Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NSP Final > Neurological Disorder Medical Management > Flashcards

Neurological Disorder Medical Management Flashcards

1
Q

what are the neurological diseases dentists should be aware of?

A

 Stroke (Cerebrovascular accident)
 Parkinson’s Disease
 Dementia and Alzheimer’s
 Epilepsy
 Multiple Sclerosis
 Cerebrospinal Fluid Shunts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the risk factors for a stroke that dentists should be aware of?

A

◦ Hypertension
◦ Congestive heart failure
◦ Diabetes mellitus
◦ TIA or previous CVA
◦ Increasing age >75 years
◦ Elevated blood cholesterol or lipid levels
◦ Coronary atherosclerosis/Atrial fibrillation
◦ Cigarette smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what should be asked if a patient has a history of strokes?

A
  1. Date of the Stroke Event
  2. Type of Stroke
  3. Current Status
  4. Current Medical Therapy
  5. Residual Disabilities
  6. MD Consultation: if dental treatment is needed within 90 days
  7. Routine Dental Care Timing: should be delayed to 90 days after stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What analgesic is recommended for pain control in stroke patients, and which should be avoided?

A
  • Acetaminophen is recommended because it does not increase bleeding risk
  • ASA (aspirin) and NSAIDs due to increased bleeding risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the recommended anesthetic dose and formulation for stroke patients?

A

a maximum of 2 cartridges of 2% lidocaine with epinephrine concentrations of 1:100,000 or 1:200,000
*reduce epinephrine use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what antibiotics should be avoided in stroke patients?

A

metronidazole and tetracyclines in patients taking Warfarin (decreases warfarin metabolism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the purpose of INR in patients taking warfarin?

A

INR (International Normalized Ratio) measures blood clotting ability and is used to monitor anticoagulant levels in patients taking warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

At what INR value is it generally safe to proceed with routine dental treatment without modifying warfarin dosage?

A

If the INR is ≤ 3.5, routine dental care or simple oral surgery can usually proceed without modifying the warfarin dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is INR useful for monitoring antiplatelet drugs like aspirin or clopidogrel?

A

No, INR is not useful for monitoring antiplatelet drugs or NOACs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What local measures can be taken to minimize hemorrhage during dental procedures?

A

Use good surgical technique, suture, apply prolonged pressure, and use hemostatic agents like Gelfoam + thrombin, stents, or electrocautery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why must bleeding risk be assessed in patients on antiplatelet or anticoagulant therapy before dental treatment?

A

Because these medications impair blood clotting and can increase the risk of prolonged bleeding during or after procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some common antiplatelet drugs that may increase bleeding risk?

A

Aspirin (ASA)
Plavix (clopidogrel)
Aggrenox (aspirin + dipyridamole)
discontinued Ticlopidine (Ticlid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are New Oral Anticoagulants (NOACs) and examples of them?

A

Apixaban (Eliquis)
Rivaroxaban (Xarelto)
Edoxaban (Savaysa)
Dabigatran (Pradaxa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

are there any issues with devices for stroke patients?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drug-related precautions should be taken during dental treatment for stroke patients?

A
  • Minimize the amount of anesthetic with vasoconstrictor—use no more than 2 cartridges of 2% lidocaine with 1:100,000 or 1:200,000 epinephrine.
  • Avoid epinephrine in retraction cords to reduce cardiovascular risk.
  • Avoid prescribing metronidazole or tetracyclines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are emergency dental care guidelines for patients at risk of stroke or cardiovascular events?

A
  • Keep appointments short and low-stress.
  • Use nitrous oxide/oxygen sedation (N₂O/O₂) if needed.
  • Monitor blood pressure and oxygen saturation.
  • Recognize stroke symptoms (e.g., facial droop, speech issues).
  • Provide oxygen and call EMS immediately if stroke is suspected.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the acronym for quick stroke diagnosis?

A

FAST
face
arm
speech
time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the key features of a generalized tonic-clonic (grand mal) seizure?

A
  • Starts with aura in 1/3 of patients (unusual sensory perception).
  • Tonic phase: muscle stiffness, pupil dilation, loss of consciousness.
  • Clonic phase: jerking of limbs/head, possible incontinence.
  • Seizure lasts ~60 seconds.
  • Followed by confusion, drowsiness, and need for rest to regain function.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what should be asked if a patient has a history of seizures?

A

◦ Type of seizures
◦ Age at time of onset
◦ Cause of seizures
◦ Medications
◦ Regularity of MD visits
◦ Degree of control
◦ Frequency of seizures, date of last seizure
◦ Precipitating factors
◦ Prodromal symptoms – can you alert us if they occur?
◦ History of seizure related injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How should dental care be managed in epileptic patients?

A
  • Well-controlled patients can receive normal dental care.
  • Poorly controlled patients require MD consultation, may need additional meds, and sometimes referral for care under general anesthesia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the concern with using antiepileptic drugs during pregnancy, and which are safer options?

