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5-3 DRUGS IN DENTISTRY Flashcards

1
Q

Medicines Act 1968

A

An act of parliament controlling medicines for human use

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2
Q

Dental Practitioners Formulary

A

lists the drugs that dentists are allowed to use

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3
Q

prescriptions must include:

A

-patient full name and address
-dated
-age and DOB for under 12’s
-medication required, form and strength
-dose and frequency
-total quantity required
-signed in ink
-practice stamp

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4
Q

storing drugs:

A

-in accordance with/ manufacturer’s instructions, eg fridge
-locked away
-strict rotation system
-tracking system

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5
Q

How long should a drug log be kept

A

11 years

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6
Q

drug records/logs must include:

A

-prescribing dentist
-patient
-date given
-supplier, batch number
-expiry dates

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7
Q

supplying medications and instructions include:

A

-patient name
-practice name
-practice address
-“Keep out of reach of children” label
-date given
-name of medication
-written instructions on how to take
-written warnings and side effects
-verbal instructions

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8
Q

How should medicines be disposed?

A

-pharmaceutical bins (yellow with blue lid)

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9
Q

Who can advise on taking medications?

A
  • only the dentist
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10
Q

what general advice can a Dental Nurse give on taking medications?

A

“take what you usually would for a headache”
“speak to the dentist or a pharmacist”

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11
Q

Nurse responsibilities around medication? (7)

A

-general knowledge of medicines in dentistry
-safe storage
-checking labels and expiry dates
-ensuring patient confidentiality
-correct disposal
-DO NOT self prescribe
-report breach or abuse of medicines

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12
Q

GDC standard for Drugs in Dentistry?

A

“dentists have a duty to provide, and patients have a right to expect, adequate and appropriate pain and anxiety control”

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13
Q

What does the term ‘anaesthesia’ refer to?

A

‘the loss of all sensation’

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14
Q

In dentistry, what is the primary effect of local anaesthetics

A

The loss of pain sensation only, while pressure sensation can still be felt.

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15
Q

What are the main types of sensations that the sensory nerve supply in teeth and their support structures respond to?

A

Temperature, pressure, and pain.

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16
Q

How are local anaesthetics administered in dental procedures

A

They are given by injection before the dental treatment begins.

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17
Q

What role do sensory neurons (nerve cells) play in sensation?

A

Sensory neurons transmit electrical impulses from the body tissues to the brain, where the information is analyzed and interpreted.

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18
Q

How do local anaesthetics work to block pain during dental procedures?

A

They block the electrical transmissions along sensory neurons from the source of stimulation, preventing painful information from reaching the brain.

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19
Q

What happens to the patient’s awareness during a dental procedure under local anaesthesia

A

The patient remains conscious and fully aware of the treatment but does not feel any unpleasant or painful stimuli (unless sedated).

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20
Q

What other sensations are blocked by local anaesthetics during dental procedures besides pain?

A

The sensations of hot and cold.

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21
Q

What sensations remain when local anaesthetics are used during dental procedures?

A

-pressure
-vibration

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22
Q

During a tooth extraction with local anaesthetic, what sensations will the patient be aware of?

A

-pushing
-wiggling
-pressure

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23
Q

What are the typical sizes of local anaesthetic cartridges used in dentistry

A

They are available in 2.2 mL or 1.8 mL sizes.

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24
Q

What are the main components found in a local anaesthetic cartridge

A

Anaesthetic, sterile water, buffering agents, preservative, and a vasoconstrictor (in some cases).

