10/5: Asthma, Diabetes and Allergy Flashcards
(T/F) You need to get the medical history of all patients, even if they appear healthy
True
This is a chronic inflammatory disease of the airways characterized by REVERSIBLE episodes of increased airway hyperresponsiveness
Asthma
Is Asthma reversible or irreversible episodes?
Reversible
Asthma usually has a _______ onset
Sudden
When do peak symptoms occur for asthma?
10-15 min
Inadequate treatment of asthma results in ER visits for what percentage of patients?
25%
How many people worldwide does asthma affect?
300 million
Asthma accounts for how many deaths worldwide (pre-covid)
1 in 250 deaths
Has the prevalence of asthma doubled since the 1960s in the USA?
Yes - from 2% to 7%
This is a disease that can lead to chronic obstructive pulmonary disease that involves repeated attacks
Asthma
Asthma is a disease primarily of (children or adults)
Children
What is the 2nd most common chronic disease in children?
Asthma
What is the most common chronic disease in children?
Caries
What percentages of children are affected by asthma?
10%
What percentage of adults are affected by asthma?
6%
Do females or males have a higher presence of asthma?
Females
The prevalence of asthma during childhood is higher in boys or girls?
Boys
Asthma has a slightly higher prevalence among which communities?
African Americans
Hispanics
Asthma can be triggered by what kinds of stress?
Emotional
Physical
Can asthma be triggered by allergies to food or drugs?
Yes
Can asthma be exercise-induced?
Yes - breathing through the mouth and inhaling colder and drier air
Asthma can be divided into 2 categories
Extrinsic
intrinsic
This category of asthma is allergic asthma
Extrinsic - pollens, dust, molds, allergic foods such as milk, fish, shellfish
This category of asthma is non-allergic asthma
Intrinsic
What category of asthma occurs more often in children?
Extrinsic
What drugs and chemicals can trigger extrinsic asthma?
Penicillin
Vaccines
Aspirin
Sulfites
What percent of asthmatic children outgrow extrinsic asthma by late teens or early twenties?
50%
Intrinsic asthma usually develops in adults older than
35
Psychological and physiological stress can induce what kind of asthma attack?
Intrinsic
Intrinsic asthma attacks are precipitated by what specific non-allergic factors?
Respiratory infection, physical exertion, environmental and air pollution
Psychological and physiological stress can induce what kind of asthma attack?
Intrinsic
What is the “Triad” in triad asthmatics?
Asthma
Nasal polyps that recur
sensitivity to aspirin and NSAIDs
What should you avoid if you have asthma?
Aspirin and NSAIDs
What does aspirin cause for people?
Bronchoconstriction in 10%
Sensitivity to aspirin in 20-40%
Do nasal polyps in Triad asthmaticus recur?
Yes
Do triad asthmaticus respond to bronchodilators?
No
Triad asthmaticus manifests with what 3 things?
Wheezing
Dyspnea
hypoxia
What are the symptoms of asthma?
(WCCIAD)
a. Wheezing and coughing
b. Cyanosis
c. Chest congestion
d. Increased blood pressure
e. Anxiety and agitation
f. Dyspnea and tachypnea
What is the underlying goal in the dental management of patients with asthma?
Prevent acute attack
You can help prevent asthma by getting what vaccination?
Pneumonia
Influenza
COVID
Through a good medical history, the dentist should be able to determine the ____________ of the disease
severity and stability
What should a dentist know regarding a patient with asthma?
Frequency/severity of attacks
Time of day of attacks (most occur at night)
Any current or past problems with asthma attacks
How are attacks usually managed
Has the patient ever received emergency care for an acute attack
What is the asthma risk assessment severity based on?
Frequency of symptoms
Impairment of lung function
Risk of attacks
How should you manage asthma in a dental setting?
Sit patient upright
Administer bronchodilator - Ventolin (improvement in 15 sec. If no improvement, administer again. Up to 3 times)
Administer epinephrine-bronchodilator and antispasmodic
Adminster oxygen if bronchodilator is unsuccessful
What is categorized as mild asthma?
