week 6 Flashcards
(48 cards)
Acute Respiratory Distress Syndrome (ARDS)
(progression of acute injury and damage from activated neutrophils). Acute injury recruits neutrophils (il-8 TNF). Activated neutrophils cause damage,
Emphysema
(destruction of alveolar walls and permanent enlargement of airspaces): smoking, alpha-1 antitrypsin deficiency (imbalance of proteases and anti-proteases), air pollution- you damage the airways and it leads to secondary damage (imbalance of trypsin and antitrypsin (trypsin destroys foreign material. Antitrypsin turns it off). Neutrophils and macrophages release elastases and oxygen free radicals. Smoking worsens by inhibiting alpha-1-antitrypsin.
-barrel chest with hyperinflation
Centrolobular (smoking related): more towards the lobes. Panacinar (alpha-1-deficient more towards alveoli)
Bronchiectasis
(results from obstruction of bronchi and persistent necrotizing infections): destruction of elastin and muscles in bronchial walls-congenital expression often caused by cystic fibrosis. Features: persistent foul smelling cough, hemoptysis (old blood form tissue damage), hypoxemia. Destruction of the walls
asthma
(reactive airway disease and narrowing of airways-hyper-reactivity): eosinophil pathway. Pathology: Hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy
• Types:
Atopic- childhood onset often with allergic rhinitis
Non-atopic- non-immune, occupational exposures
Summary types of lung disease
- Restrictive: caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs
- Vascular: gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious (comes on slowly)
- Obstruction: blocked airways; gas exchange through septal walls not impaired; unable to exhale
Relievers
• Short-acting- rapid bronchodilators
• Less severe cases
• Typically beta2 agonist at minimum dose and frequency (intermittent)
-e.g., albuterol (rapid onset and 4-6 hr effect); salmeterol (slower onset, 12 hr effectiveness)
• Mechanism of action: directly relax airway smooth muscle. Side effects rare if used correctly
Controllers
• Take regularly for long-term stable control-often more side effects
• Inhaled: corticosteroids/drug of choice for moderate to severe asthma
-often combine with beta 2 agonists
-chronic management, not for rescue
-e.g., fluticasone
• Side effects: nose bleeds, sores in nose, mouth, tongue that don’t heal, oropharyngeal candidiasis (thrush), interfere with growth in children
Add-on controllers
• Methylxanthine drugs; theophylline (tablet or inhaler)
(1) Mechanism: phosphodiesterase inhibitor and increases cAMP and relaxes airway smooth muscle (by inhibiting Myosin light chain kinase)
(2) Monotherapy for mild asthma
(3) Combine with corticosteroids to reduce steroid doses and side effects (severe asthma)
(4) Also helps relax diaphragmatic fatigue in COPD
(5) Toxicity: nausea, headache and anxiety
Antimuscarinics
- E.g., ipratropium –reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists (asthma not COPD)
- E.g., ipratropium (related to tiotropium-Spriva-which is not approved for asthma, but is approved to treat COPD) –reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists-sometimes combine antimuscrinics with 2 agonists (eg, albuterol)
- Side effect of dry mouth
- Used as an inhalant for bronchospasms
Leukotriene modifiers
- E.g, montelukast (Singulair)
- Use is for prophylaxis (chronic)-for patients who have trouble with inhaled therapies (e.g., nasal bleeding)-can take orally)
- Mechanism: block leukotriene-binding to receptor- anti-inflammatory. Esp effective for aspirin induced asthma.
f. Cromolyn
-inhibits release of inflammatory mediators such as histamine from mast cells. Prophylactic use before exercise, mow a lawn ect.
Omalizumab
inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma
COPD
- Causes:
• Long smoking hx, or exposure to environmental irritants
• Airflow limitations-due to progressive, irreversible airway remodeling
• Not fully reversible in contrast to asthma which can be at least partially reversible - Treatment:
• Longer acting bronchodilators such as tiotropium bromide (Spireva)
• Longer acting beta 2 agonists such as salmeterol
• Theophylline with glucocorticoids (glucocorticoids alone not very effective)
• Typical response is not as good as asthma
bupropion
antideppressant, used to treat smoking
F. Renal cell carcinomas
- Properties
• 80-90% of renal malignancies—most frequent
• More common in males >40 yrs, and smokers
• Analgesic users (NSAIDS)
• Obesity - Symptoms
• Often asymptomatic (and not discovered until large)
• Hematuria
• Dull flank pain
• Fever
• Fatigue - Most likely metastasizes to lungs or bone, sometimes to regional lymph nodes
- Types:
• Clear cell- abundant glycogen or lipid
• papillary
wilms tumor
nephroblastoma. most common in first 3 years, most common congenital tumor
shistomsomoaisis
bladder infection from snails
prostate malignancy
adenocarcinoma, can metastasize to bone and lymph node
b. PSA (prostate specific antigen)-only associated with prostate tissue
• >4-6 mg/ml is abnormal (usually higher with age)
• Rapidly increasing PSA means high risk for cancer
• The more PSA bound to alpha-1-antichymotrypsin, the greater the risk of cancer
c. Treatment
• Prostatectomy (affects bladder function)
• Radiation
• Hormonal: block androgen receptors-affects male functions
• Chemotherapy or bisphosphonate
Tamusolin
relaxes ureter muscle (often have spasm due to irritation of the stone), lets stone pass
Calcium/oxylate stone
80% , bicarb it
Struvite
10%. only one that is more common in females and only one you acidisize urine
uric acid/ cysteine
other 10%
gout and cysteing
\Hydrochlorothiazide
stone. thiazide diuretic—reduces calcium in urine
Sodium bicarbonate
atone- all but struvite
