When a pt reports having a respiratory disease, what are 5 things the dental hygienist must do before beginning treatment?
Learn what type of disorder
determine agents being used to manage symptoms
assess respiratory rate and qualities
observe facial color
perform extraoral examination
Name the 3 main anitomical structures of the upper and lower respiratory tracts. (3 structures each)
Upper: nasal cavity, pharynx, larynx
Lower: trachea, bronchi, lungs
The lungs contain millions of ________ and are connected with the _______ and _______________ by the bronchioles and trachea.
With inspiration the alveoli _________ and during expiration air is forced __________
In the continous renewal of air; oxygen is _____________ and carbon dioxide is ______________
What is reduced availability of oxygen to the various cells of the body?
What are 5 types of hypoxia?
Oxygen fails to reach the blood of the lungs.
The following causes may cause what type of hypoxia?
too little oxygen in the atmosphere
obstruction of the respiratory passages
thickening of the pulmonary membrane
loss of functional pulmonary tissue
hypoxic hypoxia: failure of oxygen to reach blood of the lungs
failure to transport oxygen to the tissues because of too little blood flow.
The following may cause what type of hypoxia?
low cardiac output as a result of heart failure
stagnant hypoxia: failure to transport oxygen to the tissues because of too little blood flow
too little hemoglobin in the blood to transport oxygen to the tissues.
The following may cause what type of hypoxia?
the person may have adequate hemoglobin in the cells, but the oxygen-carrying cpacity of hemoglobin is compromised by carbon monoxide or some other poison
anemic hypoxia: too little hemoglobin in the blood to transport oxygen to the tissues
failure of the tissues to use oxygen even though adequate quantites are transported
The following may cause what type of hypoxia?
cyanide poisoning and vitamin deficiencies resulting in diminished quantities of oxidative enzymes in cells
histotoxic hypoxia: failure of the tissues to use oxygen even though adequate quantities are transported
air hunger as a result of respiratory abnormality.
The following may cause what type of hypoxia?
respiratory abnormality, causing the blood to by hypoxic, or even more often, when too much carbon dioxide collects in the body fluids; an occasional person develops psychic ______ because of neurosis
What is a self-limiting, inflammatory viral infection of the URT, it is spread person to person by airborne dropelts, the location it affects is the nose, pharynx and larynx, clinical implications are that the person is infected 1-2 days before symptoms occur, frequency of occurrence comes from numerous different viruses, seasonal, age, general health status, fatique etc. The Dx is based on history and symptoms, and secondary bacterial infections can cause complications?
the common cold
Is the common cold an infection of the upper or lower respiratory tract?
how is the common cold spread?
person to person by airborne droplets
What are the 3 main anatomical structures that are affected by the common cold?
What is a clinical implication of the common cold?
It is contagious before symptoms appear and the pt even knows they have it
true or false. At present there are no antiviral agenst that are effective against the viruses responsible for the common cold in humans.
What are 3 general measures to be taken to help treat the common cold?
Why would it be helpful to take an analgesic/antipyretic for the common cold? Why would it be helpf ul to inhale steam, take antitussive syrups with codeine, or an expectorant such as guaifenesin (Mucinex)?
analgesic/antipyretic: relief of headache, fever, and associated muscular aches and pains
steam, antitussive syrups, Mucinex: to reduce cough
What is the best management strategy for allergic rhinitis?
avoid/elliminated the responsible allergen
What is the most commonly used opioid antitussive and is safe and effective when used as directed? When is the use of this drug not recommended?
when CHRONIC pulmonary disease is present
What is the active ingredient in most OTC antitussive syrups, and is safe and effective to reduce cough?
What is a drug that provides relief of cough associated with respiratory infections and related conditions; it facilitates the removal of viscous mucus and promotes pfoductive and more frequent coughing; there are no drug-drug interactions with it in dentistry.
Allergic rhinitis may be one of what 2 types?
Which type of allergic rhinitis is caused by pollesn from trees, grasses, or flowers, lasts several weeks, disappears, and then returns the following pollenating season?
Which type of allergic rhinitis is due to sensitivity to a variety of allergens, such as house dust, and may occur throughout the year?