Attacks <3/week
<30 min duration
Only w/ exercise or allergen
Inhaler use rare
Usually, childhood, outgrow
What is categorized as moderate asthma?
3-5 attacks/week
Last 30 min-several hours
Affects sleep
Occasional ER visits
Inhaler used more common
What is categorized as severe asthma?
Daily attacks
Use inhaler daily
May use steroids
Frequent ER visits - occasionally hospitalized
Limits daily activity
What is the 3rd leading cause of death in the USA?
Diabetes
What is the leading cause of blindness in the USA?
Diabetes
This is a group of metabolic syndromes resulting from low levels of the hormone insulin
Diabetes
Are you hypo or hyperglycemic in diabetes mellitus?
Hyperglycemic
What type of diabetes is insulin-dependent?
Type 1 diabetes
What type of diabetes is more common in children and adolescents?
type 1 diabetes
What cell is destroyed in both Type 1 and Type 2 diabetes?
Beta cells
What does beta cell destruction lead to?
Absolute insulin deficienct
What type of diabetes have an abrupt onset?
Type 1 diabetes
What type of diabetes have a slow onset?
Type II diabetes
What diebetes are usually seen in adults, overweight, milder?
Type II diabetes
Ketoacidosis is uncommon in what type of diabetes?
Type II diabetes
Are blood sugar levels more stable in type 1 and type 2 diabetes?
Type II diabetes
What kind of diabetes can you get during pregnancy?
Gestational
You get more stable glucose levels and calories when?
Morning
What occurs in a pregnant woman with type II diabetes after childbirth?
Glycemic control returns to normal, but have increased risk of developing diabetes within 5-10 years
Monitoring what is common in diabetic patients?
Blood pressure-hypertension
In diabetic ketoacidosis, the body produces high levels of blood acids called
Ketones
What kind of respiration patterns do you get in diabetic ketoacidosis?
Kussmaul’s respirations
Diabetic ketoacidosis is rare in people with what type of diabetes?
Type 2
Glucose values will be above what in diabetic ketoacidosis?
300 mg/dl
What treatment is there for diabetic ketoacidosis
a. Fluid and electrolyte replacement
b. Insulin therapy
In hyperglycemia, is it slow or fast onset?
Slow
In hypoglycemia, is it slow or fast onset?
Fast
Do you get “fruity-smelling breath” and “Kussmaul’s breathing” in hyper or hypo-glycemia?
Hyperglycemia
When you think polyuria, polydipsia, or polyphagia what are you thinking of?
Hyperglycemia
Mood swings, tachycardia, lethargy, and nausea are symptoms of hypoglycemia or hyperglycemia?
Hypoglycemia
Your blood glucose values are what in hypoglycemia?
<50 mg/100 ml
Do you get altered levels of consciousness in hypoglycemia or hyperglycemia?
Hypoglycemia
What are ways to manage hypoglycemia in a conscious patient?
Administer 100% oxygen
Oral carbohydrates if conscious
Medical assistance
What are ways to manage hypoglycemia in an unconscious patient?
Cake icing
50% dextrose (20-50ml) IV
Glucagon 1mg IM or IV
Epinephrine 1/1000 0.5 mg IM
What is an ideal HbAlc level if you have diabetes?
6.5% or below
A1c measures the average amount of sugar in your blood over the past _____ months
Long term glucose: 30-90 days
If you are at risk of developing type 2 diabetes, your target HbA1C should be
6%
If you have a blood glucose reading of <70mg/dl, you should consider what? And wait how long?
a. Consider deferring elective treatment
b. Wait 15 minutes and retest
If you have a blood glucose reading of >200mg/dL, you should do what regarding treatment?
a. Defer treatment
b. Refer to physician
If you fast (8-12 hours), your glucose level will be
80-130 mg/dL
Your glucose levels 1-2 hours after a meal is
<180 mg/dl
What is caused by excess insulin and occurs in three stages?
Insulin shock - major goal is to prevent this
What is the most common stage of insulin shock?
Mild stage
This stage of insulin shock is characterized by hunger, weakness, trembling, tachycardia, pallor, sweating, paraesthesias
Mild stage
This stage is characterized as a substantial blood glucose drop, patient becomes incoherent, uncooperative, and sometimes belligerent or resistant to reason or efforts at restraint?
