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Dental Management of the Medically Complex Patient > Pulmonary Disease > Flashcards

Pulmonary Disease Flashcards

1
Q

what are the types of pulmonary disease

A
  • asthma
  • chronic obstructive pulmonary disease: bronchitis and emphysema
  • tuberculosis
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2
Q

what is asthma

A
  • chronic inflammatory airway disorder
  • airway hyper responsiveness to stimuli
  • bronchial edema
  • narrowing of the ariways- obstruction
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3
Q

what are the signs and symptoms of asthma

A
  • recurrent and reversible episodes of:
  • dyspnea
  • wheezing
  • coughing
    -tightness of chest
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4
Q

which is a true asthma symptom

A

tightness of chest

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5
Q

what are the aggravating/complicating factors of asthma

A
  • smoking
  • air pollutants: urban and industrial
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6
Q

what are the stages of asthma

A
  • controlled
  • partially controlled
  • uncontrolled
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7
Q

how frequent are the daytime symptoms and need for rescue meds in controlled asthma

A
  • twice or less per week
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8
Q

how frequent are the daytime symptoms and need for rescue meds in partially controlled asthma

A
  • more than twice a week
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9
Q

how frequent are the daytime symptoms and need for rescue meds in uncontrolled asthma

A

three or more features of partiallly controleld asthma present in any week

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10
Q

what are the types of asthma

A
  • extrinsic
  • exercise induced
  • intrinsic
  • drug induced
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11
Q

describe extrinsic asthma and another name for it

A
  • 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
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12
Q

what is the mechanism of extrinsic asthma

A

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

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13
Q

describe exercise induced asthma

A
  • unknown pathogenesis
  • children and young adults
  • triggered by exercise and thermal changes
    -cold air irritates mucosa resulting in airway hyperactivity
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14
Q

describe instrinsic asthma and another name for it

A
  • 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
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15
Q

what is the mechanism in instrinsic asthma

A
  • allergen -> activation of mast cells, basophils and eosinophils -> bradykinin, histamine, interleukines, leukotrienes -> bronchoconstriction
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16
Q

describe drug induced asthma

A
  • subset of intrinsic
  • affects children, young adults, and middle aged adults
  • common antigens
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17
Q

what common antigens cause drug induced astham

A
  • NSAIDs, ASA
  • beta blockers
  • ACEi
  • anticholinergic drugs
  • food dye
  • metabisulfites in food and in local anesthetics with epinephrine
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18
Q

what are the types of treatments for asthma

A
  • inhaled beta 2 agonists
  • short acting beta 2 agonists
  • long acting beta 2 agonists
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19
Q

what do the inhaled beta 2 agonists do for asthma tx

A
  • bind to beta2 receptors in lungs smooth muscle relaxation
  • bronchodilation
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20
Q

what are the short acting beta 2 agonists used for

A

single use (rescue) meds used alone

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21
Q

what do the long acting beta 2 agonists do for asthma

A
  • used in combination with steroids on a scheduled protocol
  • used alone leads to CVD complications
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22
Q

what are the side effects of asthma treatments

A
  • tremors, tachcyardia
  • increases blood sugar
  • cough
  • K+ decrease
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23
Q

what is an example of a short acting beta 2 agonist

A

albuterol

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24
Q

what is an example of an anticholinergic med used to treat asthma

A
  • atrovent
  • spiriva
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25
Q

what is an example of a methylxanthine used to tx asthma

A

theophylline

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26
Q

wwhat is an example of a mast cell stabilizer used to treat asthma

A

cromolyn

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27
Q

what is an example of a corticosteroid used to tx asthma

A
  • dexamethasone
  • fludrocortisone
  • methylprednisone
  • prednisone
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28
Q

what is an example of leukotriene receptor antagonists used to treat asthma

A

singulair

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29
Q

what is an example of combination inhalers used to tx asthma

A
  • advair diskus
  • symbicort
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30
Q

