 receptor

Term
what does cromolyn do to help asthma
Definition

inhibition of mast cell degranulation;   >     inhibit mediator release from bronchial mast cells;

  inhibit inflammatory response to allergens on eosinophils

  inhibition of parasympathetic & cough reflexes

Term
is cromolyn given as acute exacerbatin or prophylaxis
Definition
prophylaxis
Term
what is a potent bronchoconstrictor drug class that is 100 times more potent then histamines
Definition
leukotrienes
Term
how do leukotriene inhibitors relate to people that have aspirin induced asmtha
Definition
they work very well
Term
what is the only allregy related asthma drug
Definition
the biologic omalizumab
Term
how does omalizumab work
Definition

they will bind to IgE and inhibit igE binding to mast cell t lymphocytes and macrophages

not used in acute attacks

Term
how do you measure the effectiveness of a drug treatment in asthma
Definition
asthma frequency & severity   &   decrease steroid dose requirements 
Term
how do you know omalizumab works
Definition
shown to lessen asthma frequency & severity   &   decrease steroid dose requirements 
Term
how do you give olzalumab
Definition
sub Q once a month
Term
what is the most effective agent at controling asthma
Definition
glucocorticoids
Term
what is the mechanism of action for glucocorticoids
Definition
binds coactivators to directly inhibit histone   acetyltransferase (HAT) & to recruit histone   deacetylase-2 (HDAC2), reversing histone acetylation &   results in suppression of activated inflammatory genes
Term
what is inhibited in glucocorticoid use
Definition

 

inhibit degranulation of inflammatory cells

  decrease capillary permeability

decreasein accumulation in lung of basophils, eosinophils, etc

decrease in LT production & release

increase in  ­ b-AR synthesis [prevent & reverse b-AR desensitization

 

Term
what is taking place to stop the inflammation with glucorticoid use
Definition
 bind to the GR receptor and stimulating deactelation or inhibiting acetylation to prevent gene expression og inflammatory cells
Term
what corticosteroids have high 1st pass metabolism thus less systemic SE
Definition

budesonide

fluticasone

mometasone

Term
what corticosteroids are prodrugs
Definition

ciclesonide

beclomethasone

Term
what classes of drugs are considered controller meds
Definition

Corticosteroids
Long Acting Beta Agonists (LABA’s)
Leukotriene modifiers (LTRA)
Cromolyn & Nedocromil
Methylxanthines: (Sustained-release theophylline)
Omalizumab ( Xolair)

Term
what drugs are considered quick relief meds
Definition

Short acting bronchodilators (SABA’s)
Systemic corticosteroids
Anticholinergics

Term
what type of hypersensitivity classifications does anaphylaxis occur in
Definition
type1-3
Term
what are the acute mediators of anaphylaxis
Definition

mast cells and basophils dgranulate to release

Tryptase
Histamine
Chymase
Carboxypeptidase
Cytokines

Term

what kind of phases does anaphylaxis have

 

Definition

  • can have one phase
  • can have two phases (treated then goes into it again)
  • can have a protracted anaphylaxis (extended over 24 hrs)

Term
what are the typical signs of anaphylaxis (any of the three then classified anaphylaxis)
Definition

 

1.Acute onset of an illness (minutes to hours) with involvement of skin and/or mucosal tissue and respiratory compromise and/or reduced blood pressure.
2.Symptoms involving two or more organ systems (skin/mucosal, respiratory, cardiovascular, GI)  that occur rapidly after exposure to a likely allergen for that patient.
3.Reduced BP following exposure to a known allergen for that patient. 

