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