pulmonary alterations (copy)

alveolar ventialtion

alveolar ventialtion

movement of air into lungs and removal of co2

perfusion

distribution of blood flow

collapse of alveoli

atelectasis; lack of surfactant

compliance equation

change of volume over change in pressure

FEV1

forced expiratory volume in 1 second

FEV1/FVC low

obstructive disease (can’t relax)

FEV1/FVC ~normal

restrictive disease (can’t expand)

hypoventilation (bradypnea) leads to

hypercapnea (high co2)—acidosis

hyperventilation (tachypnea) leads to

hypocapnea (low co2)—alkalosis

clubbing cause

chronic lung disease; emphysema, chronic bronchitis

hypoxemia

reduced oxygenation of arterial blood caused by respiratory alterations

hypoxia

reduced oxygenation at the tissue cellular level (could be perfusion, not always lung problem)

low V/Q

(ventilation/perfusion)

impaired ventilation

very low V/Q (shunt)

blocked ventilation

high V/Q

no bloodflow (alveoli dead space—0 perfusion)

obstructive breath sounds

dyspnea and wheezing

common obstructive disorders

asthma

COPD

emphysema

chronic bronchitis

in asthma, alpha 1 receptors cause

bronchioles to constrict

histamine causes

edema of bronchiolar wall

beta-2 receptor causes

bronchioles to relax

beta-2 agonists

fast-acting inhaler medicine for asthmatics

oral or inhaled

relief in bronchiospasm of bronchi and bronchioles and prevents excercise induced bronchiospasm

aka albuterol

long acting agonists treat COPD

ADVERSE

• mimic SNS so tachycardia, palpitations, tremors, angina

INTERACTIONS

• beta blockers reduce effectiveness

• MAOIs and triclyic antideoresseants/ antidiabetic drugs require inc. doage bc beta agonists cause hyperglycemia

3 asthma attack steps

sm. muscle constriction

edema of walls by histamine

inc. mucuous secretion

diagnosis when

FEV1 inc by >12% or >200ml after administration of a short acting beta agonist (SABA)

intermittent asthma

symptoms <2x a week, SABA only

mild persistent asthma

symptoms >2x a week but not everyday, ICS (low dose inhaled corticosteroid)

moderate persistent asthma

symptoms daily, ICS + LABA

peak flow meter

cues for resp. problems are subjective

peak flow meter provides objective diagnostic finding of how bad the asthmatic’s breathing is

peak flow meter green zone

80~100% of normal peak flow

peak flow meter yellow zone

50~80% of normal peak flow

peak flow meter red zone

less than 50% of normal peak flow

medical alert

four types of inhalation drug therapy

• metered-dose inhalers (MDI)

• respimats

• dry-powder inhalers (DPI)

• nebulizers

2 types of asthmatic drugs

anti-inflammatory agents

bronchodilators

anti-inflammatory agents drugs

glucocorticoids (prednisone)—long term

• significant ability to suppress immune system and decrease inflammation so good for long term chronic asthma

• dec. leukotrines, prostaglandins, histamine which mediate inflammation

  • dec. edema of airways

bronchodilators

beta-2 agonists (albuterol)—acute

inhaled vs oral/IV glucocorticoid

inhaled glucocorticoids ( beclomethasone/ QVAR) are very effective and much safer

• use spacer

nasal = fluticasone

oral glucocorticoids (flovent) for short term management of post exacerbation symptoms

long term IV/oral glucocorticoids adverse effects

hyperglycemia - monitor diabetes (cataract, glaucoma)

adrenal suppression

don’t give if has sytemeic fungal infection

don’t give if on non-sparing diuertics bc will give hypokalemia

osteoporosis

peptic ulcer (C/I)

• alter blood sugar regulation and sodium retention is SE of glucosteriods, preexisting conditions worsen during admin

adrenal suppression

prolonged glucocorticoid use can dec. ability of adrenal cortex to produce glucocorticoids of its own

reccomed lowest amount possible

alternate day dosing - helps minimize bone mineralization muscle wasting and risk for GI bleeding

oral/IV use of glucocorticoids when

moderate to severe asthmatics

acute exacerbations of asthma or COPD

discontinuing glucocorticoids must be done

slowly

times of stress during discontinuing glucocorticoids

give oral/IV glucocorticoids

leukotriene receptor antagonists drugs (anti-inflamm)

zileuton [zyflo] - direct leukotrine inhibitor

zafirlukast [accolate]

montelukast [singulair]

• above two: prevent activation of leukotrines

normally prescribed in adjunctive therapy to dec. bronchospasm and inflammation

zylo & accolate = liver damage

leukotriene adverse effects

depression, suicidal thinking, suicidal behavior

montelukast use

• prophylaxis and treatment of asthma

• prevention of EIB

• relief of allergic rhinitis

cromolyn (mast cell stabilizer)

not for acute, for prophylaxis

anti-inflamm. prevent leuko and histo release; keep WBC from stimulating inflamm response

reduce long-term allergy-related asthma, bronchospasm, mild-moderate asthma

give w nebulizer

use

• chronic asthma

• EIB

• allergic rhinitis

bronchodilators

provide symptomatic relief but does not alter underlying disease process

patients taking bronchodilators will take glucocorticoids as well

beta-2 adrenergic agonists

bronchodilators drugs

albuterol, levalbuterol

LABA drugs

samleterol, formoterol, aformoterol (inhaled)

albuterol, terbutaline (oral)

inhaled bronchodilators adverse effects

tachycardia, angina, tremor

oral bronchodilators adverse effects

angina pectoris, tachydysrhythmias, tremor

LABAS contraindications

using alone in asthma (always use with glucocorticoids)

anticholinergic drugs

ipratropium (atrovent)

inhaler or nebulizer, wait 5 min after other drugs

relieves bronchospasm and reduces secretions in clients who have COPD

inhibit acetylcholine (actyl causes vasoconstriction of bronchi)

ADR

• local - dry mouth and pharyngeal irritation, inc. ocular pressure if have glaucoma (give them water and candy to ease) (C/I w glaucoma)

• headache, dizziness, blurred vision, epistaxis

enhance beta2 agonist effect

SABA can cause

inc. heart rate and nervousness

ICS is for

maintenance, not for acute

status asthmaticus

interventions do not help airway

rinse mouth after

steroid (glucocorticoid)