 

Term
what are the most frequent signs and symptoms of anaphylaxis
Definition

Urticaria/angioedema  88

Upper airway edema  56

Dyspnea/wheeze  47

Flush  46

Hypotension  10-33

Gastrointestinal

Term
if the respiratory systom is involved in anaphylaxis what are the symptoms
Definition

Nose: pruritus, congestion, rhinorrhea, and sneezing
Laryngeal: pruritus and “tightness” in the throat, dysphagia, dysphonia and hoarseness/stridor, dry “staccato” cough
Lungs: shortness of breath, dyspnea, chest tightness, cough, and wheezing

Term
what are the oral symptomes of anaphylaxis
Definition

pruritus of lips, tongue, and palate; edema of lips and tongue; metallic taste in mouth

Term
what are the cutaneous symptoms in anaphylaxis
Definition

flushing, pruritus, urticaria, angioedema, morbilliform rash, and pilor erecti; pruritus in unusual places (scrotum, vagina, ear) - ( > 90% of patients)

Term
what are the GI symptoms of anaphylaxis
Definition
nausea, abdominal pain (colicky), vomiting (large amount of “stringy” mucus), diarrhea (30% of patients
Term
why should we treat anaphylaxis immediately
Definition
the longer the patient is in anapylaxis the harder it is to treat
Term
what ae the cardiovascular symproms of anaphylaxis
Definition

 

feeling of faintness, syncope, chest pain, dysrhythmia, hypotension.  (Shock: 10% of patients)

 

Term
if this organ system is involved in anaphylaxis it is most likely to result in death
Definition
cardiovascular and respiratory systems
Term
when diagnosins anaphylaxis what do you try to find out
Definition

 

Suspected culprit Route Dose Sequence of symptoms Timing Treatment •Duration of exposure and symptoms
Associated factors (exercise, meds, food)
Records of acute event (ER visit)

 

Term
what tests will the patient undergo after anaphylaxis
Definition
2-4 weeks after you will perform skin tests based on the history
Term
what allergies put you at higher risk for anaphylaxis
Definition

 

Food (e.g., peanut, tree nut, seafood, finned fish, milk, or egg)
Insect stings or bites
Natural rubber latex
Medications

 

Term
what are the therapeutic objectives and indices of effecr
Definition

Resolve episode
Prevent death
Prevent recurrence

for indices of effect monitor the patient for current signs and symptom resolution and new ones

Term
when do you use epinephrine in anaphylaxis
Definition

if they are having cardiac issues or respiratory issues

if you have 2 or more systemes involved

Term
what is the problem with epinephrine
Definition

not used or not used properly or delayed use

people allow there epinephrine to outdate

Term
what symptoms should you refer a patient for asthma evaluation
Definition

cough

wheezing

breathlessness

 

especially if these are present at triggers (stron smells, animals etc...)

Term
how should you assess asthma
Definition

look ar severity

control

responsiveness

Term
when should somoene go on daily controller therapy for asthma patients
Definition
persistant symptoms
Term
what is the lung function for intermittent, mild, moderate, sever forasthma
Definition

intermittent is>80%

mild is >80%

moderate it 60-80%

sever <60

Term
how do you measure nightime symptoms in asthma
Definition
occurances per month
Term
what are some risk factors in asthma
Definition

  • poor perceivers
  • asthma history of intubation or icu admission
  • 2 or more asthma hospitilizations in a month or>3 ER visits a year
  • if they are filling more then 2 fills for short acting beta agonist
  • drug use

Term
when should you send the patient to the hospital
Definition

  • repiratory distress (can't speak right or walk), drowsiness nasal flaring, retractions
  • severe exacerbation lung function below 60%
  • if they don't respond to beta 2 agonist in promp and not sustained for 3 hours or no improvement after2-6 hours corticosteroid

Term
whats the objective in treating asthma
Definition

prevent chronic and troublesome symptoms
prevent frequent use of inhaled SABA for symptoms
maintain (near) “normal” pulmonary function
maintain normal activity levels
meet patients’ and families’ satisfaction with care
prevent recurrent exacerbations of asthma (ED/hospitalizations)
prevent progressive loss of lung function

Term
whats are some asthma indices of asthma (subjectively)
Definition

  • symptoms of asthma and ability of meds to control it
  • asthma related to ER visists
  • and related conditions
  • things that effect severity like rhinitis/sinusitis

Term
what are the rules of two for asthma
Definition

Asthma not controlled (persistent) if:

> 2 episodes of daytime symptoms/week
> 2 episodes of nocturnal symptoms/month
> 2 canisters of short-acting beta2-agonist in a year
>= 2 oral steroid courses for exacerbations in past year

