Term
| Volume of conduction zone dead space. |
|
Definition
| 15 ml; anatomic and physiologic |
|
|
Term
|
Definition
| lipoprotein that lines the surface of the alveoli and reduces surface tension. |
|
|
Term
|
Definition
|
|
Term
| Type II epithelial cells: |
|
Definition
| Cuboidal cells make surfactant |
|
|
Term
| Vasoconstriction, blood clot, and fat emboli in pulmonary circulation all result in |
|
Definition
|
|
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
|
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
|
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
|
Definition
|
|
Term
| Describe the pathological changes related to pleural effusion and pneumothorax. |
|
Definition
|
|
Term
|
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
|
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
|
Definition
| : a state in which there is a reduced amount of air entering the pulmonary alveoli. |
|
|
Term
|
Definition
| : below-normal oxygen content in arterial blood due to deficient oxygenation of the blood and resulting in hypoxia. |
|
|
Term
|
Definition
| : reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. |
|
|
Term
|
Definition
Obstructive
reversible airway obstruction, airway inflammation, and increased airway responsiveness associated with cough, wheezing, etc.
Reverses spontaneously or with treatment |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
|
Term
| Single greatest cause of disease and premature death in U.S. today |
|
Definition
|
|
Term
|
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
|
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
|
|
Term
| Approach to Smoking Treatment |
|
Definition
View as chronic health condition, requiring multiple interventions
5 As (ask, advise, assess, assist, arrange)
Counseling
Pharmacotherapy |
|
|
Term
|
Definition
relevance
risk
rewards
roadblocks
repetition |
|
|
Term
| Combination of counseling and medication is more effective than either alone. T or F |
|
Definition
|
|
Term
|
Definition
Nicotine replacement (patch, gum, inhaler, nasal spray, lozenge)
Bupropion (Zyban)
Varenicline (Chantix) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Public Health Service Guidelines |
|
|
Term
|
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
|
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
|
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
|
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
|
|
Term
| Restrictive Lung Diseases |
|
Definition
Interstitial LUng Disease (ex, idiopathic pulmonary fibrosis)
Sarcoidosis
Obesity
Scoliosis
Neuromuscular disease
treated with oral steroids |
|
|
Term
|
Definition
| basement membrane thickening that becomes permanent scarring; irreversible |
|
|
Term
|
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
|
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
|
Definition
| forced vital capacity: max volume of air that can be exhaled during a forced maneuver |
|
|
Term
|
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
|
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
|
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
|
|
Term
|
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
|
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
|
Definition
protein synth in liver, secreted in blood stream
neutralizes neutrophil elastase in the lung interstitium and protects lung parenchyma from breakdown |
|
|
Term
|
Definition
| chronic cough or mucus production for at least 3 mos in 2 successive years when other causes have been excluded |
|
|
Term
|
Definition
ventilation-perfusing mismatch:
lower ventilation: perfusing
treat with low-flow O2 |
|
|
Term
|
Definition
pus, water, blood, analectasis
alveoli filled with one of above
need high-flow O2 |
|
|
Term
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
| also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae (upper back). |
|
|
Term
|
Definition
| side to side curvature of the spine |
|
|
Term
|
Definition
| the collapse or closure of alveoli resulting in reduced or absent gas exchange. |
|
|
Term
|
Definition
| the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. |
|
|
Term
|
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
|
Definition
| Tidal volume (TV)-inspired/expired nl breath |
|
|
Term
|
Definition
| Residual vol (RV)-vol after max expiration; cannot be measured by spirometry |
|
|
Term
|
Definition
| Expiratory reserve vol (ERV)-expired after TV expired |
|
|
Term
|
Definition
| Inspiratory reserve vol (IRV)-inspired above & beyond TV |
|
|
Term
|
Definition
| Total lung capacity (TLC)-sum of 4 vols; maximal inspiration |
|
|
Term
|
Definition
| Vital capacity (VC)- max vol exhaled after max air inspired |
|
|
Term
|
Definition
| Functional residual capacity (FRC)-vol after expiration during quiet breathing |
|
|
Term
|
Definition
| Inspiratory capacity (IC)-max voly inspired after expiration quiet breathing |
|
|
Term
|
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
|
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
|
|
Term
|
Definition
ASA
sulfites
stress
illicit drug use
beta blockers |
|
|
Term
| Inhaled Corticosteroids block before or after arachidonic acid? |
|
Definition
|
|
Term
| Risk of COPD should be considered starting at ___ pack/year history |
|
Definition
|
|
Term
|
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
|
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
|
Definition
Albuterol
Pirbuterol
Levalbuterol |
|
|
Term
|
Definition
|
|
Term
| Beta agonist adverse effects |
|
Definition
tachycardia
arrhythmias
dizziness
tremors
hypokalemia
nausea
decrease in arterial PO2 |
|
|
Term
|
Definition
| fatal asthma attack on Severent; always give with an inhaled corticosteroid (ICS) |
|
|
Term
| short-acting anticholinergics |
|
Definition
|
|
Term
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
|
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 |
|
|