The following symptoms might be caused by what?
nasal congestion, sneezing, water nasal discharge, pruritus, often conjuctivitis, and pharyngitis
What are 3 main ways to medically treat allergic rhinitis?
eliminate or avoid responsible allergen
desensitization injections: effective with seasonal
All _________________ are effective H1 receptor antagonists, but pts may vary in their responses to individual agents and in their susceptibilities to potential adverse effects.
What are the 3 different classifications of antihistamines?
first generation agents
second generation agents
What type of drug reduces symptoms of nasal itching, has a moderate effect on reducing rhinorrhea and sneezing, has minimal effect on symptoms of nasal congestion, and does NOT reduce congestion of the upper respiratory tract?
first and second generation oral antihistamines
Why is the clinical use of first-generation antihistamines (such as diphenhydramine hydrochloride (benadryl)) limited?
owing to anticholinergic and sedative effecs
What are the 3 most common ADEs with first generation antihistamines?
GI symptoms: nausea, constipation, abdominal pain
What is the first line therapy for treatment of mild allergic rhinitis? (it is a second-generation antihistamine) and why is this so?
because it has virtually no sedative or anticholinergic effects
true or false. All second-generation have similar clinical efficacy in equivalent therapeutic doses.
Some experts recommend a combination of first-generation OTC antihistamines at ______________ and a second-generation antihistamine at _______________. However next-day ______________ has been observed with such regimens.
true or false. Nasal antihistamines are considered to be similar in efficacy to oral antihistamines.
What formulation of antihistamines significantly reduce symptoms of itching, redness, and watery eyes associated with allergic conjunctivitis?
Which agent has the action of blocking histamine in target tissues which reduces histaminic effects such as nasal itching, sneezing, and rhinorrhea, but not nasal congestion?
antihistamines: H1-receptor antagonists
Because antihistamines do not reduce nasal congestion, some antihistamine products combine antihistamine with what type of drug as a decongestant?
What type of drug relieves nasal congestion, is a decongestant?
To reduce nasal congestion, the coadministration of an oral decongestant with an antihistamine is recommended for a period of no more than _____ days.
What is an alpha-adrenergic receptor agonsit that counters histamine induced vascular engorgement of the turbinates and improves nasal air flow; it also may include short-term relief of ocular symptoms?
Patients with one of what 5 conditions should be cautioned about the concurrent use of pseudoephedrine?
coronary artery disease
those recieving monoamine oxidase inhibitors
What is the first line treatment for moderat to severe allergic rhinitis?
nasal corticosteroid sprays
Nasal corticosteroid sprays are clinically and statistically better than oral or nasal antihistamines in the tx of nasal congestion and sneezing, but there is no significant difference between nasal corticosteroids and oral or nasal antihistamines in relieving ________ symptoms.
When pts do not respond well to a single agent of antihistamines or nasal corticosteroids, what is given, and why?
because antihistamines and nasal corticosteroids influence different physioligic mechanisms
What is the main ADE with prolonged use of nasal corticosteroids?
epistaxis: nose bleeds
What class of drugs does the following drug fall under?
nasal spray formulation of cromolyn sodium (NasalCrom) that is available OTC
It inhibits histamine release and appears to be more effective when administered just before exposure to an allergen
What is an example of a Mast-cell stabilizer to help treat allergic rhinitis?
cromolyn sodium (NasalCrom) available OTC
What class does the following drug fall under?
a quaternary ammonium compound related to atropine, it blocks acetylcholine receptors and relieves rhinorrhea inpts with allergic rhinitis, with effects similar to thos of nasal corticosteroids
What is an example of an anticholinergic agent used to treat allergic rhinitis?
What class does the following drug fall under?
an ophthalmic formulation of a nonsteroidal antiinflammatory agent (NSAID) that significantly reduces ocular symptoms of itching associated with allergic conjuctivitis
nonsteroidal anti-inflammatory agent
What is an example of a nonsteroidal anti-inflammatory agent (NSAID) that is used to treat allergic rhinitis?
What class does the following drug fall under?
Zafirlukast (Accolate) and montelukast (Singular)
both are tablets
effective in relievin nasal sumptoms in pts with allergic rhinitis, used as an adjunct to an antihistamine or nasal corticosteroid, drugs are well tolerated with side effects similar to occurrence in placebo
Leukotriene-receptor antagonists (LRA)
What are 2 examples of Leukotriene-receptor antagonists (LRA) used to treat allergic rhinitis?
