ch 30-31

the Physician’s Desk Reference (PDR) & Mosby’s Dental Drug Book

drug reference books that should be kept in a dental office as a reference source when a patient is taking an unknown medication

what does the FDA gathers information about?

the FDA gathers information about drugs used in dentistry

what is the most common route for taking a medication?

the most common route is the oral route

what is administered via inhalation (gas)?

Nitrous Oxide (N2O) and oxygen (O2)

how are local anesthetics and vaccinations administered?

they are administered via an intramuscular injection

b.i.d.

the Latin abbreviation for a medication that is taken twice a day

t.i.d

the Latin abbreviation for a medication that is taken three times a day

q.i.d

the Latin abbreviation for a medication that is taken four times a day

Rx

the abbreviation for ‘prescription’

analgesics

also known as Pain Relievers (“pain killers”)

non–narcotic painkillers

 prescribed for the relief of mild to moderate pain and do not require a Rx. CAN BE PURCHASED OTC

aspirin

Acetylsalicylic Acid

Analgesic (pain reliever)

antipyretic (fever reducer)

anticoagulant (blood thinner)

Tylenol™

Acetaminophen  

(! Excessive use causes liver damage.)

Analgesic (pain reliever)

antipyretic (fever reducer)

NSAID (nonsteroidal anti-inflammatory)

Advil™ / Motrin™

Ibuprofen

(! Excessive use causes kidney damage)

Analgesic (pain reliever)

antipyretic (fever reducer)

NSAID (nonsteroidal anti-inflammatory)

Aleve™

Naproxen

Analgesic (pain reliever)

(nonsteroidal anti-inflammatory) NSAID

narcotic painkillers

prescribed for the relief of severe pain and are addictive, thus requiring a Rx from a doctor to purchase

• Codeine

• Morphine

• Vicodin

• Oxycodone

these 4 are narcotic painkillers

the Federal Schedule of Drugs

 includes five levels of drugs

schedule I drugs

these drugs have no accepted medical use, have a high potential for abuse, and are illegal

schedule V drugs

these drugs have the lowest abuse potential and can be purchased OTC (Do not require a Rx)

what is a drug?

a chemical compound that changes a body’s chemical processes, used for the diagnosis, treatment, &/or prevention of diseases

what is a side effect?

an unintended physiological response or result

what is a drug interaction?

an unintended physiological response due to one drug changing the action of another drug when combined

what does it mean to be addicted?

to be physically dependent on a drug

what is a Rx Body?

Also known as the “signature”, includes the type of medication, dosage, and quantity of medication prescribed (the instructions, in other words)

routes of administration: oral route

pills, tablets, capsules, & liquids

• the most common route, but also the slowest route

routes of administration: Inhalation route

Inhaling a gaseous substance and allowing it to be absorbed through the lungs (O2 is the most commonly used drug in a med. emergency)

routes of administration: sublingual route

medication is placed under the patient’s tongue & allowed to dissolve & be absorbed through the mucosal tissue

injection (parenteral) routes: Subcutaneous (SC):

 The drug is injected under the skin, into fat

injection (parenteral) route: Intramuscular (IM)

the drug is injected directly into a muscle

injection (parenteral) route: Intravenous (IV)

the drug is injected directly into a blood vessel

injection (parenteral) route: Intradermal (ID)

the drug is injected between the layers of skin

what color is the emergency oxygen tank?

the tank’s color is green

what is the assistant’s role in a healthcare office?

the assistant’s role is to monitor the patient for signs of an impending medical emg

what are the signs of an impending medical emg.?

Eyes:  Pupil dilation and vascularization

Gait:  The way a patient walks

Speech:  Slurred or strained?

Signs of anxiety

what is the first step if a patient has a medical emergency and/or goes unconscious?

the first step is to remove all items from the patient’s mouth and call 911 if they are unconscious

what is the second step if a patient has a medical emergency and/or goes unconscious?

the second step is the take and evaluate the patient’s vital signs, starting with pulse

 if unconscious make sure the patient’s airway is open by tilting their head back & chin up

what is the third step if a patient has a medical emergency and/or goes unconscious?

the third step is to place your ear over the patient’s mouth to listen and feel for breaths while also watching their chest for signs of respiration (chest rise and fall)

what is the fourth step if a patient has a medical emergency and/or goes unconscious?

the fourth step is to perform CPR

how should CPR begin/the first step?

cpr should begin with 30 chest compressions, which should be performed at a rate of 100 compressions per minute. 

