Lecture 2 - Upper Respiratory Tract Flashcards
(83 cards)
1
Q
Respiratory System Components
A
Upper and Lower Respiratory
2
Q
Three Functions of Respiratory System
A
Bring oxygen into the body Gas exchange (O2 in, CO2 out) Expel CO2 and other waste
3
Q
Structure of the Respiratory System
A
Nose / Nasal Cavity (U) Sinuses (U) Pharynx (U) Larynx (U) Trachea (L) Bronchi (L)
4
Q
Protective Features of the Respiratory System: Hair
A
Acts as a filter
5
Q
Protective Features of the Respiratory System: Goblet Cells
A
Produce mucus to trap material
6
Q
Protective Features of the Respiratory System: Cilia
A
Move trapped material toward throat
7
Q
Protective Features of the Respiratory System: Blood Supply
A
Warms air and adds humidity
8
Q
Protective Features of the Respiratory System: Cough / Sneeze
A
Function to clear the airway
9
Q
Cough Function
A
CNS reflex when irritated to clear debris
10
Q
Layers of Bronchial Tubes
A
Cartilage, Muscle, Epithelial Cells
11
Q
Part of Brain that Controls Respiration
A
Medulla
12
Q
Controls Diaphragm Contraction and Inspiration
A
Parasympathetic NS
13
Q
Controls Bronchoconstriction
A
Vagal Stimulation
14
Q
Controls Rate, Depth and Dilation
A
Sympathetic Stimulation
15
Q
Upper Respiratory Tract Conditions
A
Common Cold
Seasonal Rhinitis
Sinusitis
Pharyngitis + Laryngitis
16
Q
Lower Respiratory Tract Conditions
A
Atelectasis Pneumonia Bronchitis Bronchiectasis Obstructive Pulmonary Disorders - CF, COPD, RDS
17
Q
Pneumonia: Definition
A
Inflammation of the Lungs
18
Q
Pneumonia: Cause
A
Bacterial or Viral infection of lung tissue
Aspiration of foreign substance into LRT
19
Q
Pneumonia: Manifestation
A
Localized swelling, engorgement, exudation
20
Q
Bronchitis: Definition
A
Narrowing of airway via inflammation
21
Q
Bronchitis: Causes
A
Occurs when bacteria, virus or foreign material infect inner lining of bronchi
22
Q
Obstructive Pulmonary Disorders
A
COPD
Asthma
Cystic Fibrosis
Respiratory Distress Syndrome (RDS)
23
Q
COPD: Manifestations
A
Air is trapped in the LRT
Alveoli degenerate and fuse together
Gas exchange greatly impaired
24
Q
Cystic Fibrosis: Definition
A
Hereditary disease involving exocrine glands resulting in thick lung secretions
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RDS: Defintion
Common in premature infants born before development of lungs and have low levels of surfactant.
Loss of lung compliance and increasing hypoxia
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COPD: Prevention and Tx
Reduce environmental irritants, no smoking, filter allergens, open airways with bronchodilation, decrease inflammation
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Adult Respiratory Distress Syndrome (ARDS): Characteristics
Progressive loss of lung compliance and increasing hypoxia
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Adult Respiratory Distress Syndrome (ARDS): Causes
Cardiovascular collapse
Major burns
Severe trauma
Rapid depressurization
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Adult Respiratory Distress Syndrome (ARDS): Tx
Reversal of the underlying cause combined with ventilatory support
30
Xanthines: Function
Facilitate respiration by dilating airways
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Two Categories of Xanthines
Sympathomimetics and Anticholinergics
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Xanthines: Drugs
Aminophylline
Caffeine
Dyphylline
Theophylline
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Xanthines: Action
Direct effect on the smooth muscles in bronchi and blood vessels
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Xanthines: Indications
Symptomatic relief or prevention of bronchial asthma and for reversal of bronchospasm associated with COPD
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Xanthines: Pharmacokinetics
Narrow therapeutic margin
Rapidly absorbed for the GI tract
Metabolized in the liver and excreted in the urine
36
Xanthines: Contraindications
GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, or hyperthyroidism
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Xanthines: Adverse Effects
Related to theophylline levels in the blood
| GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death
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Xanthines: Interactions
Many drugs interact with xanthines
| Nicotine increases the metabolism
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Xanthines: Assessment
Peptic ulcer, gastritis, renal or hepatic dysfunction, and coronary disease
Monitor blood pressure, pulse, cardiac auscultation, peripheral perfusion, and baseline electrocardiogram
Skin, BS, liver and renal function, appropriate lab values, as well as theophylline levels
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Sympathomimetics: Function
Mimic the effects of the sympathetic nervous system.
