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How does parasympathetic stimulation affect the airways?
bronchoconstriction (Ach provides basic airway tone)
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How does sympathetic stimulation affect the airways? (2)
- beta2- bronchodilation
- alpha1- bronchoconstriction [very minor component]
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Beta2 stimulation __________ ciliary movement [mucociliary elevator].
increases
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What are the principals of therapy for inflammatory respiratory disease? (5)
eliminate cause (if possible), administer oxygen, bronchodilation, decrease inflammation, adjunctive drugs (antitussives, mucolytics, decongestants)
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__________ is the single most important therapeutic intervention for hypoxemia.
Oxygen
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FIO2 of ________ or greater can be very effective as supplemental oxygen.
0.30
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Increased FIO2 is effective for treating hypoxemia only if it is a result of.... (4)
low FIO2 (high altitude), hypoventilation, diffusion impairment, V/Q mismatch
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What are signs of hypoxemia? (4)
cyanosis, tachycardia, decreased level of consciousness, hyperpnea
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Increased FIO2 MAY help with hypoxia caused by... (2) [may raise oxygen carrying by a very small amount- enough to save the animals life]
anemia, low cardiac output
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What are methods of oxygen administration? (5)
nasal prongs or nasal cannula, face mask, oxygen cage/chamber, tracheal intubation, hyperbaric chambers
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What are indications for hyperbaric oxygen chamber use? (6) [only very specialized facilities have this]
CO poisoning, severe anemia, wound healing post-CPR, burns, pancreatitis
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What are potential causes of CNS oxygen toxicity? (2)
hyperbaric chambers, diving at depths
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What causes direct pulmonary damage due to oxygen toxicity?
with prolonged exposure to increased FIO2 (if mechanical ventilation, wean down to lowest possible FIO2]
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What are pulmonary effects of oxygen toxicity? (4)
type 1 pneumocytes degenerate, type 2 pneumocytes proliferate, enodthelial breakdown, thickened capillary/alveolar membrane
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What is the rule of thumb to prevent oxygen toxicity?
maintain PAO2 < 250mmHg [generally corresponds to FIO2 <0.5]
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What is absorption atelectasis? How is it normally prevented?
collapse of alveoli with FIO2 = 1 from oxygen moving from alveoli to blood; Nitrogen is usually present within the alveoli to maintain stable alveolar volume
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What are 3 classes of bronchodilators?
beta-2 adrenergic agonists, methylxanthines (caffeine), anticholinergics (antimuscarinics)
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Beta-2 agonist activation of G-coupled receptors causes activation of __________, which converts _______ to _______--> _______ is activated and inhibits __(2)__--> MLK is _________ and ________ are opened to _________ the cell
adenylate cyclase; ATP; cAMP; PKA; IP3 and DAG; phosphorylated; K+ channels; hyperpolarize
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What are some selective beta-adrenergic agonists? (3)
terbutaline (Brethine), clenbuteral (ventipulmin), albuterol
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Selective beta agonists have minimal ____________ compared to non-specific beta agonists, such as Isoproterenol.
extrapulmonary effects
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What is the mechanism of action of selective beta-2 agonists?
bind to beta-2 receptors--> increase adenylate cyclase--> increased cAMP--> cAMP inactivates MLCK within airway smooth muscle--> decrease intracellular Ca2+--> smooth muscle relaxation
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Metered dose inhalers are useful for delivery on __(2)__.
beta-2 agonists and inhaled corticosteroids
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Other than bronchodilation, what are other effects of beta-2 agonists? (4)
uterine smooth muscle relaxation, decreased serum potassium, decrease mast cell degranulation, increase ciliary activity
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What 3 drugs contain methyxanthines?
theophylline, caffeine, theobromine
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What is the mechanism of action of methylxanthines?
adenosine 1 (A1) receptor antagonism--> prevents ASM contraction AND phosphodiesterase inhibition--> inhibit Ca2+ influx into cell--> muscle relaxation/ bronchodilation
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Effects of methylxanthines. (6)
bronchodilations, CNS stimulation (restlessness), cardiovascular vasodilation/increased HR, mild diuresis, GI upset, inhibit mast cell degranulation
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What are routes of administration of methylxanthines? (2)
parenteral, oral
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3 anticholinergics.
atropine, glycopyrrolate, ipratropium
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Anticholinergics act by inhibiting the action of _________ at the _________ of the ________--> inhibition of __(2)__
Ach; muscarinic receptors; PNS; bronchoconstriction and bronchospasm
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Muscarinic (M3) receptors are coupled to _________, which activates _________ to induce _________.
Gproteins; phospholipase; PI3 and Cβ induced Ca2+ release
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Effects of giving atropine. (7)
bronchodilation, block bronchoconstriction, tachycardia, decreased GI motility, decreased salivation, thickened respiratory secretions, mydriasis
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Ipratroptium is used as a(n) _________; it has a _______ onset and _______ duration of action.
inhalant; slow; long
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Corticosteroids are useful in managing __________, such as... (3)
inflammatory airway disease; COPD in horses, feline asthma, canine chronic bronchitis
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What is the mechanism of action of corticosteroids?
bind to cytoplasmic receptors that translocate to nucleus and interact with specific genomic gene expression--> decrease leukocyte accumulation, inhibit leukotriene and prostaglandin release, increase responsiveness to beta-2 receptor agonists
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How are corticosteroids administered for inflammatory airway disease? (3)
inhales, injected IM, oral
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What side effect is associated with injected corticosteroids IM?
diabetes
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What stimulates the cough reflex?
stimulation og specialized stretch receptors of vagal afferents located in bronchi, diaphragm, external auditory canal, larynx, nose, paranasal sinuses, pericardium, pharynx, pleura, stomach, trachea, and tympanic membrane
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Cough suppressants are useful for... (2)
chronic bronchitis, infectious tracheobronchitis
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Cough suppressants SHOULD NOT be used for... (3)
[productive/moist coughs] lungworms, pneumonia, pulmonary edema
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Most cough suppressants are ________ derivatives, such as... (4)
opioid based; codeine and promethazine, hydrocodone (hycodan), butorphanol (torbugesic)
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_____ receptor agonists are more potent antitussive drugs than ______ agonists.
Mu; Kappa
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Centrally-acting CNS stimulant with respiratory selectivity, commonly used for neonatal resuscitation; also used as reversal of anesthetic-induced respiratory depression.
Doxapram HCl
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