Card Set Information

2011-04-03 15:13:35
Chapter sixteen

week twelve
Show Answers:

  1. 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
  2. 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
  3. The lungs contain millions of ________ and are connected with the _______ and _______________ by the bronchioles and trachea.
    • alveoli
    • nose
    • oral cavity
  4. With inspiration the alveoli _________ and during expiration air is forced __________
    • expand
    • out
  5. In the continous renewal of air; oxygen is _____________ and carbon dioxide is ______________
    • supplied
    • removed
  6. What is reduced availability of oxygen to the various cells of the body?
  7. What are 5 types of hypoxia?
    • hypoxic hypoxia
    • stagnant hypoxia
    • anemic hypoxia
    • Histotoxic hypoxia
    • dyspnea
  8. Oxygen fails to reach the blood of the lungs.
    HYPOXIC hypoxia
  9. 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
  10. failure to transport oxygen to the tissues because of too little blood flow.
    STAGNANT hypoxia
  11. 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
  12. too little hemoglobin in the blood to transport oxygen to the tissues.
    ANEMIC hypoxia
  13. 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
  14. failure of the tissues to use oxygen even though adequate quantites are transported
    HISTOTOXIC hypoxia
  15. 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
  16. air hunger as a result of respiratory abnormality.
  17. 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
  18. 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
  19. Is the common cold an infection of the upper or lower respiratory tract?
  20. how is the common cold spread?
    person to person by airborne droplets
  21. What are the 3 main anatomical structures that are affected by the common cold?
    • nose
    • larynx
    • pharynx
  22. What is a clinical implication of the common cold?
    It is contagious before symptoms appear and the pt even knows they have it
  23. true or false. At present there are no antiviral agenst that are effective against the viruses responsible for the common cold in humans.
  24. What are 3 general measures to be taken to help treat the common cold?
    • rest
    • fluids
    • good diet
  25. 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
  26. What is the best management strategy for allergic rhinitis?
    avoid/elliminated the responsible allergen
  27. 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?
    • Codeine
    • when CHRONIC pulmonary disease is present
  28. What is the active ingredient in most OTC antitussive syrups, and is safe and effective to reduce cough?
  29. 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.
  30. Allergic rhinitis may be one of what 2 types?
    • seasonal
    • perennial
  31. 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?
  32. Which type of allergic rhinitis is due to sensitivity to a variety of allergens, such as house dust, and may occur throughout the year?
  33. The following symptoms might be caused by what?
    nasal congestion, sneezing, water nasal discharge, pruritus, often conjuctivitis, and pharyngitis
    allergic rhinitis
  34. What are 3 main ways to medically treat allergic rhinitis?
    • eliminate or avoid responsible allergen
    • desensitization injections: effective with seasonal
    • pharmacologic strategies
  35. All _________________ are effective H1 receptor antagonists, but pts may vary in their responses to individual agents and in their susceptibilities to potential adverse effects.
  36. What are the 3 different classifications of antihistamines?
    • first generation agents
    • second generation agents
  37. 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
  38. Why is the clinical use of first-generation antihistamines (such as diphenhydramine hydrochloride (benadryl)) limited?
    owing to anticholinergic and sedative effecs
  39. What are the 3 most common ADEs with first generation antihistamines?
    • sedation
    • dry mouth
    • GI symptoms: nausea, constipation, abdominal pain
  40. What is the first line therapy for treatment of mild allergic rhinitis? (it is a second-generation antihistamine) and why is this so?
    • loratadine: Claritin
    • because it has virtually no sedative or anticholinergic effects
  41. true or false. All second-generation have similar clinical efficacy in equivalent therapeutic doses.
  42. 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.
    • bed time
    • day time
    • sedation
  43. true or false. Nasal antihistamines are considered to be similar in efficacy to oral antihistamines.
  44. What formulation of antihistamines significantly reduce symptoms of itching, redness, and watery eyes associated with allergic conjunctivitis?
    ophthalmic formulations
  45. 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
  46. Because antihistamines do not reduce nasal congestion, some antihistamine products combine antihistamine with what type of drug as a decongestant?
    alpha-adrenergic agonist
  47. What type of drug relieves nasal congestion, is a decongestant?
    alpha-adrenergic agonis: pseudoephedrine (sudafed)
  48. To reduce nasal congestion, the coadministration of an oral decongestant with an antihistamine is recommended for a period of no more than _____ days.
  49. 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?
