Pulmonary Meds

Question 1

Pulmonary Medication Goals

Answer 1

• Promote airflow
  – Bronchodilation or decrease bronchoconstriction
• Secretion removal
• Improve ventilation / oxygenation (VQ)
• Optimize breathing pattern (Helps with one or more of these above)

Question 2

Bronchomotor Tone is controlled by what?

Answer 2

Balance between dilation and constriction
Adrenergic (Dialation) & Cholinergic (Constriction) influences

Question 3

Cholinergic does what?

Answer 3

• Parasympathetic input increase tone and causes narrowing of passages
• Mast cells and blood start inflammatory response
• Invading organisms (bacteria/virus) or irritants (allergens) start immune response

Question 4

What causes bronchoconstriction?

Answer 4

• Vagus nerve (parasympathetic) releases ACH – M1, M2 & M3 receptors (Muscarinic receptors)
• Response to stimulation of mucosa by irritants
  – Results in bronchoconstriction
  – Release of pulmonary secretions
  + mucus production
• RESULT is: decreased air flow

Parasympathetic fibers, Reflex, Local Mediators

Question 5

What do mast cells do in the lungs?

Answer 5

• Mast cells are IgE anitbody activated
• 100-500k receptor sites
• Has 1000 granules to contain chemical mediators for inflammation (Histamine and Protease)

Question 6

Bronchodialators

Answer 6

• Sympathetic
• NE/EP from Adrenal Medulla - dialation of bronchial tree

Question 7

How to properly use an MDI?

Answer 7

1. Shake it
2. Exhale
3. Tilt head back
4. Start inhaling and then push button
5. The once you have inhaled it all and hold for 5 seconds
6. Then exhale for 5 seconds

Question 8

MDI vs Dry Powder Inhaler

Answer 8

Dry Powder has less of a timing effect otherwise the same!

Question 9

Receptors in the Lungs

Answer 9

Muscarinic receptors (Cholinergic)
* Increase cGMP
* Bronchoconstriction

Adrenergic Beta2 receptors
* Increase cAMP
* Bronchodilation

Alpha 1 receptors
* Decreases cAMP
* Bronchoconstriction

Question 10

What do bronchodialators do?

Answer 10

Smooth muscle relaxation of the bronchi or bronchioles

• Increase cAMP – facilitates smooth muscle relaxation
  Or
• Block increase cGMP
  – cGMP normally facilitates smooth muscle constriction
  – However, if blocked: results with relaxation of smooth muscle