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68wm6 p2 COPD

Chronic Obstructive Pulmonary Disease

At what age do symptoms of COPD generally appear Symptoms begin in the 40's
At what age do the symptoms of COPD progress into disability? 50's and 60's
What is COPD characterized by? Changes in the alveolar walls and capillaries and lung elastin degradation
What is Cor Pulmonale? Failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the
What can lead to Cor Pulmonale? Most chronic lung diseases or condition causing prolonged low blood oxygen levels can lead to cor pulmonale
What is the primary cause of emphysema? Smoking
What are some visible manifistations of emphysema? *Use of accessory muscles *Spontaneous pursed-lip breathing *Development of barrel-chest
What are three diagnostic tests which can be done to confirm emphysema? *Pulmonary function test (PFT) *Arterial blood gas *Alpha –antitrypsin assay
What is the most common cause of chronic bronchitis? Smoking
What characterizes chronic bronchitis? Recurrent chronic productive cough for a minimum of three months for at least two years
What can chronic infection from bronchitis lead to? Scarring, which in turn leads to obstruction
True or False: Chronic Brochitis leads to hypersecretion of mucous. True
What are PTs with chronic bronchitis at an increased risk for? Infection, Hypoxia, polycythemia and hypercapnia
For PTs with chronic bronchitis, when is the cough most productive? In the morning
True or False: PTs with chronic brochitis are at higher risk of heart failure True. More specifically, right ventricle failure.
What are the medication types bronchitis is treated with? *Bronchodilators (Greater air intake) *Mucolytics (mucous reduction) *Antibiotics (reduce risk of infection)
What are the causes of extrinsic asthma? external factors and occurs in response to allergens such as pollens, dust spores, feathers, or animal dander, food etc
What are the causes of intrinsic asthma? From internal causes. Not fully understood but often triggered by upper respiratory infection and emotional upsets
What are asthma attacks caused by? Release of histamines
What does asthma result from? An altered immune response
How much has the death rate for asthma increased over the past 10 years? Increased by 50%
Which form of asthma is fatal if not reversed? Status asthmaticus
What is a gradual irreversible process of chronic dilation of the bronchi that eventually destroys the elastic and muscular properties of the lung? Bronchiectasis
What does Bronchiectasis follow? Repeated lung infections
What are some manefistations of Bronchiectasis? *Crackles and wheezing *Prolonged expiratory phase *Hemoptysis *Foul-smelling sputum *Dyspnea, cyanosis and clubbing of fingers
What is asthma? edema of respiratory mucosa and excessive mucous production obstruct airways
What is the action of antiasthmatic drugs? Increases levels of cAMP producing bronchodilation
What is the action of anticholenergic drugs in regards to antiasthmatics? Produces bronchodilation by decreasing intracellular levels of cyclic guanosine monophosphate (cGMP)
What is purpose of corticosteroids in regards to treatment of asthma? Decreases airway inflammation.
What is the action of Leukotriene Receptor Antagonists in regards to antiasthmatics? Decreases the release of substances that can contribute to bronchospasms
What is the action of Mast Cell Stabilizers in regards to antiasthmatics? Decreases the release of substances that can contribute to bronchospasms
What are Mast cells? Cells in the lungs that react to allergens and release histamines and slow-reacting substance of anaphylaxis (SRS-A)
What are the contraindications of antiasthmatics? *Inhaled corticosteroids. *Long-acting adrenergic agents. *Mast cell stabilizers should not be used during acute attacks of asthma
Diabetic PTs may experience loss of glycemic control during what antiasthmatic therapy? Corticosteroid
True or False: Diabetics who lose glycemic control during corticosteroid therapy should immediately discontinue use False. Corticosteroids should never be abruptly discontinued
What drug increases theophylline levels and the risk of toxicity? Cimetidine
Corticosteroids interact negatively with what drugs? *May decrease the effectiveness of antidiabetic agents. *May cause hypokalemia with potassium losing diuretics *May increase risk of digoxin toxicity
True or False: Bronchdilators can have adverse effects on the CV system True. Assess CV status of patients taking bronchodilators or anticholinergics and monitor EKG changes and chest pain.
How should a PT be instructed to use a corticosteroid and bronchodilator inhalers if the PT is prescribed both? Administer the bronchodilator first, then wait five minutes before taking the corticosteroid/sympathomimetic
When using an aerosol inhaler, how long between inhalations must you wait if more than one inhalation is prescribed? At least 1 minute
When using isoproterenol and epinephrine inhalers, how long must you wait in between inhalations? 3-5 minutes
When using metaproterenol inhalers, how long must you wait in between inhalations? at least 10 minutes between inhalations
What can a PT use to monitor the effectiveness of the antiasthmatic drug regimen? Peak flow meters
What is the action of Leukotriene Antagonists? Antagonizes the effects of leukotrienes, which are components of slow-reacting substance of anaphylaxis (SRS-A)
What is the purpose of Leukotriene Antagonists? Decrease inflammatory process that is part of asthma, and decrease frequency and severity of asthma.
