commonly used drugs Flashcards
ASA system
System to estimate medical risk
Originally designed for general anesthesia patient
Commonly known as ASA Classification
ASA classes
1,2,3,4,5,6,E
ASA 1
Normal, Healthy patient without systemic disease
ASA 2
Mild systemic disease
asa 3
Severe systemic disease, limits activity but no
incapacitating
asa 4
incapacitating systemic disease that is constant threat to life
asa 5
Not to survive 24 hours with/without operation
asa 6
Brain-dead patient awaits for organ donation
asa e
Emergency operation
Precedes number status ( i.e. ASA E-II)
ASA Classification, Definition
Normal or Usual:
Distress:
Normal or Usual: Ability to climb one flight of stairs or walk 2 level city blocks
Distress: Undue fatigue, shortness of breath, or chest pain
asa 2 examples
Type II or Non insulin dependent diabetes
Well controlled epilepsy ( no seizure in the past year)
Well controlled asthma
Hypothyroid / Hyperthyroid patient under treatment and currently euthyroid
Healthy pregnant female
> 60 y/o patient
Extreme phobic patient
Drug allergy or multiple allergies patient
Systolic 140/159mmHg and diastolic 90-94mmHg
may proceed with tx
asa 3 examples
Type I DM, well controlled patient
Symptomatic thyroid disease patient
>6 months without any residual complication
Myocardial infarction
CVA
BP (169-199) systolic / (95-114) diastolic
Epilepsy: Several seizures per year
Asthma,: Stress / exercise induced / hospitalization
Angina Pectoris (stable angina)
CHF with
orthopnea ( > 2 pillow)
Ankle edema
COPD
ASA III
No S/S of distress at rest, BUT?
tx mod
tx?
No S/S of distress at rest, BUT not under stressful situation
Serious treatment modification is needed
Yellow light for treatment ( proceed with caution
ASA IV
S/S of their medical problem when?
Their medical problem has greater significance than?
OK for ?
If invasive dental treatment is needed?
go ahead?
S/S of their medical problem at REST
Their medical problem has greater significance than
elective dental treatment
OK for non invasive dental emergency treatment
If invasive dental treatment is needed hospital
Red light for treatment ( DON’T Proceed)
asa 4 examples
Unstable Angina
<6 months without any residual complication
Myocardial infarction
CVA
BP >200 systolic / >115 diastolic
Uncontrolled dysrhythmias
Severe CHF or COPD
Wheel chair bound or need supplemental oxygen
Uncontrolled epilepsy
Uncontrolled IDD
ASA V
def
Hospitalized patient with?
dental care?
ASA V
Moribound patient not to expect to survive 24 hours\
Hospitalized patient with end-stage disease
Palliative dental care
Examples of ASA V Patients
Hospital heart valve surgery patients in need of dental
extractions
Hospital patients with end-stage organ disease in need
of palliative dental care
Patient Demographic in asa classes
Patient Demographic
ASA I or II = 85% dental patients
ASA III or IV = 14% dental patients
Sedation
Definition
Reduction of irritability or agitation by administration of
sedative drugs, generally to facilitate a medical procedure
MO Dental Board
Moderate Sedation forms
sedations?
Site Certificate for?
Moderate Sedation: Enteral, Parenteral, Pediatric
Deep Sedation / General
Site Certificate for each typ
Pediatric Patient Definition and sedations
A patient aged twelve (12) or under. The use of preoperative sedatives for children (aged twelve (12) and under) except in extraordinary situations must be avoided due to the risk of unobserved respiratory obstruction during transport by untrained individuals.
Children (aged twelve (12) and under) can become moderately sedated despite the intended level of minimal sedation; should this occur, the guidelines for moderate sedation apply.
Minimal Sedation (Anxiolysis)
Minimal sedation (Anxiolysis)—A minimally depressed level of consciousness produced by a pharmacological method, which retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. Note: In accord with this particular definition, the drug(s) and/or techniques used should carry a margin of safety
wide enough never to render unintended loss of consciousness. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation. When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the maximum recommended dose (MRD) of a drug that can be prescribed for unmonitored home use
minimal sedations for kids
The use of preoperative sedatives for children (aged twelve (12) and under) except in extraordinary
situations must be avoided due to the risk of unobserved respiratory obstruction during transport by
untrained individuals. Children (aged twelve (12) and under) can become moderately sedated despite the
intended level of minimal sedation; should this occur, the guidelines for moderate sedation apply.
NO with anxiolytics
Nitrous oxide/oxygen may be used in combination with a single enteral drug in minimal sedation.
Nitrous oxide/oxygen when used in combination with sedative agent(s) may produce minimal, moderate, or deep sedation or general anesthesia.
Moderate Sedation (Conscious Sedation)
A drug induced depression of?
Generally, no interventions are required to?
Cardiovascular function?
Moderate Sedation (Conscious Sedation)
A drug induced depression of consciousness during which
patients respond purposefully to verbal commands, either alone
or accompanied by light tactile stimulation.
Generally, no interventions are required to maintain a patent
airway, and spontaneous ventilation is adequate.
Cardiovascular function is usually maintained
Deep Sedation
A drug-induced depression of ? during which?
The ability to independently maintain ventilatory function?
Patients may require assistance in?
Cardiovascular function?
Deep Sedation
A drug-induced depression of consciousness during which
patients cannot be easily aroused but respond purposefully
following repeated or painful stimulation.
The ability to independently maintain ventilatory function may be
impaired.
Patients may require assistance in maintaining a patent airway
and spontaneous ventilation may be inadequate.
Cardiovascular function is usually maintained.
Opioids Mechanism of Action
mu, kappa, delta, sigma
morphine adrs
Midazolam
metabolism, elim, placenta, paradox?