What is a possible dental drug interaction when patients are taking leukotriene-receptor antagonists to treat allergic rhinitis?
interation with erythromycin: decreased efficacy of LRA (because of increased metabolism
interaction with aspirin: increased toxicity of LRA (because of decreased metabolism)
What is chronic nasal obstruction or stiffness that is not caused by an allergy? It may be caused by:
result of overuse of nasal decongestant; sprays can lead to rebound congestion
or deviation of the nasal septum
What are 4 ways to medically treat vasomotor rhinitis?
vaporizer in room
systemic sympathomimetic drugs: not recommended for long-term use
topical vasoconstrictors: not recommended
sprays: may result in taste disturbances
What condition may occur dugin the common cold, or as an isolated infection; the throat becomes sore, and irritated, and the voice sounds hoarse, and later the pt may lose their voice altogether?
What are 3 ways to medically treat acute laryngitis?
advised not to talk or smoke
steam inhalations, hot gargles and drinks
expectorant (such as guaefenesin) may be administered to remove viscous mucus
What type of laryngitis is more common in occupations in which the voice is used constantly; excessive use of tobacco and alcohol are predisposing factors; and chronic sinusitis may make pt more susceptible?
The following symptoms are signs of which type of laryngitis?
hoarseness, frequent coughs, pain may be minimal or absent
What are 2 ways to medically treat chronic laryngitis?
gargling with warm salt water
What disease is recognized as the leading cause of death from an infectious disease?
true or false. resistant cases of TB have increased
true or false. There is disparities between white and racial/ethnic minorities. TB is higher in other races than in whites.
both are true
tuberculosis is an infectious disease caused by _____________________ a bacillus
How is tuberculosis transmitted from person to person?
airborne droplets when an infected person coughs or sneezes
true or false. If a person's immune system is poor TB can spread to other parts of the body besides the lungs
How is TB treated?
with LONG-TERM administration of two or more antituberculosis drugs
What test is used for the screening of tuberculosis?
tuberculin skin test: TST or Mantoux
What does it mean if a pt presents with an induration on their forearm where the TB test was administered?
the pt is infected with the bacillus
Definitieve diagnosis for TB is done by what?
a sputum examination; the DNA
What type of drugs for TB provide the foundation of treatment for TB?
What type of drugs are less effective and usually more toxic?
Primary drugs: Isoniazid, rifampin, pyrazinamide
Second-line drugs: streptomycin
true or false. first-line and second-line drugs are often used in combination to treat TB
Describe the treatment for TB that is recommended by the CDC.
Initial therapy: isoniazid, rifampin, and pyrazinamide along with ethambutol or streptomycin for about 2 months
Followed by: rifampin and isoniazid for 4 months in areas with low incidence of TB
Addition of: streptomycin or ethambutol for the first 2 months in areas of high incidence
Name 3 bactericidal agents in the treatment of TB.
When isoniazid is used as a single-drug therapy for TB, what is it for?
to prevent TB
When isoniazid is used in combination with other agents for TB, what is it for?
treatment of established TB infection
What are family members of a pt infected with TB given to prevent them from getting it?
isoniazid prophylactically for 6 months to a year
Most anti-TB drugs are _____________ and slow down the growht and multiplication of the TB infection.
Why must a combination of bacteriostatic drugs be taken on a regular schedule for the treatment of TB?
to reduce development of drug resistance and resolve active infection
true or false. Most bacteriostatic agents used to treat TB are taken orally
Streptomycin is a bacteriostatic agent used to treat TB, how is it usually administered?
daily as a single IM injection
Who and when presented guidelines for TB prevention in healthcare facilities?
Written TB infection-control programs are based on what?
the prevalence of disease in local community
true or false. Patients with clear signs and symptoms of TB should NOT be seen in the dental facility
true or false. The CDC advises dental offices to add screening questions for TB on the health history, and that if TB signs and symptoms are reported to refer the pt for medical evaluation.
