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Pharm Part II > E2: Respiratory Part 1 ASTHMA(I'll give you asthma!) > Flashcards

E2: Respiratory Part 1 ASTHMA(I'll give you asthma!) Flashcards

1
Q

oxygen saturation is measured with a _________…Acceptable normal ranges are from ___ to ___% percent, although values down to ___% are common.

A

pulse oximeter…95 to 100….90%

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2
Q

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…Persistent symptoms for at least ___ days without improvement..BUT _____ of illness ALONE is unreliable

A

10 days.. Duration

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3
Q

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…______ symptoms: fever, facial pain, purulent nasal discharge for 3-4 consecutive days at beginning of illness…AND imaging not routinely recommended

A

Severe… imaging (can’t tell on a scan)

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4
Q

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…What % of acute Rhinosinusitis cases are VIRAL?

A

98% are viral!!!

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5
Q

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…IF in the rare chance it IS Bacterial in nature. Rx these 2 bad boys: What if their allergic?

A

Amoxicillin, Clavulanate…if allergic Clindamycin!

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6
Q

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…What drugs should you avoid in ACUTE Sinusitis?

A

Decongestants and Antihistamines

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7
Q

What are the 4 drugs recommended in Sinusitis/Allergic Rhinitis?

A

1.PseudoEphedrine 2.AntiHistamines 3.Analgesics 4.Antibiotics (if bacterial OF course)

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8
Q

DENTAL DRUG INTERACTION!!! Use _________ (vasoconstrictor) with caution with DECONGESTANTS, as these drugs are ________ and may enhance cardiac stimulation (tachycardia) and elevate blood pressure!!!

A

epinephrine…sympathomimetics

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9
Q

Why is it important to ask the patient if they are taking claratin-D vs regular claratin?

A

D (decongestant) is a Sympathomimetic and will tag team with EPI

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10
Q

What was the new rhinitis drug in 2012 that is a “dry” nasal corticosteriod?

A

QNASL Nasal Areosol

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11
Q

Oh I’ll give you ASTHMA! Recurrent bronchial ______ spasm, inflammation, swelling of bronchial mucosa, hypersecretion of _______

A

smooth muscle… mucous

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12
Q

Oh I’ll give you ASTHMA! What is the most common form? What age group is it usually seen in?

A

Extrinsic Asthma-seasonal allergens, pollen, dust mites, animal dander…children and young adults

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13
Q

Oh I’ll give you ASTHMA! IT IS A _____ response relationship between allergen exposure and ____ (WHAT ANTIBODY??) mediated sensitization, positive skin test, family Hx

A

DOSE…IgEEEEEE

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14
Q

Oh I’ll give you ASTHMA! During attack, _____ antibodies affixed to _____ cells along bronchial tree

A

IgEEEEEE…MAST

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15
Q

Oh I’ll give you ASTHMA! histamine = broncho________; _______ vascular permeability

A

constriction….increased

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16
Q

Oh I’ll give you ASTHMA! _________ = smooth muscle spasm; increased vascular permeability; attract

A

leukotrienes

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17
Q

Oh I’ll give you ASTHMA! What type of immune cells prolong inflammatory response?

A

T lymphocytes

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18
Q

Oh I’ll give you ASTHMA! What type of asthma is seldom associated with family history of allergy or to a known cause, patients are non-responsive to skin testing, has NORMAL IgE levels and is more for middle-aged adults

A

INTRINSIC asthma

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19
Q

Oh I’ll give you ASTHMA! Intrinsic asthma is associated with ENDOGENOUS causes: emotional _____; _____

A

stress… GERD

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20
Q

DID YOU KNOW that these drugs aspirin, NSAIDS, cholinergics, beta blockers, ACE inhibitors, barbiturates, opiates can INDUCE _______

A

ASTHMA!!!

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21
Q

YOU DID KNOW THIS….Thanks Steve!!! Asthmatics are more likely to have hypersensitivity reaction to _____! (incidence ranges from 5-15%)

A

ASPIRIN

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22
Q

What is the “Aspirin Hypersensativity Triad”?

