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Disc (adherence/ adhesion) is a temporary sticking of the disc either to the ____ or the condyle.
adherence, fossa
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T/F joint dislocation is also known as hypermobility
false, hypermobility is joint subluxation
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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
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TMJ subluxation is also known as ______ and is more common in which gender
hypermobility, females more common
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name one CI to prescribing muscle relaxants in TMD patients
those with sleep apnea
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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
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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
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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
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While the focus of this lecture was Pharm management of TMD, what are 3 other forms of treatment?
- Surgery
- Occlusal appliances
- Physcial treatment
- Behavioral therapy
- Sleep hygiene (emphasized for effectiveness)
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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 .
place correctly:
Celebrex
Ibuprofen
Naproxen
- Ibuprofen and celecoxib (celebrex) not as effective
- Naproxen works better
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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
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COX (1 or 2) inhibitors carry risk of GID events such as ulcerations, r______ t______ and bleeding diathesis
1, renal toxicity
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COX ___ inhibitors carry increased risk of cardiovascular events in at risk pts (HTN, CAD, HLD)
cox 2 example, vioxx pulled from market
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What two routes of injection may Corticosteroids be administered?
how
- oral
- direct into joint space
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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
- osteoporosis
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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
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Opioid pain management tolerance develops but constipation side effect tolerance does not. T or F?
True, so must manage with laxatives or stool softeners
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Which of the following have been shown to be more effective for TMD?
Benzodiazepines
Nonbenzo sedative hypnotics
- Benzodiazepines
- especially in patients with a muscular component to their TMJ pain
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which of the following are long acting benzodiazepines wit anticonvulsive activity that are more beneficial?
lorazepam
clonazepam
diazepam
midazolam
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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.
- drowsiness
- psychomotor impairment
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Name 3 nonbenzo sedative hypnotics
- ambien (zolpidem)
- lunesta (eszopiclone)
- sonata (zalepon)
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Paraflex, Flexeril, robaxin and others relax muscles peripherally or centrally?
CNS pathways
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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
Higher.
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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