Chapter 8. Respiratory System

Question 1

The volume inspired or expired with each normal breathing and what measuring device?

Answer 1

Lung volume/ Tidal volume.

Spirometer

Question 2

• The volume that remains in the lung after a maximal expiration, cannot measured by spirometer.
• vol. of air expired in 1s after max inspiration. Measured by spirometer.

Answer 2

• Residual volume

- Forced expiratory volume (FEV1)

Question 3

Lung capacities:

The sum of all four lung volumes. The volume in the lungs after maximal inspiration.

Answer 3

Total lung capacity: (tidal volume, inspiratory lung volume, expiratory lung volume, residual volume)

Question 4

• Measure vol. that has been exhaled at the end of the first second (FEV1). Diagnosis of obstructive lung diseases such as asthma and COPD.
• test to determine asthma severity for patient at home. This test measures the highest forced expiratory flow.

Answer 4

• Spirometer

- Peak flow meter

Question 5

Sites and cause for asthma and COPD

Answer 5

A: -Bronchus or bronchial tube
-Inflammation in bronchus
C: Alveoli (enlarged, over-stretched, loss of long elasticity) Air trapped in lung.
-Permanent (irreversible) enlargement alveoli (emphysema) and /or Chronic bronchitis

Question 6

Symptoms and tx for asthma

Answer 6

• Wheezing(main), cough, sputum, and SOB, cheat tightness, tachy♥️, tachypnea and pulses paradoxus
• Bronchodilators, Steroids (ICS, PO, IV), Eosinophilic, Obstruction of airflow is reversible

Question 7

Immunization and prevention for asthma and COPD

Answer 7

A: -Flu vaccine annually Pneumococcal vaccine
-Avoid triggers (allergens, exercise, emotional stress, cold air, (NO trigger is warm air)
C: -Flu vaccine annually and Pneumococcal vaccine Q5- 10y in high risk.
-Causes of COPD, smoking, alpha1-antitripsine deficiency, air pollution, secondary smoke.

Question 8

Symptoms and tx for COPD,

-DOC, cholinergic antagonist by blocking the brochoconstriction caused by activation of the PSNS

Answer 8

-Shortness of breath (SOB) (dyspnea), fatigue, cough, sputum
-Bronchodilators (SABD, LABD)
acute COPD oral steroids (not used? inhaled corticosteroids) Antibiotics (pneumonia) Neutrophil due to bacterial infections. Obstruction of airflow is irreversible
-Ipratropium DOC

Question 9

Physiology of Lower Respiratory Tract: -Ventilation:

-What and where is the gaseous exchange?

Answer 9

• Ventilation: Air moves from Atmosphere ➡️URT➡️LRT➡️alveoli

- Respiration: alveoli capillary membrane

Question 10

Factors that decrease the respiration

Answer 10

• Increased in resistance to air flow
• Decrease ventilation
• Decrease diffusion
• Mucosal edema
• Increased bronchial secretion
• Bronchospasm

Question 11

• Arrangement of Bronchiole smooth muscles

- Diseases

Answer 11

• Tracheobronchial tubes have smooth muscle fibers arranged on a spiral around the tube
-Asthma, COPD is Emphysema and Bronchitis

Question 12

Anatomy of Upper respiratory tract. Give Disorders:
Sinus (prenasal cavity in & around the nasal cavity)
Nasal cavity
Pharynx
Larynx
Trachea (past outside thoracic cavity)

Answer 12

Acute rhinitis
Acute pharyngitis
Acute tonsillitis
Acute laryngitis
Common cold (most prevalent of URI, and NOT life threatening but causes severe discomfort).

Question 13

Tx for Upper respiratory tract

Answer 13

Antihistamine ➡️ Runny nose Decongestants (Sympathomimetics) ➡️ nasal congestion Antitussive ➡️ Cough
Antibiotics ➡️ Infections
Expectorants ➡️ Bring up mucus

Question 14

Advantages of nasal route over oral route absorption of drugs
may include:

Answer 14

Nasal route has more blood vessels, higher onset of absorption.
Although smaller surface area than intestine, this has faster onset of action due to large quantity of blood vessels in the nasal route.

Question 15

Which reaction can ozone cause in the lungs?

Answer 15

Ozone is a gas that may cause irritation and toxicity of pulmonary system. The main reaction of ozone in the body is oxidation.

Question 16

Inflammation of the tongue, presence of pinkish-red central lesions on the dorsal surface of the tongue III- It can be a chronic condition of the tongue seen in?

Answer 16

Glossitis— pernicious anemia

Question 17

This is an anti-inflammatory, nonsteroid inhaler, mast cell stabilizer used in asthma prophylaxis and as antiallergic agent.

Answer 17

Sodium cromoglycanate

Question 18

Causes for asthma and COPD

Answer 18

• Avoid triggers (allergens, exercise, emotional stress, cold air, (NO trigger is warm air)
• Causes of COPD, smoking, alpha1-antitripsine deficiency, air pollution, secondary smoke.

Question 19

Examples of drug(s) that may precipitate asthma:

Answer 19

Aspirin, β-Blockers, NSAIDs, Cholinergic drugs

Question 20

Pathophysiologic characteristics of asthma:

Answer 20

Airway obstruction and inflammation
Thickened smooth muscle of airway
Mucosal edema
Narrowed lumen of airway

Question 21

DOC for specific asthma emergency tx

Answer 21

Albuterol- fastest acting B-agonist

Question 22

Precursor of leukotriene

-Give product of this precursor metabolism and MOA

Answer 22

• Arac. acid
• Cysteinyl leukotrienes. Leukotriene modifiers drugs inhibit leukotriene synthesis by inhibiting 5-lipoxygenase that catalyzes the conversion of arachidonic acid to leukotriene.

Question 23

• Leukotriene modifiers drugs indications in the tx of asthma
• Montelukast a Leukotriene antagonist therapeutic use include?

Answer 23

-For prophylaxis and chronic treatment only.
NOT FOR ACUTE
-Asthma maintenance and ASA induced asthma
NOT: Acute asthma exacerbations

Question 24

This is the new relative cromolyn like drug acting in a very similar way as sodium cromoglycanate does?

Answer 24

Nedocromil sodium

Question 25

This is referred as steroid sparing agents, thus it is indicated to reduce corticosteroid doses

Answer 25

-Leukotriene antagonist

Question 26

Patient has a relevant increase in his asthma symptoms due to environmental allergies. He is currently having salbutamol and fluticasone inhalers. What would you advise as an adjunct medication to treat his symptoms? Explain.

Answer 26

Sodium cromoglycate would be the best choice because it is a safe anti-inflammatory inhaler for children and very useful in treating environmental allergy and asthma prophylaxis.