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ORS 1001 Exam 2
Terms in this set (219)
Drugs that cause relaxation, calmness, and decreased motor activity without loss of consciousness
Drugs that induce drowsiness and depressed state of consciousness that resembles natural sleep
CNS depressants are _____-dependent
GABAa is _______ _____-linked
GABAb is _____ _____-linked
What happens when GABAa is activated?
BZD receptors are linked to ______ receptors
_______ receptors are linked to sleep
_____ receptors are linked to cognition and motor function
T or F: Most BZD are selective for either BZ1 or BZ2
_______ increase the frequency at which Cl-channels open in response to GABA
T or F: BZDs have GABA mimetic activity
________ enhance GABA binding and increase the duration of GABA-activated Cl-channel opening
T or F: Barbituates have GABA mimetic activity at high doises
_______ reverses the CNS effects of BZDs
Flumazenil is classified as a ___________ antagonist at BZ receptors
Do BZDs or Barbituates have a higher theraputic index?
Do BZDs or Barbituates have a high potential for respiratory depression
Do BZDs or Barbituates have a higher risk for abuse?
Whch drug class has the suffix "azolam" or "azepam"
Drug class of choice for oral sedation
BZDs are well absorbed and most have a ______ onset of action
Most common drug class perscribed as sleep aids
BZDs are ______-soluble
Which BZDs have poor oral bioavailability due to CYP3A4
MAT (midazolam, alprazolam, and triazolam)
BZDs with the highest lipid solubility enter the ______ rapidly and can be used as induction agents in anesthesia
Main enzyms that metabolize BZDs
CYP3A4, 2C19 (both hepatic)
BZDs that do not form active metabolites. Instead, they undergo glucuronidation (conjugation). This makes them useful in _____ patients and those who are ______ impaired
LOT (Lorazepam, Oxazepam, and Temazepam), Elderly, Hepatically
Amnestic effects of BZDs are ____-dependent
BZD used for muscle relaxant
A minimally depressed level of consciouseness, produced by a pharmacologic method, that retains the patient's ability to maintain an airway independently and continuously and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected
A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained
A drug-induced depression of conciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimulation. The ability to maintain ventilatory function independently may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained
A drug-induced loss of consciousness during which patients are unarousable, even by painful stimulation. The ability to maintain ventilatory function independently is often impaired. Patients often require assistance maintaining a patent airway, and positive-pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired
Requirements for a patient to be discharged to a reliabel adult after sedation (3)
Oriented and ambulatory
Stable vital signs
Signs of increasing alertness
Triazolam shouldn't be given with what other drugs due to CYP3A4 inhibition? (6)
Several antiviral drugs (ritonavir)
T or F: Lorazepam is not subject to CYP3A4 interactions
T or F: Alprazolam is not subject to CYP3A4 interactions
Which BZD is associated with a "hangover" feeling, and what causes this?
Diazepam, Active metabolites
Which BZD is best associated with muscle relaxation effects?
Which BZD is most commonly used for pediatric patients?
T or F: Midazolam is subject to CYP3A4 interactions
An elderly patient presents to your office and needs sedation. Which BZDs should you consider? (2)
Triazolam has a ______ half-life and _____ onset
Which injectable BZD has a risk of thrombophlebitis?
The "Z" drugs are selective for the ______ subunits of GABA
Difference between "Z" drugs and BZDs
Less memory loss
Adverse effects of Eszopiclone (2)
Drug of choice for sedation of a pregnant patient
The relief of anxiety through the dentist's behavior. The building block for all other forms of psychosedation
Best way to give sedation to a patient with nausea and vomiting
Rectal sedation is good for the induction of ____ to _____ sedation
Minimal to moderate
Key disadvantages of IM sedation (2)
Inability to titrate
Inability to reverse drug action
Onset time for IM sedation
Antiemetic and anticholinergic grugs should be given in what way?
What quadrant should a gluteal injection be given in?