  50. Patients with one of what 5 conditions should be cautioned about the concurrent use of pseudoephedrine?
    • coronary artery disease
    • hypertension
    • diabetes mellitus
    • hyperthyroidism
    • those recieving monoamine oxidase inhibitors
  51. What is the first line treatment for moderat to severe allergic rhinitis?
    nasal corticosteroid sprays
  52. 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.
  53. When pts do not respond well to a single agent of antihistamines or nasal corticosteroids, what is given, and why?
    • combination therapy
    • because antihistamines and nasal corticosteroids influence different physioligic mechanisms
  54. What is the main ADE with prolonged use of nasal corticosteroids?
    epistaxis: nose bleeds
  55. 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
    Mast-cell stabilizer
  56. What is an example of a Mast-cell stabilizer to help treat allergic rhinitis?
    cromolyn sodium (NasalCrom) available OTC
  57. What class does the following drug fall under?
    nasal ipratropium
    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
    anticholinergic agent
  58. What is an example of an anticholinergic agent used to treat allergic rhinitis?
    nasal ipratropium
  59. What class does the following drug fall under?
    ketorolac (Toradol)
    an ophthalmic formulation of a nonsteroidal antiinflammatory agent (NSAID) that significantly reduces ocular symptoms of itching associated with allergic conjuctivitis
    nonsteroidal anti-inflammatory agent
  60. What is an example of a nonsteroidal anti-inflammatory agent (NSAID) that is used to treat allergic rhinitis?
    ketorolac (Toradol)
  61. 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)
  62. What are 2 examples of Leukotriene-receptor antagonists (LRA) used to treat allergic rhinitis?
    • Zafirlukast (Accolate)
    • Montelukast (Singular)
  63. 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)
  64. 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
    vasomotor rhinitis
  65. 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
  66. 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?
    acute laryngitis
  67. 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
  68. 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?
    chronic laryngitis
  69. The following symptoms are signs of which type of laryngitis?
    hoarseness, frequent coughs, pain may be minimal or absent
  70. What are 2 ways to medically treat chronic laryngitis?
    • steam inhalation
    • gargling with warm salt water
  71. What disease is recognized as the leading cause of death from an infectious disease?
  72. true or false. resistant cases of TB have increased
  73. true or false. There is disparities between white and racial/ethnic minorities. TB is higher in other races than in whites.
    both are true
  74. tuberculosis is an infectious disease caused by _____________________ a bacillus
    mycobacterium tuberculosis
  75. How is tuberculosis transmitted from person to person?
    airborne droplets when an infected person coughs or sneezes
  76. true or false. If a person's immune system is poor TB can spread to other parts of the body besides the lungs
  77. How is TB treated?
    with LONG-TERM administration of two or more antituberculosis drugs
  78. What test is used for the screening of tuberculosis?
    tuberculin skin test: TST or Mantoux
  79. 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
  80. Definitieve diagnosis for TB is done by what?
    a sputum examination; the DNA
  81. 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
  82. true or false. first-line and second-line drugs are often used in combination to treat TB
  83. 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
  84. Name 3 bactericidal agents in the treatment of TB.
    • Isoniazid
    • rifampin
    • streptomycin
  85. When isoniazid is used as a single-drug therapy for TB, what is it for?
    to prevent TB
  86. When isoniazid is used in combination with other agents for TB, what is it for?
    treatment of established TB infection
  87. 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
  88. Most anti-TB drugs are _____________ and slow down the growht and multiplication of the TB infection.
  89. 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
  90. true or false. Most bacteriostatic agents used to treat TB are taken orally
  91. Streptomycin is a bacteriostatic agent used to treat TB, how is it usually administered?
    daily as a single IM injection
  92. Who and when presented guidelines for TB prevention in healthcare facilities?
    • CDC
    • 2005
  93. Written TB infection-control programs are based on what?
    the prevalence of disease in local community
  94. true or false. Patients with clear signs and symptoms of TB should NOT be seen in the dental facility
  95. 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.
  96. What are 5 signs of TB?
    • cough for more than 3 weeks
    • blood in sputum
    • night sweats
    • unexplained weight loss
    • close association with someone who has had TB
  97. 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
  98. true or false. Oral health care workers need to have annual TB tests, as another administrative control.
