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case pres Flashcards

1
Q

what is COPD

A

chronic obstructive pulmonary disease
chronic, progressive and irreversible disease
Combination of emphysema and chronic bronchitis

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2
Q

what is emphysema

A

disease seeing damage to alveoli

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3
Q

what is chronic bronchitis

A

damage to respiratory epithelium seeing excess mucous production and variable airway narrowing

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4
Q

symptoms of COPD

A

shortness of breath
persistent chest cough
frequent chest infections
persistent wheexing

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5
Q

aetiological factors of COPD

A

smoking!
air pollutants
genetics

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6
Q

name 3 complications of COPD

A

heart failure
pneumonia
frailty

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7
Q

classification of COPD

A

either stage 1-4 or ABCD classification (2017)

stage 1-4 based on FEV1
ABCD based on symptom assessment and exacerbation history

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8
Q

name 4 dental implications of COPD

A
  • may be unable to cope with dental dam
  • majority of patients predisposed to tobacco related lesions
  • inhaled steroids are a candida risk
  • may not be able to lie flat as could cause breathlessness
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9
Q

what can severe exacerbations of COPD lead to

A

respiratory failure

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10
Q

type 1. vs type 2 respiratory failure

A

type 1 - hypoxia, reduced surface for gas exchange
type 2 - hypercapnia, ventilation failure

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11
Q

sedation and COPD

A

inhalation - oxygen administration may cause respiratory depression - avoid
IV - midazolam can induce respiratory depression - avoid, referral to hospital if absolutely necessary

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12
Q

salbutamol inhaler

A

short acting beta 2 agonist
smooth muscle relaxation and dilation of airways
patient takes as and when required to treat exacerbations

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13
Q

active ingredients in trimbow inhaler

A

betametasone (corticosteroid)
formoterol (long acting beta agonist)
glycopyrronium (long acting muscarinic agonist)

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14
Q

fexofenadine

A

antihistamine for hayfever

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15
Q

naproxen

A

NSAID
patient takes for osteoarthritis related pain
similar antiplatelet effect as low dose aspirin

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16
Q

senna

A

stimulant laxative
increases intestinal activity to cause a bowel movement

17
Q

values for hypertension

A

> 140/90mmHg

18
Q

risks associated with hypertension

A

heart attack
stroke
heart disease
heart failure
kidney disease
vascular dementia

19
Q

how was elizabeths hypertension treated

A

lifestyle changes rather than medications
stopped smoking, lost weight and altered her diet to contain less salt
regular GP visits to assess status

20
Q

possible medications for hypertension

A

ace-inhibitors
beta blockers
calcium channel blockers
diuretics

21
Q

dental elements of hypertension

A
  • increased post op bleeding
  • side effects of drugs (xerostomia, gingival hyperplasia)
  • lichenoid drug reactions
  • increased risk of cardiac complications - MI, angina
22
Q

osteoarthritis

A

degenerative joint disease seeing cartilage repair dysfunction

23
Q

treatment of osteoarthritis

A

nothing alters progression
treatment aims to reduce pain and maintain function
- NSAIDS
- muscle strengthening around joints
- walking aids
- weight loss
- prosthetic replacement

24
Q

dental implications of osteoarthritis

A

-TMJ involvement - rare
-chronic NSAID use - ulceration, prolonged bleeding
-controversy on whether antibiotic prophylaxis in prosthetic joint patients
-manual dexterity may become impaired limiting OH ability

25
Q

pack years

A

measurement of how much a patients has smoked over a long period of time
number of packs per day (20 cigs/pack) x number of years patient has smoked

26
Q

6 dental implications of smoking

A

oral cancer
periodontal disease
necrotising conditions
extrinsic staining of teeth
dry socket
candida
xerostomia

27
Q

treatment of pseudomembranous candida if altered inhaler habits didn’t work

A

miconazole 20mg/g gel to area 4 x day
fluconazole 50mg 1x day 7 days

28
Q

staging vs grading of perio disease

A

staging - severity of disease (1-4 based on worst site of bone loss)
grade - rate of progression (ABC, worst site of bone loss/ patient age)

29
Q

how do inhaled corticosteroids predispose patients to candida

A

deposit of some drug onto oral mucosa leading to topical effects (immunosuppression and anti inflammatory effects)
decrease in local immune response allowing candida overgrowth

30
Q

what advice was given regarding inhaler use

A

patient was originally using her inhaler after brushing her teeth
advised her to use inhaler before brushing, rinse with water then brush teeth

31
Q

how could pseudomembranous candidiasis be treated if inhaler change had not been successful

A

miconazole 20mg/g gel 4 x day
fluconazole 50mg 1x day 7 days

case presentation (3 decks)

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