Lung Pathology and Pharmacology Flashcards
What is atelectasis?
Inadequate expansion of airspaces
Acute Respiratory Distress Syndrome (ARDS)
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
COPD
(congestive obstructive pulmonary disease: emphysema, asthma, bronchietasis)
Emphysema
destruction of alveolar walls and permanent enlargement of airspaces
Chronic bronchitis
(persistent cough > 3 months in 2 consecutive years): smoking, air pollution
Bronchiectasis
(obstruction of bronchi and persistent necrotizing infections): destruction of elastin and muscles in bronchial walls
Three characteristics of Asthma
(reactive airway disease and narrowing of airways-hyperreactivity):
- Hyperinflated lungs,
- Thick mucus plugs in airways
- Smooth muscle hypertrophy
Fibrosing lung diseases is associated with…
Collagen vascular diseases such as rheumatoid arthritis
Occupational lung diseases
(restrictive, e.g., mineral dust-induced, silicosis, asbestosis [mesothelioma])
Sarcoidosis
Abnormal connective tissue and reduced elastic propertis; multi-organ involvement)
Pulmonary embolus originate from what location in the body?
Deep veins in legs
Two causes of pulmonary hypertension
- Heart disease
2. Recurrent thromboemboli
Restrictive lung disease
Caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs
Vascular lung disease
Gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious
Obstruction lung disease
Blocked airways; gas exchange through septal walls NOT impaired; unable to exhale
What causes tuberculosis?
Mycobacterium tuberculosis
5 Characteristics of Tuberculosis
- Usually lungs but can affect other organs
- Flourishes in crowded, impoverished areas
- Non-contagious during long periods of dormancy
- Problems with multidrug antibiotic resistance
- Forms necrotizing granulomas
How much more likely is a smoker to develop a lung tumor?
55X more than the general population
What percent of primary lung cancers are carcinomas?
95%
What cell types are most common in lung cancer?
Adeno and squamous
What 2 groups of people have a higher prevalence of asthma?
Females and children
What are typical relievers for asthma?
Beta2 agonist at minimum dose and frequency
What is the mechanism of action for asthma relievers?
Directly relax airway & smooth muscle
What is the speed of onset and time of effect for albuterol and salmeterol
- Albuterol (rapid onset and 4-6 hrs)
- Salmeterol (slower onset, 12 hrs)
(T/F) Asthma relievers are most effective for severe cases.
False
(T/F) Asthma relievers are short-acting
True
What are the dental side effects of asthma controllers?
Nose bleeds, sores in nose, mouth, tongue that doesn’t heal
(T/F) Asthma controllers are best for long-term stability
True
(T/F) Asthma controllers often have few side effects.
False
What is the most common asthma controller?
- Inhaled corticosteroids (Fluticasone)
- chronic management, not for rescue
What is a common add-on controller for asthma?
Methylxanthine drugs; theophylline (tablet or inhaler)
What is the mechanism of add-on asthma controllers?
Phosphodiesterase inhibitor and increases cAMP and relaxes airway smooth muscle
Add-on asthma controllers can be used by themselves for:
Mild asthma
What is the advantage to combining an add-on asthma controller to a corticosteroid?
Reduce steroid doses and side effects
Example and function of antimuscarinics
- Ipratropium
- Reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists
Example and mechanism of Leukotriene modifiers
- Montelukast (Singulair)
- block leukotriene-binding to receptor
Who is the ideal patient for a leukotriene modifier?
Patients who have trouble with inhaled therapies (e.g., nasal bleeding) because it can be taken orally. Also use for prophylaxis
Cromolyn
inhibits release of inflammatory mediators such as histamine
Omalizumab
inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma
What are 3 struggles a dentist might have with an asthma patient?
- 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
2 causes of COPD?
- Long smoking hx, or exposure to environmental irritants
- Airflow limitations-due to progressive, irreversible airway remodeling
3 typical treatments of COPD?
- Longer acting bronchodilators such as tiotropium bromide (Spireva)
- Longer acting beta 2 agonists such as salmeterol
- Theophylline with glucocorticoids
(T/F) Responses to treatment in COPD are typically better than those responses in asthma patients.
False
Typical influenza treatment, and how it works?
Oseltamivir (Tamiflu)-prevents separation of virus particle from cell receptors, stopping viral spread—earlier treatment essential
What are 3 forms of Nicotine replacement therapy (NRTs)?
- Gum
- Transdermal patch
- Nasal spray
What are the 3 options for antismoking pharmacology?
- Nicotine replacement therapy (NRTs)
- Bupropion-Wellbutrin or Zyban: antidepressant
- Varenicline (Chantix)- partial nicotine agonist-relieves craving of smoking.
What are 3 causes for Atalectasis
- Aspiration
- Pneumothorax
- Pleural fibrosis
Are glucocorticoids alone an effective treatment for COPD?
No
Inhaled corticosteroids are sometimes used with what type of drug to be an effective asthma controller?
Beta 2 agonists
Cor pulmonale
Right ventricle failure
Three causes for pulmonary embolis
- Prolonged bed rest
- Surgery
- Congestive heart failure
Is sarcoidosis restrictive, obstructive or vascular?
Restrictive
Emphysema has a deficiency of what?
alpha-1 antitrypsin deficiency
