practical Flashcards
What are category B drugs in dental prescription for pregnant women?
- antibiotics: penicillins, cephalosporins, azithromycin
- analgesics: paracetamol
- try to avoid as much as possible in the first trimester
What is the prescription of dental abscess in pregnancy?
Augmentin 625mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
panadol 500
قرصين اول مرة بعد ذلك قرص كل 8 ساعات لمدة خمس أيام
listerine mouthwash or oravex or chlorhexidine
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
What is the principle treatment of prophylaxis against bacterial endocarditis prior to dental procedure?
- oral amoxicillin taken 1 hour before the procedure
- if the patient can’t take the drug orally or there is no time: I.M or I.V ampicillin within 30 minutes of starting the procedure
- if the patient is allergic to penicillin: oral clindamycin OR azithromycin taken 1 hour before the procedure
What is an example of thiazide?
hydrchlorothiazide
What is the method of action of thiazides?
inhibit sodium and chloride ions reabsorption
What are the side effects of thiazides?
- hypokalaemia
- metabolic alkalosis
- hyponatremia
- hypomagnesemia
- increase in blood glucose, lipid, uric acid concentration
What is the method of action of beta blockers?
- suppression of renin release
- -ve inotropic & chronotropic effects
- reset of baroreceptors
- decrease sympathetic flow
What are the side effects of beta blockers?
- bradycardia
- bronchospasm (non selective)
- cold extremities
- increase LDL/HDL ratio and triglycerides…atherosclerosis
- fatigue and exercise intolerance
- prolonged use of β-blockers: up-regulation of the receptors –> exaggerated effects therefore it should be withdrawn gradually
What are examples of beta blockers?
anything that ends with -olol (propanolol)
What is an example of ACEIs?
captopril
What does ACEIs stand for?
angiotensin converting enzyme inhibitors
What is the method of action of ACEIs?
- inhibit angiotensin converting enzyme responsible for angiotensin II formation & bradykinin breakdown
What are the side effects of ACEIs?
- chronic dry cough (from bradykinin breakdown)
- hyperkalaemia
- taste disturbance
- DI with NSAIDs
What does ARBs stand for?
angiotensin II receptor blockers
What is the action of ARBs?
- block AT-II receptor which mediate most of pathological cardiovascular effect of angiotensin II
What are the side effects of ARBs?
- taste disturbance and hyperkalaemia(same as ACEIs except cough)
- CI in pregnancy
What is the example of ARBs?
losartan
What are examples of CCB?
amlodipine and nifedipine
What does CCB stand for?
calcium channel blockers
What is the method of action of CCBs?
- peripheral arterial vasodilation, decrease TPR
- increase renal blood flow (diuretic action)
What are the side effects of CCBs?
- palpitations
- flushing
- headache
- Nausea
- gingival hyperplasia is associated with certain calcium channel blocker
What are th types of antihypertensives?
- thiazides
- CCBs
- ARBs
- ACEIs
- beta blockers
What happens if NSAIDs are taken more tan 5 days at full dose for patients suffering from hypertension?
decrease antihypertensive agent effect due to sodium and water retention
How to manage a case of arterial hypertension?
- patient is instructed to take their medication as usual on the day of dental treatment
- the patient blood pressure should be recorded, and if the values high: postpone
- the prescription of anxiolytic agents may prove necessary in particularly anxious patients (5-10 mg of diazepam the night before and 1-2 hours before the appointment) before dental treatment
- a good local anaesthetic technique should be performed, avoiding IV injection and using a maximum of two anaesthetic carpules with vasoconstrictor. If more anaesthesia is needed, it should be provided without vasoconstrictor
What are examples of NSAIDs?
- cataflam
- brufen
- ketofan
What is the old procedure to take if a hypertensive emergency happens?
- B.P.: (>180/120 mmHg)
- terminate any dental procedure
- give emergency drug for hypertension
- furosemide (Lasix) should be administered (40 mg tb or IM injection)
OR - captopril should be administered (25 mg via sublingual route)
What is the recent ADA recommendation for a hypertensive emergency?
- terminate any dental procedure
- patients with systolic pressure >180 mmHg and/or diastolic pressure >100 mmHg should be referred to their physician as soon as possible or sent for urgent medical evaluation
What are the symptoms of angina?
- sweating
- shortness of breath
- pain can spread to jaw, neck, arms, stomach and back
- persistent chest pain
- feeling sick or vomiting
- rapid or weak or irregular pulse
What is the procedure to take during angina emergency?
- for mild symptoms in patients previously diagnosed with angina administer glyceryl trinitrate, if possible administer aspirin 300 mg orally or 4 tablets asposcid
- oxygen supply if the patient is cyanosed or if their level of consciousness deteriorates
- if persists, treat as for ‘severe symptoms’: myocardial infarction, call for help
- if the patient loses consciousness commence basic life support procedures
What is the procedure to take if acute myocardial infarction happens?
- in dental practice, a minimum safety period of 6 months has been established before any oral surgical procedure can be carried out: in this time, dental treatment should be limited to emergency procedures aimed at affording pain relief (extractions, the drainage of abscesses and pulpectomies)
- if the patient is receiving anticoagulants, the international normalized ratio (INR) on the day of treatment should be determined, and treatment should be provided within the recommended limits (< 2.5)
- if the patient is receiving antiplatelet medication, excessive local bleeding is to be controlled, the local haemostatic measures that can be used comprise sutures: gelatin of animal origin (Gelfoam®), Kapron on the cotton
What should a diabetic patient be asked before starting a dental procedure?
