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39 terms

Respiratory Pharmacology Quiz and CH. 10

Respiratory Therapy Pharm exam 3
STUDY
PLAY
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)