What are 5 signs of TB?
cough for more than 3 weeks
blood in sputum
unexplained weight loss
close association with someone who has had TB
What condition is a pt most likely to have if the following procedure is carried out?
pt is refered to facility that meets airborne infection isolation area and provides adequate respiratory protection equipment for dental personnel
suspected or confirmed TB for pts needing urgent dental care
true or false. Oral health care workers need to have annual TB tests, as another administrative control.
Oral health care workers who test positive for TB are excluded from the work place until documentation includes what 3 things?
recieving adequate therapy
cough has resolved
they have had 3 consecutive sputum smears collected on different days with negative results for MTB
List 4 diseases of the lower respiratory tract.
chronic pulmonary disease: COPD
The following drugs are used in the management of LOWER RESPIRATORY TRACT diseases; list the action of each.
mast cell stabilizers
leukotriene receptor antagonists
corticosteroids: reduce inflammation
Beta2 bronchodilators: open airways and improve ventilation
mast cell stabilizers: inhibit mucus formation
Anticholinergic agents: promote bronchodilation and reduce airway secretions
What LRT disease is chronic with periods of remission and acute exacerbation; is exaggerated bronchoconstriction with reversible airway abstruction
What LRT disease is characterized by excess mucus production in response to smoking and exposure to allergens, chemicals, and pollutants, and is complicated by recurrent respiratory infections
What LRT disease is characterized by progressive airflow limitation and irreversible airway obstruction caused by chronic inflammation of the airways and lung parenchyma?
chronic obstructive pulmonary disease (COPD)
there has been a clinical overlap between asthma, chronic bronchitis, and COPD (LRT diseases) in patients who _________
The diagnosis of which 2 LRT diseases is clinical, made by history?
The diagnosis of what LRT disease is based on histologic examination of lung tissue?
The diagnosis of what LRT disease is based on physiologic pulmonary function?
What is a respiratory disease characterized by reversible airway obstruction from bronchial smooth muscle spasms, hypersecretion of cells, collection of mucus on the bronchiole lining, and inflammation of alveolar epithelium?
What type of asthma is associated with allergy and usually occurs in younger age groups?
Which type of asthma tends to occur in older age groups for whom the asthma attack is more severe?
What are 5 common causes for occurence of asthma attacks?
respiratory viruses: responsible for most attacks, especially kids
cold weather: more common in younger ages
exercise: more common in younger ages
aspirin: account for about 10% of intrinsic asthmatics
emotional stress: common provoking cause
What are 3 common clinical signs and symptoms of asthma attacks?
shortness of breath
may be sitting down or leaning forward to assist in breathing
Most experts now consider asthma to be an inflammatory disorder of the airway with inflammation caused by allergy or other stimuli leading to bronchial hyerpsecretion and obstruction of airflow; which therefore causes the new therapeutic emphasis to be on the use of what type of drugs?
anti-inflammatory drugs: inhalation steroids
What is the first-line therapy for asthma?
What are 3 other agents used to manage asthma symptoms?
corticosteroid spray: reduce inflammation on bronchioles
bronchodilators: aerosols or tablets
What is the goal of therapy for asthma?
for pts to control the disease to the extent that the sprays are used no more than twice a day
regular continuous use of what type of drug to treat asthma, suppresses inflammation, decreases bronchial hypersecretions, and decreases symptoms in pts with chronic asthma? Inhaled use of these drugs are more effective than regular use of beta2-selective adrenergic drugs and tend to decrease the use of systemic steroids neede for pts with severe asthma
What are 2 adverse effects of the use of inhaled corticosteroids in treating asthma?
candidiasis: pts should be counseled to rinse following the use of the agent
can slow growth in children with continuous daily used of inhaled corticosteroids
What type of drugs are the most effective for acute asthma that is uncontrolled by bronchodilators? And may also be used to treat pts recovering from an acute exacerbation?
What are 7 effects that may be caused by prolonged use of systemic corticosteroids to treat asthma?
increased blood pressure
retarded growth in children
Cromolyn sodium (Intal) and nedocromil (Tilade) are what type of drugs? They inhibit mucous formation and decrease airway hyperresponsiveness in some pts with asthma.
