E2: Respiratory Part 2 -COPD

Question 1

What are 3 things that are driving chronic bronchitis/COPD?

Answer 1

1.exessive sputum 2.Collapse of peripheral airways 3.Smooth muscle hyperplasia

Question 2

1 Etiology of Chonic Bronchitis? What is the 2nd one if the first one not present?

Answer 2

1. SMOKING DAWG 2.Recurrent Bronchial infections in non-smokers

Question 3

Symptoms of Chronic Bronchitits-excessive ____ in blood = severe debilitation

Answer 3

CO2

Question 4

Symptoms of Chronic Bronchitits- pulmonary hypertension = _____-sided heart failure

Answer 4

right-

Question 5

Symptoms of Chronic Bronchitits- they are often called “______” because they are CYANOTIC!

Answer 5

“blue bloaters”

Question 6

SAY WHAT?? Chronic Bronchitis- total lung capacity is ______; slight elevation in residual volume

Answer 6

NORMAL

Question 7

What class and generic names are Mucinex and Robitussin?

Answer 7

they are Expectorants….GUA-IF——EN——-ES-IN

Question 8

What is the mech of action for Mucinex?

Answer 8

loosens phlegm, thins secretions by UPSETTING THE STOMACH!!!! (added to opiates to prevent O.D.)

Question 9

COOL mechanism of Anti-Tussive drugs (dextroMETHorphan-Robitussin/Vicks 44)-Mechanism: depresses cough center in ______; chemical relative of _______ lacking narcotic properties except in overdose

Answer 9

medulla… morphine

Question 10

PATHOPHYS of Emphysema: smoke damages the alveolar epithelium–>release of inflammatory mediators that attract _______—>they release _______ that DESTROYS alveolar walls–>enlarged air spaces means loss of _______ of the lung.

Answer 10

neutrophils…ELASTASE….Elastic RECOIL

Question 11

Emphysema: obstruction is caused by collapse of these unsupported air spaces on _________..NO obstruction exists during ________

Answer 11

expiration…. inspiration

Question 12

Emphysema is either smoking caused or genetic alpha ________ deficiency

Answer 12

ANTI-TryPSIN

Question 13

What is associated with ‘PINK PUFFING’? What is associated with ‘BLUE BLOATERS’?

Answer 13

PINK PUFFING=EMPHYSEMA….BLUE BLOATERS=CHRONIC BRONCHITIS

Question 14

Clubbing of fingers and toes (watch glass nails) is a result of _________ in emphysema.

Answer 14

chronic oxygen deficit

Question 15

AGAIN! What is the DRUG OF CHOICE for emphysema?

Answer 15

ipraTropium (Atrovent)

Question 16

What are 4 meds used to Tx Emphysema…Be careful here. all cross over from earlier lecture.

Answer 16

1.ipratropium 2.beta adrenergic agonists 3.corticosteroids 4.xanthines

Question 17

What do ALL emphysema meds ULTIMATELY look to produce?

Answer 17

bronchodilaton to reduce the WORK of breathing

Question 18

Dental Treatment Considerations for Patients with COPD: promote _________ = reduces rate of progression

Answer 18

smoking cessation

Question 19

Dental Treatment Considerations for Patients with COPD: watch for wheezing, orthopnea while recumbent = seat
patient in a _________ position

Answer 19

semi-reclining

Question 20

Dental Treatment Considerations for Patients with COPD: activate EMS for __________

Answer 20

acute respiratory distress

Question 21

Dental Treatment Considerations for Patients with COPD: AVOID ________ AND _________ = cause respiratory depression

Answer 21

opiates and barbiturates (sedatives)

Question 22

Dental Treatment Considerations for Patients with COPD: “Red flag” drug interactions: avoid _______ antibiotics and ciprofloxacin if taking ________ = toxicity reaction

Answer 22

macrolide…theophylline

Question 23

Dental Treatment Considerations for Patients with COPD: if severe COPD, patient is at risk for developing pulmonary hypertension, increasing risk for cardiac _______ = avoid stress

Answer 23

arrhythmias

Question 24

Dental Treatment Considerations for Patients with COPD: INTERESTING!!! oxygen (versus CO2) becomes drive for
ventilation: if given too much oxygen, may induce _________!

Answer 24

apnea/acute respiratory failure

Question 25

Dental Treatment Considerations for Patients with COPD: ________ monitoring is advised: Low flow oxygen may be necessary

Answer 25

pulse oximetry

Question 26

Dental Treatment Considerations for Patients with COPD: limit oxygen to less than __ L/minute…deliver by nasal cannula during stressful/painful dental procedures

Answer 26

3 L/minute

Question 27

Dental Treatment Considerations for Patients with COPD: promote annual pneumococcal and influenza _________

Answer 27

vaccinations

Question 28

Dental Treatment Considerations for Patients with COPD: can we use Nitrous oxide?

Answer 28

AVOID!

Question 29

Dental Treatment Considerations for Patients with COPD: Can we use spray topical anesthetics?

Answer 29

AVOID!