  99. 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
  100. List 4 diseases of the lower respiratory tract.
    • asthma
    • bronchitis
    • emphysema
    • chronic pulmonary disease: COPD
  101. The following drugs are used in the management of LOWER RESPIRATORY TRACT diseases; list the action of each.
    beta2 bronchodilators
    mast cell stabilizers
    anticholinergic agents
    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
    • leukotriene receptor antagonists: reduce secretions
  102. What LRT disease is chronic with periods of remission and acute exacerbation; is exaggerated bronchoconstriction with reversible airway abstruction
  103. 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
    Chronic bronchitis
  104. 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)
  105. there has been a clinical overlap between asthma, chronic bronchitis, and COPD (LRT diseases) in patients who _________
  106. The diagnosis of which 2 LRT diseases is clinical, made by history?
    • asthma
    • chronic bronchitis
  107. The diagnosis of what LRT disease is based on histologic examination of lung tissue?
  108. The diagnosis of what LRT disease is based on physiologic pulmonary function?
  109. 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?
    bronchial asthma
  110. What type of asthma is associated with allergy and usually occurs in younger age groups?
    extrinsic asthma
  111. Which type of asthma tends to occur in older age groups for whom the asthma attack is more severe?
    Intrinsic asthma
  112. 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
  113. What are 3 common clinical signs and symptoms of asthma attacks?
    • coughing
    • shortness of breath
    • wheezing
    • may be sitting down or leaning forward to assist in breathing
  114. 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
  115. 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
    • mast-cell stabilizers
    • LRAs
  116. 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
  117. 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
    Inhaled corticosteroids
  118. 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
  119. 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?
    systemic corticosteroids
  120. What are 7 effects that may be caused by prolonged use of systemic corticosteroids to treat asthma?
    • glucose intolerance
    • weight gain
    • increased blood pressure
    • bone demineralization
    • cataracts
    • immunosuppression
    • retarded growth in children
  121. Cromolyn sodium (Intal) and nedocromil (Tilade) are what type of drugs? They inhibit mucous formation and decrease airway hyperresponsiveness in some pts with asthma.
    Mast-cell stabilizers
  122. Name 2 mast cell stabilizers used to treat asthma. What is their goal of therapy?
    • cromolyn sodium: Intal
    • nedocromil: Tilade
    • goal: reduc formation of mucus and other secretions
  123. 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
  124. 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?
    Beta2 agonists
  125. List 4 available beta2-selective aerosols that produce bronchodilation by their effects on beta-2 receptors (Beta2 agonists). used in the treatment of asthma
    • albuterol
    • terbutaline
    • pirbuterol
    • bitolterol
  126. What are 4 adverse effects of Beta2 agonists used to treat asthma?
    • increase BP
    • tremors
    • tachycardia
    • palpitations
  127. 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
    • dyphilline
    • aminophylline
  128. 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
    • ADEs: vomiting, headache, tachycardia, cardiac arrhythmias, seizures
    • drug interactions: increased myopia w/ pilocarpine (Salagen); theophylline toxicity w/macrolide antibacterial agents
  129. 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
  130. 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
  131. What is inflammation of the mucous membrane lining of the bronchi and may be either acute or chronic in nature?
  132. 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?
    actue bronchitis
  133. What happens in acute bronchitis if secondary bacterial infection occurs?
    a thick, purulent sputum is produced
  134. 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?
    chronic bronchitis
  135. Which type of bronchitis has clinical signs including; hypoxic hypoxemia, carbon dioxide retention, respiratory acidosis, and right heart failure?
    chronic bronchitis
  136. 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
    acute bronchitis
  137. The following medical treatments may be used to treat which type of bronchitis?
    antibiotics and bronchodilators (tablet or aerosol)
    others include theophylline
    chronic bronchitis
  138. 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"
  139. What 2 common histories seen recorded in pts with emphysema
    • smoking tobacco; usually preceded by chronic bronchitis
    • hereditary defect
  140. 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
  141. What is the goal of medical treatment for emphysema?
    to raise oxygen saturation withoug reducing the drive to breath
  142. 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
  143. 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)
  144. 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
    • antitrypsin deficiency
    • airy hyperresponsiveness
    • indoor pollution
  145. What are 3 major goals in the medical treatment of COPD?
    • smoking cessation
    • symptom relief
    • improvement of respiratory function
  146. List 3 drugs used for drug therapy treatment of COPD.
    • inhaled bronchodilators: albuterol, ipratropium, formoterol, saometerol, and tiotropium
    • theophylline
    • inhaled and oral corticosteroids