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76 Cards in this Set

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GOAL OF MUCOKINENESIS?
DECREASE VISCOSITY WITHOUT DEREASEING ELASTICITY
SUBMUCOSAL GLANDS FOUND WHERE?
FOUND IN CARTILAGINOUS AIRWAYS DOWN TO TERMINAL BRONCHIOLES
SMOOTH MUSCLE RELATION DRUGS(3)
SYMPATHOMIMETIC
PARASYMPATHOLYTICS
XANTHINES
PHYSIOLOGY OF MUCUS PRODUCTION (4)
PSEUDOSTRATIFIED COLUMNAR EPITHELIAL CELLS, GOBLET CELLS, CLARA CELLS, SUBMUCOSAL GLANDS
GOBLET CELLS FOUND WHERE?
(CELLS INCREASE IN CHRONIC BRONCHITIS AND AMT OF SECRETIONS)
LOCATED IN CARTILGINOUS AW DOWN TO TERMINAL BRNCHIOLES,
GOBLETS CELLS PRODUCTIONS?
PRODUCTION OF MUCUS MASS THAT IS SECRETED INTO AIRWAY
MAJORITY OF MUCUS PRODUCTION IS FROM??
SUBMUCOSAL GLANDS
CLARA CELLS FOUND WHERE?
TERMINAL BRONICIOLES
WHAT DO CLARA CELLS TURN INTO WITH CRONIC IRRITATION (SMOKING)
GOBLET CELLS
INNERVATED BY PARASYMPATHETIC SYSTEM THEREFORE CHOLINERGICS WILL INCREASE OR DECREASE SUB MUCOSAL GLAND SECRETION????
INCREASE
WHAT IS MUCUS COMPOSED OF AND PERCENTAGES???
95% WATER
3% PROTEIN AND CARBOHYDRATE
1% LIPIDS
LESS THAN .03% DNA
METHODS OF MUCOKINESIS? (4)
HYDRATION
ALKYLATION THE TOPICAL PH
RUPTURE OF DISULFIDE BONDS
PROTEOLYSIS
WHAT IS THE GEL LAYER OF THE AW MADE OF??
GLYCOPROTEINS (PUDDING LIKE) YUM!!!
MOST EFFECTIVE WAY OF MUCOKINESIS?
HYDRATION (WATER IS BEST) WATER DOES NOT CROSS THE GEL LAYER
WHAT IS USED FOR THE ALKYLATION OF TOPICAL PH TO DECREASE THE VISOCSITY OF MUCUS
NaHCO3 (SODIUM BICARB) BAKING SODA
HOW DOES NaHCO3 WORK TO MAKE MUCUS LESS ADHESIVE?
IT WEAKENS THE BONDS OF THE POLYSACCHARIDE CHAIN
HOW DOES MUCOMYST WORK AS A MUCOKINETIC?
IT RUPTURES DISULFIDE BONDS REPLACES WITH OWN SULFHYDRIL GROUP
(DISULFIDE BONDS GIVE MUCUS MOLECULE STRENGTH)
MUCOMYST DOSAGE
10-20% STRENGTH SOLUTIONS
2-3 ML OF A 2O% TID OR QID
5-6ML OF 10% TID OR QID
*10% PERFERRED LESS SIDE EFFECTS
MUCOMYST HAZARDS 2
BRONCHOSPASM (GIVE W/ BRONCHODIALATOR,INCOMPATIBLE WHEN GIVEN WITH CERTAIN ANTIBOTICS AND PROTEOLYTIC ENZYMES--THEY INHIBIT THEIR ACTION
THINGS TO KNOW ABOUT MUCO MYST (4)
REFRIGERATE AFTER OPENING
DISCARD AFTER 96 HRS
LABEL TIME AND DATE WHEN OPENED
WHEN NEBULIZING RX RECONCENTRATION MAY OCCUR SO DILUTE WHEN MED IS ABOUT 75% NEBULIZED
GENERIC

Acetylcystein
TRADENAME

Mucomyst
how does rhDNase or Pulmozyme work?

maintence drug
it is a clone of human enzyme. It is a proeolytic enzyme that helps clean up neutrophis prevelt in cystic fibrosis pts.
generic

dornase alfa
trade name

Pulmozyme
Plumozyme dosage???

MUCOKINETIC
2.5mg in a 2.5 ml solution
once a day
Plumozyme precaution (2)
refrigerate after opening and keep in low light
WHAT CAN BE USED FOR AN ACETOMINAPHEN OVER DOSE??
MUCOMYST
Amiloride
diuretic and sodium channel blocker
how much mucus is produced in a day
100 ml/day most reabsorbed about 10 ml reaches the pharynx each day
what type of solutions will stimulate mucus production
hypertonic and hypotonic solutions
Surface Tension

