Lung Pathology and Pharmacology

Question 1

What is atelectasis?

Answer 1

Inadequate expansion of airspaces

Question 2

Acute Respiratory Distress Syndrome (ARDS)

Answer 2

Caused by trauma to the lung resulting in inflammation resulting in generalized fluid accumulation (progression of acute injury and damage from activated NEUTROPHILS)-high rate of fatalities

Question 3

COPD

Answer 3

(congestive obstructive pulmonary disease: emphysema, asthma, bronchietasis)

Question 4

Emphysema

Answer 4

destruction of alveolar walls and permanent enlargement of airspaces

Question 5

Chronic bronchitis

Answer 5

(persistent cough > 3 months in 2 consecutive years): smoking, air pollution

Question 6

Bronchiectasis

Answer 6

(obstruction of bronchi and persistent necrotizing infections): destruction of elastin and muscles in bronchial walls

Question 7

Three characteristics of Asthma

Answer 7

(reactive airway disease and narrowing of airways-hyperreactivity):

1. Hyperinflated lungs,
2. Thick mucus plugs in airways
3. Smooth muscle hypertrophy

Question 8

Fibrosing lung diseases is associated with…

Answer 8

Collagen vascular diseases such as rheumatoid arthritis

Question 9

Occupational lung diseases

Answer 9

(restrictive, e.g., mineral dust-induced, silicosis, asbestosis [mesothelioma])

Question 10

Sarcoidosis

Answer 10

Abnormal connective tissue and reduced elastic propertis; multi-organ involvement)

Question 11

Pulmonary embolus originate from what location in the body?

Answer 11

Deep veins in legs

Question 12

Two causes of pulmonary hypertension

Answer 12

1. Heart disease

2. Recurrent thromboemboli

Question 13

Restrictive lung disease

Answer 13

Caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs

Question 14

Vascular lung disease

Answer 14

Gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious

Question 15

Obstruction lung disease

Answer 15

Blocked airways; gas exchange through septal walls NOT impaired; unable to exhale

Question 16

What causes tuberculosis?

Answer 16

Mycobacterium tuberculosis

Question 17

5 Characteristics of Tuberculosis

Answer 17

1. Usually lungs but can affect other organs
2. Flourishes in crowded, impoverished areas
3. Non-contagious during long periods of dormancy
4. Problems with multidrug antibiotic resistance
5. Forms necrotizing granulomas

Question 18

How much more likely is a smoker to develop a lung tumor?

Answer 18

55X more than the general population

Question 19

What percent of primary lung cancers are carcinomas?

Answer 19

95%

Question 20

What cell types are most common in lung cancer?

Answer 20

Adeno and squamous

Question 21

What 2 groups of people have a higher prevalence of asthma?

Answer 21

Females and children

Question 22

What are typical relievers for asthma?

Answer 22

Beta2 agonist at minimum dose and frequency

Question 23

What is the mechanism of action for asthma relievers?

Answer 23

Directly relax airway & smooth muscle

Question 24

What is the speed of onset and time of effect for albuterol and salmeterol

Answer 24

• Albuterol (rapid onset and 4-6 hrs)

- Salmeterol (slower onset, 12 hrs)

Question 25

(T/F) Asthma relievers are most effective for severe cases.

Answer 25

False

Question 26

(T/F) Asthma relievers are short-acting

Answer 26

True

Question 27

What are the dental side effects of asthma controllers?

Answer 27

Nose bleeds, sores in nose, mouth, tongue that doesn’t heal

Question 28

(T/F) Asthma controllers are best for long-term stability

Answer 28

True

Question 29

(T/F) Asthma controllers often have few side effects.

Answer 29

False

Question 30

What is the most common asthma controller?

Answer 30

- Inhaled corticosteroids (Fluticasone) | - chronic management, not for rescue

Question 31

What is a common add-on controller for asthma?

Answer 31

Methylxanthine drugs; theophylline (tablet or inhaler)

Question 32

What is the mechanism of add-on asthma controllers?

Answer 32

Phosphodiesterase inhibitor and increases cAMP and relaxes airway smooth muscle

Question 33

Add-on asthma controllers can be used by themselves for:

Answer 33

Mild asthma

Question 34

What is the advantage to combining an add-on asthma controller to a corticosteroid?

Answer 34

Reduce steroid doses and side effects

Question 35

Example and function of antimuscarinics

Answer 35

- Ipratropium | - Reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists

Question 36

Example and mechanism of Leukotriene modifiers

Answer 36

- Montelukast (Singulair) | - block leukotriene-binding to receptor

Question 37

Who is the ideal patient for a leukotriene modifier?

Answer 37

Patients who have trouble with inhaled therapies (e.g., nasal bleeding) because it can be taken orally. Also use for prophylaxis

Question 38

Cromolyn

Answer 38

inhibits release of inflammatory mediators such as histamine

Question 39

Omalizumab

Answer 39

inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma

Question 40

What are 3 struggles a dentist might have with an asthma patient?

Answer 40

- Asthmatics tend to be mouth breathers—dry mouth - Asthma inhalers irritate muscosa of mouth, especially back of roof of mouth - Make sure asthmatics bring inhalers to appoint: avoid asthma attacks

Question 41

2 causes of COPD?

Answer 41

- Long smoking hx, or exposure to environmental irritants | - Airflow limitations-due to progressive, irreversible airway remodeling

Question 42

3 typical treatments of COPD?

Answer 42

1. Longer acting bronchodilators such as tiotropium bromide (Spireva) 2. Longer acting beta 2 agonists such as salmeterol 3. Theophylline with glucocorticoids

Question 43

(T/F) Responses to treatment in COPD are typically better than those responses in asthma patients.

Answer 43

False

Question 44

Typical influenza treatment, and how it works?

Answer 44

Oseltamivir (Tamiflu)-prevents separation of virus particle from cell receptors, stopping viral spread—earlier treatment essential

Question 45

What are 3 forms of Nicotine replacement therapy (NRTs)?

Answer 45

1. Gum 2. Transdermal patch 3. Nasal spray

Question 46

What are the 3 options for antismoking pharmacology?

Answer 46

1. Nicotine replacement therapy (NRTs) 2. Bupropion-Wellbutrin or Zyban: antidepressant 3. Varenicline (Chantix)- partial nicotine agonist-relieves craving of smoking.

Question 47

What are 3 causes for Atalectasis

Answer 47

1. Aspiration 2. Pneumothorax 3. Pleural fibrosis

Question 48

Are glucocorticoids alone an effective treatment for COPD?

Answer 48

No

Question 49

Inhaled corticosteroids are sometimes used with what type of drug to be an effective asthma controller?

Answer 49

Beta 2 agonists

Question 50

Cor pulmonale

Answer 50

Right ventricle failure

Question 51

Three causes for pulmonary embolis

Answer 51

1. Prolonged bed rest 2. Surgery 3. Congestive heart failure

Question 52

Is sarcoidosis restrictive, obstructive or vascular?

Answer 52

Restrictive

Question 53

Emphysema has a deficiency of what?

Answer 53

alpha-1 antitrypsin deficiency