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Oral Medicine and Diagnosis > Caring for the Patient with Pulmonary Disease > Flashcards

Caring for the Patient with Pulmonary Disease Flashcards

1
Q

what are the two categories of pulmonary disease

A
  • congenital
  • acquired
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2
Q

what are the types of congenital pulmonary disease

A
  • cystic fibrosis
  • bronchitis
  • emphysema
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3
Q

what are the types of acquired pulmonary disease

A
  • industrial
  • recreational
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4
Q

what are the causes of industrial pulmonary disease

A
  • black lung (coal miners)
  • asbestosis (miners)
  • bronchitis (steel mills, smog)
  • COPD
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5
Q

what are the causes of recreational pulmonary disease

A
  • tobacco (cigarettes, cigars, pipes, vaping, chew)
  • cannabis
  • cannabidol- topicals
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6
Q

what are the problems aggravated by smoke and smoking

A
  • periodontal disease
  • peri implantitis
  • asthma
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7
Q

the negative of cigarette smoking on the periodontium is:

A

cumulative and dose dependent

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8
Q

the severity of attachment loss is directly related to:

A

the amount of smoking measured either as pack years or number of cigarettes per day

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9
Q

cigarette smoking significantly increases the risk for tooth loss by:

A

70%

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10
Q

what are the effects of smoking on the periodontium

A

the host response to bacterial plaque and the ability of the wound healing response in the host are significantly affected
- the functions of vascularity - ability to provide O2, nutrients, cells and growth stimulants to the tissues

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11
Q

what parts of angiogenesis are altered from smoking

A
  • induction of VEGF signaling
  • formation of tip cells
  • stalk cell development
  • vessel outgrowth
  • anastomisis and perfusion
  • maturation and stabilization
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12
Q

what are the effects of smoking on periodontal disease

A
  • vascular alterations
  • altered neutrophil function
  • decreased IgG production
  • decreased lymphocyte proliferation
  • increased prevalence of periopathogens
  • altered fibroblast attachment and function
  • difficulty in eliminating pathogens by mechanical therapy
  • negative local effects on cytokine and growth factor products
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13
Q

what is refractory periodontitis

A

the smokers become refractory to the traditional periodontal treatment and tend to show more periodontal breakdown that non smokers after therapy

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14
Q

in studies of pts who failed to respond to the conventional therapy, including different combinations of OHI, SRP, surgery and anitbiotics, approximately ___ were smokers

A

90%

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15
Q

what is chronic inflammatory airway disorder

A
  • airway hyper responsiveness to stimuli
  • bronchial edema
  • narrowing of the airways- obstruction
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16
Q

what are the signs and symptoms of asthma

A
  • recurrent, reversible episodes of:
  • dyspnea (shortness of breath)
  • wheezing
  • coughing
  • tightness of chest
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17
Q

which of the following is a true asthma symptom

A

shortness of breath/constriction of airway/dyspnea

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18
Q

what are the aggravating/complicating factors for asthma

A
  • smoking
  • air pollutants - urban or industrial
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19
Q

what are the stages of asthma

A
  • control
  • partially controlled
    -uncontrolled
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20
Q

what are the controlled asthma daytime symptoms, limitations of actions, nocturnal symptoms, need for rescue meds, and lung function

A
  • twice or less per week
  • none
  • none
  • twice or less per week
  • normal
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21
Q

what are the partially controlled asthma daytime symptoms, limitations of actions, nocturnal symptoms, need for rescue meds, and lung function

A
  • more than twice a week
  • any
  • any
  • more than twice a week
  • less than 80% predicted
22
Q

what are the uncontrolled asthma daytime symptoms, limitations of actions, nocturnal symptoms, need for rescue meds, and lung function

A

three or more features of partially controlled asthma present in any week

23
Q

what are the types of asthma

A
  • extrinsic (allergic)
  • exercise induced
  • intrinsic
  • drug induced
24
Q

describe intrinsic and other names for it

A
  • idiosyncractic, nonallergic, nonatopic
  • second most common
  • middle aged individuals
  • triggered by respiratory irritants (tobacco, air pollution, emotional stress, gastro reflux)
  • infrequently association with family hx
  • normal IgE levels
25
Q

what is the pathway for intrinsic asthma

A
  • allergen -> lymphocytes -> activation of mast cells, basophils, and eosinophils -> bradykinin, histamine, leukotrienes, interleukins -> bronchoconstriction
26
Q

what are the considerations for patients with asthma

A
  • medications
  • level of control/severity
  • how often do you use your inhaler
  • does your inhaler have a spacer
  • how many attacks per week
  • do you have any night time attacks
  • have you ever been to ER or hospitalized from an attack
  • do you have a spirometer to keep a record of your lung function
27
Q

what is status asthmaticus

A

severe prolonged asthma attack ( more than 24 hours ) -> life threatening

28
Q

what is the drug of choice for an acute asthma attack

A

short acting beta 2 adgrenergic agonist (inhaler)

