Pulmonary Disease Flashcards
what are the types of pulmonary disease
- asthma
- chronic obstructive pulmonary disease: bronchitis and emphysema
- tuberculosis
what is asthma
- chronic inflammatory airway disorder
- airway hyper responsiveness to stimuli
- bronchial edema
- narrowing of the ariways- obstruction
what are the signs and symptoms of asthma
- recurrent and reversible episodes of:
- dyspnea
- wheezing
- coughing
-tightness of chest
which is a true asthma symptom
tightness of chest
what are the aggravating/complicating factors of asthma
- smoking
- air pollutants: urban and industrial
what are the stages of asthma
- controlled
- partially controlled
- uncontrolled
how frequent are the daytime symptoms and need for rescue meds in controlled asthma
- twice or less per week
how frequent are the daytime symptoms and need for rescue meds in partially controlled asthma
- more than twice a week
how frequent are the daytime symptoms and need for rescue meds in uncontrolled asthma
three or more features of partiallly controleld asthma present in any week
what are the types of asthma
- extrinsic
- exercise induced
- intrinsic
- drug induced
describe extrinsic asthma and another name for it
- allergic or atopic
- most common
- children and young adults
- typical fam hx
- triggered by allergesn-pollen, dust, house mites, animal dander, mold
- exaggerated inflammatory responsew
what is the mechanism of extrinsic asthma
allergen -> T helper lymphocyte type 2 (Th2) -> antibody production of high levels of IgE -> activation of mast cells, basophils, and eosinophils -> bradykinin, histamine, leukotrienes -> bronchoconstriction
describe exercise induced asthma
- unknown pathogenesis
- children and young adults
- triggered by exercise and thermal changes
-cold air irritates mucosa resulting in airway hyperactivity
describe instrinsic asthma and another name for it
- idiosyncratic, nonallergic, non atopic
- second most common
- middle aged individuals
- triggered by respiratory irritants (tobacco, air pollution, emotional stress, gastroesophageal reflux disease)
- infrequently associated with fam hx
- normal IgE levels
what is the mechanism in instrinsic asthma
- allergen -> activation of mast cells, basophils and eosinophils -> bradykinin, histamine, interleukines, leukotrienes -> bronchoconstriction
describe drug induced asthma
- subset of intrinsic
- affects children, young adults, and middle aged adults
- common antigens
what common antigens cause drug induced astham
- NSAIDs, ASA
- beta blockers
- ACEi
- anticholinergic drugs
- food dye
- metabisulfites in food and in local anesthetics with epinephrine
what are the types of treatments for asthma
- inhaled beta 2 agonists
- short acting beta 2 agonists
- long acting beta 2 agonists
what do the inhaled beta 2 agonists do for asthma tx
- bind to beta2 receptors in lungs smooth muscle relaxation
- bronchodilation
what are the short acting beta 2 agonists used for
single use (rescue) meds used alone
what do the long acting beta 2 agonists do for asthma
- used in combination with steroids on a scheduled protocol
- used alone leads to CVD complications
what are the side effects of asthma treatments
- tremors, tachcyardia
- increases blood sugar
- cough
- K+ decrease
what is an example of a short acting beta 2 agonist
albuterol
what is an example of an anticholinergic med used to treat asthma
- atrovent
- spiriva
what is an example of a methylxanthine used to tx asthma
theophylline
wwhat is an example of a mast cell stabilizer used to treat asthma
cromolyn
what is an example of a corticosteroid used to tx asthma
- dexamethasone
- fludrocortisone
- methylprednisone
- prednisone
what is an example of leukotriene receptor antagonists used to treat asthma
singulair
what is an example of combination inhalers used to tx asthma
- advair diskus
- symbicort
what are the oral signs of asthma
- mouth breather: high palatal vault, overjet, crossbite, greater facial height
- dry mouth
- candida
- enamel defects and caries
- gingivitis/periodontitis
- enamel erosion possible with GERD
what are the dental tx considerations with unstable asthma
- dental treatment should be limited to urgent care only
- treatment of acute pain, bleeding or infection
what are the dental tx considerations with stable asthma
- any indicated dental tx may be provided if management protocols are considerd
- consult with physician for severe persistent asthma
what are the drug interactions with asthma and what do they do