A

1.Aspirin Hypersensativity 2.Asthma 3.Nasal Polyps

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23
Q

Why in the world do some asthmatics have an aspirin allergy?? Aspirin Inhibits bronchodilating _____…Allergic reactions = mimic _______

A

PGE2…asthma attack

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24
Q

How many exposures does it usually take to develop an aspirin sensitivity with asthma?

A

about 15 exposures

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25
Q

There is EVEN as CROSS SENSATIVITY with asthmatics-aspirin-and _______

A

NSAIDS (Tylenol ONLY!)

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26
Q

What is the preservative that can cause asthma (found in food and some inhalers even!)?

A

Sulfite

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27
Q

What age group is most effected by exercise-induced asthma?

A

children and young adults

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28
Q

Say what?! There is ______ asthma, caused by an inflammatory response of bronchi to infection

A

Infectious asthma

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29
Q

What is the type of asthma attack that will scare you as much as an MI?? It has persistent life-threatening bronchospasm DESPITE drug therapy/intervention and can last for more than 24 hours!!

A

Status Asthmaticus!

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30
Q

What is the likely cause of Status Asthmaticus? What can happen w/o intervention??

A

Respirtatory INFECTION…DEATH can result

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31
Q

Symptoms of Asthma (I’ll give you asthma!): termination of attack is accompanied by _________: thick, stringy mucous episodes are SELF-limiting

A

productive cough

32
Q

Which class of Asthma Am I ??? symptoms only when exposed to trigger; symptoms last less than an hour and occur less than twice per week…FEV (forced expiratory volume): >80%

A

Mild (intermittent OR persistent)

33
Q

Which class of Asthma Am I ??? symptoms more than twice per week that affect sleep and activity level, occur over several days, and on occasions requires emergency care…FEV >80%

A

Moderate

34
Q

Which class of Asthma Am I ??? ongoing symptoms that limit activity…frequent attacks, at night…occasional need for emergency hospitalization; FEV

A

Severe

35
Q

Asthma Med Consider this: FOR _________ asthma = rescue bronchodilator prn

A

mild intermittent

36
Q

Asthma Med Consider this: FOR ________ asthma = anti-inflammatory drug with low dose inhaled corticosteroid, cromolym or anti-leukotriene

A

mild persistent

37
Q

Asthma Med Consider this: FOR ________ asthma = one medium dose of inhaled corticosteroid, or two daily medications….low to medium dose inhaled corticosteroid and long-acting bronchodilator

A

moderate persistent

38
Q

Asthma Med Consider this: FOR ________ asthma = daily medications…high-dose inhaled corticosteroid with long acting bronchodilator and oral corticosteroid

A

severe persistent

39
Q

Asthma is often under treated. The MAN Recommends ________ as preferred therapy for mild persistent asthma, but providers disregard due to perceptions of risk/benefit

A

inhaled corticosteroids

40
Q

DAAANG! In a survey of 1000 people, ___% did not use asthma controller medications. Even if they did 85% had poorly controlled disease

A

49%

41
Q

_________ are Important RESCUE drugs for asthma = “inhalers”

A

Beta Adrenergic Stimulants

42
Q

Beta Adrenergic Stimulants target _______ receptors in airway

A

beta 2

43
Q

Which drug is in ALL DENTAL EMERGENCY KITS for SHORT acting asthma drugs?

A

albuterol…(levalBUTEROL (Xopenex HFA)….pirBUTEROL

44
Q

What are 2 examples of LONG acting Beta Adrenergic stimulants?

A
  1. SAL-MET-EROL (Severent Diskus) 2.SAL-MET-EROL WITH FluTICaSone (ADVAIR Disckus)
45
Q

What is the duration of salmeterol?

A

12 hours (long acting)

46
Q

What is the name of the steroid in Advair?

A

Fluticasone

47
Q

Woot Woot! Dental Considerations with inhalers: 3 main ones:

A

1.Taste alteration 2.oral candadiasis 3.hyper-reflexive airway (boy who cried wolf)

48
Q

What are you going to ask your asthma patient? Tell them to BRING THEIR _______!

A

HOW OFTEN do you use your inhaler? If more than 2x, refer for better Tx!…BRING THEIR INHALERS!

