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REVISION BDS > MOS minor oral surgery 327 (331) > Flashcards

MOS minor oral surgery 327 (331) Flashcards

(80 cards)

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1
Q

acetylsalicyclic acid

A

aspirin

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2
Q

why use aspirin

A

analgesic

superior anti inflammatory properties to paracetamol
but ibuprofen more commonly used

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3
Q

prostaglandings in pain

A

trauma and infection causes breakdown of membrane phospholipids producing arachidonic acid

arachindonic acid can be broken down to form prostaglandins

these sensitise the tissue to other inflammaotyr products e.g. leikotrienes = pain

therefore if prostaglandin reduction is descreased - pain moderated

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4
Q

mechanism of action of aspirin

A

reduced prostagland production

inhibits COX1 and COX2 (150x better at COX1)
* reduces platelet aggregation and predisposes to gastric mucosa damage

mainly peripherally acting agent

antipyretic
* reduces temp raising effect of IL-1 and brain levels of prostaglandings
* reduces elevated temp in fever
* doesn’t bring temp below normal if temp normal prior to taking drug

anti inflammatory
* vasodilators and therefore affect capillary permeability
* reduced redness, swelling and pain

metabolic
* BMR inc
* platelet aggregation dec
* prothrombin dec

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5
Q

adverse effects of aspirin

A

GIT problems -care with GORD and ulcer pts; PGE2 and PGI2 )inhibit glastic acid secretion, inc blood flow through mucosa)

hypersenitivity - acute bronchospasm, skin rashes, allergies

overdose - tinnitis, metabolic acidosis

mucosa aspirin burns

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6
Q

aspirin interaction

A

WARFARIN

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7
Q

aspirin and warfarin

A

enhances warfarin

displaces from binding sites on plasma proteins inc warfarin availability

warfarin is usually bound and inactive

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7
Q

aspirin and warfarin

A

enhances warfarin

displaces from binding sites on plasma proteins inc warfarin availability

warfarin is usually bound and inactive

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8
Q

aspirin and pregnancy

A

reduces platelets in baby
inc haemorrhage risk
jaundice risk
delayed labour
reye’s syndrome - causes liver and brain swelling, seizures and coma

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9
Q

steroid pts and aspirin

A

25% develop PUD

aspirin can cause perforation

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10
Q

aspirin and pts with renal or hepatic issues

A

aspirin is metabolised in liver and excreted by kidney - so reduce dose

nephrotoxicity - PGE2 and PGI2 made in kidney; if inhibited then reduced sodium retention, poor renal perfusion and failure may result

hyperkalaemia adn interstitial nephritis possible

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11
Q

G6PD deficiency and aspirin

A

gluc-6-phos dehydrogenase
med and african populations
can develop acute haemolytic anaemia
max aspirin dose 1g per day

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12
Q

max dose ibuprofen

A

2.4g daily in adults

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13
Q

iburpofen caution

A

previous or active PUD
elderly
pregnancy/lactation
renal/cardiac impairment
hypersensitivity
asthma
taking other NSAIDs
long term systemic steroids

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14
Q

overdose of ibuprofen signs

3

A

nausea
vomiting
tinnitus

activated charcoak if more than 400mg/kg in last hour

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15
Q

e.g. cox-2 selective

A

celecoxib

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16
Q

use of celecoxib

A

useful anti-inflammatory actions
fewer damaging GI actions
has fewer upper GI effects compared to non-selectives

all NSAIDs inc selective COX-2 inhibitors are contraindicated in active PUD

selective cox-2 inhibitor

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17
Q

use of celecoxib

A

useful anti-inflammatory actions
fewer damaging GI actions
has fewer upper GI effects compared to non-selectives

all NSAIDs inc selective COX-2 inhibitors are contraindicated in active PUD

selective cox-2 inhibitor

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18
Q

cox-2 selectives mech of action

A

COX-2 enzyme resposible for generation of inflammatory prostaglandins altought sometimes COX-1 involved

PGE2 is generated in low physiolcal amounts by COX1 in gastric tissues and has protective effect

prostaglandins esp PGE2 are generated in excessive amounts during inflammation via elevated COX2 levels
* prodcues inc vasodilation, inc vascular permeablity and sensitises pain fibre nerve endings to bradykinin, 5HT and other mediators

