Respiratory Pharmacology

Question 1

Compare the difference between the mechanisms of action of zafirlukast (Accolate) and montelukast (Singulair) with zileuton (Zyflo).

Answer 1

Leukotriene Drugs = zafirlakast (Accolate) and montelukast (Singulair) - blocks leukotriene receptors, zileuton (Zyflo) - inhibits the synthesis of leukotrienes

Question 2

Describe the clinical manifestations that result from dental drug interactions with theophylline

Answer 2

CNS stimulation (nausea/vomiting) and increasing risk for seizures

Question 3

Describe the mechanism of action of beta adrenergic agonists in the management of asthma and chronic respiratory diseases.

Answer 3

Beta Adrenergic Agonists - stimulates alpha receptors = vasoconstriction, beta receptors = bronchial relaxation.

Question 4

Describe the mechanism of action of methylxanthines in the management of asthma and chronic respiratory diseases.

Answer 4

Methylxanthines - block phosphodiesterase which increases cAMP.

Question 5

Describe the mechanism of action of nasal decongestants.

Answer 5

Direct Alpha Adrenergic Stimulants - vasoconstriction to reduce edema. Mixed Function Adrenergic Stimulants - alpha and beta stimulation, direct and indirect effects (sympathomimetic). Orally Administered - directly stimulates alpha receptors of respiratory mucosa causing vasoconstriction, and beta receptors to cause bronchial relaxation.

Question 6

Discuss an important dental drug interaction associated with nasal decongestants.

Answer 6

Epinephrine - it’s a vasoconstrictor, nasal decongestants are sympathomimetics and may enhance cardiac stimulation (tachycardia) and elevate blood pressure

Question 7

Discuss the dental considerations associated with bronchodilators and glucocorticoid medications.

Answer 7

Taste alteration, Oral candidiasis, Overuse of inhalers = hyper-reflexive airway, Have patients bring their inhalers to appointments, Ask how often they use inhalers (more than once daily or 2 days per week = uncontrolled asthma)

Question 8

Discuss the mechanisms of action of mucolytics.

Answer 8

Mucolytics - exerts mucolytic action through its free sulhydryl group - opens up disulfide bonds in mucoproteins, lowering mucous viscosity.

Question 9

Discuss the mechanisms of action of expectorants.

Answer 9

Expectorants - irritation of stomach while stimulating respiratory fluid volume (lubricates) - decreasing mucous viscosity.

Question 10

Discuss the mechanisms of action of anti-tussive medications.

Answer 10

Anti-tussives - depresses cough center in medulla.

Question 11

Discuss why glucocorticoid medications are used to manage asthma.

Answer 11

Glucocorticoids are drugs of choice to reduce inflammation.

Question 12

Identify drugs that are associated with pulmonary disease.

Answer 12

Oxygen >40%, Sedatives, Beta blockers, Opiates, Aspirin, Various Antimicrobials, Oils and Solvents

Question 13

Provide examples of glucocorticoid medications.

Answer 13

beclomethasone (Beclovent), triamcinolone (Azmacort, Nasacort), flunisolide (Aerobid), budesonide (Pulmicort), fluticasone (Flonase, Flovent)

Question 14

List the dental drugs that adversely interact with theophylline.

Answer 14

Macrolide Antibiotics - erythromycin, ciprofloxacin (Cipro), clarithromycin, doxycycline. Systemic (azole) Antifungals - ketoconazole