Substance/Anxiety/Neuro

Question 1

Opioid Prescribing Rules

Answer 1

7 days adults, 5 days minors

Question 2

Opioid Dosing may not average —– Morphine Equivalent Dose (MED) over the prescribed period

Answer 2

> 30mg

Question 3

Opioid Rx Requirements:

Answer 3

CDT code & days worth

Question 4

Opioid agonists (methadone, buprenorphine)

Answer 4

Suppress craving and withdrawal symptoms

Block acute effects of other opioids reducing euphoric effect

Question 5

Cardiovascular (arrhythmias, MI, stroke) concern in those with recent use of cocaine and methamphetamine—avoid epinephrine x

Answer 5

24 hours

Question 6

Focal Seizures with Retained Awareness

Answer 6

May experience an aura 
Clinical presentation 
variable
Occipital cortex—flashing lights
Motor cortex—rhythmic jerking on body opposite affected side Parietal—distortion of spatial perception
Frontal—sudden speech difficulties
•
Postical
May return to pre-event baseline
May experience worsened neurologic function for a period of time

Question 7

Occipital cortex—

Answer 7

flashing lights

Question 8

Motor cortex—

Answer 8

rhythmic jerking on body opposite affected side

Question 9

Parietal—

Answer 9

distortion of spatial perception

Question 10

Frontal—

Answer 10

sudden speech difficulties

Question 11

Postical

Answer 11

May return to pre-event baseline

May experience worsened neurologic function for a period of time

Question 12

Postictal =

Answer 12

somnolence, confusion, headache

Question 13

Generalized —– most common

Answer 13

tonic-clonic

Question 14

Tonic phase (~1 minute) =

Answer 14

muscle stiffness

Question 15

Clonic phase (~ 2 minutes) =

Answer 15

muscles jerk and twitch

Question 16

Postictal phase =

Answer 16

initial deep sleep followed by gradual awakening; confusion and/or agitation

Question 17

Status Epilepticus

Answer 17

Repeated seizures over short period of time without a recovery period
Gravely hypoxic and acidotic
Extensive brain injury, possible death
Abrupt withdrawal from anticonvulsant medication or abused drug0

Question 18

Types of Stroke

Answer 18

Ischemic (60-80%)
-atherosclerosis, emboli, hypotension

Hemorrhagic

Question 19

Transient Ischemic Attack

Answer 19

Transient episode of neurologic dysfunction caused by focal ischemia without acute infarction
Still a risk for permanent injury Considered a neurologic emergency

Question 20

CVA

Drug therapy

Answer 20

Antihypertensive drugs Antiplatelet drugs Statins

Question 21

Dental Management of Individuals with a History of CVA/TIA

Answer 21

Timing IMPORTANT!
Stroke risk elevated for 6 months after event
Recent TIA, patient considered unstable Stress reduction
Tylenol for analgesia

Question 22

Benzos not really used

Answer 22

chronically, mainly to be used acutely.

Question 23

Syncope tx

Answer 23

Treatment
Supine, feet up
Support airway
Oxygen, aromatic ammonia

Question 24

—- used to monitor vitamin k antagonists

Answer 24

INR

Question 25

Newer Oral Anticoagulant Drugs

Answer 25

NOT monitored with INR (don’t work by that mechanism) Stable blood levels obtained in blood
Usually hold 1 preoperative dose and 1 postoperative dose
Patients with renal impairment may need to hold more pre-operative doses

Question 26

—- is analgesic of choice —– may potentiate bleeding

Answer 26

Tylenol

NSAIDs

Question 27

Medical Management of vWD

Answer 27

Desmopressin (DDAVP), replacement therapy with vWF- containing concentrates, and antifibrinolytic therapy

Question 28

Desmopression (DDAVP)

Answer 28

Stimulates the release of vWF from endothelial cells Increases plasma factor VIII and vWF levels

Question 29

vWD: Type 1 and most type 2 can be treated as

Answer 29

outpatient Pre-op: desmopressin
Post-op: antifibrinolytic therapy
Local measures—primary closure if possible
Acetaminophen or acetaminophen-opioid combos for analgesia