E2: Respiratory Part 1 ASTHMA(I'll give you asthma!)

Question 1

oxygen saturation is measured with a _________…Acceptable normal ranges are from ___ to ___% percent, although values down to ___% are common.

Answer 1

pulse oximeter…95 to 100….90%

Question 2

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…Persistent symptoms for at least ___ days without improvement..BUT _____ of illness ALONE is unreliable

Answer 2

10 days.. Duration

Question 3

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…______ symptoms: fever, facial pain, purulent nasal discharge for 3-4 consecutive days at beginning of illness…AND imaging not routinely recommended

Answer 3

Severe… imaging (can’t tell on a scan)

Question 4

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…What % of acute Rhinosinusitis cases are VIRAL?

Answer 4

98% are viral!!!

Question 5

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…IF in the rare chance it IS Bacterial in nature. Rx these 2 bad boys: What if their allergic?

Answer 5

Amoxicillin, Clavulanate…if allergic Clindamycin!

Question 6

Interesting: Differential Diagnosis of Bacterial Sinusits vs another cause…What drugs should you avoid in ACUTE Sinusitis?

Answer 6

Decongestants and Antihistamines

Question 7

What are the 4 drugs recommended in Sinusitis/Allergic Rhinitis?

Answer 7

1.PseudoEphedrine 2.AntiHistamines 3.Analgesics 4.Antibiotics (if bacterial OF course)

Question 8

DENTAL DRUG INTERACTION!!! Use _________ (vasoconstrictor) with caution with DECONGESTANTS, as these drugs are ________ and may enhance cardiac stimulation (tachycardia) and elevate blood pressure!!!

Answer 8

epinephrine…sympathomimetics

Question 9

Why is it important to ask the patient if they are taking claratin-D vs regular claratin?

Answer 9

D (decongestant) is a Sympathomimetic and will tag team with EPI

Question 10

What was the new rhinitis drug in 2012 that is a “dry” nasal corticosteriod?

Answer 10

QNASL Nasal Areosol

Question 11

Oh I’ll give you ASTHMA! Recurrent bronchial ______ spasm, inflammation, swelling of bronchial mucosa, hypersecretion of _______

Answer 11

smooth muscle… mucous

Question 12

Oh I’ll give you ASTHMA! What is the most common form? What age group is it usually seen in?

Answer 12

Extrinsic Asthma-seasonal allergens, pollen, dust mites, animal dander…children and young adults

Question 13

Oh I’ll give you ASTHMA! IT IS A _____ response relationship between allergen exposure and ____ (WHAT ANTIBODY??) mediated sensitization, positive skin test, family Hx

Answer 13

DOSE…IgEEEEEE

Question 14

Oh I’ll give you ASTHMA! During attack, _____ antibodies affixed to _____ cells along bronchial tree

Answer 14

IgEEEEEE…MAST

Question 15

Oh I’ll give you ASTHMA! histamine = broncho________; _______ vascular permeability

Answer 15

constriction….increased

Question 16

Oh I’ll give you ASTHMA! _________ = smooth muscle spasm; increased vascular permeability; attract

Answer 16

leukotrienes

Question 17

Oh I’ll give you ASTHMA! What type of immune cells prolong inflammatory response?

Answer 17

T lymphocytes

Question 18

Oh I’ll give you ASTHMA! What type of asthma is seldom associated with family history of allergy or to a known cause, patients are non-responsive to skin testing, has NORMAL IgE levels and is more for middle-aged adults

Answer 18

INTRINSIC asthma

Question 19

Oh I’ll give you ASTHMA! Intrinsic asthma is associated with ENDOGENOUS causes: emotional _____; _____

Answer 19

stress… GERD

Question 20

DID YOU KNOW that these drugs aspirin, NSAIDS, cholinergics, beta blockers, ACE inhibitors, barbiturates, opiates can INDUCE _______

Answer 20

ASTHMA!!!

Question 21

YOU DID KNOW THIS….Thanks Steve!!! Asthmatics are more likely to have hypersensitivity reaction to _____! (incidence ranges from 5-15%)

Answer 21

ASPIRIN

Question 22

What is the “Aspirin Hypersensativity Triad”?

