Pulmonary Flashcards
What is the most common form of Asthma?
Atopic asthma is the most common type of asthma and involves stimulation of Th2 responses by inhaled antigens, leading to type I immunoglobulin-E–mediated hypersensitivity reactions
What is Nonatopic or Intrinsic Asthma?
- Usually ASA sensitive
- Show later disease onset
What is exercise induced asthma?
- Hyperventilation triggers mast cell mediator release
- More comon in cold, dry climates
What are the 5 classifications of Asthma?
- Mild Intermittent
- Mild Persistent
- Moderate Persistent
- Severe Persistent
- Very Severe Persistent
What drugs can all forms of Asthma benefit from?
Short acting B2 agonist for symptom relief
How do you treat Mild Persistent Asthma?
- Short acting B2 agonist for symptom relief
- Inhaled Corticosteroid
How would you treat Moderate Persistent Asthma?
- Short acting Bw agonist for symtom relief
- Inhaled Corticosteroid
- Long Acting Beta Agonist
How do you treat Severe Persistent Asthma?
- Short acting B2 agonist for symptom relief
- High Dose Inhaled Corticosteroid
- Long Acting Beta Agonist
How do you treat a patient with Very Severe Persistent Asthma?
- Short acting B2 agonist for symptom relief
- Inhaled Corticosteroid High Dose
- Long Acting Beta Agonist
- Oral Corticosteroid
Describe Low Risk Asthma Risk Stratification…
- Infrequent episodes
- Normally do not require chronic use of maintenance medications
- Normal treatment protocol
Describe Moderate Risk regarding Asthma Risk Stratification…
- History of intermittent attacks
- Require medical supervision and chronic maintenance therapy
- Acute therapy meds available
Describe the Significant Risk in regards to Asthma Risk Stratification…
- Frequent episdoes in spite of maintenance meds
- Treat only when asymtomatic
- Possible Consult
- Consider treatment in hospital setting for extensive surgical treatment
Describe High Risk for Asthma Risk Stratification…
- Symptomatic at time of treatment
- Audible Wheezing
- Signs of medciation side effects (tachycardia)
- Refer to physician prior to elective treatment
- Palliative emergency care only
How do you dentally manage an asthma patient?
- Determine severity of asthma present
- Hospital admissions
- ER visits
- Inhaler brought to all appointments
- Consider use of B2 agonist inhaler pre-op
What 2 drugs should you avoid giving asthma patients?
- Aspirin
- Demerol
Why should you avoid giving an asthma patient aspirin?
Why should you avoid giving Demrol to a patient with Asthma?
- Meperidine (Opioid) should be used with extreme caution in patients having an acute asthmatic attack,
- Patients with chronic obstructive pulmonary disease or cor pulmonale, patients having a substantially decreased respiratory reserve, and patients with preexisting respiratory depression, hypoxia, or hypercapnia.
- In such patients, even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea.
What is COPD?
Describe Chronic Bronchitis…
- Excess mucus production that causes cough for at least 3 months of the year for last 2 years
- Smokers over age 40
Describe Emphysems…
- Distention of air spaces distal to terminal bronchioles due to destruction of alveolar walls
How do you dentall manage a COPD patient?
- Review medical history for concurrent disease
- Hypertension
- Coronary artery disease
- Patient comfort/ability to breathe
- Monitor vital signs
- Pulse Oxymetry
Is administering epinephrine in a COPD patient safe?
- No contraindications for local anesthesia with epinephrine
What should you consider supplementing a COPD patient with?
Supplemental oxygen if oxygen saturation < 95%
How should you approach Nitrous Oxide Sedation regarding a COPD patient?
- Caution with mild to moderate COPD
- Avoid with severe COPD
What is Theophyline?
A bronchodilator used to treat emphysema and chronic bronchitis
How would you assess/dentally manage an Unstable COPD patient?
- Shortness of breath at rest
- Productive cough
- Upper respiratory tract infection
- Oxygen Saturation < 91%
- Reschedule appointment
- Appropriate medical referral