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**NR 507 Midterm Study Guide ALL TOPICS COVERED *ACE IT**

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Midterm Study Guide Pulmonary:  Review concepts related to anticholinergic drugs and the treatment for asthma o (Block acetylcholine binding (primarily in lung) -> bronchodilation through decreased parasympathetic response  Tiotropium, Ipratropium o Short-acting beta-adrenergic agonists (SABA) – activate beta receptors primarily in the lung -> bronchodilation through increased sympathetic response  Albuterol o Oral corticosteroids – inhibit inflammatory cells and chemical production -> reduce inflammatory process  Prednisone, prednisolone, methylprednisolone o Long acting:  Inhaled corticosteroids  Beclomethasone, triamcinolone  Mast cell stabilizers  Cromolyn  Leukotriene modifiers  Zafirlukast, Montelukast  Long acting beta2 adrenergic agonists  Salmeterol  Methylxanthines  Theophylline  Monoclonal antibodies  Omalizumab  Bronchitis and associated pathogenesis o In bronchitis, inspired irritants promote bronchial inflammation, causing bronchial edema, increases the size and number of mucous glands and goblet cells in the airway epithelium, smooth muscle hypertrophy with fibrosis, and narrowing of the airways. o Hypersecretion of thick, tenacious mucus occurs and cannot be cleared because of impaired ciliary function. The lung’s defense mechanisms are therefore compromised, increasing susceptibility to pulmonary infection, which contributes to airway injury and ineffective repair. o Frequent infectious exacerbations from bacterial colonization of damaged airways are complicated by bronchospasm with dyspnea and productive cough.  Chronic bronchitis and related acid/base disturbances, perfusion, blood flow between the heart and lungs o Characterized by bronchial inflammation, hypersecretion of mucus, chronic productive cough, persisting for at least 3 consecutive months for at least 2 successive years. o Symptoms: productive purulent cough, copious sputum production, shortness of breath, wheezing, rhonchi, cyanosis, peripheral edema. o Ventilation is decreased resulting in alveolar hyperinflation and hypercapnia resulting in respiratory acidosis. o The high concentration of CO2 creates an unfavorable condition for gas exchange thus causing a ventilation/perfusion mismatch. o Decreased perfusion of the pulmonary capillaries with oxygenated blood results in chronic pulmonary hypoxia. Right and Left shunting = blood passes from the RV to the lungs to LV without perfusion (gas exchange)  Asthma signs and symptoms

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