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25
What role does sterile water play in a local anaesthetic cartridge?
acts as a carrying solution for the other constituents, and makes up the bulk of the cartridge contents.
26
Why are buffering agents included in local anaesthetic cartridges?
maintains the contents of the cartridge at a neutral pH, so they are neither acidic nor alkaline and do not irritate the soft tissues when they are injected.
27
What is the purpose of the preservative in local anaesthetic cartridges?
to give an adequate shelf‐life to the contents.
28
What does a vasoconstrictor do in some types of local anaesthetic?
acts to prolong the action of the anaesthetic by closing (constricting) local blood vessels so that the solution is not carried away so quickly in the bloodstream.
29
what is Anaesthetic
to block the electrical nerve transmissions to the brain so that neither pain nor temperature changes can be felt.
30
What are both the anaesthetic agent and any vasoconstrictor in local anaesthetic cartridges classified as?
They are classified as drugs and are subject to strict regulations regarding safe disposal.
31
How should half-used or spent local anaesthetic cartridges be disposed of?
They should be disposed of in sharps bins as hazardous waste.
32
How should out-of-date, unused local anaesthetic cartridges be disposed of?
They should be disposed of in a pharmaceutical bin as non-hazardous waste.
33
What is the composition of Lidocaine (Lignospan, Xylocaine)?
2% lignocaine hydrochloride as the local anaesthetic with 1:80,000 adrenaline (epinephrine) as a vasoconstrictor.
34
What is the composition of Articaine?
carticaine as the local anaesthetic with 1:100,000 adrenaline as a vasoconstrictor.
35
Citanest:
3% prilocaine hydrochloride as the local anaesthetic, with 0.03 units/mL felypressin (Octapressin) as a vasoconstrictor.
36
Citanest plain:
4% prilocaine hydrochloride as the local anaesthetic, with no vasoconstrictor present.
37
Mepivacaine:
3% mepivacaine hydrochloride as the local anaesthetic, with no vasoconstrictor present (known as Scandonest).
38
What is the primary use of local anaesthetics in dentistry?
to block pain sensation to the brain.
39
What should be recorded in the patient's notes regarding the anaesthetic given?
-anaesthetic given -number of cartridges given -expiry date -batch number -Type of injection (infiltration, nerve block, intra-ligamental etc. - Special instructions to patient e.g. beware of self injury whilst numb
40
What is adrenaline used for?
- it is used as a vasoconstrictor -reduces bleeding
41
How does adrenaline (epinephrine) affect a patient’s heart?
It is a potent cardiac stimulant, increasing the rate and depth of the heartbeat.
42
Why is adrenaline (epinephrine) useful in emergency situations like anaphylaxis?
It raises blood pressure and helps prevent the heart from stopping when blood pressure drops to dangerously low levels.
43
Which patients should avoid dental local anaesthetics containing adrenaline (epinephrine)?
-Hypertension (high blood pressure) -Cardiac disease (e.g., coronary artery disease or valve defects) -Hyperthyroidism (overactive thyroid gland)
44
Why should elderly patients be carefully monitored when using dental local anaesthetics with adrenaline (epinephrine)?
take medications that interact with adrenaline, have undiagnosed health issues, or have reduced ability to process drugs effectively due to aging.
45
: Why is it important to consider thyroxine when administering local anaesthetics with adrenaline (epinephrine)?
Thyroxine increases the body’s metabolic rate, including heart rate, which can amplify the stimulating effects of adrenaline on the heart.
46
What is an alternative for patients who cannot use local anaesthetics with vasoconstrictors?
: Local anaesthetics without vasoconstrictors can be used, but the analgesic effect wears off more quickly, and there is a higher risk of bleeding during surgical procedures.
47
What is the alternative local anaesthetic for patients who cannot use vasoconstrictors?
3% Citanest is an option, with the only contraindication being pregnancy due to the presence of felypressin.
48
Why is felypressin in Citanest contraindicated during pregnancy?
Felypressin is a potent drug that can induce labor because it causes contraction of the uterine muscles
49
What is the main disadvantage of using local anaesthetics with no vasoconstrictor for certain patients?
The analgesic effect wears off more quickly, and there is a higher risk of bleeding during surgical procedures.
50
What are topical anaesthetics used for in dentistry?
Topical anaesthetics are applied directly to the mucosa. The contact area is numbed for a short time.
51
What forms can topical anaesthetics take?
they can be in the form of sprays, pastes, gels, or creams.
52
Why is ethyl chloride considered hazardous?
It is highly inflammable and suction units must not be used to aspirate it.
53
When is ethyl chloride most suitable for use?
It is suitable for very quick procedures such as incising an abscess.
54
What is ethyl chloride and how does it work as an anaesthetic?
Ethyl chloride is a volatile liquid that evaporates rapidly when sprayed onto the mucosa, freezing the gum and blocking pain sensations. Its action is very short-lived.
55
What is the composition of Oraquix and how is it used?
: Oraquix is a gel made from a mixture of lidocaine and prilocaine, applied to the gingivae prior to scaling.
56
What is Ultracare and how is it used?
Ultracare is a benzocaine topical anaesthetic gel applied to the mucosa at the site of a local anaesthetic injection.
57
what is ultracare?
-benzocaine
58
what are analgesics?
-pain relieving drugs -over-the counter medicines which patients are recommended to purchase themselves
59
When might analgesics be used in dental care?
-Control of pain before emergency dental treatment (e.g., pulpitis) -Post-operative dental pain (e.g., after an extraction) -Pain from infections, often alongside antibiotics (e.g., severe pericoronitis)
60
most common analgesics
-paracetamol -ibuprofen -aspirin
61
what is paracetamol