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19
Q

acetaminophen

A

paracetamol

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20
Q

paracetamol mode of action

A

simple analgesic without anti-inflammatory action

  • hydroperoxides generated from metabolism of arachidonic acid by COX and exert postive feedback to stimulate COX activity
  • feedback is blocked by paracetamol which indirectly inhibits COX esp in brain
  • helps reduce prostaglandin activity in the pain pathways of the CNS (e.g. thalamus)
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21
Q

effects of paracetamol

7

A
  • analgesic
  • antipyretic
  • little anti-inflammatory action
  • no effects on bleeding
  • no significate warfarin interaction
  • less irritant to GIT
  • suitable for kids
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22
Q

cautions for paracetamol

3

A

renal impairment
hepatic impairment
alcohol dependence

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23
Q

side effects of paracetamol

4

A

rashes
blood disorders
hypotension when infused
liver damage and less freq kidney damage with OD

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24
possible interaction with paracetamol | 4
cytotoxics domperidone (antemetic/sickness) lipid regulating drugs metoclopramide (antiemetic)
25
max dose paracetmol
4g for adults (8x500mg tablets) risk hepatic damage (hepatocellular necrosis) and renal tubular necrosis may not present for several days after send to A&E for assessment
26
signs paracetamol overdose | 3
anorexia, nausea, vomitting for early 24hrs persistence of nausea and start abdo pain (right subcostal - indicate hepatic necrosis) liver damage is max at 3-4days - jaundice, renal failure, haemorrhage, hypoglyceamia, encephalopahty, cerebral oedema, death
27
caution to pts with paracetamol
other preparation often contain e.g. night nurse, co-codamol, coproxamol
28
opioid analgesic used in dentistry
dihydrocodeine
29
dihydrocodeine qualities
acts in spinal cord- dorsum horn pathways and associated palei-spinothalamic pathway * specific receptors which are closely associated with neuroanl pathways that transmit pain to CNS * withdrawal from drug will lead to psychological cravings and pt will be ill BNF states relatively ineffective in dental pain
30
opioid issues
tolerance and dependence
31
tolerance and opioids
pt build up tolerance, dose needs progressivly inc to have same effect
32
opiod effect on smooth muscle
constipation urine and bile retention
33
opioid side effects
constipation vomitting drowsiness pupil constriction tolerance and dependence inc salivation
34
opioid interactions
enhanced by alcohol antidepressants and mono-amine oxide inhibitors dopaminergics (parkinsons)
35
dihydrocodeine caution with
hypotension asthma pregnancy/lactation renal and hepatic disease elderly and children never in raised intracranial pressure or head injury
36
overdose of opioid signs management
degrees of come, resp depression and pupil constriction naloxone - antidotes to coma/bradypnoea (amount dependent on severity)
37
carbamazepine is an
anti-epileptic/anti-neuropathic drugs
38
carbamzepine uses in dental setting | 3
trigeminal neuralgia post herpetic neuralgia functional, TMD, atypical facial pain
39
dose for cabmazepine
100mg tablets 1 tablet, 2 times daily send 20 tablets(10days) | build up from there
40
dose for paracetamol
500mg tablets 2 tablets, 4 times a day send 40 tablets (5 day)
41
dose for ibuprofen
400mg tablets 1 tablet, 4 times a day send 20 tablets (5day)
42
what to do when pt on carbamazepine
monitor pts bloods and liver function - FBC and liver function tests side effects of carbamazepine * leukopenia * dizziness * ataxia * drowsiness common
43
contraindications to carbmazepine use | 3
AV conduction abnormalities (unless paced) history of bone marrow depression porphyria
44
other useful drugs for neuropathic pain | 2 not on dental list
gabapentin phenytoin | GMP or oral med
45
common side effects of carbamazepine | 4
leukopenia dizziness ataxia drowsiness
46
basic stages of surgery | 10
consent (written) anaesthesia surgical access bone removal as necessary tooth division as necessary procedure debridement suture achieve haemostatsis post op instructions and medications
47
principels of surgical access | 11
* wide based incision (circulation) * scalpel in 1 firm continuous stroke * no sharp angles * adequately sized flap * flap retraction down to bone and done clearly * minimise trauma to ID papillae * no crushing * keep tissue moist * ensure flap margins and sutures on sound bone * ensure closure not under tension * aim for healing by primary tension -> minimise scarring