True or False: Leukotriene Antagonists are an effective treatment for acute asthma attacks False. It is for prevention and reduction of symptoms, not for acute attacks.
What are noteable adverse effects of Leukotriene Antagonists? *abdominal pain *drug-induced hepatitis (females) *CHURG-STRAUSS SYNDROME *arthralgia *myalgia
What decreases absorption of Leukotriene Antagonists? food (especially high-fat or high-protein meal) decreases absorption
What increases blood levels of Leukotriene Antagonists? Aspirin
What decreases blood levels of Leukotriene Antagonists? Erythromycin and theophylline
Leukotriene Antagonists increase effects and risks of of bleeding with what drug? Warfarin (coumadin)
What needs to be assessed before and periodically throughout Leukotriene antagonist therapy? Assess lung sounds, respiratory function and allergy symptoms
How should PO Leukotriene Antagonists be administered? At regular intervals on an empty stomach, 1 hr before or 2 hr after meals
After opening packet of Leukotriene Antagonists, administer full dose within how long after opening? 15 minutes
The action of zafirlukast, a leukotriene receptor antagonist, is to; Leukotrienes block leukotriene formation. Leukotrienes are part of the inflammatory pathway that cause bronchoconstriction.
What is a bronchodilator? A bronchodilator is a drug used to relieve bronchospasms associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema
What can antagonize the therapeutic effects of bronchodilators? Concurrent use of beta-blockers
What foods should you avoid while on bronchodilators? Poods that contain xanthine (colas, coffee, chocolate).
How do xanthines affect cAMP? Xanthines inhibit the breakdown of cAMP
What are used for quick relief of asthma symptoms? Adrenergic bronchodilators
What is the action of adrenergic bronchodilators? Binds to beta 2-adrenergic receptors in airway smooth muscle, increasing cAMP activates kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium, decreased intracellular calcium relaxes smooth muscle airways.
Adrenergic bronchodilators are selective for which receptors? beta2 (pulmonary) receptors.
Adrenergic bronchodilators when used with what may lead to a hypertensive crisis? MAO inhibitors
What can negate the effects of Adrenergic bronchodilators? (Remember the action) Beta-blockers
What should be done when a PT using an adrenergic bronchodilator suffers a paradoxical bronchospasm? Withhold medication and notify physician or other health care professional immediately
How do you 'prime' an adrenergic bronchodilator? Prime the inhaler before first use by releasing 4 test sprays into the air away from the face
Adrenergic bronchodilators for nebulizer, compressed air or oxygen flow should be what? 6-10L/min
A single treatment of 3ml of adrenergic bronchodilators via nebulizer should last how long? 10 minutes
After how many sprays should a canister of adrenergic bronchodilator be discarded? 200 sprays
What is the use of Zanthines? Long-term control of reversible airway obstruction caused by asthma or COPD
What do zanthine inhalers do? Increase diaphragmatic contractility and bronchodilation
What are the contraindications of zanthine inhalers? Hypersensitivity to aminophylline or theophylline
What are the noteable contraindications of zanthine inhalers *SEIZURES *ARRHYTHMIAS *Angina *Palpitations *Rash
When should Zanthine peak levels be evaluated? *30 min after a 30 min IV loading dose *12-24 hr after initiation of a continuous infusion *1-2 hr after rapid-acting oral forms *4-12 hr after extended-release oral forms
What are the therapeutic serum levels of Zanthines? *10-15 mcg/ml for asthma *6-14 mcg/ml for apnea of prematurity
What drug levels of zanthine are associated with toxicity? 20+ mcg/ml
What may falsely elevate drug concentration levels of zanthine? Caffeine
What are the first signs of zanthine toxicity? Tachycardia, ventricular arrhythmias, or seizures
Theophylline (zanthine) doses should not exceed what? 400mg/day
Why should zanthines NOT be refrigerated? Crystals may form
If crystals form in refrigerated zanthine, how can they be disolved? Sit in room temperature.
How long after zanthine IV therapy should you wait before beginning immediate release PO dose? 4-6 hours
How long after zanthine IV therapy should you wait before beginning extended release PO dose? immediately after DC
How often should the PT have zanthine serum levels tested? q 6-12 months
Created by: Shanejqb
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