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Pulmonary Flashcards

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1
Q

Epistaxis vessels

A

Most commonly occurs in anterior segment (Kiesselbach plexus)
Life threatening hemorrhage if in posterior (sphenopalatine aftery – branch of maxillary)

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2
Q

What does IL-5 do?

A

Calls in eosinophils (seen in asthma, and other stuff)

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3
Q

What does IL-4 do?

A

IgE class switch

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4
Q

What does Il-10 do?

A

inhibits TH1 cells and stimulates more TH2 cells (which release IL-4, 5, and 10

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5
Q

Gene associated w/ primary pulmonary HTN

A

Inactivation of BMPR2 (usually inhibits vascular sm muscle formation)

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6
Q

lung stem cell?

A

Type II pneumocyte. Also makes surfactant

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7
Q

Who are predisposed to lung abscess?

A

those at risk of LOC & aspiration. Oropharyngeal contents (esp alcoholics, epileptics) lead to anaerobes invading: Bacterioides, fusobacterium, peptostreptococcus and S aureus.
Tx: clinda

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8
Q

Bacteria likely in lung abscess (4)

A

Bacterioides
Fusobacterium
Peptostreptococcus
S. aureus

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9
Q

Tx for lung abscess

A

Clindamycin

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10
Q

Uses for H1 blockers

A

allergy, motion sickness, sleep aid

Diphenhydramine, dimenhydrinate, chlorpheniramine

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11
Q

Three H1 blockers (1st Gen)

A

Diphenhydramine
Dimenhydrinate
Chlorpheniramine

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12
Q

1st gen Histamine blocker toxicity

A

Sedation, antimuscarinic, anti-alpha adrenergic

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13
Q

2nd gen H1 blockers (four)

A

Loratidine
Fexofenadine
Desloratadine
Cetirizine

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14
Q

Use for 2nd gen H1 blockers

A

allergies

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15
Q

Benefit of 2nd gen H1 blockers

A

less sedating than 1st gen because decreased CNS entry

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16
Q

Guaifenesin use

A

expectorant, thins secretions; does not suppress cough

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17
Q

N-acetylecysteine uses

A

Mucolytic, loosens mucous plugs in CF patients by disrupting disfulfide bonds
- also used in acetaminophen overdose

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18
Q

Dextromethorphan use

A

antitussive ; synthetic codeine analog. Has mild opioid effect when used in excess
- give naloxone for OD.

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19
Q

Dextromethorphan MOA

A

NMDA glutamate receptor antagonist

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20
Q

Two adverse effects of dextromethorphan

A
  1. Overdose - needs naloxone

2. serotonin syndrome if combined w/ other serotonergic drugs

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21
Q

Pseudoephedrine, phenylephrine MOA

A

alpha adrenergic agonists, used as nasal decongestants

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22
Q

Pseudoephdrine and phenylephrine use

A
  • reduce hyperemia, edema, nasal congestion
  • open obstructed Eustachian tubes
    Note: illicitly used to make meth!!
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23
Q

Pseudoephedrine/phenylephrine toxicity

A
  1. HTN

2. CNS stimulation/anxiety (pseudoephedrine)

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24
Q

Endothelin receptor antagonists (use)

A

Pulmonary HTN (ex: Bosentan)

