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Pathophysiology > Week 10 > Flashcards

Week 10 Flashcards

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1
Q

Bronchodilators- β2-Agonists

A

These stimulate β2-adrenergic receptors, leading to relaxation of bronchial smooth muscles and airway dilation. Short-acting agents provide quick relief, while long-acting agents are used for maintenance therapy

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2
Q

Bronchodilators- Anticholinergics

A

These block muscarinic receptors, preventing bronchoconstriction. Agents such as ipratropium and tiotropium are commonly used in chronic obstructive pulmonary disease (COPD) management

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3
Q

Anti-Inflammatory Agents- Corticosteroids

A

Inhaled corticosteroids reduce airway inflammation and are essential in asthma management

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4
Q

Anti-Inflammatory Agents- Leukotriene Modifiers

A

These inhibit leukotrienes, which are inflammatory mediators, thus reducing bronchoconstriction and inflammation

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5
Q

Mucolytics and Expectorants

A

Agents like dornase alfa N-acetylcysteine and hypertonic saline facilitate mucus clearance from the airways

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6
Q

stimulation of sympathetic receptors relies on

A

circulating adrenaline and noradrenaline

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7
Q

are there sympathetic nerve fibres in the lungs

A

no

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8
Q

what are the CNS neurotransmitters

A

noradrenaline and adrenaline

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9
Q

PNS neurotransmitter

A

acetylcholine

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10
Q

Parasympathetic nerve supply to lungs comes via which CN

A

10th cranial nerve - the vagus nerve

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11
Q

Lung receptors are called

A

muscarinic receptors

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12
Q

agonist drugs

A

bind to a receptor and stimulate it to
produce the desired therapeutic effect// mimic
the natural neurotransmitter

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13
Q

antagonist drugs

A

bind to a receptor, but do not stimulate it to produce a response
It blocks the receptor and prevents it from binding to its normal neurotransmitter

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14
Q

“Relievers” for asthma inc

A

Short-acting beta-2 agonists
Short acting muscarinic antagonists
Oral and intravenous corticosteroids

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14
Q

Asthma management
“Relievers”

A

Bronchodilator medicines
* Resolution of bronchoconstriction

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15
Q

Short acting beta-2 agonists (SABAs) result in what

A

Results in smooth muscle relaxation and
bronchodilation

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16
Q

Common side effects of Short acting beta-2 agonists (SABAs)

A
  • Dose dependent
  • Tachycardia, tremor, palpitations, headache, agitation
  • Caution: Beta blocking medications (cardiac pharmacology) can cause bronchoconstriction and decrease efficacy of SABAs
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17
Q

Short acting muscarinic antagonists (SAMAs) MOA

A

Binds to muscarinic receptors blocking the action of acetylcholine-> Reduces bronchomotor tone,
which effectively leads to bronchodilation

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18
Q

Inhaled corticosteroids- Synthetic glucocorticoids
Mechanism of action

A
  • Multiple anti-inflammatory effects, inhibiting both inflammatory cells and release of inflammatory mediators
  • Anti-inflammatory actions help control symptoms and improve lung function
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19
Q

Inhaled corticosteroids (ICS)- Beclomethasone action

A

act topically at the site of deposition in the
bronchial tree after inhalation

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20
Q

Inhaled corticosteroids (ICS)- Budesonide action

A

reduces non-specific bronchial hyper-
responsiveness in asthmatic patients to both direct (histamine, methacholine) and indirect (exercise) provocative stimuli

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21
Q

Inhaled corticosteroids (ICS)- Ciclesonide action

A
  • reduces airway reactivity to adenosine
    monophosphate in hyperreactive patients
  • attenuates increase in inflammatory cells (total
    eosinophils) and inflammatory mediators
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22
Q

Inhaled corticosteroids (ICS)- Fluticasone propionate or furoate action

A

improves the symptomatic control, allows
reduction of other drugs, such as rescue
bronchodilators, and may limit risk of decline in
lung function

