Respiratory pathophysiology Flashcards

1
Q

Chemicals that contribute to increased airway resistance include:
a. nitric oxide
b. inositol triphosphate
c. vasoactive intestinal peptide
d. phospholipase C
e. leukotrienes
f. cyclic adenosine monophosphate

A

b. inositol triphosphate
d. phospholipase C
e. leukotrienes

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2
Q

All other thing being equal, the ___________ has the most significant contribute to airflow resistance.

A

radius of the airway

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3
Q

What physiologic systems determine airway diameter?

A

PNS (vagus nerve)
mast cells & non-cholinergic PNS
non-cholinergic PNS (nitric oxide)
SNS (circulating catecholamines)

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4
Q

What physiologic systems lead to bronchoconstriction?

A

PNS (vagus nerve)
mast cells & non-cholinergic PNS

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5
Q

What physiologic system lead to bronchodilation?

A

Non-cholinergic PNS (nitric oxide)
SNS (circulating catecholamines)

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6
Q

__________ supplies parasympathetic innervation to airway smooth muscle.

A

Vagus nerve (CN 10)

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7
Q

Stimulation of the ______ receptor produces bronchoconstriction

A

M3

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8
Q

_____________ & ______________ also release chemicals that promote bronchoconstriction

A

Mast cells & non-cholinergic c-fibers

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9
Q

There are no __________________ in airway smooth muscle

A

sympathetic nerve endings

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10
Q

B2 receptors embedded in airway smooth muscle are activated by

A

catecholamines in the systemic circulation

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11
Q

Non-cholinergic PNS stimulation produces ____________ which also promotes_______________

A

nitric oxide; bronchodilation

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12
Q

Smooth muscle contraction leads to

A

decreased airway diameter–> increased airway resistance–> reduce airflow

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13
Q

Smooth muscle relaxation leads to

A

increased airway diameter–> decreased airway resistance–> improved airflow

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14
Q

Mediators that lead to bronchoconstriction include

A

histamine
prostaglandins
leukotrienes
platelet activating factor
bradykinin
substance P
neurokinin A
calcitonin gene related peptide

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15
Q

Pulmonary medications can be broken down into

A

direct acting bronchodilators
anti-inflammatories
methylxanthines

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16
Q

Direct acting bronchodilators include

A

Beta 2 agonists
anticholinergics

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17
Q

Examples of direct acting bronchodilating anticholinergics include

A

atropine
glycopyrrolate
ipratropium

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18
Q

Examples of direct acting bronchodilating beta 2 agonists include

A

albuterol
metaproterenol
salmeterol

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19
Q

Anti-inflammatory drugs include

A

Cromolyn
leukotriene modifiers
inhaled corticosteroids

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20
Q

Examples of inhaled corticosteroids include

A

beclomethasone
fluticasone
triamcinolone
budesonide
flunisolide

21
Q

Examples of leukotriene modifiers include

A

zileuton
montelukast
pranlukast
zafirlukast

22
Q

Methylxanthines include

A

theophylline

23
Q

Anesthetic agents with bronchodilating properties include

A

volatile anesthetics
ketamine

24
Q

How do steroids work in the airway?

A

stimulates intracellular steroid receptors
regulates inflammatory protein synthesis leading to decreased airway inflammation and hyperresponsiveness

25
Q

How do leukotriene modifiers work?

A

inhibits 5-lipoxygenase enzyme reducing leukotriene synthesis

26
Q

How do anticholinergics work in the airway?

A

prevent Ach from binding to M3 receptors leading to decreased IP3 and decreased iCa2+

27
Q

How does cromolyn work in the airway?

A

stabilizes mast cell membranes

28
Q

How do beta 2 agonists work in the airway?

A

block cytokines, leukotrienes and histamine from leaving the mast cell and stimulate B2 receptors in the smooth muscle leading to increased cAMP & decreased Ca2+

29
Q

Side effects of beta 2 agonists include

A

tachycardia, dysrhythmias, hypokalemia, hyperglycemia, tremors

30
Q

Side effects of anticholinergics include

A

inhibits secretions–> dry mouth
urinary retention
blurred vision
cough
increased intraocular pressure with narrow angle glaucoma

31
Q

Side effects of corticosteroides include

A

dysphonia
myopathy of laryngeal muscles
oropharyngeal candidiasis
possible adrenal suppression

32
Q

Side effects of cromolyn include

A

negligible

33
Q

Side effects of leukotriene modifiers include

A

negligible

34
Q

How does theophylline work?

A

inhibits phosphodiesterase–> increased cAMP, increased endogenous catecholamine release
inhibits adenosine receptors

35
Q

Side effects of theophylline are dependent on

A

plasma concentrations

36
Q

At a plasma concentration of >20 mcg/mL of theophylline, side effects include

A

N/V, diarrhea, HA, disrupted sleep

37
Q

At a plasma concentration of >30 mcg/mL of theophylline, side effects include

A

seizures
tachydysrhythmias
CHF

38
Q

Which pulmonary function test is the MOST sensitive indicator of small airway disease?
a. forced expiratory volume in 1 second
b. forced expiratory flow 25-75%
c. forced vital capacity
d. diffusion capacity of carbon monoxide

A

b. forced expiratory flow 25-75%

39
Q

_____________ measure how much air the lungs can hold at a single point in time

A

Static lung volumes

40
Q

Examples of static lung volumes include

A

RV, ERV, Vt, IRV, FRC, IC, VC, TLC

41
Q

__________ measure how quickly air can be moved in and out of the lungs over time

A

FEV1, FVC, FEV1/FVC ratio, and MMEF

42
Q

____________ measures how well the lungs can transfer gas across the alveolocapillary membrane

A

Diffusing capacity

43
Q

Examples of diffusing capacity include

A

diffusing capacity of carbon monoxide (DLCO)

44
Q

A normal FEV1 value is

A

> 80% of the predicted value

45
Q

A normal FEV1/FVC ratio value is

A

> 75-80% of the predicted value

46
Q

Lung volumes and capacities are measured with

A

spirometry

47
Q

The most sensitive indicator of small airway disease is

A

forced expiratory flow at 25-75% vital capacity (mild maximal expiratory flow rate)

48
Q

A normal diffusing capacity (DLCO) is

A

17-25 mL/min/mmHg