Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Week 1 > Pharmacologic Behavior Management Techniques > Flashcards

Pharmacologic Behavior Management Techniques Flashcards

1
Q

Why do we need pharmacologic management?

A
  • Safey treat very anxious, fearful, uncooperative patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Reasons for uncooperative behavior:

A
  • Very young age
    • ex. Pre-cooperative
  • Lack cognitive/emotional developement
    • ex: child with special needs
  • Child’s temperament
  • Parenting Style
    • lack of expectations or discipline
  • PTS in medical/dental setting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NC Law: Nitrous Oxide under age 13

A
  • only sedative agent that can be administered under age of 13
  • only need dental liscense, no special permit
  • need informed consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NC Law: Sedative agent other than Nitrous Oxide under 13 y.o.

A
  • Falls under:
    • Moderate Pediatric Conscious Sedation
      • OR
    • General Anesthesia
  • Grey Areas:
    • Anxiolysis
    • unsupervised premed to children outside office before appointment
      • discouraged by AAPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Goals of Pharmacologic Management

A
  • Protect the patients safety and welfare
  • minimize:
    • physical discomfort and pain
    • psychological trauma
  • Maximize:
    • amnesia
  • control:
    • anxiety
    • behavior or movement
  • Return patient to a physiologic safe state for discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Moderate Pediatric Conscious Sedation Permit: requirements

A
  • required for sedation of patients under 13
    • other than nitrous oxide
  • obtained from NC board of Dental Examiners
  • Include:
    • supervision of CRNA or other personal that administers sedative medications
      • employed or contracted
    • Thorough knowledge of agents
    • Proper training
    • planned and documented rational for use of sedation
      • risk-to-benefit analysis
    • Thorough Medical History and Physical Evaluation
    • informed consent
    • facility with all necessary equipment to handle an emergency
    • Properly trained employees
      • monitoring technique
      • emergency response-PALS or ACLS certification
    • Available mobile emergency medical services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Nitrous Oxide

A
  • least regulated
  • Very effective, but relies on proper patient selection
    • not Moderate to Severe Anxiety
  • in NC, only sedative agent administered in pedo without addtional training or liscense
  • Physiologically safe when administered with oxygen
  • most common side effect-Nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Advantages of Nitrous Oxide and Oxygen delivery by inhalation

A
  • Safety
    • impossible to lose consciousness or maintain airway
  • Rapid Onset and Recovery Time
    • due to low blood:gas solubiliity
  • Titratable
    • low blood:gas solubility allows for maximum effect with minimal discomfort
    • 35-50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nitrous Oxide: Disadvantages

A
  • Equipment cost
  • lack of patient acceptance
  • Weakness of agent
    • moderate to severe anxiety
  • Contraindications
    • acute otitis media
    • active pulmonary infection
  • Potential Chronic Toxicity
    • dentist and staff
  • Potentiation
    • when used in combo with another sedative agent- can take patient into deeper level than wanted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sedation Patient Selection

A
  • Successful:
    • mild to moderate fear or anxiety who cooperate
  • Unsuccessful
    • extreme anxiety and uncooperative
    • combative
    • defiant
    • resistant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dental Anesthesiology

A
  • 2012 ADA voted to be newest recognized dental specialty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Minimal Sedation

A
  • Aka Minimal Conscious Sedation
  • 13 y.o. or older
  • admin: oral or rectal routes
    • 1 pharmacological agent
    • 1 or more doses
    • Does not exceed Maximum recommended dose
  • can combine with nitrous oxide
  • used for behavioral management
  • Minimal depressed levels of consciousness
  • patient retains ability to:
    • independently and continuously maintain an airway
    • respond normal to tactile stimulation and verbal command
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Minimal Sedation Regulation in NC

A
  • Requires moderate sedation permit
    • no additional permit needed
    • Moderate Pediatric Conscious Sedation-Pedo dentists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Moderate Sedation

A
  • 3 subcategories
    • Moderate Conscious Sedation
    • Moderate Conscious Sedation limited to oral routes and nitrous oxide inhalation
    • Moderate Pediatric Conscious Sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Moderate Conscious Sedation

A

Subcategory of moderate sedation

  • Drug induced depressed consciousness
  • Patients respond to verbal commands, either alone or w/light tactile stimulation
  • Admin:
    • 13+ y.o.
    • oral, nasal, rectal, or parenteral routes (PORN)
    • Multiple pharm agents
    • multipile doses w/in 24 period
    • Can use w/Nitrous oxide
  • Used for Behavioral control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Moderate Conscous Sedation limited to oral routes and nitrous oxide inhalation

A
  • drug induced depressed consciousness
  • responds purposefully to verbal commands, alone or w/light tactile stimulation
  • Admin:
    • 13+
    • Oral route and nitrous oxide inhalation
    • single or multiple pharm agents
      • single or multiple doses w/in 24 hrs
  • Used for behavioral control
17
Q

Moderate Pediatric Conscious Sedation

A
  • drug induced depressed consciousness
  • respond purposefully to verbal commands, alone or w/light tactile stimulation
  • Admin:
    • 13+
    • oral, nasal, rectal, parenteral (PORN)\
    • single or multiple pharm agents
    • single or multiple doses w/24 hr period
    • can use w/nitrous oxide
18
Q

Educational requirement for Moderate Conscious Sedation or Moderate Pediatric Conscious Sedation Permit

A
  • Dentist must meet 1:
    • Option1:
      • 60 hrs didactic training including:
        • Pediatric Advanced Life Support (PALS)
        • Intravenous conscious sedation
      • Manage 10 pts supervised w/ intravenous sedation
    • Option 2:
      • Pre-doctoral dental or post-grad program w/
        • intravenous conscious sedation equivalent to one above
    • Option 3:
      • Internship or residency w/:
        • intravenous conscious sedation equivalent to one above
  • Moderate Pediatric Conscioius Sedation requires in addition:
    • Board approved pedo dental degree
    • pediatric residency program
      • OR
    • equivalent hours of CE dental anesthesia
19
Q