what are the oral signs of asthma

A
  • mouth breather: high palatal vault, overjet, crossbite, greater facial height
  • dry mouth
  • candida
  • enamel defects and caries
  • gingivitis/periodontitis
  • enamel erosion possible with GERD
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31
Q

what are the dental tx considerations with unstable asthma

A
  • dental treatment should be limited to urgent care only
  • treatment of acute pain, bleeding or infection
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32
Q

what are the dental tx considerations with stable asthma

A
  • any indicated dental tx may be provided if management protocols are considerd
  • consult with physician for severe persistent asthma
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33
Q

what are the drug interactions with asthma and what do they do

A
  • 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
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34
Q

what is status asthmaticus

A

severe prolonged asthma attack that is more than 24 hours and life threatening

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35
Q

what are the overall dental treatment considerations for asthma

A
  • 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
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36
Q

what is the drug of choice for an acute attack

A

short acting beta 2 adrenergic agonist (inhaler)

37
Q

what drugs should be avoided with astham

A
  • aspirin, NSAIDs, narcotics, macrolide antibiotics like erythromycin
  • sulfite (preservative) containing local anesthetics may need to be avoided
38
Q

what are the sedation options for patients with asthma

A
  • nitrous
  • short acting benzodiazepine
39
Q

what is the patient presentation of an asthma emergency

A
  • RR greater than 25 breaths/min, labored breathing
  • tachycardia greater than 110 BPM
  • flushed apperance
40
Q

what do you do with an asthma emergency

A
  • 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
41
Q

small doses of 1:1000 epi are:

A

smooth muscle dilators

42
Q

what is chronic obstructive bronchiolitis

A
  • 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
43
Q

what is emphysema

A

-long term chronic obstructive bronchiolitis leads to destruction of lung parenchyma and alveolar walls
- decreased elastic recoil
- difficulty in maintaining airway opening during expiration

44
Q

COPD is the ____ leading cause of death in the USA

A

3rd

45
Q

what are the chracteristics of COPD causing death

A
  • corticosteroid resistant progressive chronic inflammatory disease
  • poorly reversible/irreversible airway obstruction
  • entrapment of air and dyspnea upon exertion
46
Q

what are the complicating factors of COPD

A
  • smoking
  • air pollutants - urban and industrial
  • CVD: comborbidity
47
Q

what are the signs and symptoms of COPD

A
  • dyspnea
  • cough
  • sputum
  • tightness in chest
48
Q

what is the FEV in each stage of COPD

A
  • stage 1: more than 80%
  • stage 2: between 50-80%
  • stage 3: between 30-50%
  • stage 4: less than 30%
49
Q

what is FEV

A

forced expiratory volume in 1s

50
Q

what is FVC

A

forced vital capacity

51
Q

exacerbations of COPD are triggered by:

A
  • viral or bacterial infections
  • haemophilus influenza
  • streptococcus pneumoniae
52
Q

complications of COPD:

A
  • pulmonary HTN
  • cor pulmonale (R sided heart enlargement)
  • thoracic bullae
  • nocturnal hypoxia
53
Q

what are the comorbidies with COPD

A
  • HTN
  • ischemic heart disease
  • heart failure
  • MI
  • muscle wasting
  • osteoporosis
54
Q

what is the tx for COPD

A
  • inhaled long acting bronchodilators
  • corticosteroids if asthma also present and/or more reversible obstruction
  • smoking cessation is only intervention that actually reduced disease progression
55
Q

what are the drugs used to treat COPD

A

same as asthma

56
Q

what are the oral manifestations of COPD

A
  • dry mouth
  • steven johnson syndrome with theophylline
57
Q

what are the side effects of smoking seen in COPD

A
  • halitosis
  • tooth staining
  • nicotine stomatitis
  • periodontal disease
  • oral potentially malignant disorders: leukoplakia, erythroplakia
  • oral SCC
58
Q

what stage of COPD needs dental tx in hosptial

A

stage III and up

59
Q

if less than stage III COPD how do we treat these patients

A
  • 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
60
Q

what meds should be avoided with COPD

A
  • 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
61
Q

what is TB

A

granulomatous infectious disease caused by mycobacterium tuberculosis

62
Q

most common site of infection in TB:

A

lungs

63
Q

TB can also effect:

A

cutaneous, lymphatic and other tissues due to the multiple species of mycobacterium

64
Q

what species of mycobacterium can also be involved in TB

A
  • m. kansasii
  • m. bovis
  • m. microti
  • m. canetti
  • m. avium complex
  • m. abscessus
  • m. africanum
65
Q

WHO estimated _____ of the population is infected with TB

A

1/3

66
Q

TB is the greatest ______ killer of humans

A

universal single pathogen

67
Q

US rates of TB are low because of:

A
  • better sanitation
  • improved hygiene
  • more efficient delivery of anti TB meds
68
Q

what are the at risk populations in the US for TB

A
  • racial and ethnic minorities
  • inner city residents in conregate faciltiies
  • immunocompromised patients - HIV, med suppressed, DM
69
Q

TB is transmitted via:

A
  • airborne transmission via infectious respiratory droplets from:
  • coughing
  • sneezing
  • talking
  • singing
70
Q

what are the signs and symptoms of TB

A
  • persistent, unexplained cough
  • fever
  • malaise
  • night sweats
  • unintentional weight loss
  • hemoptysis
  • dyspnea
71
Q

what are the risk factors for TB

A
  • 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
72
Q

what are the facilities with high risk exposure to TB

A

health care facilities, nursing homes, correctional faciltiies, homeless shelters, accommodations for the mentally disabled, refugee shelters

73
Q

what is the TST test and describe

A
  • Mantoux
  • 95% sensitivity
  • 75% specificity
74
Q

what are the tests for TB and vaccine

A
  • TST
  • IGRA
  • Bacille Calmette Guerin vaccination
75
Q

what are the oral signs of TB

A
  • uncommon
  • more frequent presentation: deep irregular, painful ulcer on the tongue dorsum
  • may occur in other areas: gingiva, lips, palate, buccal mucosa
  • scrofula
76
Q

what is scrofula

A
  • TB involvement of cervical and submandibular lymph nodes
  • lymph nodes are enlarged and painful
  • abscess with purulence may be present
77
Q

what people are at risk for progression to active TB

A
  • 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
78
Q

what are the diseases that are at risk for progression to active TB

A
  • silicosis
  • DM
  • chronic renal failrue
  • leukemia
  • lymphoma
  • solid organ transplant
  • head and neck cancer
  • lung cancer
79
Q

what is the antibiotic regimen phases for TB and their length

A
  • intensive phase: 8 weeks
  • continuous phase: 18 weeks or longer
    -multidrug resistance: 8- 20 months
80
Q

what does the intensive phase of TB tx entail

A
  • isoniazid
  • rifampicin
  • pyrazinamide
  • ethambutol
81
Q

describe isoniazid

A
  • hepatotoxic - avoid acetominophen
  • P450 inhibitor - increased concentration of other drugs
82
Q

describe rifampicin

A
  • hepatotoxic; impaired healing
  • increased gingival bleeding
  • P450 inducer
  • decreased concentration of other drugs
83
Q

what drugs are given in the continuous phase of TB tx

A
  • isonizaid
  • rifampicin
84
Q

what drugs are given in the multidrug resistance phase in TB tx

A
  • pyrazinamide
  • a fluoroquinolone
  • amikacin, kanamycin
  • ethionamide
  • cycloserine
85
Q

how do you determine if a TB patient is noninfectious for dental tx

A
  • 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
86
Q

if signs and symptoms of TB approach ask if:

A

sputum positive

87
Q

what are the CDC guidelines for TB

A

same as COVID

88
Q
A

Dental Management of the Medically Complex Patient (13 decks)

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