T or F: IV conscious sedation patients cannot maintain a patent airway
Time of onset of IV sedatives
T or F: Recovery from IV administered drugs is longer and less complete than that following N2O-O2 inhalation sedation
When using IV sedation, the gag reflex is _______
T or F: 5% dextrose solution for IV fluids is contraindicated in diabetic patients
Dr. Youngblood's favorite vein to use for IV sedation
Medial antibrachial vein
Guage needle used for IV sedation in dentistry
During deep sedation, the patient's ability to maintain ventilatory function _____ be impaired
During general anesthesia, the patient's abilitity to maintain ventilatory function ____ be impaired
During stage II of anesthesia, the _____ reflex disappears
Stage III sedation: onset of automatic respiration to cessation of eyeball movements. Eyelid reflex is lost, swallowing reflex disappears, marked eyeball movement may occur. Which plane is being described?
Stage III sedation: From cessation of eyeball movements to beginning of paralysis of intercostal muscles. What plane is being described?
Stage III sedation: From beginning to completion of intercostal muscle paralysis. Diaphragmatic respiration persists, pupils dilated and light reflex is abolished. What plane is being described?
Which plane of stage III sedation was the desired plane for surgery when muscle relaxants were not used?
Stage III sedation: From complete intercostal paralysis to diaphragmatic paralysis (apnea). What plane is being described?
Main BZDs that we use as sedatives (2)
Which class of drugs is known for its retrograde amnesia?
Main dissociated anesthetic that we use for sedation
Ketamine should not be used on what type of patients?
Side effects of Ketamine (3)
Elevated BP and heart rate
Excess saliva production
Diazepam trade name
Diazepam is metabolized where?
Contraindications of Diazepam (2)
Allergy to BZDs
Half life of Diazepam
Patients who are given Valium should be advised to avoid what after the procedure?
High fat meals
Which BZD has retrograde and anterograde amnesia?
Which class of sedatives cause CVS and respiratory depression?
Narcotics are good for what types of sedation?
Deep to general anesthesia
Drugs used for general anesthesia (2)
Propofol should be avoided in patients with what allergy?
Propofol is _____ protective but _____ depressive
Why are we shying away from brevital lately?
What is Verrill sign and what does it indicate?
Halfway ptosis of the upper eyelid. Indicates the patient is approaching deep sedation
Drug used for reversal of anticholinergic toxicity and emergence delirium
T or F: A patient can be discharged as long as the can walk, even if its with assistance
If a patients cannot maintain balance without dizziness, lightheadedness or assistance, they cannot be _______
Most common complication of IV sedation
T or F: After loss of natural teeth, resorption can be accelerated by wearing dentures
Alveolar resorption rates _______ as mandibular plane angle inceases
11 Characteristics of preprosthetic surgery
1. No evidence of intraoral or extraoral pathologies
2. Proper inter arch jaw relationships
3. Large alveolar processes (U-shape)
4. No hard or soft tissue protuberances
5. Adequate palatal vault form
6. Proper posterior tuberosity notch
7. Adequate attached keratinized mucosa
8. Adequate vestibular depth
9. Strength where mand fracture may occur
10. Protection of neurovasucal bundle
11. Adequate bony support and attached soft tissue covering for implant placement
BL compression of lateral socket walls after simple extraction with fingers
Armamentarium for alveoplasty after removal of multiple teeth (3)
Most commonly used instrument for bone removal during alveoplasty
Difference between a normal hand piece and a surgical handpiece
Does not produce a front end exhaust to prevent air emphysema
Bone file is used in a _______ mechanism only
Main reason to use interseptal alveolplasty over simple alveoplasty
When you extract two or more teeth, you MUST do what on the same day?
What type of suturing will you do for palatal tori surgery?
Interrupted (thin mucosa)
During an interseptal alveoplasty, the buccal plate is _________
For mandibular tori reduction, the alveolar crest incision is extended _____-_____cm past the tori
Strongest portion of the suture needle
2/3 from tip of the needle
When passing the suturing needle, it should be done with what type of movement
When should you use a tapered suturing needle tip?
