midterm guide Flashcards

Question

# allogratft * From? *properties * Types of Allografts?

Answer 1

* From other individuals of the same species * Cadavers * Tissue bank *** Osteoinduction & osteoconduction** * Types of Allografts - Freeze-dried bone allograft (FDBA): 6-15 months - Demineralized freeze-dried (DFDBA) 6 months - Irradiated bone (2.5 million rads)

Answer 2

- Ready availability - Eliminate second surgery - Reduced anesthesis & surgical time - Decrease blood loss - Fewer complication

Answer 3

- Associated with the use of tissues from another person - Immune responses

Answer 4

* Different species * Anorganic bone treated to remove its organic component * **Highly osteoconductive** * Rapid revitalized through new blood vessels * Slowly resorbing matrix structure (6 months ~)

Answer 5

* Natural or Synthetic * Mostly osteoconductive * Variety of textures, sizes, and shapes * Crystalline or amorphous * Granular or molded * take longer to absorb

Answer 6

I. Ceramic : HA, TCP II. Calcium Carbonate : Bio Coral III. Biocompatible composite polymer IV. Bioactive glass ceramic : Bio-glass

Answer 7

 Biocompatible  Stability for space maintenance  Manipulability  Primary closure throughout healing period is essential to GBR outcome

Answer 8

 Polytetrafluoroethylene (e-PTFE, TR e-PTFE), or titanium mesh * Titanium Reinforced PTFE Membranes (TR e-PTFE), Ti-Enforced microporous (ePTFE) ** Gold standard for GBR  Optimal graft containment**

Answer 9

flap management - 2nd surgical procedure to remove membrane

Answer 10

Natural: collagen of animal origin - Enzymatic degradation - Limited ability to maintain space - 4 to 6 months of retention

Answer 11

 Synthetic: poly(lactic) and poly(glycolic) acid copolymers - Degradation by hydrolysis - Highly variable rate of membrane resorption (pH & material composition)

Answer 12

ingrowth of osteogenic cells while preventing migration of unwanted cells

Answer 13

 Sedation  Anxiolysis  Muscle relaxation  Anterograde amnesia  Anticonvulsant effects

Answer 14

 Fatigue  Drowsiness  Respiratory depression !  No direct analgesic Effect

Answer 15

 Enhances inhibitory effect of neurotransmitters  Facilitates GABA receptor binding  ↑membrane conductance of Chloride ions

Answer 16

Flumazenil (Romazicon)  Competitive antagonist of benzodiazepine receptors (GABA)

Answer 17

 Enhance GABA inhibitory function = ↑Cl channel = hyperpolarization of cell membrane  Results Rapid onset of unconsciousness

Answer 18

 Arterial and venous dilatation  Largely replacing Thiopental (Barbiturates)

Answer 19

 General Anesthesia Medicine  Selective NMDA receptor blocker

Answer 20

 Dissociative, Hallucinogenic and Amnesic Effect  Sympathomimetic medicine

Answer 21

 Hallucinogenic, Nightmare emergence, Increase Salivary flow

Answer 22

mu kappa delta sigma

Answer 23

Kappa (κ)  Miosis  Sedation

Answer 24

Mu (μ)  μ1 : Analgesia  μ2 : Respiratory Depression  Physical dependence  Muscle rigidity

Answer 25

Delta (δ)  Behavioral response to pain

Answer 26

Sigma (σ)  Dysphonia  Hallucinations

Answer 27

 Analgesia  Sedation  Euphoria  Anti-tussive

Answer 28

 Respiratory Depression  Coma  Emesis  Constipation  Histamine release  Potential for addiction

Answer 29

 Miosis  Mechanism of action ○ Edinger-Westphal nucleus of Oculomotor nerve ○ Enhanced parasympathetic stimulation  Significance? ○ Most other causes of coma and respiratory depression produce mydriasis (dilation of pupil)  All Addicts demonstrate pin-point pupils

Answer 30

* Fentanyl=100X potency of morphine *

Answer 31

Morphine: Conjugate with glucuronic acid ○ Morphine-6-glucuronide (potent analgesic) ○ Morphine-3-glucuronide (inactive) Fent: Inactive metabolite ○ Remember the “end “ of the effect is due to redistribution!! ○ Fentanyl will accumulate in body fat with repeated injections

Answer 32

transdermal along with IV and IM like morphine

Answer 33

morphine: Onset 5-10mins, peak within 30mins, T ½ 1.5 – 2 hours, Duration of action : 4-6 hours fent: Onset of action < 60 sec with peak effect in 2 – 5 mins, Duration 30 – 60 mins | fent is much more lipid soluble, morphine less BBB penetration

Answer 34

**Morphine Elimination:**  End product eliminated by kidney  Renal failure patient may have narcosis and vent failure for days ! **Fent Elim**  Little effect on renal patient  Clearance dependent on hepatic blood flow

Answer 35

**Morphine Adverse Effects**  Nausea and Vomiting: Stimulate medullary chemoreceptor trigger zone  Severe respiratory depression: Rigid chest syndrome  Histamine Release: May lead to profound drop in BP and systemic vascular resistance **Fent ADRs**  No histamine release  Rigid Chest Syndrome: After large drug bolus !!

Answer 36

naloxone/narcan

Answer 37

 Competitive antagonist at opioid receptors  Greater affinity for μ receptors than κ or δ receptors

Answer 38

IV administration of 0.4mg IV (Titrate to effect !!!)