Answer 22

1.Aspirin Hypersensativity 2.Asthma 3.Nasal Polyps

Question 23

Why in the world do some asthmatics have an aspirin allergy?? Aspirin Inhibits bronchodilating _____…Allergic reactions = mimic _______

Answer 23

PGE2…asthma attack

Question 24

How many exposures does it usually take to develop an aspirin sensitivity with asthma?

Answer 24

about 15 exposures

Question 25

There is EVEN as CROSS SENSATIVITY with asthmatics-aspirin-and _______

Answer 25

NSAIDS (Tylenol ONLY!)

Question 26

What is the preservative that can cause asthma (found in food and some inhalers even!)?

Answer 26

Sulfite

Question 27

What age group is most effected by exercise-induced asthma?

Answer 27

children and young adults

Question 28

Say what?! There is ______ asthma, caused by an inflammatory response of bronchi to infection

Answer 28

Infectious asthma

Question 29

What is the type of asthma attack that will scare you as much as an MI?? It has persistent life-threatening bronchospasm DESPITE drug therapy/intervention and can last for more than 24 hours!!

Answer 29

Status Asthmaticus!

Question 30

What is the likely cause of Status Asthmaticus? What can happen w/o intervention??

Answer 30

Respirtatory INFECTION...DEATH can result

Question 31

Symptoms of Asthma (I'll give you asthma!): termination of attack is accompanied by _________: thick, stringy mucous episodes are SELF-limiting

Answer 31

productive cough

Question 32

Which class of Asthma Am I ??? symptoms only when exposed to trigger; symptoms last less than an hour and occur less than twice per week...FEV (forced expiratory volume): >80%

Answer 32

Mild (intermittent OR persistent)

Question 33

Which class of Asthma Am I ??? symptoms more than twice per week that affect sleep and activity level, occur over several days, and on occasions requires emergency care...FEV >80%

Answer 33

Moderate

Question 34

Which class of Asthma Am I ??? ongoing symptoms that limit activity...frequent attacks, at night...occasional need for emergency hospitalization; FEV

Answer 34

Severe

Question 35

Asthma Med Consider this: FOR _________ asthma = rescue bronchodilator prn

Answer 35

mild intermittent

Question 36

Asthma Med Consider this: FOR ________ asthma = anti-inflammatory drug with low dose inhaled corticosteroid, cromolym or anti-leukotriene

Answer 36

mild persistent

Question 37

Asthma Med Consider this: FOR ________ asthma = one medium dose of inhaled corticosteroid, or two daily medications....low to medium dose inhaled corticosteroid and long-acting bronchodilator

Answer 37

moderate persistent

Question 38

Asthma Med Consider this: FOR ________ asthma = daily medications...high-dose inhaled corticosteroid with long acting bronchodilator and oral corticosteroid

Answer 38

severe persistent

Question 39

Asthma is often under treated. The MAN Recommends ________ as preferred therapy for mild persistent asthma, but providers disregard due to perceptions of risk/benefit

Answer 39

inhaled corticosteroids

Question 40

DAAANG! In a survey of 1000 people, ___% did not use asthma controller medications. Even if they did 85% had poorly controlled disease

Answer 40

49%

Question 41

_________ are Important RESCUE drugs for asthma = “inhalers”

Answer 41

Beta Adrenergic Stimulants

Question 42

Beta Adrenergic Stimulants target _______ receptors in airway

Answer 42

beta 2

Question 43

Which drug is in ALL DENTAL EMERGENCY KITS for SHORT acting asthma drugs?

Answer 43

albuterol...(levalBUTEROL (Xopenex HFA)....pirBUTEROL

Question 44

What are 2 examples of LONG acting Beta Adrenergic stimulants?

Answer 44

1. SAL-MET-EROL (Severent Diskus) 2.SAL-MET-EROL WITH FluTICaSone (ADVAIR Disckus)

Question 45

What is the duration of salmeterol?

Answer 45

12 hours (long acting)

Question 46

What is the name of the steroid in Advair?

Answer 46

Fluticasone

Question 47

Woot Woot! Dental Considerations with inhalers: 3 main ones:

Answer 47

1.Taste alteration 2.oral candadiasis 3.hyper-reflexive airway (boy who cried wolf)

Question 48

What are you going to ask your asthma patient? Tell them to BRING THEIR _______!

Answer 48

HOW OFTEN do you use your inhaler? If more than 2x, refer for better Tx!...BRING THEIR INHALERS!