A
  • main concern is teratogenicity
  • valproic acid and phenytoin pose higher risks (Category D)
  • levetiracetam (Keppra) and lamotrigine (Lamictal) are considered safer (Category C)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the major dental and medical concerns associated with Dilantin (Phenytoin)?

A
  • Causes gingival hyperplasia—manage with good oral hygiene and possibly surgery.
  • Leads to bone marrow suppression—increased infection risk, delayed healing, and bleeding.
  • May cause osteoporosis and serious conditions like Stevens-Johnson syndrome
  • Classified as Pregnancy Category D due to teratogenic effects.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the major concerns and precautions for patients on Tegretol (carbamazepine)?

A
  • Causes xerostomia, ataxia, and bone marrow suppression (increased infection risk, delayed healing, bleeding).
  • Avoid ASA/NSAIDs due to bleeding risk.
  • Avoid erythromycin, which can increase carbamazepine to toxic levels.
  • Watch for osteoporosis and Stevens-Johnson Syndrome.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the key dental and systemic considerations for a patient taking Depakene (valproic acid)?

A
  • Bleeding risks; petechiae, bone marrow suppression, decreased platelet aggregation
  • Avoid ASA and NSAIDs
  • Drowsiness
  • Pregnancy concerns (D for seizures, X for migraines)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are key considerations for dental care in patients taking Lamotrigine (Lamictal)?
- Ataxia - Serious Adverse Reaction: Risk of Stevens-Johnson syndrome - Pregnancy: Classified as old FDA Category C for seizures
26
How should you manage a dental patient at risk of a grand mal (tonic-clonic) seizure?
- Use a rubber bite block - Position the chair in a supported supine position - Schedule the appointment within time the patient has taken anti-convulsant meds - Watch for early signs such as irritability - ask patient to warn of aura
27
what should you do if a patient is experiencing a grand mal seizure during a procedure?
◦ STOP dental treatment ◦ Leave patient in chair ◦ Clear work area ◦ Turn patient on side to avoid aspiration ◦ Do NOT attempt to use a padded tongue blade ◦ Passively restrain only to prevent injury
28
what is a POST grand mal seizure and what should you do if it occurs?
a seizure after the first usually not longer than 60 sec that rarely progress to cardiac arrest ◦ Oxygen (100%), maintain airway, and mouth suction ◦ Activate EMS as needed ◦ Discontinue dental treatment ◦ Look for traumatic injuries ◦ Afterward patient may be in a deep sleep ◦ Arrange patient transport
29
Seizures do not usually require emergency medical attention. Only call 911 if one or more of these are true:
◦ The person has never had a seizure before ◦ The person has difficulty breathing or waking after the seizure ◦ The seizure lasts longer than 5 minutes ◦ The person has another seizure soon after the first one ◦ The person is hurt during the seizure ◦ The person has a health condition like diabetes, heart disease, or is pregnant ◦ The seizure happens in water (swimming pool, lake, etc.)
30
What is the recommendation for analgesics and antibiotics in Parkinson’s patients?
Analgesics: Ensure good pain control to reduce stress and discomfort. Antibiotics: No need for antibiotic prophylaxis unless another indication exists.
31
How should anesthesia be managed in Parkinson’s disease patients?
Provide effective pain control to reduce stress, which can worsen involuntary movements. Local anesthesia with epinephrine (1:100,000) is usually well tolerated
32
Why is anxiety a concern in dental care for Parkinson’s patients, and how is it managed?
Untreated or poorly controlled Parkinson’s may lead to exaggerated tremors and high anxiety. Use anxiety and stress-reduction techniques, such as calm communication and short appointments.
33
Are bleeding issues expected in Parkinson’s patients? What about blood pressure concerns?
Bleeding: No bleeding problems are expected. Blood Pressure: Must monitor, as dopamine therapy may cause hypotension
34
Do Parkinson’s patients require special modifications to dental care plans?
If well-controlled, they do not require altered dental care or treatment plans
35
Why is chair positioning important in Parkinson’s patients during dental care?
- Adjust for comfort and reduce unnecessary movement - Be cautious when raising the chair at the end of the visit due to muscle rigidity and orthostatic hypotension from dopamine therapy - Patients may need assistance getting out of the chair safely
36
How do tremors affect dental treatment in Parkinson’s disease?
Tremors are usually self-limited and rarely, they may be severe enough to interrupt dental treatment.
37
What should be considered when planning dental treatment for a Parkinson’s patient?
- Assess the patient’s ability to maintain oral hygiene - Schedule treatment when medications are at their peak effect—2–3 hours after taking Parkinson’s medications
38
What oral complications are associated with Parkinson’s disease?
- Staring, excess salivation, drooling - Decreased blinking and swallowing - Muscle rigidity may impair oral hygiene - May need mechanical toothbrushes, assisted brushing, or chlorhexidine rinse
39
What are common oral side effects of Parkinson’s medications?
Xerostomia (dry mouth) Nausea Tardive dyskinesia * Recommend salivary substitutes and topical fluoride
40
