Chapter 8 Pain Management and Pharmacology

threshold of pain

ability to withstand pain

hypokinetic

high tolerance for pain

hyperkinetic

low tolerance for pain

fifth vital sign

the patients concept of the intensity of pain

anxiety abatement

control of emotional and stress factors through psychological methods

stress reduction

voice calming, concerned movement, thoughtful, caring manners, soft setting

relaxation methods

guided imagery; suggestions of happy times, relaxing places; patient thoughts dwell on suggested happy thoughts or scenes

deep-breathing exercises

patient concentrates on breathing and muscle movement; oxygenates blood stream and brain oxygen supply

distraction technique

discuss patient hobbies, family, and accomplishments to divert attention from dental treatment

biofeedback principles

use of memory, reasoning, judgment, and perception applied to uncomfortable situations; patient concentrates on reducing tension progressively from toe to head with relaxing suggestions

cognitive behavioral therapy

psychotherapeutic therapy using counseling to discover patient's thoughts that are causing behavior stress in dental (or other) situations; learning to control body functions; may include hypnosis

conscious sedations

relaxation of mental and physical distress without loss of consciousness. Relief of pain without the loss of consciousness

pre-medication

medicine to depress the central nervous system (CNS) administered prior to treatment by mouth, by intramuscular injections, or by intravenous injection

benzodiazepines

Xanax, Ativan, Librium, Valium, Halcion, and Serax

barbiturates

Nembutal, Surital, Seconal, Amytal, Luminal, and Mberal

hypnotic

chloral hydrate, equanil

T.E.N.S (transcutaneous electrical nerve stimulations)

device to send small electrical impulses to nerve ending to block pain signals

analgesia

relaxation and sedation without loss of consciousness by inhalation of a combination of nitrous oxide and oxygen gas

opioid

analgesic drugs are classified according to nonnarcotic drugs or nonopioid drugs or narcotic drugs

acetaminophens

carefully used in proper doses as an aspirin replacement for young children and adults

antipyretic

lower fever

salicylate

used as an analgesic, antipyretic, and anti-inflammatory

enteric-coated

buffer chemicals added to reduce stomach upset

nonsteroid anti-inflammatory

analgesic, antipyretic, and anti-flammatory

ibuprofen

nonnarcotic drug

naproxen

nonnarcotic drug

narcotic drugs (examples of)

morphine, methadone, dolophine, meperidine, demerol, dihydromorphinone, dilaudid, oxycodone, percocet, pentazocine, talwin, codeine, empirin 3, propoxyphene, darvon

anesthesia

without feeling

topical analgesia

application of topical anesthetics to pain sites

local anesthesia

loss of sensation in a selected area

infiltration

passing into

regional or field anesthesia

around the nerve ending for anesthesia of a block of two or three teeth apices

block anesthesia

injection into a nerve bundle to enable anesthesia to a wider area, such as the mandibular quadrant of teeth or palatal into the palate

inraosseous

directly into the spongy bone for a single tooth or multiple teeth in the same quadrant

interpulpal

injecting directly into the pulp chamber using a long needle

untraligamentory

done mainly in the mandibular arch for one or two teeth in the same quadrant

electronic-controlled local anesthesia ("the want")

computer-controlled anesthetic-delivery system for subcutaneous or intramuscular local anesthetic and nerve blocks, consisting of a sterile disposable handpiece component and a computer control unit

anesthetic syringle

has a harpoon on the plunger end to penetrate the rubber plunger in the carpule and provide suction to draw back the solution

bevel

the slant at the entry tip on the needle

lumen

the hole in the needle's shaft for solution to pass through

carpule

also called cartridge, glass vial containing to anesthetic solution to be placed by the syringe

anesthetic solution

two types

ester

alcohol-based solution, such as procaine or propoxycaine

amide

water-based solution, such as lidocaine, prilocaine, articaine

vasoconstrictor

a chemical that is added to the anesthetic solution to constrict blood vessels

hemostasis

epinephrine is added in various intensities from 1 drop of epinephrine to 50,000 drops of anesthetic solution

allergy

a reaction to the anesthesia

anaphylactic shock

a reaction to the medication, delivery, or amount of anesthesia

hematoma

blood swelling or bruise

trismus

grating or tonic contracting of the jaw or muscle rigidity

paresthesia

abnormal feeling occurring after anesthesia has worn off

local anesthetics (examples of)

lidocaine, benzocaine, tetracaine, procaine, propoxycaine, mepivacaine, bupivacaine, prilocaine

Stage l - analgesia

a loss of sensation but conscious and able to carry on a conversation

Stage ll - Excitment

loss of consciousness

Stage lll - surgical anesthesia

skeletal muscles relax, breathing becomes regulars, eye movement stops. This stage has four planes or levels

Plane l

light surgery stage

Plane ll

moderate stage of surgery

Plane lll

deep surgery

Plane lV

respiratory and circulatory dysfunction

Stage IV - medullary paralysis

not desired; breathing center and vital function stop working, death may occur if patient is not revived immediately

hypoxia

oxygen insufficiency

malignant hyperthermia

a reaction that may cause high fever, muscle rigidity

anesthesia unit

equipment that receives and delivers gases by means of tubing and regulation devices to control anesthetic flow

pressure gauges

indicate the amount of gas pressure present within the cylinder tanks

regulators

control the amount of gases coming from the central supply to the anesthesia stand

flowmeters

control the amount of gas from the anesthesia unit to the patient

nasal mask

placed over patients nose to present gas into the body

reservoir bag

may be used for hand-forced induction pressure of gases and a monitor to observe patient breathing rate and force

blood pressure equipment

stethoscope and sphygmomanometer to monitor blood pressure

emergency tray

a tray or box containing syringes and equipment necessary to deliver drugs or medicines for medical emergencies

emergency plans and numbers

emergency transportation and phone numbers

defilbrillator

mechanical device to restore heart contractions

oximeter

monitoring equipment used to determine oxygen saturation in the blood

patient records and history

current records of patient with history and condition

volatile liquids

halothane, enflurane, isoflurane

ketamine

an intramuscular general anesthetic

pharmacology

the study of drugs and their effects

brand or proprietary name, and generic

each drugs registered U.S. patented name

absorption

process in which fluids are transferred from the administration site by the circulating body fluids

distribution

process of dividing and delivering the absorbed drug to the desired site

metabolism

process of physical and chemical changes that enable the body to use the drug

excretion

process of elimination of waste products from the body

adverse effects

response to a drug that is not desired because it is too intense, too weak, toxic, possibly allergic, and so on

addiction

compulsive, uncontrollable dependence on a drug to the extent that cessation causes severe physiological and emotional reactions

anaphylaxis

a life-threatening allergic reaction to a drug that may produce an immediate or a delayed body reaction

antagonism

opposite or contrary action of a drug

dependence

physical (chemical) or psychological (desire) need to use a drug despite related problems that may accompany it

drug interaction

effect resulting from the combination of two or more drugs at one time

idiosyncrasy

unusual and abnormal drug response that may be genetic in nature or a result of an immune disorder

intolerance

inability of the body to endure a drug or the incapacity of a drug to achieve a desired effect because of long-term use

overdose

effects from excessive drug dosage

side effects

reaction from a drug that is not the desired treatment outcome

secondary effect

an indirect effect or consequence resulting from drug action

synergism

harmonious action of two drugs to produce a desired effect

teratogenic

drug effects on a fetus

onset

start of the drug effect and the length of its effect

duration

depends on its method of entry into the body

potency

strength

efficacy

intensity

enteral

into the intestines