E2: Respiratory Part 1 ASTHMA(I'll give you asthma!) Flashcards
oxygen saturation is measured with a _________…Acceptable normal ranges are from ___ to ___% percent, although values down to ___% are common.
pulse oximeter…95 to 100….90%
Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…Persistent symptoms for at least ___ days without improvement..BUT _____ of illness ALONE is unreliable
10 days.. Duration
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
Severe… imaging (can’t tell on a scan)
Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…What % of acute Rhinosinusitis cases are VIRAL?
98% are viral!!!
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?
Amoxicillin, Clavulanate…if allergic Clindamycin!
Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…What drugs should you avoid in ACUTE Sinusitis?
Decongestants and Antihistamines
What are the 4 drugs recommended in Sinusitis/Allergic Rhinitis?
1.PseudoEphedrine 2.AntiHistamines 3.Analgesics 4.Antibiotics (if bacterial OF course)
DENTAL DRUG INTERACTION!!! Use _________ (vasoconstrictor) with caution with DECONGESTANTS, as these drugs are ________ and may enhance cardiac stimulation (tachycardia) and elevate blood pressure!!!
epinephrine…sympathomimetics
Why is it important to ask the patient if they are taking claratin-D vs regular claratin?
D (decongestant) is a Sympathomimetic and will tag team with EPI
What was the new rhinitis drug in 2012 that is a “dry” nasal corticosteriod?
QNASL Nasal Areosol
Oh I’ll give you ASTHMA! Recurrent bronchial ______ spasm, inflammation, swelling of bronchial mucosa, hypersecretion of _______
smooth muscle… mucous
Oh I’ll give you ASTHMA! What is the most common form? What age group is it usually seen in?
Extrinsic Asthma-seasonal allergens, pollen, dust mites, animal dander…children and young adults
Oh I’ll give you ASTHMA! IT IS A _____ response relationship between allergen exposure and ____ (WHAT ANTIBODY??) mediated sensitization, positive skin test, family Hx
DOSE…IgEEEEEE
Oh I’ll give you ASTHMA! During attack, _____ antibodies affixed to _____ cells along bronchial tree
IgEEEEEE…MAST
Oh I’ll give you ASTHMA! histamine = broncho________; _______ vascular permeability
constriction….increased
Oh I’ll give you ASTHMA! _________ = smooth muscle spasm; increased vascular permeability; attract
leukotrienes
Oh I’ll give you ASTHMA! What type of immune cells prolong inflammatory response?
T lymphocytes
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
INTRINSIC asthma
Oh I’ll give you ASTHMA! Intrinsic asthma is associated with ENDOGENOUS causes: emotional _____; _____
stress… GERD
DID YOU KNOW that these drugs aspirin, NSAIDS, cholinergics, beta blockers, ACE inhibitors, barbiturates, opiates can INDUCE _______
ASTHMA!!!
YOU DID KNOW THIS….Thanks Steve!!! Asthmatics are more likely to have hypersensitivity reaction to _____! (incidence ranges from 5-15%)
ASPIRIN
What is the “Aspirin Hypersensativity Triad”?
1.Aspirin Hypersensativity 2.Asthma 3.Nasal Polyps
Why in the world do some asthmatics have an aspirin allergy?? Aspirin Inhibits bronchodilating _____…Allergic reactions = mimic _______
PGE2…asthma attack
How many exposures does it usually take to develop an aspirin sensitivity with asthma?
about 15 exposures
There is EVEN as CROSS SENSATIVITY with asthmatics-aspirin-and _______
NSAIDS (Tylenol ONLY!)
What is the preservative that can cause asthma (found in food and some inhalers even!)?
Sulfite
What age group is most effected by exercise-induced asthma?
children and young adults
Say what?! There is ______ asthma, caused by an inflammatory response of bronchi to infection
Infectious asthma
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!!
Status Asthmaticus!
What is the likely cause of Status Asthmaticus? What can happen w/o intervention??
Respirtatory INFECTION…DEATH can result
Symptoms of Asthma (I’ll give you asthma!): termination of attack is accompanied by _________: thick, stringy mucous episodes are SELF-limiting
productive cough
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%
Mild (intermittent OR persistent)
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%
Moderate
Which class of Asthma Am I ??? ongoing symptoms that limit activity…frequent attacks, at night…occasional need for emergency hospitalization; FEV
Severe
Asthma Med Consider this: FOR _________ asthma = rescue bronchodilator prn
mild intermittent
Asthma Med Consider this: FOR ________ asthma = anti-inflammatory drug with low dose inhaled corticosteroid, cromolym or anti-leukotriene
mild persistent
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
moderate persistent
Asthma Med Consider this: FOR ________ asthma = daily medications…high-dose inhaled corticosteroid with long acting bronchodilator and oral corticosteroid
severe persistent
Asthma is often under treated. The MAN Recommends ________ as preferred therapy for mild persistent asthma, but providers disregard due to perceptions of risk/benefit
inhaled corticosteroids
DAAANG! In a survey of 1000 people, ___% did not use asthma controller medications. Even if they did 85% had poorly controlled disease
49%
_________ are Important RESCUE drugs for asthma = “inhalers”
Beta Adrenergic Stimulants
Beta Adrenergic Stimulants target _______ receptors in airway
beta 2
Which drug is in ALL DENTAL EMERGENCY KITS for SHORT acting asthma drugs?