29
Q

what drugs should you avoid with asthma

A
  • aspirin, NSAIDs, narcotics, macrolide antibiotics like erythromycin
  • sulfite (preservative) containing local anesthetic may need to be avoided
  • nitrous (better)
  • short acting benzodiazepine
30
Q

what is the presentation of an asthma emergency

A
  • respiratory rate greater than 25 breaths/min, labored breathing
  • tachycardio greater than 110 beats/min
  • flushed appearance
31
Q

what should you do with asthma attack emergency

A
  • stop treatment, inform supervising faculty, administer O2 and call 4444
  • remove all items from pt mouth
  • recrod the time attack began
  • raise the dental chair
  • give short acting beta 2 adrenergic agonist inhaler
  • administer O2
  • administer 0.3-0.5mL of 1:1000 epi - small doses are Sm dilators
  • call an ambulance
  • re administer short acting B2 adrenergic agonist every 20 minutes until EMS arrives
  • the emergency team will continue treating the pt with bronchodilators and oral systemic corticosteroids
32
Q

what are the types of COPD

A
  • bronchitis
  • emphysems
33
Q

what is bronchiolitis

A
  • chronic obstruction of small airways
  • excessive tracheobronchial mucus production to cause coughing and sputum production for greater than or equal to 3 months for greater than or equal to 2 consective years in the absence of infection or other causes of chronic cough
34
Q

what is emphysema

A
  • longterm chronic obstructive bronchiolitis leads to destruction of lung parenchyma and alveolar walls
  • decreased elastic recoil
  • difficulty in maintaining airway opening during expiration
35
Q

what is type II

A

type II is a progression of type I leading many to just use these as descriptive terms for COPD

36
Q

COPD is the ______ leading cause of death in the US

A

third

37
Q

what are the aggravating/complicating factors for COPD

A
  • smoking
  • air pollutants - industrial or urban
  • CVD - morbidity
38
Q

what are the signs and symptoms of COPD

A
  • dyspnea
  • cough
  • sputum
39
Q

what is the tx for COPD

A
  • inhaled long acting bronchodilators
  • corticosteroids if asthma also present and/or more reversible obstruction
  • smoking cessation is the only intervention that actually lessens disease progression
40
Q

what are the meds to treat asthma/COPD

A
  • short acting beta 2 agonists : albuterol
  • anti cholinergics: atrovent and spiriva
  • methylxanthines: theophylline
  • corticosteoids: dexxamethasone, fludrocortisone, methylprednisone, prednisone
  • leukotriene receptor antagonists: singulair
  • combination inhalers: advair (fluticasone/salmeterol) and symbicort (budesonide/formoterol)
41
Q

what are the oral manifestations of COPD

A
  • dry mouth
  • steven johnson syndrome with theophylline
42
Q

dry mouth and steven johnson syndrome with theophylline exacerbate smoking side effects of:

A
  • halitosis
  • tooth staining
  • nicotine stomatitis
  • periodontal disease
  • oral potenitally malignant disorders: leukoplakia and erythroplakia
  • oral SCC
43
Q

when do you need a med consult for COPD

A

in mild to moderate COPD to determine the presence of respiratory failure right sides heart failure

44
Q

when do you consider dental tx in a hospital setting

A

COPD stage III or higher or who have respiratory and heart failure

45
Q

what do you do with greater than stage III COPD pt

A
  • place the pt in a semi supine position to avoid respiratory distress
  • avoid using a rubber dam
  • avoid treating if upper respiratory infection is present
  • local anesthetic with epi is accetable - may need to limit epi is CVD too
46
Q

what do you avoid in treatment of COPD pt

A
  • barbituates
  • narcotics
  • NO is contraindicated
  • benzodiazepines- low dose may be acceptable in certain situations- consult physician
  • erythromycin, macrolide ABs such as clarithromycin, azithromycin and ciprofloxacin should not be presscribed to COPD patients already taking theophylline
  • can cause theophylline toxicity
47
Q

what are the general, cardiovascular, respiratory, GI, and neurological symptoms of theophylline toxicity

A
  • general: agitation, irritability, restlessness
    -cardiovascular: sinus tachycardia, ventricular tachycardia atrial fibrillation, supraventricular tachycardia, hypotension, cardiac arrest
  • respiratory: tachypnea, acute lung injury, respiratory alkalosis
  • GI: nausea, vomiting, abdominal pain
  • neurological: tremors, hallucinations, seizures
48
Q

what are the low level interventions

A
  • health/med eval
  • exams
  • dental prophy
  • radiographs
  • optical oral scans
49
Q

what are the moderate level interventions

A
  • SRP
  • simple restorative procedures; 1-2 teeth
  • simple extractions; 1-2 teeth
  • impressions
50
Q

what are the high risk interventions

A
  • complex restorative procedures on more than 2 teeth
  • mulitple extractions
  • surgical extractions
  • implant placement
  • full arch impressions
  • dental care under general anesthesia
51
Q
A

Oral Medicine and Diagnosis (12 decks)

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