Most commonly used suture size for oral procedures
Most common non-resorbable suture material
Resorption time of gut sutures
If you need a resorbable suture material to last longer before resorption, you can treat a gut suture with what?
Silk sutures should not be left in for longer than _____ days
Minimum tissue between free edge and suture
The knot of a suture should be moved where?
T or F: After an extraction, the sutures should go over the empty sockets
Where should the first suture be placed after an extraction?
Papilla closest to the vertical release
Which suture technique allows you to hold material in the socket?
Braided suture material is easier to manipulate, but is often avoided due to its increased _______ properties
Silk is a _______ material
Important concept for horizontal matress suturing technique
Anterior-posterior compression that everts wound edges, decreasing the number of sutures needed
Where does the "X" form in the figure 8 suturing technique?
Over the socket
What happens if a suture pulls through during the continuous technique?
It all becomes loose
Pell and Gregory Classification: Class 1, 2, 3 refers to the tooths location relative to what?
Anterior-posterior relationship of the ascending ramus
Pell and Gregory Classification: Class A, B, C, refers to the tooths location relative to what?
Depth of impation relative to the occlusal plane
Ideal movement of extraction of a maxillary 3rd molar
Bucally, distally, down
When removing root tips after removal of a crown in an impacted mandibular 3rd molar, what instrument should be used?
During the extraction of a vertically impacted mandibular 3rd molar, you section bisect the tooth. How far should you put your bur during the bisectioning?
All the way to the furcation
Anesthesia for maxillary tori removal (3)
1. Bilateral greater palatine block
2. Incisive block
3. Local infiltration
______ is used to carefully dissect the tissues and reflect them from the underlying bone during a maxillary torus reduction
Molt no. 9
In order to prevent hematoma, what must be done while suturing after a maxillary torus reduction? What is the best way to do this?
Pressure dressing. Temporary denture with a soft liner
Anesthesia techniques used for mandibular tori removal (3)
1. Bilateral lingual
2. Inferior alveolar nerve block
3. Local infiltration
During a mandibular torus removal, the trough created by the handpiece should not extend past what?
Inferior border of the torus
Where is soft tissue reduction most commonly needed after extraction for proper manufacturing of a denture?
After a vestibuloplasty, the edge of the mucosal flap is sutured to the ________
Best suture material to use for lingual frenectomy
After a frenectomy, what should be done to increase vestibular depth?
Undermining the surrounding mucosa
T or F: Blood pressure increases with odontogenic infections
Abcess is a _____ process
Are abcesses or cellulitis more dangerous in late stages?
A patient presents with indurated swelling of the cheek. What is your primary diagnosis?
Severe odonotogenic infection areas (4)
Boundaries of the "danger space"
Patients should be sent to a hospital if they have a temperature of _______ or higher (test question)
What is the pathway of odontogenic infections related to? (test question)
What type of bacteria cause 94% of odontogenic infections?
Supragingival bacteria come from the _______ group and are gram ______
Primary odontogenic bacteria are ______ ______
Major groups of anaerobic bacteria in odontogenic infections (2)
Gram positive cocci
Gram negative rods
Anginosis group secrete ______ which breaks down ______
What type of bacteria cause cellulitis?
_______ bacteria produce collagenases
Peptostreptococcus species secrete _______, which causes _____ _____
Pepsin, Necrotizing fasciitis
Prevotella secrete _____ and _____
Prophyromonas have _______ that help them attach to oral epithelial cells
Elastase is secreted by _______ and degrades ________ cell junctions
______ make black pigment
T or F: Antibiotics alone will not clear infections that have eroded into the bone
If lingual drainage of an abcess is superior to the mylohyoid space, then it will enter the ____ space
If lingual drainage of an abcess is inferior to the mylohyoid space, then it will enter the ____ space
If the apex of a maxillary canine is above the levator anguli oris, the drainage of an abcess of that tooth will be in the ____ space
If you open a patient's mouth and the tongue is elevated, then the abcess is in the ____ space
Subligual (THIS SHIT BAD)
Primary maxillary spaces of odontogenic infections (4)
Primary mandibular spaces of odontogenic infections (4)
Secondary fascial spaces of odontogenic infections (6)
Superficial and deep temporal
What muscle do odontogenic infections follow if they travel down the neck and to the mediastinum?