albuterol…(levalBUTEROL (Xopenex HFA)….pirBUTEROL
What are 2 examples of LONG acting Beta Adrenergic stimulants?
- SAL-MET-EROL (Severent Diskus) 2.SAL-MET-EROL WITH FluTICaSone (ADVAIR Disckus)
What is the duration of salmeterol?
12 hours (long acting)
What is the name of the steroid in Advair?
Fluticasone
Woot Woot! Dental Considerations with inhalers: 3 main ones:
1.Taste alteration 2.oral candadiasis 3.hyper-reflexive airway (boy who cried wolf)
What are you going to ask your asthma patient? Tell them to BRING THEIR _______!
HOW OFTEN do you use your inhaler? If more than 2x, refer for better Tx!…BRING THEIR INHALERS!
What is the RED FLAG DRUG IN DENTISTRY from this Section? What 2 medications does it clash with for this special honour?
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)
What are the three possible side effects if I mix erythromycin and theosophylline?
(antibiotics and methylXanthine-red flag dental drugs) 1.CNS Stimulation(nausea/vomiting) 2.cardiac effects 3.seizures
The Red Flag MethylXanthines block ________ which INCREASES cAMP
PhosphoDiesterase
Leukotrienes = chemical mediators that produce similar effects to _______
histamine
What is the mech for zileutron (Zyflo) (leukotriene)?
inhibits the SYNTHESIS of leukotrienes
What is the mech for zafirlukast (Accolate), montelukast (Singulair)?
BLOCK leukotriene receptors
Holy shit: MonteLukast (Singulair) possibly associated with mood and _____!
suicide
What is the DRUG OF CHOICE for reducing inflammation??
STEROIDS!
What are the 3 types of immune cell STEROIDS inhibit to therefore inhibit inflammation?
1.Basophils 2.Eosinophils 3.Leukocytes
What was the FIRST OTC steroid preparation?
triamcinolone acetonide (Nasacort)
What is the #1 risk of Nasacort (the first OTC steroid)?
Slowing the growth of children
What are the 4 dental considerations with steroids?
1.oral candidiasis 2.susceptiblity to infection 3.delayed wound healing 4.Adrenal suppression
What are the 2 indications for the SAFE drug Mast Cell Inhibitors?
1.Seasonal Allergies 2.Exercise-induced asthma
What is the ONLY Mast Cell Inhibitor to know?
CroMolyn (because that has to do with MAST cells?! wtf)
DR. S SAID TO KNOW THIS ONE! What is the DRUG OF CHOICE (class and generic name) for EMPHYSEMA?
Anticholinergic–IPRA-TROP-IUM (Dr. S said to know this one)
What is the mech for ipratropium? Blocks the action of _______ at parasympathetic sites in bronchial smooth muscle causing broncho_______; decreases _____ levels
acetylcholine….dilation…cGMP
What is the REALLY important DENTAL side effect of ipratropium?
DRY Mucus MEMBRANES
Asthma, this blows my gord– ________ leads to problems
with craniofacial development: vaulted palate, increased anterior facial height greater over jet, higher prevalence of crossbite
mouthbreathing
Medication-Related Oral Care Considerations with Asthma-_________ from beta 2 agonists -bacterial, fungal and viral infections
xerostomia
potential for acid erosion of enamel _______ and ________ exacerbate reflux disease
beta agonists…theophylline (methylxanthine)
Inhaled steroids cause acute ___________ form of candidiasis…How do Pts prevent this??
acute pseudomembranous…rinse thoroughly after use!
A common side effect of anti-leukotrienes, theophylline, some antihistamines
Headache
Tx an Astma Pt: When is the best time to schedule an asthma patient?
Late morning, most attacks are at NIGHT
Tx an Astma Pt: _______ is a good Tx for reducing stress/anxiety (Dr. Caputo!)
Nitrous Oxide
Tx an Astma Pt: Avoid ______ because they release histamine!!!
OPIATES
Tx an Astma Pt: What type of anesthesia is CONTRAINDICATED?
Outpatient General Anesthesia
haha HW like Question: ASTHMA ATTACK—First 3 steps!
1.Epinephrine (0.3-0.5mg) 2.Oxygen 3.Bronchodilators (albuterol)