- aspirin can trigger asthma
- NSAIDs can trigger asthma
- opiods and barbituates: respiratory depression
- sulfites in epinephrine preparation of local anesthetics
- theophylline and macrolides or ciprofloxacin: potent inhibitor of CYP3A4. increases levels of theophylline. toxicity causing arrythmia and seizures)
- cholinergic agonists: effect of cholinergic agents promotes bronchoconstriction. sialogogues are contraindicated in pts with uncontrolled asthma
what is status asthmaticus
severe prolonged asthma attack that is more than 24 hours and life threatening
what are the overall dental treatment considerations for asthma
- avoid known precipitating factors
- reduce risk of attack
- have pt bring medication inhaler to each apppointment
- recommend prophylaxis with inhaler before appointments for those with moderate to severe asthma
what is the drug of choice for an acute attack
short acting beta 2 adrenergic agonist (inhaler)
what drugs should be avoided with astham
- aspirin, NSAIDs, narcotics, macrolide antibiotics like erythromycin
- sulfite (preservative) containing local anesthetics may need to be avoided
what are the sedation options for patients with asthma
- nitrous
- short acting benzodiazepine
what is the patient presentation of an asthma emergency
- RR greater than 25 breaths/min, labored breathing
- tachycardia greater than 110 BPM
- flushed apperance
what do you do with an asthma emergency
- stop tx, inform facult, administer O2, call 4444
- remove all items from pt mouth
- record the time of attack
-raise the dental chair - give short acting B2 adrenergic agonist inhaler
- administer O2
- administer 0.3-0.5ml of 1:1000 epi
- call an ambulance
- re-administer short acting beta 2 adrenergic agonist inhaler every 20 minutes until EMS arrives
- ER team will treat pt with bronchodilators and oral systemic corticosteroids
small doses of 1:1000 epi are:
smooth muscle dilators
what is chronic obstructive bronchiolitis
- obstruction of small airways
- excessive tracheobronchial mucus production to cause coughing and sputum production for more than 3 months and more than 2 consecutive years in the absence of infection or other causes of chronic cough
what is emphysema
-long term chronic obstructive bronchiolitis leads to destruction of lung parenchyma and alveolar walls
- decreased elastic recoil
- difficulty in maintaining airway opening during expiration
COPD is the ____ leading cause of death in the USA
3rd
what are the chracteristics of COPD causing death
- corticosteroid resistant progressive chronic inflammatory disease
- poorly reversible/irreversible airway obstruction
- entrapment of air and dyspnea upon exertion
what are the complicating factors of COPD
- smoking
- air pollutants - urban and industrial
- CVD: comborbidity
what are the signs and symptoms of COPD
- dyspnea
- cough
- sputum
- tightness in chest
what is the FEV in each stage of COPD
- stage 1: more than 80%
- stage 2: between 50-80%
- stage 3: between 30-50%
- stage 4: less than 30%
what is FEV
forced expiratory volume in 1s
what is FVC
forced vital capacity
exacerbations of COPD are triggered by:
- viral or bacterial infections
- haemophilus influenza
- streptococcus pneumoniae
complications of COPD:
- pulmonary HTN
- cor pulmonale (R sided heart enlargement)
- thoracic bullae
- nocturnal hypoxia
what are the comorbidies with COPD
- HTN
- ischemic heart disease
- heart failure
- MI
- muscle wasting
- osteoporosis
what is the tx for COPD
- inhaled long acting bronchodilators
- corticosteroids if asthma also present and/or more reversible obstruction
- smoking cessation is only intervention that actually reduced disease progression
what are the drugs used to treat COPD
same as asthma
what are the oral manifestations of COPD
- dry mouth
- steven johnson syndrome with theophylline
what are the side effects of smoking seen in COPD
- halitosis
- tooth staining
- nicotine stomatitis
- periodontal disease
- oral potentially malignant disorders: leukoplakia, erythroplakia
- oral SCC
what stage of COPD needs dental tx in hosptial
stage III and up
if less than stage III COPD how do we treat these patients
- place pt in semi supine position to avoid respiratory distress
- avoid using rubber dam
- avoid treating if upper respiratory infection is present
- local anesthetic with epi is acceptable and low flow O2 can be used
what meds should be avoided with COPD
- meds that cause respiratory depression: barbituates, narcotics, NO