Term
why is cromolyn not that good
Definition
it's dosed 3-6 times a day and need to start 2 weeks ahead of time
Term
if someone has pareneral allergies what is a good option
Definition
allergy immunotherapy
Term
if you use regular water in a nedipot wow will it burn
Definition
it is not isotonic
Term
if someone is prego how should you help them with allergies
Definition

avoid triggers

don't begin immunotherapy

can try singulair

chlorphenrimne is drug of choice

avoid oral decongestants

consider cromolyn

 

Term
what are the time frames for acute subacute and chronic cough
Definition

acute is < 3 weeks

subacute is 3-8 weeks

chronic is >8 weeks

Term
what are complications of cough
Definition

}Exhaustion
}Musculoskeletal pain
}Hoarseness
}Excessive perspiration
}Urinary incontinence
}Rib fractures
}Cardiac dysrhythmias
}Syncope
}Stroke

Term
what are some systemic treatments of cough (antitussives)
Definition

}Dextromethorphan
}Diphenhydramine (and other 1st-generation antihistamines)
}Chlophedianol
}Benzonatate
}Codeine
}Hydrocodone

Term
what are some topical antitussives
Definition

}Camphor
}Menthol
}Volatile oils

Term
what is an example for protussives
Definition
guaifenesin
Term
what is the cold standard antitussive that all others are compared
Definition
codeine
Term
FDA is reviewinf use of OTC cough and cold products in what age group
Definition
2-11 years old
Term
under what age is no cough and cold med supposed to be used
Definition
4 years
Term
when using narcotic antitussive how are they working
Definition
they act centrally to supress the cough
Term
how does dextomethorphan work and how does it compare to codeine and what drug interaction does it have
Definition

it acts centrally on the medulla to increase cough threshold

it is equipotent to codeine

it interacts with MAO's and can cause seratonin syndrome

Term
how does benzonatate work
Definition

  • this works peripherally by numbing the cough reflex (this introduces a choking risk since you may lose gag reflex)
  • works within 15-20 min

Term
what antihistamines can you use for a cought
Definition

diphenhydramine

can use other sedating antihistamines like 1st generation)

Term
if your going to use a humidifier then what kind is it
Definition
cold air (warm can have mold)
Term
guaifensin has a big issue with most of it's formulations
Definition
this will break up the mucus, but is with a cough suppresant usually)
Term
what should you treat the common cold with
Definition

}Antitussives

}Expectorants
}Antihistamine-decongestant combinations
}Antihistamines
Term
how is methylxanthines cleared
Definition
the liver
Term
what are the greneral prinicples of therapy
Definition

 

  • avoidance measaures anti-inflammatory (every day control corticosteroids)
  • bronchodilators (SABA for quick reliefe, quick onset anticholinergics, LABA in combo with corticosteroids) 
  • systemic steroids (moderat to severe)

 

Term

for beta agonists why use inhaled route

 

Definition
to avoid toxicities
Term
if someone is getting tremor with inhaler beat agonist use what is the issue
Definition

maybe swollowing the drug

too much, wrong technique

Term
what drugs interact with beta agonists
Definition

diuretics- hypokalemia

beta blockers

sympathomimetics-additive toxicity

MAOI and tricyclics

Term
the black box warning of death for salmeterol and formetrol is for what disease state
Definition
asthma
Term
what is the role of an anticholinergic (ipatropium)
Definition
used for moderate to severe bronchospasms (reduces admissions to ER)
Term
methlxanthines are not used often why
Definition

less effective

high rates of toxicity

must adjust doses for use

Term
what is the most effective inhaler treatment for asthma (exp in preventing death)
Definition
inhaled corticosteroids used as a controller
Term
how do you taper down on corticosteroids (inhalers)
Definition
wait three months of controlled asthma and start to step it down
Term
parents may say they are scared of stunting growth with use of corticosteroids what should you say
Definition

  • it stunts by 1.54cm/year and they can catch up
  • asthma can stunt growth
  • if they are forced to take systemic steroids for acute exacerbation they will end up recieving more steroids

 

Term
when would you use leukotrienes
Definition

as a second line as an alternative to inhaled steroids

for moderate to severe disease

Term
what options to you have for an add on with inhaled corticosterois
Definition

you can add on LABA

or less often add on leukotrienes

Term
if you have an asthma patient with liver dysfunction what do you need to be worried about
Definition

