Asthma

Question 1

β-2 agonist

Answer 1

Albuterol
Salmeterol
Formoterol

Question 2

Inhaled Corticosteroids

Answer 2

Fluticasone

Question 3

Oral Corticosteroids

Answer 3

Prednisone

Question 4

Mast Cell Stabilizers

Answer 4

Cromolyn

Nedocromil

Question 5

Methylxanthines

Answer 5

Theophyline

Aminophylline

Question 6

Leukotriene antagonists

Answer 6

Montelukast

Zarfilukast

Question 7

Anticholinergic

Answer 7

• Atrovent = Ipratroprium
• Combivent =
  Ipratropium + Albuterol

Question 8

IgE Antibody

Answer 8

Omalizumab (Xolair)

Benralizumab (Faserna)

Question 9

Drug Classes for bronchodilation

Answer 9

• Methylxanthines
• Anticholinergics
• β-2 agonists

Question 10

What drug should be avoided in Methyxanthine class?

Answer 10

Erythromycin

Question 11

What are Anticholinergics used for?

Answer 11

• Inhibit parasympathetic effects on respiratory system
• Increased mucos
• Smooth muscle contraction
• Alt. for pts w/ adverse rxn to β-adrenergics or in combo with β-adrenergics

Question 12

side effects of methylxanthines

Answer 12

tachy, arrhythmia, seizures, and insomnia

Question 13

What are the Anti-Inflammatory drug classes for asthma treatment?

Answer 13

Corticosteroids
Chromolyn, Nedocromil
Leukotriene modifiers

Question 14

Corticosteroids

Answer 14

Beclomethasone: vanceril, beclovent

Question 15

Cromolyn & Nedocromil

Answer 15

Intal

Tilade

Question 16

Leukotriene Modifiers

Answer 16

Accolate
Singulair
Zyflo

Question 17

Monoclonal Antibody (mAb)

Answer 17

Identical antibodies produced by ONE TYPE of immune cell, all CLONES of a single parent cell

Question 18

Polyclonal Antibody

Answer 18

Antibodies derived from different cell lines

Question 19

Isotypes

Answer 19

Immunoglobuline grouped by variation in heaby chain constant domains:

IgG
IgA
IgM
IgE
IgD

Question 20

Reduces Serum Levels of IgE

Down-Regulates expression of IgE receptors on mast cells and basophils

Answer 20

Omalizumab (Xolair)

Question 21

Benralizumab (Faserna)

Answer 21

Reduces IgE levels

Question 22

Dental side-effect of prolonged use of β-2 agonists

Answer 22

Decreased saliva –> Increase in lactobacilli and S. mutans –> caries

Question 23

Oral health considerations in people with asthma

Answer 23

Decreased salivary flow and caries

Increased oral mucosal changes (nebulized corticosteroids –> oropharyngeal candidiasis, tongue enlargement, dysphonia, throat irritation and xerostomia)

Increased gingivitis (inhaled steroids –> immunological depression; mouth breathing, increased calculus production)

Orofacial abnormalities (increased anterior face height, higher palatal vaults, greater overjet, and posterior crossbites from mouth breathing)

Question 24

If a patient is wheezing and coughing should they be treated?

Answer 24

no. ask them to return when symptoms disappear

Question 25

If you have a pt with hx of asthma and they are anxious in the dental chair which of the following can you administer? a. Hydroxyzine b. Benzodiazepene c. IV sedation d. Narcotics e. Barbituates f. NO

Answer 25

Anxiety is a known asthma trigger. NO = medical consult since NO can potentially cause airway irritation. for mild-mod asthmatics only. Hydroxyzine and Benzodiazepines = safe Narcotics and barbiturates = AVOID IV sedation = use extreme caution. Limited airway control

Question 26

What are the appropriate therapies for pain management in asthmatic pt.? a. local anesthetic + vasoconstrictor b. local anesthetic only c. Acetaminophen d. NSAIDs, aspririn

Answer 26

vasonstrictors = AVOID d/t sodium metabisulfite (highly allergenic) Acetaminophen = YES NSAIDs = AVOID! 20% of asthmatic pts experience bronchoconstriction after ingestin NSAIDs

Question 27

Fluoride supplements should be prescribed for all asthmatic pts. True or False

Answer 27

True. Especially for those using β-agonists

Question 28

To maintain good OHI, Instruct asthmatic pts to _______ after using inhaler

Answer 28

rinse mouth

Question 29

You may need to be aware of the possibility of prescribing antifungal agents for asthmatic pts using inhaler. True or False

Answer 29

True. oropharyngeal candidiasis is an oral health concern

Question 30

major cause of death in asthmatics

Answer 30

Mucous plugs

Question 31

MOA of inhaled β-agonists

Answer 31

stimulate adenylyl cyclase and cAMP production

Question 32

What do Methylxanthanes do?

Answer 32

Reduce bronchoconstriction of early and late phase Do not affect hyperresponsiveness in bronchioles

Question 33

Early Phase asthma

Answer 33

Allergen/irritant activates mast cells Inflammatory mediators are released Intense inflammation (bronchial wall constrictions, vasodilation/permeability, epithelial damage) Bronchospasm (mucous secretion, edema)

Question 34

Late Phase astchma

Answer 34

5-6hrs Inflammation Lymphocytes, Monocytes, Eosinophils and Neutrophils infiltrate mediators (IL4, IL-5, TNF) accentuate cytokines from Eosinophils and neutrophils ^ ^ Self-perpetuating cycle *Future attacks may be worse