adrenal cortex and feedback
when the hypothalamus senses stress in any way (infection, emotional, trauma, hypoglycemia) it releases CRH which travels to the anterior pituitary which then releases ACTH adrenocorticotropic hormone. this hormone signals to the adrenal cortex to release cortisol. cortisol is involved in a negative feedback loop with the hypothalamus and the anterior pituitary.
cortisol
increases plasma proteins, catabolism and muscle breakdown. it also increases free fatty acids, and blood glucose for energy to “fight or flight”. stimulates the sympathetic nervous system
also suppresses the immune and inflammatory systems by decreasing capillary permeability, decreasing accumulation of neutrophils and macrophages, decreasing cytokines and phagocytosis
Cushing syndrome
excess cortisol in the body. leads to red cheeks, rounded face, buffalo hump, excess hair growth, think skin, stretch marks, thin arms and legs, poor wound healing and a loose hanging abdomen
sympathetic vs autonomic
sympathetic: the neurotransmitter is norepinephrine. this is the arousing response in which alpa 1 receptors increase blood pressure, beta 1 receptors increase HR, and beta 2 receptors bronchodilate
parasympathetic: the neurotransmitter is acetylcholine. this is the calming response in which muscarinic receptors are on the heart, organs, sweat glands, and smooth muscle and the nicotinic receptors are on the skeletal muscle and the adrenal glands
adrenergic
pupils dilate, HR BP and contractility increase, bronchioles dilate, liver releases glucose, gut decreases secretions, motility and digestion, bladder constricts the sphincter, muscles increase in strength and GU ejaculation occurs
cholinergic
sweat glands increase water, pupils constrict, saliva and tears increase, HR BP and contractility decrease, bronchioles constrict, gut secretions and motility increase, bladder detrusor muscle tone increases and sphincter relaxes, GU orgasm and errection
function of the bronchial smooth muscle
the tone of the smooth muscles surrounding the airways determine the airway radius. the presences or absence of airway secretions influences airway patency. bronchial smooth muscle is innervated by the autonomic nervous system: parasympathetic has vagal control which causes bronchoconstriction and sympathetic innervates beta 2 adrenergic receptors for bronchodilation
type I allergic responses
- first exposure: allergens activate the helper T cells which activate the B cells. the B cells then form IgE which binds to receptors on mast cells.
- subsequential exposures: antigens or allergens bind to the IgE and create a crosslink which causes the mast cells to degranulate. when this happens, they release histamine. this causes the release of many pro-inflammatory substances such as mediators and cytokines
antigen
a substance or molecule that the body recognizes as non-self. it triggers an immune response
innate immunity
nonspecific immunity
- the first line of defense: barriers are skin, mucous membranes, stomach acid, normal intestinal flora
- the second line of defense: injured or compromised cells release chemokines such as prostaglandins, leukotrienes, kinins, and histamines. these initiate an inflammatory process which increases vascular permeability. neutrophils are the first to arrive at the scene and they phagocytose invaders but they die in the process. macrophages also phagocytize invaders, destroy them with lysosomes, and act as antigen-presenting cells that alert b cells and t cells to recognize the antigen as nonself. dendritic cells break up invader proteins and present a small amount of antigen to other immune cells
adaptive immunity
B-cells: engulf antigens and present them on their surface. they are then activated by hylper t cells and differentiate into plasma cells that produce antibodies and memory cells. T-cells will also differential to for memory t cells and activated T cells. Monoclonal antibodies are lab made clones of antibodies that have specific targets.
eosinophil
a type of red blood cell. an increase usually means there is a parasitic infection, an allergic reaction, or cancer. can be present in blood and in tissue at the site of inflammation
MAST cells
immune cell made in bone marrow. it is found widely distributed where the body come into contact with the environment. contains chemicals such as histamone, heparin and cytokines. responsible for allergic reactions such as itching or flushing
asthma
a chronic inflammatory disorder that causes edema of the airway, excessive mucous secresion with plugging, bronchospasm, and airway remodeling
symptoms of asthma
wheezing, breathlessness, chest tightness, nighttime or early morning couching, tachypnea, use of accessory muscles, increased HR, and hyper resonant lung fields due to air trapping. *the presence of wheezing or coughing is not a dependable standard for evaluating severity of an attack
causes of asthma
IgE mediated allergic respinse to triggers, it is associated with other atopic or allergic conditions. could also be genetic or environmental, or due to viral infection
types of asthma
intermittent
mild: recurrent, reversible changes
moderate: recurrent reversible changes
severe: less reversible due to airway remodleing- chronic inflammation results in the process of fibrosis, enlargement of smooth muscle cells and enlargement of mucous glands
Status asthmatics: acute or severe attack that is not responsive to bronchodilators. can lead to respiratory failure
* need to reduce triggers and promote early and effective treatment
acute asthma
administering medications by metered dose inhaler or nebulizer is most effective
- rescue medications are for quick relief and they are short acting
- maintenance medications are for prevention and long term control
peak flow meter
80% of the patients best is a safe range.
50% -80% of the best means there needs to be an increase in controller meds
<50% of the patients best requires urgent intervention
metered dose inhaler use
- an inhaler must be primed if it has not been used in a while and before the first use. to do this spray the inhaler 3-4 times
- next shake the inhaler for 10-15 seconds and breath out all the way
- next hold the inhaler with the mouthpiece down and place it in your mouth forming a tight seal with your lips
- slowly start to breathe in and press the inhaler down once but keep breathing in slowly
- take the inhaler out and hold breath for 10 seconds
- pucker lips and breathe out slowly
7 if the dose is another puff of the same med wait 1 min then repeat. when done place the bap back on the mouthpiece and rinse mouth with water and spit. do not swallow
combination of ICS and LABA
- fluticasone(ICS)/ salmeterol (LABA)
- budensonide(ICS) /formoterol (LABA)
effects: improved lung function and quality of life with reduced dyspnea, exacerbations, and use of unhaler
cystic fibrosis
is caused by chloride channel dysfunction that leads to mucus hypersecretion, airway inflammation, recurrent lung infections, gastrointestinal dysfunction, male infertility, and elevated sweat chloride levels.
a new CFTR modulator drug improves production, intracellular processing, and function of the defective CFTR protein in patients with a specific genetic mutation. this drug can cause abdominal pain. diarrhea, rash, increased ALT and ASTs (liver function tests)