- whether their diabetes is well-controlled
- what their HbA1C is or the most recent blood sugar test
What are the diagnostic tests for diabetic patients before dental procedures?
- random blood glucose sugar test: if blood sugar level is 200 mg/dL or higher –> no procedure
- fasting blood sugar test: if blood sugar level is 126 mg/dL or higher –> no procedure
- 2 hours post-prandial blood sugar test: 200 mg/dl or more –> no procedure
- Glycosylated Hemoglobin Hb A1C: Diabetic controlled <7, Diabetic uncontrolled =8 or above
What is the dental management considerations for diabetic patients?
- postpone any dental intervention in uncontrolled diabetes
- update medical history and medications
- confirm that patient has eaten and taken medications before initiating treatment
- anticipate and be prepared to manage hypoglycaemia
- prevent, treat and eliminate infections promptly
- achieve profound local anaesthesia
- ensure excellent oral hygiene and provide profound preventive care
- reinforce regular diet and medication regimen before and after dental appointments
- take glucometer reading if patient is high risk, on insulin or having surgery
What is the blood glucose level for hypoglycaemia?
> 70mg/dl
Why does hypoglycaemic attacks require urgent treatment?
prolonged hypoglycaemia may lead to irreversible brain damage
What are the symptoms of hypoglycaemia?
- dizziness, confusion, headache
- shaking, mood changes, unusual behaviour
- profuse sweating
- palpitation
What is a device used to measure blood glucose level?
glucometer
What is the management of hypoglycaemia?
- terminate dental treatment immediately
- awake/alert patient:
administer sugary juice and monitor blood glucose and repeat sugary solution administration as necessary - unconscious patient: seek emergency medical assistance –> administer glucagon intramuscular injection followed by oral glucose supplement OR
administer 50% dextrose solution intravenously
What is the prescription to a diabetic patient?
augmentin 625mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
flagyl/amrizole 500mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
panadol 500mg
قرصين كل 8 ساعات بعد الأكل لمدة خمس أيام
chlorhexidine (or tantumverde)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
NSAIDs: should be avoided as much as possible especially for long term pain treatment in patients receiving oral hypoglycaemic drug.
for severe pain, cataflam 50 mg or brufen 400 mg (minimum dose and monitor for hypoglycemia)
قرص عند اللزوم أو قرص كل 12 ساعة مع اضافة قرصين براسيتامول فى نصف اليوم لمدة خمس أيام
How to manage a patient with anaphylactic shock?
- treatment must be immediate
- placed horizontally by dental chair adjustments or placing on the floor
- if respiratory depression is present, oxygen should be administered or mouth to mouth respiration performed
- adrenaline IM “NEVER IV”
- given hydrocortisone sodium succinate IV
What is the prescription for dental abscess?
augmentin 625mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
flagyl/amrizole 500mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
cataflam 50/ brufen 400mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
listerine mouthwash (or oravex)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
What is the prescription for dental abscess with renal disease?
augmentin 625mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
flagyl/amrizole 500mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
panadol 500mg
قرصين كل 8 ساعات لمدة خمس أيام
listerine mouthwash (or oravex)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
What is the prescription for dental abscess with liver disease?
augmentin 625mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
flagyl 250mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
panadol 500mg
قرصين كل 8 ساعات لمدة خمس أيام
listerine mouthwash (or oravex)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
kepron ampoule or adrenaline
What is the prescription taken for dental abscess with pregnancy?
augmentin 625mg
قرص كل 8 ساعات بعد الأكل لمدة خمس أيام
panadol 500mg
قرصين اول مرة بعد ذلك قرص كل 8 ساعات لمدة خمس أيام
listerine mouthwash (or oravex orchlorhexidine)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
What is a prescription for candidiasis (oral thrush)?
nystatin (mycstatin) oral suspension
ملء قطارة موضعيا بالفم كل 6 ساعات لمدة 5 أيام
OR
miconazole(daktarin/miconaz) oral gel
نصف معلقة موضعيا بالفم كل 6 ساعات لمدة 5 أيام
What is the prescription of oral herpes simplex virus?
acyclovir (zovirax) cream
دهان 3 مرات يوميا لمدة 5 أيام
paracetamol 500mg tablet (panadol 500mg) or any other analgesic dose
قرصين كل 8 ساعات لمدة خمس أيام
What is the prescription of recurrent aphthous stomatitis/ulcer?
gengigel (contains hyaluronic acid)
OR
oracure (LA + antiseptic)
نصف معلقة موضعيا بالفم 3-4 مرات يوميا لمدة أسبوع
BBC spray (LA+ antiinflammatory + antiseptic)
سبراى 3-4 مرات يوميا لمدة أسبوع
mouthwash(chlorhexidine or tantum verde)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا لمدة أسبوع
What is the prescription of xerostomia?
pilocarpine 5mg (salagen)
قرص 2-3 مرات يوميا
OR
cevimeline 30mg (evoxac)
قرص 2-3 مرات يوميا
stannous fluoride gel 0.04%
معجون أسنان 3 مرات يوميا
sodium carboxymethyl cellulose (0.5% aqueous solution)
مضمضة للفم معلقة كبيرة بعد غسل الأسنان لمدة دقيقة ثلاث مرات يوميا
trident or extra sugar free (with xylitol) gum
What is the prescription for facial pain (trigeminal neuralgia)?
Carbamazepine (Tegretol) 100 mg
مرتين يوميا قرص
العلاج ممكن ان يستمر من اسابيع الى شهور
- gradual withdrawal is a must to avoid severe side effects