Facility Requirements for Moderate Conscious Sedation Permit

A
  • Operatory big enough for:
    • emergency equipment and personal
    • effective management of emergencies
  • CPR board or dental chair w/o enhancements
  • Lighting
  • Suction equipment
    • non-electric back-up suction
  • Positive Oxygen Delivery system
    • Full face mosk for adults and peds
    • back-up E-cylinder
    • portable Oxygen tank seperate from central system
  • oral and nasal airways
    • various sizes
  • BP monitor
  • Pulse Oximeter
  • Automatic External Defibrillator (AED)
  • IV set up
  • Syringes
  • Tourniquet and Tape
20
Q

Emergency Medications Required for Moderate Conscous Sedation Permit

A
  • Epinephrine
  • Atropine
  • Narcotic Antagonist (Naloxone)
  • Antihistamine
  • Corticosteroid
  • Nitroglycerine
  • Bronchodilator
  • Antiemetic
  • Benzodiazepine antagonist (Flumazenil)
  • 50% dextrose
21
Q

Additional Requirements for Moderate Conscious sedation permit

A
  • Maintenance of sedation records for 10 yrs
  • Demonstrate:
    • Proper monitoring
      • sedation & recovery
    • Drug dose calculation and admin
    • Medical Emergencies management
    • Sterile Technique
    • CPR certified personel use
      *
22
Q

Moderate Conscious Sedation Permit: emergency management of what situations

A
  • Laryngospasm
  • Bronchospasm
  • Emesis and aspiration
  • Respiratory depression and arrest
  • Angina pectoris
  • MI
  • Allergic reactions
  • Convulsions
  • Syncope
  • Bradycardia
  • Insulin Shock
  • Cardiac Arrest
23
Q

Deep Sedation

A
  • Drug Induced depressed consciousness w/partial loss of protective reflexes
  • Can’t maintain airway independently
  • can’t respond purposefully to verbal command
24
Q

Deep Sedation Permit Requirements

A
  • General Anesthesia Permit
    • No further exam needed
25
Unintentional Deep Sedation
* Situation has to be infrequent and unintetional * important for moderate sedation to be trained to deal with patient * Causes: * hyper-responder to meds * exhaustion/lack of sleep * potentiation w/other agents * nitrous oxide
26
General Anesthesia
* controlled state of depressed conscioussnes due to pharm agents w/ partial or complete loss of protective reflexes * can't * maintain airway * respond purposefully to physical stimuli or verbal commands
27
General Anesthesia Permit requirements
at least 1 * 1 year of advanced anesthesiology training * Oral Surgeon * Diplomate status or eligible for exam by American Board of Oral Surgeons * Fellow of American Society of Anesthesiology * Dentist admin General Anesthesia 5 yrs before NC law-Feb 1, 1990
28
Sedation Technique: Patient Selection
* unsuccessful behavior guidance * ASA 1 or 2 patients * Patients below the age of reason * pre or uncooperative * Extent of treatment needs * Older patients w/poor experiences or coping abilities * Travel distance of patient/family * even w/no behavior problems * Developemental delay or compromising medical condition
29
Sedation Technique: Medical History--\> Issues to consider
* Respiratory issues * asthma * allergies * acute infection * Diseases affecting * cardiovacular * neuromuscular * hepatic * renal * Current Meds w/OTC * Previous sedations or general anesthesia * Ventilator use at birth * especially for premature * suggests bronchopulmonary dysplasia * Sleep apnea and/or snoring * suggests-airway obstruction * Family history of disease or adverse response to medications * malignant hyperthermia
30
Sedation Technique: Physical Assessment
* must be done before sedation or GA * Includes: * General Physical conditions * Vital Signs * HR, Respiratory Rate, BP * Vital Statistics * height and weight * Airway * must have unobstructed airway * risk assessment
31
Sedation Technique: Airway
* Vital for patent airway before sedation * Upper airway patency checked by dentist * tonsils * oropharynx * Tonsillaar Hypertrophy * Obstruction\>50% * contraindication for conscious sedation
32
Mallampati Score
33
Sedation Techniques: Monitoring Principles
* Important Principles: * pre-sedation vital signs=baseline * early recognition of potential problems * during procedure and recovery * Monitor: * clinical level of consciousness * airway * Cardiovascular system * Respiratory system
34
Presedation preparation
* Written Informed cosent * witnessed by 3rd party * review alternative tx and risks
35
Presedation instructions
Given Verbally and written * Dietary Precautions * NPO requirements * Expectations of: * sedation * post-op behavior * Legal guardian present during procedure * 2 adults for recovery and transport
36
Day of procedure:
* Review Medical Hx * look for recent changes or trauma * NPO status * Medication status * Presence of acute illness * Have patient empty bladder/pee * Obtain baseline vital signs
37
Selection of Sedative Medication
* Up to dentist based on multiple variables: * desired depth of sedation * working time * comfort w/medication * DDI
38
Commmonly available and used sedatives
* Chloral Hydrate * Diazepam (Valium) * Midazolam (Versed) * Hydroxyzine * Meperidine * Nitrous oxide and oxygen
39
Discharge Criteria
Before they leave office the must: * vital signs and airway are stable * no Nausea or fever * Oriented and aware enough to recognize guardian * Can walk (minimally), talk, maintain open airway by supporting head posture * well hydrated * guradian present * Post-op instructions given verbal and written

Week 1 (4 decks)

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