-adults 1-2 500mg tablets -used for pain relief and reducing fever (anti-pyretic ) in patients with viral infections e.g. herpes simplex virus. -Sold in small quantities at pharmacies (16) to prevent overdose, which could cause liver damage.
62
What is ibuprofen
-a non-steroidal anti-inflammatory (NASI) analgesic. -Not recommended for asthmatics or children under 12years. -Adults 1-2 200mg tablets taken with water, with or after food to prevent stomach ulceration
63
what is aspirin
analgesic and anti-pyretic, best taken in soluble form to prevent stomach ulceration.
64
What are contra-indications with aspirin
- Must never be given to children under 12 years - Not to be used after surgical procedures because it is an anti-coagulant - Not to be used by asthmatics
65
What are the precautions for using ibuprofen?
It is not recommended for asthmatics or children under 12 years old.
66
amoxicillin dosage:
-Under 6: 250mg 3 x day -Over 6: 500mg 3 x day -Dose may be doubled for severe infections
67
Clindamycin dosage:
Adults 150-300mg 4 x day
68
Erythromycin dosage:
-Under 6 250mg 4 x day -Over 6 250-500mg 4 x day -Dose may be doubled for severe infections
69
Metronidazole dosage:
Adults 200mg 3 x day
70
Tetracycline dosage:
* Age 12-17 250mg 4 x day * Adult 250mg 4 x day * Dose may be doubled for severe infections
71
What factors determine the choice of an antibiotic for dental infections
The antibiotic chosen depends on the type of bacteria (aerobic or anaerobic) suspected of causing the infection and whether the patient has any allergies to a specific antibiotic.
72
what is aerobic bacteria?
Aerobic bacteria thrive in oxygen-rich environments
73
what is anaerobic bacteria?
anaerobic bacteria thrive in low-oxygen conditions, such as in periodontal pockets or pericoronitis.
74
Why is there growing concern about antibiotic resistance?
There is concern that bacteria are becoming resistant to antibiotics, which is why antibiotics should be restricted and only prescribed when absolutely necessary.
75
When should antibiotics be prescribed for dental infections?
Antibiotics should be reserved for systemic infections.
76
How long should antibiotics typically be prescribed for dental infections?
Antibiotics are typically prescribed for 5 days, but they may be stopped after 3 days if the infection has resolved.
77
What is Clindamycin used for in dental infections?
Clindamycin is used as an alternative antibiotic when other antibiotics are ineffective or when the patient is allergic to other options (such as amoxicillin).
78
When is Erythromycin prescribed in dental practice?
erythromycin is prescribed for patients who are allergic to penicillin.
79
When is Metronidazole prescribed in dental practice?
Metronidazole is commonly prescribed for anaerobic infections, such as severe periodontal infections, pericoronitis, or infections associated with abscesses
80
When is Tetracycline prescribed in dental practice?
Tetracycline is used for treating periodontal infections and can also be prescribed for patients with dental abscesses or chronic periodontitis.
81
What is the antiviral treatment for Herpes simplex causing cold sores?
Aciclovir is an antiviral cream used to treat Herpes simplex cold sores.
82
How often should Aciclovir be applied for effective treatment of cold sores
Aciclovir should be applied five times a day to the affected area.
83
What type of environment do fungal infections thrive in?
-warm -moist -
84
where can candida albicans be found?
* under denture (denture stomatitis) * creases at angle of mouth (angular cheilitis)
85
The 3 antifungals dentists can prescribe ?
-nystatin suspension -fluconazole -miconazole
86
how is nystatin suspension taken?
-1ml 4 x day after meals, swirl around the mouth and swallow
87
how is fluconazole taken?
- Suspension: Adults 50mg/5ml 1x day for 7 days -tablet: 50mg tablet 1x day for 7 days
88
how is miconazole taken?
-gel held in the mouth after food -Age 2 - adult 2.5ml 4 x day
89
How should diazepam be taken for anxiety before a dental appointment?
4-5mg should be taken before going to bed and 4-5mg taken an hour before the dental appointment.
90
What is the most commonly used oral sedative in dental practice?
Diazepam
91
# mixture What is inhalation sedative?
nitrous oxide (maximum 50%) and oxygen
92
how are inhalation gases administered?
inhaled through the nose via a nasal mask.
93
What is the usual ratio of gases in inhalation sedation?
50:50
94
what does the inhalation-sedation machine do?
stops oxygen dropping below 30 % limits nitrous oxide to 50% max
95
What colour collar will oxygen cylinders have?
White
96
What colour collar will nitrous oxide cylinders have?
Blue
97
what is used for intravenous sedation?
Midazolam
98
how is midazolam administered?
intravenously in back of hand or inner elbow
99
what is the age for intravenous sedation?
16 years old
100
what are instructions following intravenous sedation?
INSTRUCTIONS FOLLOWING SEDATION FOR 24 HOURS * The patient should be driven home by car or taxi by an escort * The escort should stay with the patient for the rest of the day * The patient should stay home and rest * No alcohol for 24 hours * No driving for 24 hours * Not to operate machinery, including cooker or kettle * Not to sign any important legal documents
101
emergency drug records must include:
-drug name and dose -administration route -suppliers name -date of supply -batch number -expiry date
102
What medical emergency glucogel used for
Faint * Hypoglycaemia (conscious patient
103
How is gluco-gel administered?
Oral as a drink, or; * Gel applied in buccal sulcus
104
what medical emergency is glucagon used for?
hypoglycaemia (unconscious patient)
105
how is glucagon administered?
intra muscular injection
106
what is salbutamol used for?
asthma attackw
107
how is salbutamol administered?
inhalation
108
what medical emergency is Adrenaline 1:1000 used for
anaphylaxis
109
How is Adrenaline 1:1000 administered? (anaphylaxis)
intra muscular injection
110
what is hydrocortisone used for?
allergic reaction
111
how is hydrocortisone administered
intra muscular injection
112

Dental (8 decks)

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