49
Q

What is the RED FLAG DRUG IN DENTISTRY from this Section? What 2 medications does it clash with for this special honour?

A

Methyl-XANTHINES (older class of drug-given to people as a last resort)…1.Antibiotics (erythromycin, cipro, clarithro, doxy) AND 2.Systemic azole antifungals (ketoconazole)

50
Q

What are the three possible side effects if I mix erythromycin and theosophylline?

A

(antibiotics and methylXanthine-red flag dental drugs) 1.CNS Stimulation(nausea/vomiting) 2.cardiac effects 3.seizures

51
Q

The Red Flag MethylXanthines block ________ which INCREASES cAMP

A

PhosphoDiesterase

52
Q

Leukotrienes = chemical mediators that produce similar effects to _______

A

histamine

53
Q

What is the mech for zileutron (Zyflo) (leukotriene)?

A

inhibits the SYNTHESIS of leukotrienes

54
Q

What is the mech for zafirlukast (Accolate), montelukast (Singulair)?

A

BLOCK leukotriene receptors

55
Q

Holy shit: MonteLukast (Singulair) possibly associated with mood and _____!

A

suicide

56
Q

What is the DRUG OF CHOICE for reducing inflammation??

A

STEROIDS!

57
Q

What are the 3 types of immune cell STEROIDS inhibit to therefore inhibit inflammation?

A

1.Basophils 2.Eosinophils 3.Leukocytes

58
Q

What was the FIRST OTC steroid preparation?

A

triamcinolone acetonide (Nasacort)

59
Q

What is the #1 risk of Nasacort (the first OTC steroid)?

A

Slowing the growth of children

60
Q

What are the 4 dental considerations with steroids?

A

1.oral candidiasis 2.susceptiblity to infection 3.delayed wound healing 4.Adrenal suppression

61
Q

What are the 2 indications for the SAFE drug Mast Cell Inhibitors?

A

1.Seasonal Allergies 2.Exercise-induced asthma

62
Q

What is the ONLY Mast Cell Inhibitor to know?

A

CroMolyn (because that has to do with MAST cells?! wtf)

63
Q

DR. S SAID TO KNOW THIS ONE! What is the DRUG OF CHOICE (class and generic name) for EMPHYSEMA?

A

Anticholinergic–IPRA-TROP-IUM (Dr. S said to know this one)

64
Q

What is the mech for ipratropium? Blocks the action of _______ at parasympathetic sites in bronchial smooth muscle causing broncho_______; decreases _____ levels

A

acetylcholine….dilation…cGMP

65
Q

What is the REALLY important DENTAL side effect of ipratropium?

A

DRY Mucus MEMBRANES

66
Q

Asthma, this blows my gord– ________ leads to problems
with craniofacial development: vaulted palate, increased anterior facial height 􏰀 greater over jet, higher prevalence of crossbite

A

mouthbreathing

67
Q

Medication-Related Oral Care Considerations with Asthma-_________ from beta 2 agonists -bacterial, fungal and viral infections

A

xerostomia

68
Q

potential for acid erosion of enamel _______ and ________ exacerbate reflux disease

A

beta agonists…theophylline (methylxanthine)

69
Q

Inhaled steroids cause acute ___________ form of candidiasis…How do Pts prevent this??

A

acute pseudomembranous…rinse thoroughly after use!

70
Q

A common side effect of anti-leukotrienes, theophylline, some antihistamines

A

Headache

71
Q

Tx an Astma Pt: When is the best time to schedule an asthma patient?

A

Late morning, most attacks are at NIGHT

72
Q

Tx an Astma Pt: _______ is a good Tx for reducing stress/anxiety (Dr. Caputo!)

A

Nitrous Oxide

73
Q

Tx an Astma Pt: Avoid ______ because they release histamine!!!

A

OPIATES

74
Q

Tx an Astma Pt: What type of anesthesia is CONTRAINDICATED?

A

Outpatient General Anesthesia

75
Q

haha HW like Question: ASTHMA ATTACK—First 3 steps!

A

1.Epinephrine (0.3-0.5mg) 2.Oxygen 3.Bronchodilators (albuterol)

Pharm Part II (28 decks)

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