Pharm Exam 2 Part 3.txt

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Pharm Exam 2 Part 3.txt
2012-03-10 09:10:24
Pharm Exam part

Pharm Exam 2 Part 3
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  1. is composed of mucus mixed with inflammatory cells, cellular debris, polymers of DNA and filamentous (F)-actin, and bacteria
  2. Mucus is usually cleared by airflow and ciliary movement, and sputum is cleared by
  3. Purulent, green phlegm is caused by the neutrophil-derived enzyme myeloperoxidase, indicating neutrophil activation; this sputum contains very little mucin and can be considered
  4. is defined clinically as daily sputum expectoration for 3 months of the year for at least 2 consecutive years, usually in a tobacco smoker or ex-smoker.
    chronic bronchitis (CB)
  5. there is hyperplasia of submucosal glands and goblet cells. The number of goblet cells increases, and there is hypertrophy of the submucosal glands, as measured by the Reid index of gland-to-airway wall thickness ratio
    The CB airway
  6. is considered the most important predisposing factor to airway irritation and mucus hypersecretion, but other factors can include viral infections, pollutants, and genetic predisposition.
    Tobacco Smoke
  7. Mucus hypersecretion can occur during an acute asthmatic episode or can be a chronic feature of asthma accompanying airway inflammation. Turner-Warwick and Openshaw51 reported that as many as 80% of patients with asthma report
    increased sputum expectoration
  8. In actue, severe, and fatal asthma patients have received large amounts of beta-agonist bronchodilators, sometimes even by the intravenous route, it is likely that beta receptors are fully saturated. beta agonists may induce the secretion of viscous mucus, so it is possible that under these circumstances the aggressive use of beta agonists may contribute to
    airway obstruction
  9. is defined as the production of watery sputum of 100 mL or more per day. This occurs in about 9% of patients with chronic asthma.
  10. These are considered mucoregulatory medications and are most effective when bronchorrhea is associated with airway inflammation
    corticosteroids, indomethacin by aerosol, or macrolide antibiotics
  11. Patients with congenital fucosidosis also have a form of bronchorrhea caused by the inability of mucins to polymerize. This form of bronchorrhea does not respond to
    mucoregulatory therapy
  12. is a rare disease characterized by the formation of large gelatinous or rigid branching airway casts.59 These casts are more cohesive than those seen in ordinary mucus plugging. The casts can be spontaneously expectorated, and occasionally patients cough up large impressions of their tracheobronchial tree
    Plastic bronchitis
  13. The prevalence of plastic bronchitis is unknown. This disease may also overlap with diseases such as asthma and with the severe mucus plugging sometimes seen in bronchopulmonary
    aspergillosis or middle lobe syndrome
  14. Patients who die usually have respiratory failure related to
    central airway obstruction
  15. is a chronic hereditary disease characterized by impaired function of the CFTR protein. There is chronic airway infection, often with Pseudomonas and other gram-negative organisms. There is also chronic airway inflammation, and infection and inflammation together lead to bronchiectasis, progressive pulmonary function decline, and eventually death.
    Cystic fibrosis
  16. The decreased mucin in CF sputum may be related to chronic bacterial infection by
    Pseudomonas aeruginosa and bacterial breakdown of mucin
  17. Airway epithelia in CF show excessive absorption of sodium (Na+) compared with normal epithelia. There is a limited ability for the epithelial cells to secrete chloride (Cl-) through the chloride CFTR channels (see Figure 9-6) stimulated by cAMP. The result of excessive Na+ absorption and limited Cl- secretion may lead to
    decreased water and increased reabsorption of the periciliary fluid
  18. Physical properties of mucus include:
    viscosity, elasticity, cohesivity, and adhesivity (normal ranges of these properties are needed for adequate mucus transport to occur)
  19. In the airway, adhesive forces refer to the attractive forces between
    the mucus and airway surface
  20. Mucokinetic agents are either abhesives, such as surfactant, which reduces the adhesivity of secretions, or agents that increase the power of
    airflow and cough
  21. is the resistance of a fluid to flow. More specifically, is the proportionality constant (ratio) of applied force to rate of flow
    viscosity or loss modulus
  22. is the ability of a deformed material to return to its original shape. Ideal solids store energy during deformation, and this energy is available when the force is removed
    Elasticity or storgae modulus
  23. The viscous properties of an ideal or Newtonian liquid can be described by
    loss modulus, G
  24. The properties of an ideal or Hookean solid can be described by
    storage modulus, G
  25. The complex modulus (G*) is
    the vectorial sum of viscosity and elasticity and is useful for describing the deformation of a pseudoplastic mucus
  26. is a viscoelastic material and responds to an applied stress as a fluid and as a solid
    mucus gel
  27. As the tips of the cilia contact the gel during the forward power stroke, the gel is stretched, and its elastic recovery causes it to snap forward. At the same time, the mucus gel flows forward as a liquid under the forward beat of the
  28. If such a rubber strip is loaded on one end with a weight and allowed to hang, it would initially stretch as an elastic solid. If the applied force remains, the strip would slowly elongate because of its viscosity (i.e., the rubber would �flow�). After removing the weight, the rubber recovers most of the elastic elongation because of stored energy, but it would not recover the entire length because of flow. This describes?
    Viscoelastic substance
  29. The ability of mucus to be drawn out into threads was initially identified for cervical mucus; it was termed
  30. Spinnability was found to increase with increasing
  31. Spinnability and mucus transport were also found to decrease as the purulence of sputum from CB patients
  32. gives information about internal cohesion forces in mucus
  33. is defined as the product of cohesivity, and adhesive work. is one of the strongest determinants of the ability of sputum to be cleared by cough
  34. The greater the tenacity of sputum, the worse the
    cough clearability
  35. Evaluation of mucus properties is complicated by the fact that mucus exhibits
    non-Newtonian rheology
  36. Some mucus exhibits a sudden collapse of viscous behavior at high applied stress; this is called
    apparent yield stress
  37. Mucus is often thixotropic�stable at rest but becoming more fluid with applied
    force. Then thickens once removed
  38. Because of its non-Newtonian behavior, evaluation of the properties of mucus and of the effect of drugs on those properties is complicated and must be performed under standardized conditions of dynamic shear rate and across the linear portion of
    Stress strain curve
  39. Three drugs are currently approved by aerosol to modify airway secretions
    NAC, dornase alfa, and hypertonic saline.
  40. Mucolytic agents decrease the elasticity and viscosity of mucus because the gel structure is
    broken down
  41. The therapeutic options for controlling mucus hypersecretion are outlined as follows:
    remove ausative factors, optimize tracheobronchial clearance, and use mucoactive agents when indicated
  42. Classic mucolytics reduce mucins by severing disulfide bonds or
    charge shielding
  43. Acetylcysteine does not improve mucus clearance when given as an aerosol and should not be used as a
    mucoactive medication.
  44. As a mucolytic, NAC has been used in conditions associated with
    viscous mucus secretions
  45. A second use of NAC is as an ________ to reduce hepatic injury with actetaminophen overdose
    antioxidant antidote
  46. Because there are no data that show NAC to be effective for lung disease and because of the high risk of side effects, we do not
    recomend its use