Respiratory Pharmacology Quiz and CH. 10

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Respiratory Therapy Pharm exam 3

This explains the relationship between the internal pressure, surface tension, and the radius of a bubble.

La Place's Law

The major stimulus for secretion of surfactant in lamellar bodies into the alveolus is

inflation of the lung w/ chemically coupled stretch response

The usual method of administering exogenous surfacant to babies is

direct installation into the lungs through 5 french catheter and ETT

What is the brand name of Calfacant

Infasurf

What is the dose of Calfacant

3 ml/kg in two divided doses

What is steroid diabetes

hyperglycemia resulting from corticosteroid therapy

What is the Budesonide dosage for a SVN

0.25 mg or 0.5 mg/ 2 ml

The corticosteroids used in pulmonary disease are all analogs of

Cortisol

When the HPA axis is stimulated by stress, it sends signals to the median eminence which then releases what

corticotropin-releasing factor (CRF)

After CRF is released from the median eminence, where does it travel to and what does it do

it travels to the anterior pituitary gland and releases corticotropin (ACTH) into the blood.

What does ACTH do after it is released into the blood

ACTH stimulates the adrenal cortex to produce glucocorticoids

What is an example of a glucocorticoid and what 3 things do they do

Cortisol; Glucocorticoids raise glucose levels, regulate the metabolism of carbs, fats, and proteins, and relieves stress

How does cortisol and glucose levels act as a feedback mechanism to the HPA axis

As cortisol increases the level of energy in the body, it also relieves stress by inhibiting the hypothalumus and completing the HPA axis. (this acts as a feedback mechanism for homeostasis)

List two ways in which steroids decrease inflammation

1. upregulate the transcription of antiinflammatory genes (e.g. lipocortin) 2. supress factors which cause transcription of genes involved in inflammation (e.g. AP-1 and NF-xB)

What are the 2 most common inflammatory lung diseases

Chronic bronchitis and asthma

How do you prevent thrush from inhaled steroid use

instruct patient to gargle after treatment

What 2 affects do surfactant agents have on alveoli

they reduce alveolar surface tension to stabilize the alveoli, and decreased the pressure needed for alveolar inflation

What is Surface Tension, and what is the unit of measurement

surface tension is the force that holds the liquid surface intact at the liquid-gas interface; the units are dyn/cm

Write the equation for pressure in an alveoli

P = (2 x ST) / r

What three affects can exogenous surfacant have on the alveoli of a baby in respiratory distress?

decrease surface tension, increase compliance, decrease work of breathing

What produces, stores, and releases surfacant? What does surfacant do?

Type II alveolar cells; surfacant regulates surface tension in alveoli

What replaces missing pulmonary surfacant in RDS of a newborn, and replaces the deficient endogenous surfacant pool

exogenous surfacant

What percent of surfacant is fat? What proteins are found in lipids?

90%; SP-A, B, C, and D

Which two surfacant proteins are hydrophobic? Which two are water-soluble

SP-B and C are hyrdophobic (low molecular weight); SP-A and D are water-soluble (high molecular weight)

Which proteins improve that adsorption and spreading of the phospholipid in the liquid-air interface in the alveolus

SP-B and C

Which protein regulates both secretion and exocytosis of surfactant from the type II cell, as well as reuptake of surfactant for recycling and reuse

SP-A

Which protein does not have a clear role in surfacant production, and may not be correctly designated as a surfactant associated protein

SP-D

What are the 3 most utilized "natural" exogenous surfactants? Include their brand names.

1. Beractant or Survanta
2. Calfacant or Infasurf
3. Poractant alfa or Curosurf

These details relate to which exogenous surfactant:
1. Modified natural surfactant suspension
2. Prophylactic & rescue agent
3. Dose 4 ml/kg, given in quarters(prone, supine, left side, right side)
4. If 2 dose (left side, right side)
5. Administered through 5-french catheter placed into ETT.
6. Bovine origine

Beractant (Survanta)

These details relate to which exogenous surfactant?
1. Modified natural surfactant suspension
2. Prophylactic & rescue agent
3. Dose 3 ml/kg, delivered in 2 doses
4. Direct side-port or catheter administration
5. Bovine origin

Calfacant (Infasurf)

These details relate to which exogenous surfactant?
1. Natural surfactant suspension
2. Treatment or rescue agent for RDS of premature infants
3. Dose 2.5 ml/kg, delivered in 2 doses
4. Catheter administration
5. Porcine origin

Poractant alfa (Curosurf)

These details relate to which surfactant?
1. No longer available
2. Neonatal use
3. Synthetic powder surfactant preparation
4. Used both as prophylactic & rescue agent
5. Dose 5 ml/kg, given in 2 half doses
6. Direct side-port administration

Colfosceril Palmitate

List 2 Methods for delivering surfactant in infants.

1. Instillation through side-port adaptor and ETT
2. Instillation through catheter
(Do this during inspiration)

What are the approved indications for Surfactant Therapy

1. Prophylaxis in infants of <1250 g
2. Prophylaxis in infants of >1250 g with immature lungs
3. Rescue treatment in infants with RDS
(Usually infants less than 29 weeks)

High PaO2 is apotential risk for ROP and be kept lower than 80 mmHg for prevention. True or False

True

Babies usually on pressure control ventilation because their lungs are so small. True or False

True

Pressure Control Ventilation can have a set pressure, but tidal vol can vary. What are two beneficial aspects of PCV?

it increases compliance (more vol/pressure) and tidal volume

List the complications of Surfactant Therapy

AW occlusion
Desaturation
Bradycardia
High PaO2
Over ventilation (hypocarbia)
Apnea
Pulmonary hemorrhage (increases with younger, smaller, male babies with patent ductus arteriosus)
(to remember: AlWays Dig Behind High Open Acres, Please)

What 5 things should be in an assessment of surfactant therapy?

pulse/cardiac rhythm, Signs of airway occlusion, Color/activity level, Chest rise, Arterial oxygen saturation (to prevent hypoxia and hyperoxia)

(if baby is hyperventilating, turn the pressure on the ventilator down)

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