| Dilation of the bronchi with increased rate and depth of respiration
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Sympathomimetics: Drugs
```
Albuterol (Proventil HFA)
Arformoterol (Brovana)
Rphedrine (generic)
Epinephrine (epipen)
Formoterol (Foradil)
```
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Sympathomimetics: Actions
Beta2 selective adrenergic agonists
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Sympathomimetics: Indications
Acute asthma attach
Bronchospasm in acute or chronic asthma
Prevention of exercise-induced asthma
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Sympathomimetics: Pharmokinetics
Rapidly distributed after injection, transformed in the liver to metabolites that are excreted in the urine
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Sympathomimetics: Contraindications
Depends on the severity of the underlying condition
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Sympathomimetics: Adverse Effects
Sympathomimetic stimulation
CNS stimulation
GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing
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Sympathomimetics: Assessment
PMHx and Physical Exam and known allergy
Cigarette use, pregnancy and lactation
Cardiac disease, vascular disease, arrhythmias, diabetes, and hyperthyroidism
Reflexes and orientation, VS, reflexes and orientation and appropriate lab values
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Anticholinergic: Function
Patients who cannot tolerate the sympathetic effects of the sympathomimetic might respond to the anticholinergic drugs
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Anticholinergic: Drugs
Ipratropium (Atrovent)
Tiotropium (Spiriva)
Aclidinium (Tudorza Pressair)
Umeclidinium (Incruse, Ellipta)
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Anticholinergic: Actions
Anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine
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Anticholinergic: Indications
Maintenance treatment of bronchospasm associated with COPD
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Anticholinergic: Pharmacokinetics
Onset of action is 15 minutes when inhaled
| Peaks in 1-2 hours, duration of action is 3-4 hours
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Anticholinergic: Caution
Any condition that would be aggravated by Anti-ACh effects
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Anticholinergic: Adverse Effects
Related to the anticholinergic effects of the drug
| Dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, and urinary retention
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Anticholinergic: Assessment
History and Physical Exam and known allergy
Acute bronchospasm, bladder neck obstruction or prostatic hypertrophy, orientation, affect, and reflexes
Pulse and B/P, respirations and adventitious sounds and urinary output
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Inhaled Steroids: Use
Very effective treatment for bronchospasm
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Inhaled Steroids: Drugs
```
Beclomethasone (Beconase AQ)
Budesonide (Pulmicort Respules, Pulmicort Flexhaler)
Ciclesonide (Alvesco)
Fluticasone (FloventDiscus, Flovent HFA)
Triamcinolone (generic)
```
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Inhaled Steroids: Actions
Decrease the inflammatory response in the airway
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Inhaled Steroids: Indications
Prevention and treatment of asthma
| Treat chronic steroid-dependent bronchial asthma
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Inhaled Steroids: Pharmacokinetics
Well absorbed from the respiratory tract
| Metabolized by natural systems, mostly within the liver, excreted in the urine
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Inhaled Steroids: Contraindications
Not used for emergency during an acute attack or status asthmaticus
Pregnancy or lactation
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Inhaled Steroids: Adverse Effects
```
Sore throat
Hoarseness
Coughing
Dry mouth
Pharyngeal and laryngeal fungal infections
```
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Inhaled Steroids: Assessment
History and Physical Exam and known allergy
Systemic infections, pregnancy and lactation
VS, respirations, adventitious sounds, nares
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Leukotriene Receptor Antagonists: Use
Act more specifically at the site of the problem associated with asthma
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Leukotriene Receptor Antagonists: Drugs
Zafirlukast (Accolate)
Montelukast (Singulair)
Zileuton (Zyflo)
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Leukotriene Receptor Antagonists: Actions
Selectively and competitively block or antagonize receptors for the production of leukotrienes
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Leukotriene Receptor Antagonists: Indications
Prophylaxis and chronic treatment of bronchial asthma in adults and in patients younger than 12 years of age
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Leukotriene Receptor Antagonists: Pharmokinetics
Rapidly absorbed from GI tract, extensively metabolized in the liver and primarily excreted in feces
69
Leukotriene Receptor Antagonists: Caution
Hepatic or renal impairment
| Pregnancy and lactation
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Leukotriene Receptor Antagonists: Adverse Effects
Headache, dizziness, myalgia, nausea, diarrhea and abdominal pain, elevated liver enzyme concentrations, vomiting, and generalized pain
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Leukotriene Receptor Antagonists: Drug Interactions
Propranolol, theophylline, terfenadine, or warfarin
| Calcium channel blockers, cyclosporine, or aspirin
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Leukotriene Receptor Antagonists: Assessment
History and Physical Exam and known allergy
Acute bronchospasm or asthmatic attack
Impaired renal or hepatic function
Temperature, orientation and affect
73
Lung Surfactants: Defintion
Naturally occurring compounds or lipoproteins containing lipids and apoproteins that reduce the surface tension within the alveoli, allowing expansion of the alveoli for gas exchange
74
Lung Surfactants: Drugs
(Survanta), calfactant
(Infasurf), the newest drug of the class
Lucinactant (Surfaxin)
Poractant (Curosurf)
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Lung Surfactants: Actions
Replace the surfactant that is missing in the lungs of neonates with RDS
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Lung Surfactants: Indications
Rescue treatment of infants who have developed RDS
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Lung Surfactants: Pharmacokinetics
Begin to act immediately on instillation into the trachea
| Metabolized in the lungs
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Lung Surfactants: Adverse Effects
```
Patent ductus arteriosus
Hypotension
Intraventricular hemorrhage
Pneumothorax
Pulmonary air leak
Hyperbilrubinemia
Sepsis
```
79
Lung Surfactants: Contraindications
Emergency drugs; no contraindications
80
Lung Surfactants: Assessment
History and Physical Exam and known allergy
Time of birth and exact weight
Temperature, Respirations, adventitious sounds, endotracheal tube placement and patency, and chest movements
Blood pressure, pulse, and arterial pressure
Blood gases and oxygen saturation
81
Mast Cell Stabilizers: Action
Works at the cellular level to inhibit the release of histamine and inhibits the release of SRSA
82
Mast Cell Stabilizers: Indications
Exercise induced asthma
Tx of chronic bronchial asthma
Allergic rhinitis
It is no longer considered part of the treatment standards because of the availability of more specific and safe
83
Mast Cell Stabilizers: Drugs
Cromolyn (NasalCrom)