Methylxanthines, leukotriene modifiers

Term
if you have an asthma patient with heart failuer what drugs will be an issue
Definition

Methylxanthines, corticosteroids

Term

describre step2 therapy in

>12

 

Definition

ICS low dose or leukotriene cromolyn or theophylline

Term
describe step 3 therapy in >12 years
Definition

low dose ICS with a LABA

or medium strength ICS

 

alternative low dose ICS with leukatriene or (theophylline or zileuton)

Term
describe step 4 therapy for asthma in patients 12 and up
Definition

medium dose ICS with LABA

alternative is to replace laba with either leukotriene theophylline or zileuton

Term
describe step 5 therapy in asthma patients 12 and above
Definition
high dose ICS with LABA and start considering omalizumab for allergy
Term
describe step 6 therapy for asthma in patients above 12
Definition

ICS (high) + LABA

AND oral steroid

AND

Consider omalizumab if IgE allergy 

Term
what should you do if asthma is not well controlled
Definition
if thestep up a level and reevaluate in 2-6 weeks
Term
what should you do for very poor control of asthma
Definition
consider oral corticosteroids and step up 1-2 steps and reevaluate in 2 weeks
Term
before increasing therapy in asthma patients what must you first make sure of
Definition

proper inhaler technique

adherance

be aware of any environmental changes

consider alternative diagnosis

Term
in COPD what problems do patients usually have
Definition

Dyspnea (progressive, exertional, persistent), chronic cough or chronic sputum production, and risk factor exposure.  

 

Term
what are the therapeutic objectives in COPD
Definition

Relieve symptoms
Prevent disease progression
Improve exercise tolerance
Improve health status
Prevent and treat complications
Prevent and treat exacerbations
Reduce mortality
Prevent/minimize ADRs

Term
what are the subjective indices of effect in COPD
Definition

symptoms

ER visits

risk factor exposure

monitor comorbidities

Term
what is the main therapy for COPD
Definition
anticholinerigics (ipatropium)
Term
what would you use for stage one or mild COPD
Definition

SABA

or use ipatropium

Term
what are you going to use for stage 2 or moderat COPD
Definition
use the SABA or ipatorpium with a LABA, or spiriva (no need for roids here)
Term

what are you going to use for stage 3 or severe COPD

Definition

you use your PRN SABA or  ipatropium 

also use regular LABA, and roids

Term
what anticholinergic is used for short term and what one for long term
Definition
for short term use ipatropium and for long teerm use spiriva
Term
what does every COPD patient get
Definition
SABA
Term
what would you do for acute exacerbation of COPD
Definition

bronchodialator

if mucus turns green give antibiotics

if improved step down bronchodilators if not then you will give corticosteroids for 10 days

Term
when do you administer antibiotics for COPD
Definition
Cardinal symptoms: Increased dyspnea, sputum volume, sputum purulence
Administer Antibiotics IF:
ALL cardinal symptoms present
Purulent sputum with ONE additional cardinal symptom
Severe exacerbation requiring mechanical ventilation
Term
whats is cystic fibrosis
Definition
most common lethal autosomal recessive disorder
Term
what organs does cystic fibrosis affect
Definition

the pancreas and the lung

sweet glands (salty skin)

hepatobilliary

Genitourinary

is a mutlie system disease

Term
what chromosome is the CFTR gene on
Definition
7
Term
the CFTR is what type of ion channel
Definition
primary choloride channel
Term
how do you diagnoze cystic fibrosis
Definition

sweat test (gold standard)

genotyping and neonatal screening

Term
goals of therapy in cystic fibrosis
Definition

·Prevent and treat acute and chronic complications
·Provide optimal nutrition for growth and weight maintenance
·Improve the quality of life by relieving symptoms
·Prolong life by slowing pulmonary deterioration

Term
treatments of cystic fibrosis 
Definition

pancreatic enzymes, vitamins

flutter, vest

antibiotics

nebulizers

pulmozyme (recombinant human DNase)

hypertonic saline

bronchodilators

lung transplant

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