Answer 39

 Abrupt reversal = Excessive catecholamine release ○ tachycardia, hypertension, ventricular irritability  May antagonize Clonidine  Nausea/Vomiting may be observed

Answer 40

 Rapid antagonizing (1-2 min)  Brief duration of action (30-45 mins) IV ○ Rapid redistribution from CNS  T ½ is only 30–80 mins ○ Respiratory depression may linger despite “alert/awake” appearance

Answer 41

 System to estimate medical risk  Originally designed for general anesthesia patient  Commonly known as ASA Classification

Answer 42

1,2,3,4,5,6,E

Answer 43

Normal, Healthy patient without systemic disease

Answer 44

Mild systemic disease

Answer 45

Severe systemic disease, limits activity but no incapacitating

Answer 46

incapacitating systemic disease that is constant threat to life

Answer 47

Not to survive 24 hours with/without operation

Answer 48

Brain-dead patient awaits for organ donation

Answer 49

Emergency operation  Precedes number status ( i.e. ASA E-II)

Answer 50

 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

Answer 51

 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

Answer 52

 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

Answer 53

 No S/S of distress at rest, BUT not under stressful situation  Serious treatment modification is needed  Yellow light for treatment ( proceed with caution

Answer 54

 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)

Answer 55

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

Answer 56

ASA V  Moribound patient not to expect to survive 24 hours\  Hospitalized patient with end-stage disease  Palliative dental care

Answer 57

 Hospital heart valve surgery patients in need of dental extractions  Hospital patients with end-stage organ disease in need of palliative dental care

Answer 58

Patient Demographic  ASA I or II = 85% dental patients  ASA III or IV = 14% dental patients

Answer 59

**American Society of Anesthesiologists (ASA)**  Started in** 1962**  System to **estimate medical risk**  Originally designed for general anesthesia patient  Commonly known as ASA Classification

Answer 60

 Reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure

Answer 61

 Moderate Sedation: Enteral, Parenteral, Pediatric  Deep Sedation / General  Site Certificate for each type

Answer 62

 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

Answer 63

 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**

Answer 64

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.

Answer 65

 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**.

Answer 66

 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.**

Answer 67

 Qualified sedation provider—Any of the following who have satisfied the provisions of this rule:  1. A currently licensed dentist in Missouri with a valid permit to administer enteral, parenteral, or pediatric moderate sedation  2. A currently licensed anesthesiologist  3. A currently licensed certified registered nurse anesthetist.

Answer 68

Five months of Anesthesia training  Minimum of consecutive 4 months, OMS must function as an anesthesia resident with commensurate level of responsibility.  One month of pediatric anesthesia  Senior resident must have at least 150+ office based sedation cases

Answer 69

 Device to measure blood pressure and heart rate with multiple size cuffs  To auscultate the heart and lungs  Pulse oximetry with appropriate probes  Electrocardiogram  Temperature monitor  Ideal that monitor can print

Answer 70

can be used to determine BP/HR in monitoring

Answer 71

 Monitoring of concentration or partial pressure of CO2  Graph of expiratory CO2 by expired volume  Advantage of capnography  Breath to breath ventilation data  Respiratory effort  Real-time feedback on treatment ( i.e. IV med administration)

Answer 72

 Measures oxygen saturation of arterial blood  Determine percentage of oxyhemoglobin in capillaries  Operates on 650nm and 950nm wave length: oxygenated (absorbs more infrared light) and deoxy Hb (absorbs more red light) absorb different wavelenghts and the ratio of this is used to determine O2 saturation

Answer 73

endotracheal intubation

Answer 74

Should be conducted by the person planning and administering the anesthetic

Answer 75

 A tool to gather written information about the patient’s health  Completed by the patient or the patient’s guardian  Simple format which is easy to understand  Two standard formats: short and long

Answer 76

everything, based on Mallampati Classification 1: soft palate, fauces uvula, ant/post tonsillar pillars 2: soft palate, fauces uvula 3: soft palate, base of uvula 4: only soft palate

Answer 77

* Nitrous oxide is made from ammonium nitrate via 240oC heat * NH4NO3 = N2O + 2H2O * Compressed in cylinder where 30% is liquefied * N2O must be 97% pure

Answer 78

* cns depressant * second gas effect * concentration effect * rapid onset/recovery (insoluble) * not flammable/explosive but can support this in other agents * Oxygen of N2O not used by body (not broken down) * least potent anaesthetic gas

Answer 79

* Optimum concentration of N 2O for production of analgesia while maintaining patient cooperation is 35% * 20%:80% mixture N2O-O 2  10-15mg of morphine max is 70% N2O

Answer 80

concentration effect and second gas effect | CNS depressant

Answer 81

* The higher the concentration of the gas inhaled, the more rapidly arterial tension of the gas increases * Fresh gas will be pushed into the lungs from the anesthesia machine= increase arterial N 2 O arterial tension * So its important to start the Nitrous slowly and not blast it high in the beginning

Answer 82

* Occurs when a second inhalation anesthetic is administered along with N 2O-O 2 * Extreme uptake of N 2O will form a vacuum at alveoli that forces other air ( in this case, other inhalational agent) into the lungs

Answer 83

* Inhibits methionine synthetase impair B12 metabolism = decreased Bone Marrow function =Pernicious anemia (Vitamin B12 anemia) * Long term exposure ( > 24 hr exposure) = transient bone marrow depression * also causes neurological deficiencies and perihperal neuropathy

Answer 84

Full E cylinder has gaseous 750 psi and liquid states * 750 psi will stay there until the moment of empty tank blue color Full E Cylinder is about 1900 psi in gaseous state only, green color * Psi will decrease as O2 is being used