Why might Parkinson’s patients need more frequent dental visits?
- Dry mouth (xerostomia) increases the risk of dental caries * Frequent monitoring and preventative care is recommended
41
Which Parkinson’s drugs are anticholinergics and what is a major oral side effect?
Trihexyphenidyl (Artane) Benztropine mesylate (Cogentin) - dry mouth
42
What are examples of dopamine precursors and their dental implications?
Levodopa Carbidopa-levodopa (Sinemet) - May cause dyskinesia or tremors and may require sedation for procedure
43
What Parkinson’s drug class can cause orthostatic hypotension and what’s an example?
Dopamine agonists: Bromocriptine mesylate (Parlodel)
44
What are the COMT inhibitors used in Parkinson’s disease?
Tolcapone (Tasmar) Entacapone (Comtan)
45
What are the dental precautions for patients on COMT inhibitors like entacapone?
- Use caution with vasoconstrictors - Limit to 2 cartridges containing 1:100,000 epinephrine or less - Monitor vital signs and observe patient response - Always aspirate to avoid intravascular injection
46
What analgesics should be avoided in dementia/Alzheimer's patients and why?
NSAIDs in patients taking cholinesterase inhibitors due to increased risk of GI irritation or bleeding
47
Are there any concerns with antibiotic use in dementia/Alzheimer’s patients?
No issues reported with antibiotic use.
48
What anesthetic considerations are important in dementia/Alzheimer’s patients?
- Good pain control should be provided. - Local anesthesia with epinephrine 1:100,000 is usually well tolerated.
49
How does anxiety manifest in patients with poorly controlled dementia or Alzheimer’s?
- May have difficulty following commands or instructions - May appear very anxious or stressed - Use stress reduction techniques during care
50
Are bleeding problems expected in patients with dementia or Alzheimer’s?
No bleeding problems are expected.
51
Why should you monitor blood pressure in dementia/Alzheimer’s patients?
Some medications used in these patients may cause hypotension, so BP monitoring is important
52
How does disease control affect a dementia/Alzheimer’s patient’s capacity to tolerate dental care?
Well controlled: No specific changes to treatment needed. - Advancing disease: May require changes to treatment plans as capacity declines.
53
What is Memantine (Namenda) used for and what class does it belong to?
- Used for moderate to severe Alzheimer’s disease - NMDA antagonist
54
What are side effects of Memantine (Namenda)?
Dizziness Headache Constipation Confusion * May require careful patient positioning due to dizziness
55
What are the cholinesterase inhibitors that are used for mild to moderate Alzheimer’s?
- Galantamine (Razadyne) - Rivastigmine (Exelon) - Donepezil (Aricept)
56
What are common side effects of the cholinesterase inhibitors?
Nausea, vomiting, diarrhea Weight loss, loss of appetite Possible sialorrhea (excess saliva)
57
What drug interactions should be avoided with the cholinesterase inhibitors and what drug should be used with caution?
- Avoid: clarithromycin, erythromycin, and ketoconazole — these impair metabolism of Galantamine - Use caution: NSAIDS can increase risk of GI irritation or bleeding
58
which drug is a combination of memantine and donepezil?
Namzaric
59
What are possible symptoms of Multiple Sclerosis (MS)?
- Abnormal facial pain (trigeminal neuralgia–like) - Numbness of extremity - Visual disturbances - Muscle weakness
60
What is the typical onset pattern and age group for MS?
- Symptoms progress over several days - Commonly affects patients between 20–35 years old * refer to neurologists if suspected
61
When is the best time for dental treatment in MS patients?
During remission — it is the optimal time for dental care.
62
What should be considered during dental treatment in MS remission?
- Side effects of medications (e.g., anticholinergics → dry mouth) - Immunosuppressive therapy → ↑ risk of infection
63
What is the dental protocol for MS patients in relapse/active disease?
- Not suitable for routine dental care - Emergency treatment only - Risk of airway compromise and limited mobility
64
What must be assessed in MS patients on corticosteroids needing emergency care?
- Evaluate need for steroid supplementation - Always consult with MD
65
What factors should be assessed in MS patients before dental treatment?
Levels of motor impairment and fatigue
66
How should dental care be handled in stable MS with little motor impairment?
Routine dental care is appropriate
67
What are key challenges in advanced MS for dental treatment?
- May need help transferring to the dental chair - Difficulty maintaining oral home care - Poor candidates for prosthetic/reconstructive procedures
68
When should dental appointments be scheduled for MS patients with afternoon fatigue?
In the morning — prefer short morning appointments
69
Why are cerebrospinal fluid (CSF) shunts placed in patients with hydrocephalus?
To reduce intracranial pressure by diverting accumulated CSF from cerebral ventricles.
70
What is the infection risk for CSF shunts and what causes most infections?
5%–15% infection rate due to Skin flora, particularly staphylococcal organisms
71
Do dental procedures increase the risk of CSF shunt infections?
no
72
Does the American Heart Association (AHA) recommend antibiotic prophylaxis for dental procedures in patients with CSF shunts?
No, the AHA does not recommend antibiotic prophylaxis.

NSP Final (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions