The process of administering drugs directly to the lungs for therapeutic purposes.
2
What are bronchodilators?
Show answer
Drugs that relax the muscles of the bronchi, allowing for easier breathing.
3
What are inhaled corticosteroids?
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A type of medication used to reduce inflammation in the airways, often used for asthma management.
4
What is a Metered-Dose Inhaler (pMDI)?
Show answer
A pressurized inhaler that propels drugs from a canister with the aid of a propellant (HFA).
5
What is the purpose of a Spacer Chamber in inhalation therapy?
Show answer
To increase the percentage of drug inhaled into the lower airways, especially useful in children.
6
What are Dry Powder Inhalers typically used for?
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Dry Powder Inhalers are usually used for drugs given every day, especially for peptides and proteins like insulin.
7
What is the difference between a metered-dose inhaler and a dry-powder inhaler?
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A metered-dose inhaler delivers aerosolized drug to the lungs, while a dry-powder inhaler delivers powdered medications to the lungs.
8
How does a nebulizer work?
Show answer
A nebulizer changes liquid drug to mist and delivers it to the lungs over a period of time (between 10-20 minutes).
9
What is the preferred route of inhalation for medication delivery?
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Inhalation route with small particle size
10
What percentage of inhaled medication is absorbed by the lungs?
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10%–20%
11
What is the term for the first-pass metabolism in the liver?
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"First-pass" metabolism
12
What is the oral route of administration?
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Generally reserved for patients unable to use inhalers.
13
Why must theophylline be given systemically?
Show answer
Because it is ineffective by the inhaled route.
14
What is the parenteral route of administration?
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IV, mainly for severely ill patients due to fast onset and inability to absorb drugs from the GI tract.
15
What is the function of parasympathetic innervation in the tracheobronchial tree?
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Bronchoconstriction
16
What is the function of sympathetic innervation in the tracheobronchial tree?
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Bronchodilation
17
What are the two zones of the tracheobronchial tree?
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Conducting Zone and Respiratory Zone
18
What is the definition of asthma?
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A chronic inflammatory disorder caused by excessive airway hyperresponsiveness in response to triggers.
19
What is the role of Ach in asthma?
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Ach binds to airway muscarinic receptors to trigger smooth muscle contraction and mucus secretion.
20
What is the mechanism of extrinsic (allergic) asthma?
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Type I hypersensitivity reaction
21
What are the common allergens associated with extrinsic (allergic) asthma?
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Pollen, dust, pet dander
22
How is acute asthma divided into phases?
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Early phase: histamine derived, characterized by bronchoconstriction and edema; Late phase: inflammatory cells/mediators derived, characterized by mucus secretion
23
What is the epidemiology of intrinsic asthma?
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More frequent in adults, occurring after the age of 30 years.
24
What is the mechanism of intrinsic asthma?
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Due to nonallergic causes.
25
What are the triggers of intrinsic asthma?
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Smoking, chronic bronchitis, respiratory infections, air pollutants, cold air, and exercise.
26
What are the symptoms of mild intermittent asthma?
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Symptoms less than twice a week, asymptomatic between exacerbations, brief exacerbations, nighttime symptoms < twice monthly
27
What is the classification for asthma with symptoms between once a day and twice a week?
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Mild persistent
28
What is the American Society of Anesthesiologists (ASA) Classification of Asthma?
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A system for classifying asthma severity and treatment modifications.
29
What are the three levels of the ASA Classification of Asthma?
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Level 2, Level 3, and Level 4.
30
What is the treatment modification for Level 2 asthma?
Show answer
Use stress reduction protocol as needed.
31
What are pharmacological reagents?
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Substances used in pharmacology to study the effects of drugs on biological systems.
32
What does the acronym INHALE stand for in the context of pharmacological reagents?
Show answer
Inhalation
33
What are the three main categories of asthma management as shown in the slide?
What are the subcategories under Anti-inflammatory?
Show answer
Steroids, Biologics, Cromolyn
36
What are the three therapeutic goals of asthma therapy?
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Decrease the intensity and frequency of asthma symptoms, prevent asthma exacerbation, and minimize limitations in daily activity due to asthma.
37
What does the Global Initiative for Asthma (GINA) recommend for asthma patients?
Show answer
All asthma patients should receive treatment with a long-term controller medication (like ICSs) and a reliever medication.
38
What are bronchodilators?
Show answer
Bronchodilators are medications that relax the muscles in the airways, making it easier to breathe.
39
What is the primary effect of bronchodilators?
Show answer
The primary effect of bronchodilators is to widen the airways, reducing the resistance to airflow.
