Case 2 - LO 4-6

Chronic Hypoxemia

In advanced COPD chronic hypoxemia (low hlood oxygen) causes pulmonary blood vessels to _____ to redirect blood to better ______ areas of the lungs

vasoconstrict (hypoxic pulmonary constriction)

ventilated

Chronic Hypoxemia

Over time, persistant vasoconstriction and vascular remodeling leads to _____ _____

pulmonary hypertension - increased pressure in the pulmonary arteries

Pumonary Hypertension

Increases the workload of the ____ ____ as it pumps blood against higher resistance

right ventricle

what is core pulmonale

enlargement of the right ventricle of the heart

chronic strain causes right ventricular enlargement and eventually right sided ____ ____

heart failure

right sided heart failure can lead to

peripheral edema

jugular vein distension

liver congestion

these are signs of cor pulmonale

Progressive airflow obstruction and impaired gas exchange causes severe ______ and in some patients ____ retention, resulting in _____ _____

hypoxemia

CO2 (hypercapnia)

respiratory failure

Zyban is also known as

Bupropion

Zyban/bupropion inhbits reuptake of _____ and ____ in the CNS, helping to decrease ____ cravings and withdrawl symptoms

norepinephrine

dopamine

nicotine

what are the adverse effects of Zyban

xerostomia

insomnia

anxiety

increase in BP

When using zyban we want to be aware of possible _____ and need to be cautious with high doses of ____

HTN

epi

medication can cause hypertension and epinephrine can further increase the hypertension

xerstomia with Zyban use elevates the risk of

caries, oral candidiasis (thrush), and mucosal discomfort

Bronchodilators are ____-____ and ________

B2-agonists and anticholinergics

example of a B2 agonist

albuterol

short or long lasting B2 agonists (albuterol) stimulate ___ receptors to relax airway ____ ____

B2

smooth muscle (vasodilation)

exmaples of anticholinergics

ipatropium

tiotropium

anicholinergics (ipatropium, tiotropium) block ____ receptors preventing vagallymediated _______

bronchoconstriction

adverse effects of B2 agonists and antocholinergics

xerostomia

throat irritation

occasional tachycardia and arrythmias

dental implications of B2 agonists and antocholinergics

decreased salivary flow can lead to increased caries risk, candiasis infections, and mucosal discomfort

patients may need to be sat ____ due to difficulty breathing

upright

MOA for inhaled corticosteroids

reduce airway _____ and ____ production by binding to ______ receptors

inflammation

mucus

glucocorticoid

adverse effects of inhaled corticosteroids

local immunosupression leading to oral candida, or hoarse voice

dental implications for inhaled corticosteroids

dental professional should recommend whar after using an inhaler

rinse or gargle with water

for patients taking inhlaed corticosteroids we should inspect for ____, ____ plaques

white, wipeable

smoking causes increased risk of ____ disease and ___ ____

CAD and lung cancer

constant inflammatory state triggered by tobacco use contributes to wider ____ isses including worsened Type 2 diabetes control

metabolic

smoking can cause salivary changes including ____ and _____

xerostomia

halitosis

smoking can cause ____ and ____ of teeth and oral mucosa

staining

lesions

what oral changes can smoking cause

smokers palate

red/white pathces

smoking can lead to increased risk of tooth ____

decay

altered oral bacteria and decreased salivary flow increase vulnerability to decay

individuals that smoke have a higher risk of ____ ____ preogressino

periodontal disease

smoking can cause ____ symptoms of PD disease

masked

nicotine causes vasoconstriction reducing blood flow to the gums. This supresses signs of gum inflammation like bleeding and redness delating diagnosis

tobacco harms the function of the ____ and gum cells leading to _____ ____ loss, deep ____ _____, and tooth loss

PDL

alveolar bone

periodontal pockets

smoking modifies the host ______ , leading to a decreased _____ response

microbiome

immune

there is delayed recovery for individuals who smoke due to decresed ___ levels and poor ____ _____ restricting immune systems ability to fight off infection after surgery

oxygen

blood flow

individuals who smoke have a much higher risk of developing ____ ____ after tooth extraction

dry socket

individuals who smoke have a higher chance of ____ failure due to reduced _____ integration

implant

bone

individuals who smoke are at _____ risk or oral cancer

higher

lips, mouth, tonguem throat

individuals who use smokeless tobacco are at a higher risk of cancer where the smokeless tobacco is ____

placed