- benzodiazepines
- erythromycin, macrolide antibiotics (clarithyromycin, azithromycin) and ciprofloxacin should not be prescribed to COPD patients already taking theophylline
what is TB
granulomatous infectious disease caused by mycobacterium tuberculosis
most common site of infection in TB:
lungs
TB can also effect:
cutaneous, lymphatic and other tissues due to the multiple species of mycobacterium
what species of mycobacterium can also be involved in TB
- m. kansasii
- m. bovis
- m. microti
- m. canetti
- m. avium complex
- m. abscessus
- m. africanum
WHO estimated _____ of the population is infected with TB
1/3
TB is the greatest ______ killer of humans
universal single pathogen
US rates of TB are low because of:
- better sanitation
- improved hygiene
- more efficient delivery of anti TB meds
what are the at risk populations in the US for TB
- racial and ethnic minorities
- inner city residents in conregate faciltiies
- immunocompromised patients - HIV, med suppressed, DM
TB is transmitted via:
- airborne transmission via infectious respiratory droplets from:
- coughing
- sneezing
- talking
- singing
what are the signs and symptoms of TB
- persistent, unexplained cough
- fever
- malaise
- night sweats
- unintentional weight loss
- hemoptysis
- dyspnea
what are the risk factors for TB
- individuals from countries with high incidence or prevalance of TB
- individuals who visited areas with high prevalence of active TB
- close contact with individuals who have TB
- individuals who reside or work in facilities with high risk exposure
- individuals who have had skin test conversion within the past 2. years
- individuals at increased risk of latent TB: medically disadvantaged, low income, alcohol or drug use disorder
- infants, children and adolescents exposed to individuals at increased risk of latent or active TB, individuals with a positive TB skin test
- incompletion of drug therapy duration (20%)
- multidrug resistant TB
what are the facilities with high risk exposure to TB
health care facilities, nursing homes, correctional faciltiies, homeless shelters, accommodations for the mentally disabled, refugee shelters
what is the TST test and describe
- Mantoux
- 95% sensitivity
- 75% specificity
what are the tests for TB and vaccine
- TST
- IGRA
- Bacille Calmette Guerin vaccination
what are the oral signs of TB
- uncommon
- more frequent presentation: deep irregular, painful ulcer on the tongue dorsum
- may occur in other areas: gingiva, lips, palate, buccal mucosa
- scrofula
what is scrofula
- TB involvement of cervical and submandibular lymph nodes
- lymph nodes are enlarged and painful
- abscess with purulence may be present
what people are at risk for progression to active TB
- immunocompromised patients
- HIV
- infants and children under 5 years old
- systemic corticosteroid takers and other immunosuppressant meds
- recent TB infection
- tobacco, alcohol and drug use
- individuals who weight less than 90% of ideal body weight
what are the diseases that are at risk for progression to active TB
- silicosis
- DM
- chronic renal failrue
- leukemia
- lymphoma
- solid organ transplant
- head and neck cancer
- lung cancer
what is the antibiotic regimen phases for TB and their length
- intensive phase: 8 weeks
- continuous phase: 18 weeks or longer
-multidrug resistance: 8- 20 months
what does the intensive phase of TB tx entail
- isoniazid
- rifampicin
- pyrazinamide
- ethambutol
describe isoniazid
- hepatotoxic - avoid acetominophen
- P450 inhibitor - increased concentration of other drugs
describe rifampicin
- hepatotoxic; impaired healing
- increased gingival bleeding
- P450 inducer
- decreased concentration of other drugs
what drugs are given in the continuous phase of TB tx
- isonizaid
- rifampicin
what drugs are given in the multidrug resistance phase in TB tx
- pyrazinamide
- a fluoroquinolone
- amikacin, kanamycin
- ethionamide
- cycloserine
how do you determine if a TB patient is noninfectious for dental tx
- pt has taken standard multidrug therapy for TB for 2-3 weeks
- pt has been compliant with standard multidrug therapy for TB
- three consecutive negative sputum smears on acid fast bacillus testing
- patient is clinically improved
- unlikely multidrug resistant TB
- all contacts were identified, evaluated, and began treatment for latent TB
if signs and symptoms of TB approach ask if:
sputum positive
what are the CDC guidelines for TB
same as COVID