48
purpose of soft tissue retraction | 3 and how
* access to operative field * protection of soft tissues * flap design facilitates retraction dones with care using * Howarth's periosteal elevator * rake retractor
49
equipment for bone removal and tooth division
eletrical straight handpience with saline cooled bur air driven handpiece - may lead to surgical emphysema bur made of tungsten carbide * round bur for buccal gutter * fissure bur for separation protect soft tissues and caution of nerves if bur slips
50
priciples of elevator use
mechanical advantage, avoid excessive force support instrument to avoid injury to pt should it slip ensure applied force away from major structures e.g. antrum, IDC, mental nerve always use in direct vision movements * wheel and axle * wedge * lever
51
3 modes of surgical debridement
physical * bone file or nibblers to remove sharp bony edges * mitchell's trimmer or victoria currette to remove soft tissue debris irrigation * sterile saline into socket and under flap# suction * aspirate under flap to remove debris * check socket for retained apices etc
52
aims of suturing | 5
* reposition tissues * cover bone * prevent wound breakdown * achieve haemostasis * encourage healing by primary intention
53
types of suture
monofilament (monocryl R, nylon, prolene NR) single stranded, pass easily through tissue, resistance to bacterial colonisation polyfilament (vicryl R, silk NR) severeal filaments twisted together, easier handling, prone to wicking resorbable or non resorable (silk)
54
peri-operative haemostasis | 4
LA with vasoconstrictor artery forceps diathermy bone wax
55
post operative haemostatsis | 5
pressure and damp gauze LA infiltration diathermy surgicel - oxidised cellulose sutures
56
causes of tooth fracture | 6
thick cortical bone root shape and number (splayed, bulbous, kinks) hypercementosis ankylosis caries alignment
57
difficult access causes | 4
microstomia (small mouth) scarring tooth crowding trismus
58
abnormal extraction resistance causes | 4
thick cortical bone shape/form/no roots hypercementosis ankylosis
59
causes for buccal alveolar plate fracture
3s and 6-8s excess force
60
fractures peri op situations
tooth root bone - maxilla tuberosity, mandible, alveolar plate locate fracture and decide if need to go surigcal to get rest out beware - sinus, IDC
61
maxiallary tuberosity # aetiology | 5
* single standing molar * unknown unerupted 8 * patholgical gemination * extraction in wrong order - should be back to front, lower then upper * inadequate alveolar support
62
tx of maxillary tuberoisty #
* remove/tx pulp * splint and ensure occlusion free * antibiotics and antiseptics * post op instructions * remove tooth 8 weeks later
63
aetiology of mandible # peri op
impacted 8 large cyst/atrophic mandible excessive force and inadequate support
64
dx of oro-antral communication | 7
* radiographic position of roots in relation to sinus * bone came out with roots * bubbling of blood * nose holding test (can create an OAF) * direct vision * good light and suction - change in sound * probe - careful, avoid as can create
65
management of OAC if small
post op instructions - avoid nose blowing, muscial instruments, straws, smoking review
66
managment of OAC if large
suture over post op instruction antibiotics cover?
67
loss of tooth management
stop where is it suction radiograph - into sinus/inhaled
68
damage to nerves/vessels perio op can be by | 4
crush cutting/shredding transection from LA may not know at the time
69
neurapraxia
contusion of nerve/continuity of epineural sheath and axons maintained
70
axontemesis
continuity of axons but not epineural sheath (disrupted)
71
neurotemesis
complete loss of nerve
72
anaesthesia
numbness
73
paraesthesia
tingling
74
dyseasthesia
unpleasant sensation/pain
75
hypoaesthesia
reduced sensation
76
hyperaesthesia
inc/heightened sensation
77
dislocation of TMJ management
relocate immedaiated (analgesia and advice - support) unable to relocated - try LA into masseter intraorally or referral A&E | muscle spasm
78
how manage broken instruments peri op
stop where can retrieve? radiograph?
79
consent for XLA
pain, bleeding, brusing, swelling, infection damage to adj teeth/restorations, damage/extraction to developing tooth (if primary XLA) temporary or permanent altered senation jaw stiffness/fracture need for another procedure/RR sinus involvement - radiograph

REVISION BDS (43 decks)

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