Palatal abcesses can travel to the ____ sinus
Mandibular spaces involved in Ludwig's angina (3)
A patient presents with an abcess and sever swelling over the angle of the mandible. What space has the infection spread to?
You give an IAN block and the needle was not properly sterilized. The patient returns with an infection. What space is the infection most likely to be in?
The ______ temporal space is lateral to the temporalis
The _____ temporal space is medial to the temporalis
What antibiotics should be used to treat localized alveolar osteitis?
None. Its not an infection (dry socket)
Which antibiotic penetrates abcesses the best?
Occurence of oral clefts in the USA
1 in 700
Boy:Girl ratio of oral clefts
Cleft lip and palate (together) occurs about ______ as often in boys as in girls
Isolated clefts of the palate (without cleft lip) occur slightly more often in _______
Most minor form of cleft palate
What 4 areas does the medial swellings give rise to?
1. Middle portion of the nose
2. Middle portion of the upper lip
3. Middle potion of the maxilla
4. Entire primary palate
T or F: there is a genetic test that can be done to test for a cleft
Which should be done first: Removal of supernumerary teeth or bone graft?
Most common malocclusion seen in patients with clefts
(Pseudo) Class III
What happens if intervention surgery for clefts is performed too early?
Fibrosis and retardation of maxillary growth, resulting in more malocclusion
Initial orthodontic treatment is usually begun with the eruption of what teeth in cleft patients?
First maxillary permanent molar
In patients with maxillary clefts, the position of the mandible is usually _______
Velopharyngeally compromised patients have ______ difficulties
When should speech pathologists/therapy be instituted for patients with clefts
As early as possible
What is usually the last corrective surgical procedure that a cleft-afflicted indivudal undergoes?
Rule of tens for surgical repair of clefts
10 weeks of age
10 lb in body weight
10g/dL hemoglobin in the blood
When are hard palate clefts normally closed?
4-5 years old
When are cleft lips normally closed?
Early as medically possible
When are soft palate clefts normally closed?
In a bilateral cleft lip, the loss of the orbicularis oris sphincter muscle control causes the premaxilla to ______
Which cleft lip repair technique will often show restriction in the flexibility and expansion of the tissues?
Most popular cleft lip repair technique
Millard (rotation advancement)
T or F: Do not span the alveolar ridge cleft with FPDs until the two halves of the maxillary arch have been united with bone grafts
Alveolar clefts are closed when?
Where is bone harvested for alveolar cleft bone grafting?
Anterior illiac crest
The rule of 10s is used for cleft _____
What kind of malformations can cause malocclusion?
Surgical management of lacerations
1. Cleasing of wound
2. Debridement of wound
3. Hemostasis in wound
4. Closure of wound
Treatment of Craze lines
Unfilled resin to prevent staining
Duration of immobilization after tooth displacement
Duration of immobilization after root fracture
Duration of immobilization after replantation of a mature tooth
Duration of immobilization after replantation of an immature tooth
Biggest worry with mandibular fractures
Airway constriction, usually by the tongue
What are "Battle signs" and what do they usually suggest?
Buises behind the ear. Suggest a basilar skull fracture-Middle cranial fossa fracture
Periorbital ecchymosis is usually indicative of what?
Orbital rim or zygomatic complex fractures
Ecchymosis in the floor of the mouth indicates what?
Anterior mandibular fracture
Uneven pupils are known as
Anisocoria in a lethargic patients suggests what?
intracranial bleed (subdural or epidural hematoma or intraparenchymal bleed)
Most prominent location of mandibular fractures
Tripod fracture is also known as what?
Zygomatic complex fracture
If a facture occurs, but there is not complete separation, it is known as a ______ fracture
If a bone is "crushed", it is known as a ______ fracture
T or F: IMF (Intermaxillary Fixation) and MMF (Maxillomandibular Fixation) are interchangable terms
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