Pulmonary Review
Concepts Related to Anticholinergic Drugs & Treatment for Asthma:
Fast-acting Medications:
- Tiotropium & ipratropium
- Anticholinergic drugs block acetylcholine binding > bronchodilation through
de
...
Pulmonary Review
Concepts Related to Anticholinergic Drugs & Treatment for Asthma:
Fast-acting Medications:
- Tiotropium & ipratropium
- Anticholinergic drugs block acetylcholine binding > bronchodilation through
decreased parasympathetic response
Bronchitis & Associated Pathogenesis:
Bronchitis – bronchial inflammation, hypersecretion of mucus, chronic productive cough
Exposure to airborne irritants activates bronchial:
- Smooth muscle constriction
- Mucus secretion
- Release of inflammatory mediators
Chronic Bronchitis & Related Acid/Base Disturbances:
Hypercapnia (CO2 retention) > respiratory acidosis
Perfusion:
Perfusion – the actual exchange of O2 and CO2 in the bloodstream, occurs via the
alveoli and pulmonary capillaries
Ventilation – air movement in/out of the lung, is critical to ensure sufficient perfusion
Blood Flow Between the Heart & Lungs:
R heart – receives deoxygenated systemic blood and returns it to the lungs = pulmonary
circulation
L heart – receives oxygenated blood from the lungs and returns it to systemic circulation
Right to Left “shunting” – blood passes from R ventricle to lungs to L ventricle without
perfusion (gas exchange)
Asthma Signs & Symptoms:
Coughing
Wheezing
Shortness of Breath
Rapid Breathing
Chest Tightness
Bronchioles:
Composed of a 3-layer tube surrounded the lumen or air passageway
- The innermost layer, closest to the lumen, is composed of ciliated solumnar
epithelial cells’ the constant sweeping action of the cilia are important to help
clear the bronchial passageways or irritants, including infectious agents. This
layer also contains mucus producing goblet cells which traps irritants and
microbes to prevent their passage into the alveoli
- The middle layer, called the lamina propria, is embedded with connective
tissue cells, as well as immune cells. These immune cells include a number of
different kinds of WBCs, located here to help protect the airways
- The outermost layer is composed of smooth muscle cells, responsible for the
ability of the airways to constrict and dilate
Alveolar Hyperinflation with Asthma:
Plugs of mucus and pus from the inflammatory process can block alveolar passageways
which leads to air-trapping and alveolar hyperinflation
Cardiovascular Review
Concepts Related to Cardiac Output & Cardiac Contractility:
Cardiac Output – volume of blood ejected by each ventricle per minute
CO = HR x SV (heart rate x stroke volume)
Cardiac Contractility – (inotropic state) – determined by Ca+2 availability and its
interaction with actin-myosin
-Increased by sympathetic stimulation (fever, anxiety)
-Decreased by low ATP levels (ischemia, hypoxia, acidosis)
Preload/Afterload:
Preload – degree of myocardial fiber length stretch before contraction
- amount of blood entering ventricle during diastole
- increased by CHF, hypervolemia
- decreased by cardiac tamponade or hypovolemia (hemorrhage, dehydration)
Afterload – amount of tension each ventricle must develop during systole to open SL
valves and eject blood
- influenced by ventricle wall thickness, atrial pressure, ventricle chamber size
- increased by systemic hypertension, valve disease, or COPD
- decreased by hypotension or vasod
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