Question 49

What is the RED FLAG DRUG IN DENTISTRY from this Section? What 2 medications does it clash with for this special honour?

Answer 49

Methyl-XANTHINES (older class of drug-given to people as a last resort)...1.Antibiotics (erythromycin, cipro, clarithro, doxy) AND 2.Systemic azole antifungals (ketoconazole)

Question 50

What are the three possible side effects if I mix erythromycin and theosophylline?

Answer 50

(antibiotics and methylXanthine-red flag dental drugs) 1.CNS Stimulation(nausea/vomiting) 2.cardiac effects 3.seizures

Question 51

The Red Flag MethylXanthines block ________ which INCREASES cAMP

Answer 51

PhosphoDiesterase

Question 52

Leukotrienes = chemical mediators that produce similar effects to _______

Answer 52

histamine

Question 53

What is the mech for zileutron (Zyflo) (leukotriene)?

Answer 53

inhibits the SYNTHESIS of leukotrienes

Question 54

What is the mech for zafirlukast (Accolate), montelukast (Singulair)?

Answer 54

BLOCK leukotriene receptors

Question 55

Holy shit: MonteLukast (Singulair) possibly associated with mood and _____!

Answer 55

suicide

Question 56

What is the DRUG OF CHOICE for reducing inflammation??

Answer 56

STEROIDS!

Question 57

What are the 3 types of immune cell STEROIDS inhibit to therefore inhibit inflammation?

Answer 57

1.Basophils 2.Eosinophils 3.Leukocytes

Question 58

What was the FIRST OTC steroid preparation?

Answer 58

triamcinolone acetonide (Nasacort)

Question 59

What is the #1 risk of Nasacort (the first OTC steroid)?

Answer 59

Slowing the growth of children

Question 60

What are the 4 dental considerations with steroids?

Answer 60

1.oral candidiasis 2.susceptiblity to infection 3.delayed wound healing 4.Adrenal suppression

Question 61

What are the 2 indications for the SAFE drug Mast Cell Inhibitors?

Answer 61

1.Seasonal Allergies 2.Exercise-induced asthma

Question 62

What is the ONLY Mast Cell Inhibitor to know?

Answer 62

CroMolyn (because that has to do with MAST cells?! wtf)

Question 63

DR. S SAID TO KNOW THIS ONE! What is the DRUG OF CHOICE (class and generic name) for EMPHYSEMA?

Answer 63

Anticholinergic--IPRA-TROP-IUM (Dr. S said to know this one)

Question 64

What is the mech for ipratropium? Blocks the action of _______ at parasympathetic sites in bronchial smooth muscle causing broncho_______; decreases _____ levels

Answer 64

acetylcholine....dilation...cGMP

Question 65

What is the REALLY important DENTAL side effect of ipratropium?

Answer 65

DRY Mucus MEMBRANES

Question 66

Asthma, this blows my gord-- ________ leads to problems with craniofacial development: vaulted palate, increased anterior facial height 􏰀 greater over jet, higher prevalence of crossbite

Answer 66

mouthbreathing

Question 67

Medication-Related Oral Care Considerations with Asthma-_________ from beta 2 agonists -bacterial, fungal and viral infections

Answer 67

xerostomia

Question 68

potential for acid erosion of enamel _______ and ________ exacerbate reflux disease

Answer 68

beta agonists...theophylline (methylxanthine)

Question 69

Inhaled steroids cause acute ___________ form of candidiasis...How do Pts prevent this??

Answer 69

acute pseudomembranous...rinse thoroughly after use!

Question 70

A common side effect of anti-leukotrienes, theophylline, some antihistamines

Answer 70

Headache

Question 71

Tx an Astma Pt: When is the best time to schedule an asthma patient?

Answer 71

Late morning, most attacks are at NIGHT

Question 72

Tx an Astma Pt: _______ is a good Tx for reducing stress/anxiety (Dr. Caputo!)

Answer 72

Nitrous Oxide

Question 73

Tx an Astma Pt: Avoid ______ because they release histamine!!!

Answer 73

OPIATES

Question 74

Tx an Astma Pt: What type of anesthesia is CONTRAINDICATED?

Answer 74

Outpatient General Anesthesia

Question 75

haha HW like Question: ASTHMA ATTACK---First 3 steps!

Answer 75

1.Epinephrine (0.3-0.5mg) 2.Oxygen 3.Bronchodilators (albuterol)