Name 2 mast cell stabilizers used to treat asthma. What is their goal of therapy?
cromolyn sodium: Intal
goal: reduc formation of mucus and other secretions
true or false. The use of mast cell stabilizers to treat asthma may also reduce or preven bronchospasms that are induced by exercise or cold
What type of drugs used in asthma treatment have NO anti-inflammatory activity, but are the MOST effective drugs available for the treatment of acute bronchospasm and for the prevention of exercise-induced asthma?
List 4 available beta2-selective aerosols that produce bronchodilation by their effects on beta-2 receptors (Beta2 agonists). used in the treatment of asthma
What are 4 adverse effects of Beta2 agonists used to treat asthma?
List 3 other bronchodilators that are used in asthma treatment, but they are less effective bronchodilators that inhaled beta-2 agonists, and have a slower onset of action.
Theophylline, dyphylline, and aminophylline are other bronchodilators used in asthma treatment that are less effective than inhaled beta-2 agonists; but what is the benefit of using them? What are the adverse effects?
benefit: decrease the frequency and severity of symptoms in pts with chronic asthma, and can decrease oral steroid requirements in corticosteroid dependant pts
Name 2 anticholinergic agents that produce bronchodilation and are used as maintenance treatment for bronchospasm. They have no serious adverse effects.
Ipratropium bromide: Atrovent
tiotropium bromide: Spiriva
Zafirlukast and montelukast are drugs that promote chemotaxis of inflammatory cells and production of mucus, and they can cause brochoconstriction; they have been shown to be as effective as low-dose inhaled corticosteroids in some pts with mild to moderate persistent asthma. What class of drugs are these?
Leukotriene receptor antagonists
What is inflammation of the mucous membrane lining of the bronchi and may be either acute or chronic in nature?
Which type of bronchitis is most commonly a complication of colds, influenza, measles, and whooping cough? condition causes soreness behind the sternum and a dry, painful cough which may include wheezing and difficulty breathying?
What happens in acute bronchitis if secondary bacterial infection occurs?
a thick, purulent sputum is produced
Which type of bronchitis is an abnormality of varied etiology accompanied by increased secretion and chronic inflammation of the alveolar epithelium, characteristics include coughing and sputum for 3 months during past 2 yrs usually heavy set?
Which type of bronchitis has clinical signs including; hypoxic hypoxemia, carbon dioxide retention, respiratory acidosis, and right heart failure?
The following medical treatment may be used to treat which type of bronchitis?
steam inhalations and cough suppressant
in young children and elderly pts, antibiotics might be indicated
The following medical treatments may be used to treat which type of bronchitis?
antibiotics and bronchodilators (tablet or aerosol)
others include theophylline
The following are all characteristics of what Lower respiratory tract disease?
irreversible obstructive disease of the lungs with dilation and destruction of the walls of the terminal bronchioles without fibrosis leading to irregular enlargement of respiratory spaces which leads to diminished aeration of the blood, pts are usually thin, leans forward to assist breathing and is often "barrel chested"
What 2 common histories seen recorded in pts with emphysema
smoking tobacco; usually preceded by chronic bronchitis
In the progression of the emphysema disease, air is trapped in the lungs and the diaphragm is flattened, which leads to what?
hyperinflation of the lungs
What is the goal of medical treatment for emphysema?
to raise oxygen saturation withoug reducing the drive to breath
List 2 approved anticholinergic agents used in the medical treatment of emphysema; and their action.
tiotropium bromide inhalation powder (Spiriva HandiHaler): relaxes muscarinic receptors in the bronchioles to produce bronchodilation
ipratropium bromide (Atrovent): produces bronchodilation and reduces airway secretions
This disease is characterized by an initial asymptomatic phase in which lung function deteriorates without associated clinical symptoms; it then progresses, and clinical characteristics include dyspnea, sputum production, and coughing. What is it?
Chronic Obstructive Pulmonary Disease (COPD)
Name 6 risk factors for developing COPD.
cigarette smoke: most important causative factor
may overlap clinically with: bronchial asthma, chronic bronchitis, emphysema
variety of inhaled particles and gases
What are 3 major goals in the medical treatment of COPD?
improvement of respiratory function
List 3 drugs used for drug therapy treatment of COPD.
inhaled bronchodilators: albuterol, ipratropium, formoterol, saometerol, and tiotropium