fyi measured in dynes
a force at the liquid gas interface which tends to hold liquid surfaces intact
surfactant
surface agent that lowers surface tension
as surface tension decreases distending pressure increases or decreases??
decreases
pulmonary edema
when fluid crosses from the pulmonary vasculature into the extravascular space and into the alveous. It is then churned into a froth.
where is sufactant produced??
type II alveolar cells
what happens during infant respiratory distress syndrome
an immature lung does not produce surfactant
how is surfactant administered
for infant respiratory distress syndrome
thru and ET tube at birth with the first breaths of within 12 hrs followed by ventilation and turning the baby to increase distribution
3 ways surfactant can be obtained?
human lung
bovine
and synthetic
artifical surfactant is called???
Trade Exosurf Generic colfosceril palmitate
what is bovine surfactant called?
Trade Survanta
Generic Beractant
hazards of surfactant therapy
lrg volumes of surfactant can lead to aw obstruction,desaturation and bradycardia
improvement in compliance can lead to overventilation, excessive volume deliver and over oxygenation
3 ypes of hormones produced by the adrenal cortex
glucocorticoids,mineral corticoids and sex hormones
what do glucocorticoids,mineral corticoids and sex hormones regulate?
glucocorticoids regulates metabolic function and rate
mineral corticoids body water and electrolytes and sex hormones androgena and estrogens
what system do corticosteroids act within ?
endocrine system
what regulates steroid production in the body??
hypothalmic pituitary axis
3 side effects of gluco and mineralcorticoids
muscle wasting, steroid diabetes and adrenal suppression
why is alternate day administration of steroids good?
mimics night and day body rhythmic and allows body to produce cortisone on the off days
why do steroids work
constricts microvasculature decreasing leakage,
inhibits late response,
increases beta receptor density on the cell wall,
inhibits uptake 2 mechanism, increasing circulating endogenous catecholamines,
may activate adenyl cyclase, inhibit phospholipase and block arachidonic acids,
decrease leukocytes,
decrease neutrophis demargination accumulation on capillary walls thus increase number of circulating neutophils
why are steroids given after transplants
used as immunosuppressants to decrease chance of rejection also depress lymphocytes increasing the risk of develping infection
release of chemical mediators from mast cell cause
smooth muscle spasm, mucus secretion,mucosal swelling from increased vasular permabliity (leaky cells),increase eos & neutophils that shed in AW's leaving cellular debris,goblet cell hyperplasia resulting in mucus plugging and late phase response
what immunoglobin causes asthma and allergic reaction
IgE
list of mediators of inflammation (8)
histamine
heparin
ECF-A,NCF-A
bradykinin
lympokines
arachidoic acid metabolites
lipoxygenase pathway
cyclooxygenase
Effects of systemically administered steroids (10)
cushingoid appearance
obesity
growth suppression
hyperglycemia or diabetes
mood changes-irritablity or depression
thinning skin
muscle wasting
osteoporosis
hypertension
immunosuppression
advantages of aerosol steroids
minimize adrenal supression, localizes the site of treatment, less dosage required
2 types of asthma
extrinsic:allergic
intrinsic:non allergic
causes of extrinsic asthma
A FOREIGN SUBSTANCE WHICH PROVOKES AN AB REACTION
causes of INTRINSIC asthmA
COLD ARI,STRESS OR EXCERCISE
WHERE ARE MAST CELLS FOUND
IN ORGAN RICH CONNECTIVE TISSUE PRIMARILY IN THE SKIN, INTEAL TRACT AND RESP. TRAC SUBMUCOSA
WHAT CAN HAPPEN WHEN A MAST CELL DEGRANULATES
INCREASE CAPILLARY PERMEABILITY, SMOOTH MUSCLE CONTRACTION, INCREASED SECRETIONS, VASODIALATION AND EDEMA,IN NOSE:RHINITIS AND SINUSITIS, IN SKIN:URTICARIA WITH ITCHING AND ANGIOEDEMA,IN INTESTINES UPSET TUMMY FROM FOOD ALLERGIES
WHAT DO THE FOLLOWING IMMUNOGLOBULINS DO??
IgG
G:protects against dieseases encountered when growning up,
WHAT DO THE FOLLOWING IMMUNOGLOBULINS DO??

IgA,
A:protects mucus membranes from infection
WHAT DO THE FOLLOWING IMMUNOGLOBULINS DO??

IgM
M:protects against early infection
WHAT DO THE FOLLOWING IMMUNOGLOBULINS DO??
IgE,
causes asthma and allergic reaction
WHAT DO THE FOLLOWING IMMUNOGLOBULINS DO??
IgD
fetal antigen receptor
what does cromolyn sodium do??

prophylactic treatment
it's a mast cell inhibitor, mast cell woin't spill out
what does cromolyn sodium NOT do??
act on mediators themselves,operates thru cyclic amp sys,effect alpha or beta receptors, prevent IGE to mast cell
Generic:
Cromolyn sodium

Mast Cell Inhibitor
Trade:

Aarone, Intal, CrnA
Generic:
Nedocromil Sulfate

Mast Cell Inhibitor
Trade:
Tilade
Cromolyn sodium & Tilade dosage

Mast Cell Inhibitor
2 puffs of MDI QID
Generic
Hydrocortisone
Trade
solucortef

STEROID
Generic

methylprednisolone
Trade

solumedrol
STEROID
Generic

dexamethasone
Trade

decadrone
STEROID
Generic

Beclomethosone
Trade

Beclovent and Vanceril
STEROID
Generic

Flunisolide
Trade

Aerobid
STEROID
Generic
TRIAMCINOLONE
Trade
AZMACORT

STEROID
Generic

FLUTICASONE
Trade

FLOVENT

STEROID
HAZARDS OF CROMOLYN SODIUM
COUGH AND BRONCHOCONSTRICTION,NASAL CONGESTION, RASH