40
What are Short-acting β2-adrenoceptor agonists (SABAs)?
Show answer
SABAs are a class of medications used to manage acute asthma symptoms.
41
What are some examples of SABAs?
Show answer
Albuterol (Ventolin®) and levalbuterol (Xopenex®).
42
How are SABAs administered?
Show answer
By inhalation.
43
What is the onset of action for SABAs?
Show answer
1-5 minutes.
44
What is the duration of action for SABAs?
Show answer
4-6 hours.
45
What are the indications for using SABAs?
Show answer
To manage acute asthma symptoms such as shortness of breath, chest tightness, and wheezing.
46
What is the recommended duration of use for SABAs?
Show answer
For a short period of time and should be used as-needed.
47
What is the potential long-term effect of SABAs?
Show answer
Long-term use can cause β-receptor down-regulation.
48
What are Long-acting β2-adrenoceptor agonists (LABAs)?
Show answer
They are a class of medications used to manage moderate to severe asthma and COPD.
49
What are some examples of LABAs?
Show answer
Salmeterol (Serevent®) and formoterol (Foradil®).
50
What is the duration of action for LABAs?
Show answer
Around 12 hours.
51
What are the adverse effects of SABAs and LABAs?
Show answer
Skeletal muscle tremors, increased heart rate, candidiasis (rare 0.2%), xerostomia, and unpleasant sense of taste.
52
What is the rare incidence of candidiasis associated with SABAs and LABAs?
Show answer
0.2%
53
What are the indications for the use of LAMAs?
Show answer
Add-on treatment for Asthma, maintenance for COPD, and rhinitis.
54
What are the adverse effects of LAMAs?
Show answer
Low systemic absorption, xerostomia when administered in large doses and altered taste, and urinary retention in elderly patients.
55
What are the side effects of the drug mentioned?
Show answer
Headache, vomiting, restlessness, and insomnia. High concentrations may cause cardiac arrhythmias and seizures.
56
How are the drug-drug interactions described?
Show answer
The drug is metabolized by the liver and can be affected by drugs that inhibit CYP-450 like erythromycin or azoles.
57
What is the term for anti-inflammatory agents used to control chronic inflammation?
Show answer
Controller medication
58
What are the main types of controller medications for anti-inflammatory agents?
Show answer
Examples include corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs)
59
What is the role of phospholipase A2 in the inflammatory pathway?
Show answer
Phospholipase A2 catalyzes the release of arachidonic acid from membrane phospholipids.
60
What are the two main pathways that arachidonic acid can be metabolized into?
Show answer
The two main pathways are the lipoxygenase pathway and the cyclooxygenase (COX) pathway.
61
What are the examples of corticosteroids mentioned in the slide?
Show answer
Beclomethasone (Qvar), fluticasone (Flovent), and budesonide (Pulmicort)
62
How are corticosteroids used?
Show answer
Used as inhaler or oral tablets
63
What is the main mechanism of action (MOA) of corticosteroids?
Show answer
Inhibit phospholipase A2, inhibit arachidonic acid and its downstream products, reduce inflammatory cells, and decrease mucus production
64
What is the mechanism of action (MOA) of anti-IgE biologics like Omalizumab?
Show answer
Binds circulating IgE, blocking its binding to mast cells and preventing mast cell degranulation in response to allergens. Reduces eosinophils and inflammatory mediators.
65
How is Omalizumab administered and how often?
Show answer
Administered via a subcutaneous injection every 2-4 weeks.
66
What are intranasal corticosteroids used for?
Show answer
Treatment of allergic rhinitis
67
What are some examples of intranasal corticosteroids?
Show answer
Fluticasone (Flonase), triamcinolone (Nasacort)
68
What are the adverse effects of intranasal corticosteroids?
Show answer
Localized effects including nasal irritation, nosebleed, and sore throat (rarely, candidiasis). Systemic absorption is minimal.
69
What advice is given to patients regarding their inhaler/medication at the dental appointment?
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Patients are advised to bring their inhaler/medication to the appointment.
70
What medication should be avoided in patients with asthma due to aspirin-induced asthma?
Show answer
Aspirin and other NSAIDs should be avoided.
71
What is the safer alternative to aspirin and NSAIDs for patients with aspirin-induced asthma?
Show answer
Acetaminophen may be a safer alternative.
72
What are the side effects of opioids in patients with asthma?
Show answer
Bronchospasm due to histamine release
73
What are the side effects of opioids and sedatives?
Show answer
Respiratory depression
74
What side effect can anticholinergic agents cause?