Treatment of Respiratory Disease Flashcards
1
Q
what is the airway system?
A
- starts at nose and mouth
- trachea divides into two main bronchi then into smaller and smaller branches
- as airways get smaller the smooth muscle is responsible for the calibre of the airway
- calibre of the airway is reposnibile for the ease that the air will flow through it
- smooth muscle important structural and functional component and is responsible for respiratory disease such as Broncho spasm
2
Q
what are cilia?
A
- found on respiratory tract
- move mucus
- failure to produce fluid that cilia move in causes cystic fibrosis therapy found
- genetic defects that cause them to be misshapen causes primary ciliary dyskinesia not yet been effectively treated
3
Q
what is the importance of muscle control?
A
- smooth muscle control is important the way in which it is controlled is a series of the nervous system
- two most important parasympathetic/vagal and androgenic/sympathetic
4
Q
how does the parasympathetic control muscles?
A
- parasympathetic system is direct acting
- activation of the parasympathetic nervous system will cause the smooth muscle to contract causing broncho-constriction.
- you want to block this system
5
Q
how does the sympathetic control muscles?
A
- the sympathetic one causes the smooth muscle to relax
- We want to stimulate or mimic the positive effect. i.e. we want the agonist, not the antagonist.
- we want beta 2 agonist to relax smooth muscle, and we want to block the cholinergic/parasympathetic system i.e. we want anti-cholinergic/anti-muscularinic drugs
6
Q
how does the non-adrenergenic/ non-cholinergenic nerves control muscles?
A
- non-adrenergic/ non-cholinergic nerves act on smooth muscle and you’ve got various effector substances like nitric oxide and other proteins!https://s3-us-west-2.amazonaws.com/secure.notion-static.com/3b1251ec-fb2f-451a-a57f-6dca2691c504/Untitled.png
- parasympathetic nervous system also controls airway secretions so stimulating it would cause broncho-constriction and increased secretion which is the opposite of what we want in asthma treatment
7
Q
what is FEV?
A
FEV is Forced expiratory volume = volume expired after one second
8
Q
what is FVC?
A
FVC is force vital capacity = the total volume expired
9
Q
what happens during bronchoconstriction?
A
reduces FEV but FVC stays the same
10
Q
what is the basic inflammatory pathway?
A
- Allergen or foreign substance picked up by antigen-presenting cell presented to a T-hyper lymphocyte and this can either go th1 or th2
- should go down th1 but if u have asthma (or if you are prone to developing allergic diseases) then it goes down an exaggerated pathway called th2
- th2 which is a pathway related to allergy usually for fighting worms and pathways in the west predominantly for allergy
- lymphocyte changes to b cell which proliferates and then releases antibodies IgE this type is involved in allergy and asthma they are connected can feedback to each other can cascade and escalate a response.
- the other type mast and eosinophils are two types of allergic white blood cells
- Glucocorticoids are corticosteroids
11
Q
why don’t steroids work instantly?
A
- hey take hours as they produce proteins that don’t directly act on smooth muscle
- they are not acting on smooth muscle to relax it, they are acting to produce those proteins which interact with interleukins
12
Q
how do steroids work?
A
- Corticosteroid binding globulin = CBG
- steroid goes in to the cell, to it’s intracellular receptor
- steroid binds to intracellular receptor
- As it binds it produces zinc protrusions (feet)
- steroid enters the nucleus and interacts with DNA
- causes transcription of RNA then produced mediator proteins
13
Q
how do we use corticosteroids for COPD and asthma?
A
for asthma and COPD we use inhaled corticosteroids .They are destroyed by first pass metabolism when they are absorbed they are destroyed by the liver in both conditions also use intravenous steroids
14
Q
what is asthma and its symptoms?
A
- recurrent reversible airflow obstruction
- Obstruction, remember, is narrowing off the airways beyond their normal calibre, causing increased resistance and therefore increased work of breathing
-wheezing, cough and breathlessness
15
Q
what happens in the lungs during asthma?
A
- Hyperinflation.- air becomes trapped in smaller airways and cant is expelled lungs get bigger
- inflammatory changes in airways causing swelling of tissue themselves.
- bronchospasm = narrowed airways, breathlessness, and the wheezing noise associated with it
- bronchial hyper-reactivity = increased chance of having the tendency to respond by bronchospasm to inhale challenges far more than you normally would
