Pharm Mgmnt of TMD
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Disc (adherence/ adhesion) is a temporary sticking of the disc either to the ____ or the condyle.
T/F joint dislocation is also known as hypermobility
false, hypermobility is joint subluxation
Joint dislocation is a dislocation of the entire disc/condyle complex beyond the _______ combined with what?
- beyond the eminence
- combined with inability to return passively into the fossa
TMJ subluxation is also known as ______ and is more common in which gender
hypermobility, females more common
name one CI to prescribing muscle relaxants in TMD patients
those with sleep apnea
Disc adherence is the temporary sticking of the disc either to the fossa or condyle. What is disc Adhesion?
Adhesion= A FIBROTIC connection b/t the disc and the condyle or the disc and the fossa
What is the most common etiologic factor of internal joint derangements?
Name two other causes
trauma (blow to face)
prolonged mouth opening from dental/surg tx or oral intubations
Microtrauma from prolonged repetive forces such as clenching or grinding -----> tissue degeneration
T/F Females and the elderly more commonly seek TMD treatment.
False, young people more common than old, but yes female more common than male
While the focus of this lecture was Pharm management of TMD, what are 3 other forms of treatment?
- Occlusal appliances
- Physcial treatment
- Behavioral therapy
- Sleep hygiene (emphasized for effectiveness)
While NSAIDS are first line of drugs for TMD pain, ____ and ___ have been shown to be ineffective compared to placebo, while _____ has been shown to be effective .
- Ibuprofen and celecoxib (celebrex) not as effective
- Naproxen works better
What is the correct dosage of naproxen shown to be effective
500mg BID x 6 weeks
500mg BID x 8 weeks
250mg TID x 6 weeks
250mg TID x 8 weeks
500 mg BID x 6 weeks Naproxen
COX (1 or 2) inhibitors carry risk of GID events such as ulcerations, r______ t______ and bleeding diathesis
1, renal toxicity
COX ___ inhibitors carry increased risk of cardiovascular events in at risk pts (HTN, CAD, HLD)
cox 2 example, vioxx pulled from market
What two routes of injection may Corticosteroids be administered?
- direct into joint space
Intra-articular corticosteroids run risk of cartilage damage or infection.
Oral corticosteroids should be limited to ___ weeks due to decrease resistance to infection, (increased/decreased) blood glucose, O__________ and suppression of natural steroids.
- 2 weeks
- increased bld glc
Which statement(s) are true or false?
1.Opioids have been shown to be effective in managment of orofacial pain.
2.Long acting or sustained release are best for treating chronic pain
- 1 false, few studies show this, but well documented for effectiveness for lower back pain
- 2 true
Opioid pain management tolerance develops but constipation side effect tolerance does not. T or F?
True, so must manage with laxatives or stool softeners
Which of the following have been shown to be more effective for TMD?
Nonbenzo sedative hypnotics
- especially in patients with a muscular component to their TMJ pain
which of the following are long acting benzodiazepines wit anticonvulsive activity that are more beneficial?
The two side effects for pts on benzodiazepines to be aware of are ________ and _____ impairment.
Geriatric pts are sensitive to __ depression and _____ impairment because they can't clear the drug as fast, so the dose should be halved.
- psychomotor impairment
Name 3 nonbenzo sedative hypnotics
- ambien (zolpidem)
- lunesta (eszopiclone)
- sonata (zalepon)
Paraflex, Flexeril, robaxin and others relax muscles peripherally or centrally?
Benzodiazepines have a (lower, higher) therapeutic dose than centrally acting muscle relaxants.
Which of these drugs is the 14th most abused drug in the US
Muscle relaxers are more dangerous because they have a low Ther dose, so they should be titrated, starting with bedtime use only.
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