Compressions should be performed on the patient’s lower 1/3 of the sternum

what is the second step to CPR?

deliver 2 rescue breaths for 1.5 – 2 seconds per breath.

The goal is to see the chest rise in the victim, accomplished with “normal” breaths. 

Do not deliver breaths that are too forceful or deep. 

what is the compression-to-breath ratio?

the compression-to-breath ratio is 30 compressions to 2 breaths (30:2)

what should you use if the patient is not revived by performing CPR?

the automated external defibrillator (AED) will be used as the electrical jolt will reset the heart rhythm to a normal pattern

when are the electrodes of the AED placed?

the electrodes of the AED are placed only when the patient is not breathing, their heart has stopped beating and they are unconscious

cardiac arrest

this is when the patient is unresponsive, shows no signs of normal breathing, and does not have a pulse ; treatment is immediate CPR

Foreign Body Airway Obstruction (FBAO)

FBAO is the most common medical emergency in the dental office

what is the universal signal for choking?

the universal signal for choking is clutching the throat with two hands

syncope

commonly referred as fainting. this med. emg. is brought on my fear or anxiety.

what do syncope symptoms include?

syncope symptoms include:

• Dizziness

• Nausea

• Weakness

• Unconsciousness

how is syncope treated?

syncope is treated by placing patient in the subsupine position (Trendelenburg position) with their head below their feet so that oxygen-rich blood can flow to their brain

Asthma

asthma is the narrowing of the bronchioles which causes shortness of breath and breathlessness

how are asthma attacks treated?

asthma attacks are treated with an albuterol bronchial inhaler. 

what is an antihistamine medication?

an antihistamine medication is administered to reverse the reaction of histamine release.

in what case is antihistamine medication used?

during an allergic reaction

allergie reaction

an abnormal physiological response to a substance

what do common antihistamines include?

common antihistamines include diphenhydramine (Benadryl™) and epinephrine (Epi-Pen™).

anaphylactic shock

anaphylactic shock is a life threatening form of an allergic reaction that can lead to death.

The allergic reaction has become systemic.

how do you treat anaphylactic shock?

you treat anaphylactic shock by administering an IM (intramuscular) or IV (intravenous) injection of the antihistamine epinephrine for a severe allergic reaction (anaphylaxis)

diabetes

diabetes is caused from the pancreas not producing sufficient levels of insulin

what is type 1 diabetes?

Type 1 Diabetes is genetic, where the patient cannot control having type 1 diabetes

what is type 2 diabetes?

Type 2 Diabetes is self-induced, and it is reversible with exercise and a proper diet low in sugar.

what must dental treatment do when dealing with a hyperglycemic (high blood sugar level) pt.

dental treatment should stop to allow the patient to administer an insulin injection

what is Hypoglycemia?

Hypoglycemia has a rapid onset & is caused by low blood sugar levels.

what should hypoglycemic patients be asked?

hypoglycemic patients should be asked if they have eaten before treatment.

what should be given to a conscious hypoglycemic patient?

a conscious hypoglycemic patient should be administered a sugar-rich substance

Arteriosclerosis

arteriosclerosis is the cause of the majority of cardiovascular emergencies

what does arteriosclerosis do?

arteriosclerosis causes the narrowing and hardening of the arteries, thus a decrease in oxygen-rich blood flowing to the heart

angina

angina is chest pain caused by a temporary decrease in blood flow to the heart

myocardial infaction (MI)

myocardial infarction is also known as a heart attack in which a part of the heart is not receiving enough blood and oxygen.

how is Arteriosclerosis treated?

Arteriosclerosis is treated with blood thinner medications

how is angina treated?

angina is treated by administering Nitroglycerin sublingually or in an oral spray

how are myocardial infarctions treated?

myocardial infarctions are treated by:

• Administer Nitroglycerin & oxygen 

• Monitor vital signs

• Be prepared to start CPR if respiratory & cardiac failure occur

• Be prepared to use the AED

stroke

also known as a cerebrovascular accident / CVA, it is caused by a cerebral infarction, which stops blood flow to an area of the brain

Epilepsy / Seizures

Seizures can occur spontaneously or in response to stimuli (flashing lights)

what do dental emergencies include?

• Avulsed teeth

• Traumatic intrusion of teeth

• Fractured teeth (pulpal involvement?)

• Soft tissue injuries

• Fractured jaw

• Fractured prosthetics

• Abscesses

what are avulsed teeth?

a tooth that has been forcibly removed due to a trauma

what is a traumatic intrusion of teeth?

caused by a fall, car accident, or an event that forcibly pushes a tooth deep within its socket