DENT3005 Respiratory System Quiz

DENT3005 Respiratory System

• Course name: DENT3005 Respiratory System
• Lecturer: Sheetal Maria Rajan
• Lecturer email: [email protected]

Acknowledgement of Country

• University of Western Australia acknowledges Noongar land
• Noongar people are the spiritual and cultural custodians of the land
• Noongar values, languages, beliefs, and knowledge are practiced

Learning Outcomes

• Broad Objective: Explain various respiratory drugs' impact on dental practice and management strategies.
• Specific Medications Covered: Asthma and COPD

Respiratory Medications

Relievers

• SABA (Short-acting β2 agonist)
• LABA (Long-acting β2 agonist with rapid onset)

Preventers

• ICS (Inhaled Corticosteroids)
• Leukotriene Modifiers
• Mast Cell Stabilizers

Add on Therapy

• LABA
• Theophylline
• Anti-immunoglobulin (IgE) – Omalizumab
• Anti-interleukin-5 (IL5) - Mepolizumab
• LAMA (Long-acting muscarinic antagonist)

Asthma

• Chronic condition inflaming and narrowing airways in the lungs
• Affects all ages
• Symptoms: coughing, wheezing, shortness of breath, chest tightness

Asthma Attacks

• Divided into early and late phases

• Early phase (10-20 minutes): IgE binds to receptors on mast cells

• Late phase (6-9 hours): Activated TH2 lymphocytes release cytokines that recruit more inflammatory cells

• Symptoms: bronchoconstriction, vasodilation, airway inflammation

• Clinical presentation: wheezing, shortness of breath, chest tightness, coughing

• Treatment: SABAs (albuterol) – relax bronchial muscles.

COPD

• Chronic inflammatory lung disease causing obstructed airflow

• Symptoms: breathing difficulty, cough, mucus production, wheezing

• Typically caused by long-term exposure to irritating gases (e.g., cigarette smoke)

• Increased risk of heart disease, lung cancer, and other conditions

• Two most common conditions

  • Chronic bronchitis: inflammation of bronchial tubes
  • Emphysema: destruction of alveoli (air sacs)

• Chronic bronchitis (Blue bloaters)

  • Clinical definition: productive cough for most days in two consecutive years
  • Pathology: airway lumen narrowing due to mucosal thickening and excess mucus
  • Symptoms: chronic productive cough, purulent sputum, cyanosis, peripheral oedema

• Emphysema (Pink puffers)

  • Pathological definition: dilatation and destruction of air spaces distal to terminal bronchioles
  • Symptoms: exertional dyspnoea, minimal cough, tachypnoea, decreased exercise tolerance, pink skin, pursed-lip breathing, use of accessory muscles

Pharmacokinetics of Inhalers

• 5% of inhaled medication is deposited in the lungs
• 95% is swallowed and undergoes first-pass metabolism

Short-acting β2 Agonist (SABA)

• Relaxes airway smooth muscle
• Stimulates β2 adrenergic receptors, increasing cAMP
• Acts quickly (within minutes) to open airways
• Used as rescue inhalers for immediate relief
• Examples: Salbutamol, Terbutaline

Short-acting Muscarinic Antagonist (SAMA)

• Relaxes airway smooth muscle, induced by acetylcholine and post-ganglionic cholinergic nerves
• Blocks M3 muscarinic receptors
• Rapid bronchodilation (15-30 minutes)
• Used for acute bronchospasm, often combined with SABAs for enhanced effect
• Examples: Ipratropium Bromide

Long-acting β2 Agonist (LABA)

• Prolonged bronchodilation (up to 12-24 hours)
• Can be used as monotherapy or combined with inhaled corticosteroids
• Examples: Salmeterol, Formoterol, Indacaterol, Olodaterol, Vilanterol

Long-acting Muscarinic Antagonist (LAMA)

• Administration: Once daily (Tiotropium, Umeclidinium) or twice daily (Aclidinium, Glycopyrronium).
• Blocks muscarinic receptors in the airways, preventing bronchoconstriction and reducing mucus production
• For long-term control of COPD, sometimes combined with other medications

Leukotriene Modifiers

• Reduce airway hyper-responsiveness and eosinophil levels
• Block the action of leukotrienes (chemicals causing inflammation, bronchoconstriction, and mucus production)
• Taken orally once daily
• Examples: Montelukast, Zafirlukast

Mast Cell Stabilizers

• Stabilize mast cell plasma membranes
• Prevent degranulation and release of histamine, leukotrienes, and other substances causing airway inflammation
• Not used for acute bronchodilatory properties
• Example: Chromoglycate, Nedocromil

Inhaled Corticosteroids (ICS)

• Anti-inflammatory
• Reduces bronchial hyper-responsiveness
• Improves symptoms
• Used daily to control/prevent chronic symptoms and reduce exacerbations
• Examples: Beclometasone, Budesonide, Fluticasone, Mometasone, Ciclesonide

Theophylline

• Inhibits phosphodiesterase enzymes, increasing cAMP levels, relaxing bronchial muscles
• Methylxanthine derivative administered IV or orally
• Used for treating airway diseases
• Concerns: Low therapeutic window, drug interactions

Implications for Dentistry

• Medical History Considerations: Severe exacerbations, intubation, history of SABA, CVD, corticosteroid history
• Patient Factors: Airway obstruction, dementia, psychiatric disease
• Possible Oxygen Therapy: COPD/asthma patients, for compromised breathing
• Aspirin-Containing Compounds / NSAIDS: Should be avoided due to interaction with bronchodilators/corticosteroids.
• Opiates: Can cause bronchoconstriction and interactions with bronchodilators/corticosteroids
• Dry Mouth (Xerostomia): Medications can reduce saliva production, including anticholinergics and β2 agonists
• Oral Candidiasis: Inhaled corticosteroids increase risk of oral candidiasis

Community First Aid Protocol

• Rule of 4's for managing breathing difficulties with ABAs
• Use of spacer where possible

Test your knowledge on the respiratory system and its impact on dental practices as outlined in the DENT3005 course. This quiz covers various respiratory medications, including their classification and effects on asthma and COPD management. Prepare to enhance your understanding of the essential drug therapies related to respiratory health.