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25
Bosentan
Endothelin receptor antagonist used in pulmonary HTN, decreases pulmonary vascular resistance
26
Bosentan / endothelium receptor adverse effect
Hepatotoxicity. Monitor LFTs
27
PDE-5 inhibitors
sildenafil - used in pulmonary HTN | Ihhibits cGMP PDE5 and prolongs the vasodilatory effect of NO.
28
Prostacyclin analogs (two)
Epoprostenol Iloprost PGI1 (prostacyclin) w/ direct vasodilatory effects on pulmonary and systemic arterial vascular beds - inhibits platelet aggregation
29
Epoprostenol and Iloprost (use)
Prostacyglin analog - used in pulp HTN for vasodilatory effects on both pulmonary and systemic arterial vascular beds - also inhibits platelet aggregation
30
Side effects of epoprostenol and iloprost
Flushing, jaw pain
31
B2 agonists (3)
Albuterol, salmeterol, formoterol
32
Albuterol MOA
Beta 2 agonist, relaxes bronchial smooth muscle | use for exacerbation
33
Salmeterol MOA
Long acting Beta 2 agonist for prophylaxis
34
Salmeterol adverse effects
Tremor, arrhythmia
35
Fluticasone and Budesonide MOA
corticosteroids, inhibit cytokines Inactivate NF-kB, which is the transcription factor that induces production of TNF-a and other inflammatory agents. 1st line for chronic asthma
36
Ipratropium MOA
Muscarinic antagonist - competitive blocker of muscarinic receptors to prevent bronchoconstriction via parasympathetics. Also used in COPD.
37
diff btw ipratropium vs tiotropium
tiotropium is long acting
38
Montelukast, zafirlukast MOA
anti-leukotrienes. Block the CysLT1 leukotriene receptors. **Especially good for aspirin-induced asthma
39
Zileuton
antileukotriene, blocks the 5-lipooxygenase pathway which converts arachidonic acid to leukotrienes. Hepatotoxic
40
Zileuton SE
hepatotoxicity
41
Omalizumab
Anti-IgE monoclonal antibody, binds mostly unbound serum IgE and blocks binding to FcERI. Used in allergic asthma resistant to steroids and long acting beta2 agonists
42
Theophylline MOA
Methylxanthine - likely causes bronchodilation via inhibition of phosphodiesterase --> increased cAMP due to decreased cAMP hydrolysis. NARROW THERAPEUTIC INDEX, can induce cardiotoxicity and neurotoxicity
43
Theophylline SE
Narrow therapeutic window, can induce cardiotoxicity and neurotoxicity Metabolized by cyp450. Blocks actions of adenosine
44
Methacholine use
Muscarinic receptor agonist. Used in bronchial challenge test to help diagnosee asthma
45
What is major basic protein?
released by eosinophils, a potent anti-helminthic toxin that can cause damage to epithelial and endothelial cells.
46
What are in basophil granules?
heparin, histamine, SRS-A (mixture of leukotrienes)
47
Mutation of Bruton tyrosine kinase causes
X-linked agammaglobulinemia; Causes failure of bone marrow pre-B cells (CD19+ and CD20+) to develop into mature B cells (CD19+, 20+ and 21+). They have low or absent B cells, increased risk of infection with pyogenic (encapsulated) bacteria. Also increased risk of viral and parasites like enterovirus and guardians 2/2 lack of neutralizing antibodies
48
Where do you find CD15 cell marker
granulocytes | also Reed-Sternberg cells (useful for Hodgkins marker)
49
Main CF mutation (70% of cases) does what?
three BP deletion of phenylalanine at AA 508, causes impaired post-translational processing (improper folding/glycosylation) - targeted for proteasomal degradation and never reaches the cell surface
50
Mechanism of smoking on patients with AAT def?
Inactivates AAT through oxidation of a methionine residue - therefore devpt of emphysema happens at like 36 y/o instead of 51 in non-smokers
51
Biostats question: what tests do you use to compare the means of different groups?
ANOVA - two or more | t-test - two groups
52
Why does pO2 drop as blood goes from lungs into systemic circulation
addition of deoxygenated blood from bronchial circulation, intrapulm arteriovenous anastomoses, and Thebesian veins of the heart.
53
Where should thoracentesis be performed?
8th rib in midClav line, 10th rib on mid ax line, 12th rib on post scapular or paravertebral line. Lower than this risk injury to abdominal structures, and insertion of needle on INFERIOR margin risks subcostal neurovascular bundle injury
54
Tx for disseminated MAC
azithro w/ rifabutin or ethambutol. | Azithro is prophylaxis
55
Which interleukins play a role in asthma
Th2 secrete IL4 (IgE class switch) IL-5 (eosinophil recruitment) IL-10 (increase TH2 cell proliferation)
56
IL-3 Function?
stimulate bone marrow stem cells
57
Symptoms of Selective IgA deficiency
Most are asymptomatic Some have recurrent sinopulmonary and GI info concomitant autoimmune disorder also common Can cause reaction during blood txfusion due to formation of IgE against IgA
58
C1 inhibitor deficiency causes what?
hereditary angioedema
59
3 phases of pertussis
Catarrhal: like most URIs Paroxysmal: severe cough w/ insp whoop or post tussive vomiting Convalescent: cough improves
60
What kind of bacteria is bordetella pertussis?
gram negative coccobacillus | Pertactin is what allows it to adhere to ciliated epithelium
61
What inhibits neutrophil elastase?
alpha one antitrypsin
62
what inhibits macrophage elastase?
tissue inhibitors of metalloproteinases (TIMPs)
63
What are club cells?
Formerly Clara. Non-ciliated cells in terminal portions of bronchioles. Secrete proteins that protect against airway inflammation and oxidative stress, and surfactant components to prevent bronchiolar collapse
64
What is IL-12?
When macrophage presents to a T cell, it produces IL-12 that will stimulate differentiation into TH1 subset.
65
TH1 cells do what?
Cell-mediated immunity, activate macrophages and cytotoxic T cells. Secrete IL-2, IFN-gamma, and lymphotoxin beta. Result: Cytotoxicity, delayed hypersensitivity
66
TH2 cells do what?
Humoral (antibody mediated), activate B cells and promote class switching. Release IL-4, 5, 10, and 13. Promotes secretion of antibodies.
67
What does IFN-gamma do?
activate macrophages - these are necessary for delayed hypersensitivity rxn and cytotoxicity against intracellular organisms (like mycobacteria)
68
IL-12 receptor deficiency predisposes to?
Severe mycobacterial infections. This is because IL-12 makes helper T cells differentiate into TH1, which release IFN-gamma to active macrophages.

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