Obstructive vs Restrictive Disease.pdf

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4/19/2011 Airway Stuff Oxygenation Basic O 2 adjuncts Try not to intubate Consider: CPAP - continuous positive airway support BIPAP – bilevel positive airway support (IPAP and EPAP) IPAP tends to increase O 2 EPAP tends to help blow off CO 2 4/19/2011 ENMU-Roswell 19 4/19/2011 ENMU-Roswell 20 Oxygenation Caution because of air trapping in obstructive disorders - use lower pressures Restrictive might require higher pressures because of poor compliance Still use caution because a lot of your patients are combined Medications 4/19/2011 ENMU-Roswell 21 4/19/2011 ENMU-Roswell 22 Adrenergic Bronchodilators Ultra short acting – epinephrine 1 to 3 hrs Short acting – albuterol, levalbuterol (Xopenex), pirbuterol (Maxair) 5 to 8 hrs Long acting – salmeterol (Serevent), formoterol (Foradil), arformoterol (Brovana) 12 hrs 4/19/2011 ENMU-Roswell 23 Adrenergic Bronchodilators The problem: desensitization vs. downregulation Desensitization – occurs within minutes of administration Downregulation – occurs with repeated exposure Reduction in B 2 sites Think tolerance 4/19/2011 ENMU-Roswell 24 4
4/19/2011 Desensitization vs. Downregulation The Solution (ish) 4/19/2011 ENMU-Roswell 25 4/19/2011 ENMU-Roswell 26 Corticosteroids Inhibits the release and action of inflammatory mediators Increases the high affinity binding state (effectiveness) of B 2 agonist medications Increase the number of B 2 receptors (upregulation) Corticosteroids Inhaled: beclomethasone (QVAR), budesonide (Pulmicort), triamcinolone (Azmacort) Injectable: methylprednisolone (Solu Medrol) 4/19/2011 ENMU-Roswell 27 4/19/2011 ENMU-Roswell 28 Nonsteroidal Antinflammatory MAST cell stabilizers Cromolyn sodium (Intal), nedocromil sodium (Tilade) Antileukotriene agents Zileuton (Zyflo), zafirlukast (Accolate), montelukast (Singulair) MAST Cells Integral part of the inflammatory response – especially the early response When activated, they degranulate and release substances (histamine, cytokines and other bad mojo), but also release substances that contribute to the production of leukotrienes 4/19/2011 ENMU-Roswell 29 4/19/2011 ENMU-Roswell 30 5
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