PHRD5985 Pharmacotherapy Lecture 7 - Pulmonary Physiology & Pharmacology

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PHRD5985 Pharmacotherapy Lecture 7 - Pulmonary Physiology & Pharmacology
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2014-04-08 05:16:38
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Pulmonary Physiology Pharmacology
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Pulmonary Physiology Pharmacology
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  1. constituents of upper airways
    • nose
    • pharynx
  2. constituents of central airways
    • trachea
    • bronchi
  3. constituents of peripheral airways
    alveoli (pulmonary)
  4. what makes the airways very effective at increasing air temp & humidity?
    large surface area & rich blood supply
  5. particles trapped in mucus are removed from airways by coordinated ciliary beating towards pharynx
    mucociliary escalator
  6. 3 airway defenses
    • 1) filtration
    • 2) mucociliary escalator
    • 3) nerves/reflexes
  7. afferent nerves of the airways (2)
    • C-fibers
    • irritant receptors
  8. efferent nerves of the airways (3)
    • 1) cholinergic
    • 2) nitrergic
    • 3) tachykinergic
  9. what nerves influence cilia beat rate?
    cholinergic (efferent) nerves
  10. measures lung volumes & capacities
    spirometry
  11. volume of air in lungs at full inspiration
    total lung capacity
  12. volume of air remaining in lungs after max expiration
    residual volume
  13. what happens to residual vol in pt experiencing severe bronchoconstriction?
    increased residual vol
  14. FEV1
    forced expiratory volume in 1 second
  15. determined from a spirometer trace
    FEV1 & FVC
  16. what is % predicted FEV1 normalized to?
    • age
    • gender
    • body weight
  17. ratio that is useful measure of pulmonary fcn
    FEV1.0/FVC
  18. %predicted FEV1 in mild COPD
    80%
  19. %predicted FEV1 in severe COPD
    <30%
  20. simplest measure of expiratory flow - measure max flow rate of expiration
    peak flow measurement
  21. what happens to peak expiratory flow rate of a pt experiencing bronchoconstriction?
    decreased peak expiratory flow rate
  22. influences airway mucus
    neural & inflammatory mediators

    (HA, leukotrienes)
  23. which pulmonary disease is mucus most viscous - asthma, CF, or COPD?
    asthma
  24. 2 ways in which mucus is cleared from affected airways
    • 1) mucociliary escalator
    • 2) coughing
  25. liquid mucus floats on, containing lysozymes w/ antibacterial fcn
    sol layer
  26. 3 things mucus clearance is affected by
    • 1) mucus viscosity
    • 2) mucus volume
    • 3) ciliary beat frequency
  27. stimuli for C-fibers (2)
    • bradykinin
    • capsaicin
  28. what peripheral sensitization does to cough sensitivity
    increases cough receptor sensitivity
  29. MOA of mucolytics
    • mucus removal facilitated by decreased mucus viscosity by:
    • a) dec mucin molecule crosslinking
    • b) degrading DNA/proteins
  30. MOA of N-acetylcysteine
    mucolytic that decreases mucin molecule crosslinking by reducing disulfide bonds (contains a free thiol group)
  31. N-acetylcysteine contraindication
    pts w/ advanced chronic bronchitis (mucus is already fairly liquid)
  32. MOA of dornase alpha
    mucolytic that hydrolyzes extracellular DNA to decrease mucus viscosity
  33. MOA of hypertonic saline & mannitol
    (expectorant) osmotic stimuli that promote fluid flow from epithelium into mucus
  34. MOA of guaifenesin
    (expectorant) that irritates gastric mucosa to inc respiratory secretions & dec mucus viscosity
  35. MOA of codeine & hydrocodone
    centrally acting antitussives act on  opioid receptors to increase cough threshold & depress cough reflex
  36. MOA of dextromethorphan & levopropoxyphene napsylate
    (antitussive) opiate derivatives
  37. MOA of benzonatate
    peripherally acting antitussive that inhibits pulmonary stretch R's
  38. MOA of menthol on airways
    peripherally acting antitussive serves w/ local anesthetic effect on sensory nerves
  39. 3 ways bronchodilators reverse bronchoconstriction acutely
    • 1) direct relaxation of airway SM
    • 2) amplification of relaxation pathways
    • 3) inhibition of bronchoconstrictor stimuli
  40. bronchodilators that directly relax airway SM
    2-adrenoceptor agonists
  41. bronchodilators that amplify relaxation pathways
    methylxanthines
  42. bronchodilator that inhibits bronchoconstrictor stimuli
    muscarinic cholinoceptor antagonists
  43. list 5 SABA's
    • 1) albuterol
    • 2) levalbuterol
    • 3) metaproterenol
    • 4) pirbuterol
    • 5) terbutaline
  44. list 2 LABA's
    • 1) formoterol
    • 2) salmeterol
  45. list 1 ultra-LABA
    indacaterol
  46. list 2 non-selective 2-adrenoceptor agonists
    • 1) epinephrine
    • 2) isoproterenol
  47. MAIN MOA of 2-adrenoceptor agonists
    relax airway smooth muscle
  48. indication for b2-adrenoceptor agonists
    acute exacerbations of asthma
  49. MOA of theophylline & aminophylline
    • (methylxanthines)
    • 1) relax airway SM by inhibiting PDE3 or PDE4 leading to increased cAMP
    • 2) inhibit adenosine R's
  50. bronchodilator that can cause seizures as a SE
    methylxanthines
  51. MOA of ipratropium bromide, tiotropium, & aclidinium
    (muscarinic antagonists) relax airway SM by inhibiting parasympathetic bronchoconstriction
  52. contraindications for muscarinic antagonists
    • NAG
    • urinary retention
  53. MOA of corticosteroids in asthma
    decrease airway inflammation
  54. list 8 CCS's
    • 1) beclomethasone
    • 2) budesonide
    • 3) ciclesonide
    • 4) flunisolide
    • 5) fluticasone
    • 6) mometasone
    • 7) prednisolone
    • 8) triamcinolone acetanide
  55. MOA of cromolyn sodium & nedocromil sodium
    (mast cell stabilizers) dec activation of eosinophils, neutrophils, & monocytes
  56. MOA of roflumilast
    phosphodiesterase inhibitor (PDE4) increases intracellular cAMP to dec inflammatory mediator release
  57. MOA for zafirlukast & montelukast
    leukotriene R antagonists
  58. MOA for zileuton
    5-LOX inihibitor inhibits leukotriene synthesis
  59. MOA of omalizumab
    IgE binding Ab that binds to the Fc epsilon R-1 portion of circulating Ab's to prevent their binding to mast cels

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