Moderate stage
The chief danger during this stage of insulin shock is that patients may injure themselves or someone else
Moderate stage
This stage of insulin shock is characterized by complete unconsciousness
Severe stage
This stage of insulin stock is characterized by sweating, pallor, rapid and thready pulse, hypotension, and hypothermia
Severe shock
The reaction to excessive insulin (insulin shock) can be corrected by giving the patient
Something sweet (cake icing) or sweetened fruit
What is the best way of treating patients in the severe stage (unconsciousness)?
IV-glucose solution; glucagon or epinephrine
What is only the earliest oral manifestation of diabetes?
Xerostomia
What are manifestations of diabetes?
Bacterial, viral, and fungal infections (including candidiasis)
Poor wound healing
Increase incidence and severity of caries
You can get what kind of taste from metformin in oral manifestations of diabetes?
Metallic
Hyperglycemia and periodontitis are
Bidirectional
Hyperglycemia affects oral health while periodontitis affects what
Glycemic control (increases HbA1C)
This is an abnormal or hypersensitive response of the immune system to a substance introduced
into the body
allergy
For an allergic reaction to occur, the patient must have been previously exposed to the
Antigen
For an allergic reaction to occur, the patient must have been previously exposed to the antigen. The ________ exposure to the antigen causes the reaction
Subsequent
When you think of Type 1 - true IgE, antibiotic, analgesic, narcotics, anesthetics, venom, what type of allergic reaction is this?
Rapid/anaphylactic
This is an acute reaction involving smooth muscle of the bronchi in which antigen-IgE antibody complexes form in the surface of mast cells which causes sudden histamine release from these cells
Anaphylaxis
When do most anaphylaxis occur?
Within one hour of taking meds
Can you get acute respiratory compromise and cardiovascular collapse from anaphylaxis?
Yes
What is the most common cause of type 1 hypersensitivity reaction?
Antibiotics, but recently, chemotherapy drugs
You get capillary dilation and increased capillary permeability resulting in blushing and edema formation. Decreased venous return, decreased blood pressure, and cardiac output in this type of anaphylactic allergic reaction
Cardiovascular
You get increased secretions by the mucous, lacrimal, salivary, pancreatic, gastric, and intestinal growth in this type of anaphylactic allergic reaction
Stimulation of secretions
You get increased secretions by the mucous, lacrimal, salivary, pancreatic, gastric, and intestinal growth in this type of anaphylactic allergic reaction. These effects can lead to asphyxia from upper respiratory tract obstruction in this type of anaphylactic allergic reaction
Respiratory
You can get urticaria-itching, hives, erythema rash, and angioedema in this type of anaphylactic allergic reaction
Skin
You get bronchospasm, wheezing, respiratory distress, Angioedema to the larynx, and rhinitis in this type of anaphylactic allergic reaction
Respiratory
What is management of rapid allergic reactions?
Position patient supine
BCLS
Oxygen
Monitor vital
You can use what medication to manage rapid allergic reaction
Epinephrine (1/10,000 3.0cc IV or 1/1000 0.3cc IM/SC)
Benadryl (50 mg IV or IM)
Obtain medical assistance and transport to hospital
What part of the thigh should be put in the epi-pen?
outer thigh because it has thinner tissue and less fat
What is the shelf life for an epi pen?
16 months, but the FDA is allowing an additional 4 months
How long should you hold an epi-pen injector?
3-10 seconds
What are delayed allergic reactions?
Onset greater than one hour
usually non-life threatening
Antibiotics
Analgesics
Narcotics
Preservatives in anesthetics
What are signs and symptoms of delayed allergic reactions?
Rash
Pruritus (itching)
Urticaria (hives)
Edema
Rarely- hypertension, dyspnea, coma
What is management for a delayed allergic reaction?
Terminate procedure
Position patient based upon comfort
BCLS if indicated (usually not)
Benadryl 50 mg PO or IM q 4 h depending upon severity of symptoms
Continue benadryl for 24 hours after symptoms dissapear
About ______% of self report allergies are NOT true allergies?
5-10