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23
Q

Inhaled corticosteroids local Common side effects

A
  • Hoarseness (dysphonia) and candidiasis from both MDI and DPI
  • Incidence: fluticasone propionate > ciclesonide
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24
Inhaled corticosteroids systemic side effects
* Pituitary adrenal suppression * Lower bone mineral density with long-term use of high doses ICS but effect on fracture risk in patients with asthma is unclear * Risk of developing cataracts in adults
24
Long acting beta-2 agonists salmeterol xinafoate & formoterol fumarate dihydrate mechanism of actiion
* Simulate beta-2 adrenoreceptors leading to bronchodilation * Long-term treatment of reversible airways obstruction in asthma
25
Long acting beta-2 agonists (LABAs) SE and more or less common than SABAs
* Tachycardia * Tremor * Palpitations * Agitation * Headache * Less common than with SABAs
26
Non corticosteroid preventers- Leukotriene receptor antagonis action
exercise induced. inhibits bronchoconstriction induced by inflammation and smooth muscle contraction caused by leukotrienes
27
Non corticosteroid preventers- Cromones action
Mast cell stabliser
28
Management for COPD stage 1: Pharmacological interventions & Non pharmacological interventions
pharmacological: SAMA or SABA to relieve symptoms non-pharmacological: Smoking cessation, vaccination, exercise, health optimisation
29
Management for COPD stage 2: Pharmacological interventions & Non pharmacological interventions
pharmacological: LABA and / or LAMA ± SAMA or SABA to relieve symptoms non pharmacological: Smoking cessation, pulmonary rehabilitation, action plan
30
Management for COPD stage 3: Pharmacological interventions & Non pharmacological interventions
pharmacological: LAMA + LABA/ICS non pharmacological: Smoking cessation, pulmonary rehabilitation, oxygen therapy, advanced care directive
31
why would someone use Long acting muscarinic antagonists
improves lung function Decreases dynamic hyperinflation, dyspnoea and exacerbations
32
What is mucus
is a highly oligomerised mucin polymer composed of water and various macromolecular glycoproteins as part of its gel structure
33
mucoactive agents- Expectorants
* induce discharge or expulsion of mucus from respiratory tract * Requires coughing action to bring up mucus from lungs or URT * Hydrate/increase airway surface liquid layer and decrease mucus adhesiveness
34
Mucoactive agents- Mucokinetic
increase mobility and transportability
35
Mucoactive agents- Mucolytic
reduce viscosity and disrupt structure of mucus gel reducing its viscosity and elasticity * Facilitates their clearance from the airway
36
Mucoregulator agents- Carbocisteine
positively influences metabolism of mucus producing cells; antioxidant properties
37
Mucoregulator agents- Anticholinergic agents
* Anticholinergic medication block the secretory reflexes, reduce glandular output and sputum volume
38
Aspergillosis is
caused by breathing in small particles, called spores, of aspergillus in the air
38
Mucoregulator agents-
* have antimicrobial, anti-inflammatory and immunomodulatory properties * efficiently delivered to sites of infection and achieve high tissue concentrations Considered standard care therapy for CF and non CF bronchiectasis
39
Central Chemoreceptors:
* located on ventral surface of medulla * sense PaCO2 with changes in pH
40
Peripheral Chemoreceptors:
* in carotid and aortic bodies * respond to PaO2 changes, and pH and PaCO2
41
what happens to RR and TV when paO2 increases
increases
42
normal pH of the body
7.35 - 7.45
43
acidemia is
pH below 7.35
44
alkalemia is
pH above 7.45
45
what are the 2 main modulator of the pH system
renal and pulmonary systems
46
how does the pulmonary system adjust pH
expiration of CO2
47
how does the renal system adjust pH
slower - affects pH by reabsorbing bicarbonate and excreting
48
Partial pressure of oxygen in arterial blood (PaO2)
80 to 100 mmHg
49
PaO2 of CO2
35 to 45 mmHg
50
what is partial pressure
number of molecules of a gas in a mixture -
51
Decrease in alveolar ventilation
* reduction in expiration = increase in PaCO2 (hypercapnia) and in [H+] * if pH < 7.35 = acidaemia * Respiratory acidosis
52
Increase in alveolar ventilation
* Increase in expiration = decrease in PaCO2 (hypocapnia) and in [H+] * if pH > 7.45 = alkalaemia * Respiratory alkalosis
53
Pathophysiology Respiratory acidosis
Inadequate alveolar ventilation eg * Lung or chest wall defects * Airway obstruction Overproduction of CO2 eg * Hypercatabolic states Increased intake * Rebreathing CO2 containing gases * Insufflation of CO2 into body
54
Pathophysiology Respiratory alkalosis
* increased expiration * pH increases as less carbonic acid created
55
what causes Respiratory alkalosis
* central – head injury, CVA * hyperventilation e.g., panic, pain, anxiety * medications
56
PaO2 equation
CO2 + H20 <-> H2C03 <-> HCO3 - + H+
57
Bicarbonate equation
CO2 + H20 ↔ H+ + HCO3- ↔ H2CO3
58
Pathophysiology Metabolic acidosis
Increases concentration of [H+] and reduces bicarbonate concentration * lactic acidosis, ketoacidosis * diarrhoea * reduced renal acid excretion
59
Pathophysiology Metabolic alkalosis
Produces elevation of serum bicarbonate * vomiting * hypovolemia * diuretic use * administration bicarbonate
60
Hypoxaemia
* deficiency of oxygen in arterial blood
61
Hypoxaemia PaO2
<60mmHg
62
Hypoxaemia SaO2
<90%
63
Hypoxia
reduced oxygen to the body or at specific tissues
64
normal Serum bicarbonate: HCO3-
22 to 26 mEq/L
65
* Base excess (BE):
-2 to +2
66
* Oxygen saturation:
SaO2 94-100%
67
Six easy steps to basic ABG analysis and interpretation
1.Is the pH normal? 2.Is the CO2 normal? 3.Is the HCO3 normal? 4.Match the CO2 or the HCO3 with the pH 5.Does the CO2 or the HCO3 go the opposite direction of the pH? 6.Are the pO2 and the O2 saturation normal?
68
Bicarbonate buffer system found in
red blood cells, kidneys, gut, and pancreas
69
Bicarbonate buffer system function
catalyzes the formation of carbonic acid from carbon dioxide and water, which then turns into bicarbonate and hydrogen ions.these then create carbon dioxide and water, allowing acids to be excreted through the lungs.
70
Phosphate buffer system
Important for regulating urine pH
71
Plasma proteins
Help with intracellular pH
72
Haemoglobin
Found in red blood cells, buffers hydrogen ions.
73
Which chemoreceptors are primarily responsible for sensing changes in PaCO₂?
Central chemoreceptors
74
Metabolic alkalosis can result from
Vomiting Use of diuretics Administration of bicarbonate
75
Which acid-base disorder is characterised by an elevation of serum bicarbonate?
Metabolic alkalosis
76
Which of the conditions is most associated with respiratory acidosis?
Opioid-induced respiratory depressio
77
Hypoxaemia is defined as
A deficiency of oxygen in arterial blood

Pathophysiology (14 decks)

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