OSD3 Final lectures

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OSD3 Final lectures
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2013-06-14 00:48:19
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OSD3 Final lectures
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  1. seizure MCC
    • 70% unknown
    • 30% EtOH, sleep, meds, stress, hormone, drug, illness
  2. seizure terms
    • complex: partial, alerted awareness and confusion
    • simple: partial, alert
    • Generalized: unconscious from start
    • tonic clonic: grand mal, convulsions, unconcious, stiff, then jerking
    • absence: petitmal, trance like
    • tonic or atonic: drop attack
    • myoclonic: sudden muscle jerks
  3. antiepilectic drugs
    • carbamazepine
    • phenobarbital
    • phenytoin(dilantin): SE-folate def, plaque/bacteria->gingival hyperplasia ~30%
    • valproate(depakote): SE-thrombocytopenia, ging hyper rare
  4. vagal nerve stim
    • localization related epilepsy
    • stim for 30 sec/5 mins
    • reduction
    • complications: SOB, hoarsness, sore throat, cough, ear throat, nausea
  5. corpus collosum
    connects brain hemispheres
  6. seizure diet change
    ketogenic: min protein, no carbs
  7. what to know about seizure pts
    • when dx
    • control: freq, duration, last, trigger, changes
    • meds: dosing, compliance, efficacy, labs(bleeding)
    • hx: VNS, surgery
  8. dental seizure implications
    • gingival hyperplasia: more freq recall
    • manage pain/infection: possible triggers
    • thrombocytopenia
  9. seizure protocol
    • stop tx, remove, gentle restrain
    • NOTHING IN MOUTH
    • IV/IM: midazolam or valium (.75 mg/kg)
  10. seizure emergency (911)
    • pregnant, diabetic
    • in H2O
    • >5 mins
    • breathing complications
    • repeat seizures
    • injury
    • 1st seizure
  11. what to know about stroke pts
    • type
    • when, how many
    • effects, recovery
    • contributing factors
    • meds: antiplatelets, anticoagulants, HTN (beta blockers, ACE, ARB, diuretics, statins)
    • labs: INR, 2.5-3.0 critical level
  12. lovenox
    • anticoag
    • low molecular weight heparin
    • stroke prevention
  13. minimize stroke risk
    • reduce stress
    • monitor vitals
    • confirm meds
    • recognize signs/symptoms
    • manage emergency
  14. stroke signs
    • local weakness
    • numbness
    • severe headache
    • seizure
    • aphasia
    • vomiting
    • LOC
    • FAST: face droop, arm weakness, speech, time to call 911
  15. stroke dental office
    • stop
    • sit up
    • call 911! note symptoms
    • O2
    • vitals
    • BLS
    • glucose(hypoglycemia similar)
  16. parkinson's
    • bradykinesia, muscular rigidity, tremor at rest, abnormal posture and gait, dementia
    • meds: l-dopa, sinemet, dopa agonists
    • med SE: xero, facial grimacing, ortho hypoTN
  17. tardive dyskinesia
    • involuntary repetitive movements
    • meds: aricept, baclofen, requip, clonidine, benzodiazepine
    • med SE(antipsychotic): clonidine=xero, salivary discomfort, sedative effects, orthostatic hypoTN
  18. cerebral palsy
    • nonprogressive disorders that affect movement, balance, posture
    • types: spastic, athetoid or dyskinetic, ataxic, mixed
    • mixed spastic & athetoid most common
    • etiology: hypoxic or ischemic nervous system damage in perinatal or after birth
    • acquired: bacterial menengitis, viral enceplatis, head injury stroke
    • congenital: pregnancy infection, jaundice, Rh compatibility, hypoxia
    • risk factor: low APGAR (>8 normal)
  19. spastic vs athetoid
    • spastic: voluntary
    • athetoid: extrapyramidal, extremes flexion, unusual limb
  20. Cerebral palsy tx
    • botox: spastic, 2-4 months, expensive
    • selective posterior rhizotomy
    • baclofen pump: GABA release
    • Valium: benzodiazepene
    • Dantrolene: muscle relaxor
    • Anticholinergics: benztropine, triexyphenidyl
  21. selective posterior rhizotomy
    • DRG removal
    • tx for Cerebral palsy
    • SE: incontinence
  22. MS med side effects
    • immunosuppression
    • delayed healing
    • xerostomia
  23. MS dental pts
    • decresed motor (OHI)
    • scheduling: shorter, wheelchair, respiratory, gagging, semi-supine, sedation
    • neural tx changes, velocity, conduction, transmission, altered sensation, can't localize pain
  24. muscular dystrophy
    • genetic disorder-> weakens
    • duchenne: 2-6 y/o, X-linked recessive, slow progression
    • duchenne: lack of dystrophin
  25. muscular dystrophy dx
    • med hx, genetics
    • electromyography
    • creatine kinase
    • biopsy
  26. muscular dystrophy tx
    • no cure
    • phys therapy
    • surgery for muscle contracture
    • drugs: steroids, antibiotics
    • respiratory: ventilator
  27. right hemiplegic transfer
    • right side paralysis
    • used for pts w/ unilateral paralysis
    • wheelchair 30 degrees to dental chair on unaffected side
  28. A 36 year old female comes into your office with a broken front tooth. She would like to have it fixed, because she cannot smile. Her medical history is significant for brittle juvenile diabetes, end stage kidney failure, hypertension and she is on hemodialysis 3 days a week (every other day). She is awaiting a kidney donor and has been on the list for one year. Upon clinical examination, you decide the tooth is not restorable and requires an extraction.

    1. What must you consider in planning the extraction appointment for this patient?
    a. Possibility of prolonged bleeding, hyperglycemia, what days she goes to dialysis.
    b. Need for antibiotic prophylaxis, possibility of prolonged bleeding, hyperglycemia, what days she goes to dialysis.
    c. Possibility of prolonged bleeding, need for antibiotic prophylaxis, what days she goes to dialysis.
    d. Difficulty getting her numb, need for antibiotic prophylaxis, possibility of adrenal crisis, hypertension.
    Correct answer : c
  29. A 36 year old female comes into your office with a broken front tooth. She would like to have it fixed, because she cannot smile. Her medical history is significant for brittle juvenile diabetes, end stage kidney failure, hypertension and she is on hemodialysis 3 days a week (every other day). She is awaiting a kidney donor and has been on the list for one year. Upon clinical examination, you decide the tooth is not restorable and requires an extraction.

    2. The best day and time to schedule her appointment for the extractions would be:
    a. In the mid-morning on the day of dialysis since she will be able to clear all the dental anesthetic and not have a toxic build up of anesthetic.
    b. In afternoon on the day of dialysis – since her blood will be cleared of all toxins prior to her appointment, it will be optimal.
    c. In the morning right before she goes to dialysis, so there will not be any bleeding complications.
    d. In the afternoon, the day following her dialysis, since she will be at the least risk of infection.
    e. In the morning, the day following her dialysis, since she will be well-rested and at less risk for prolonged bleeding.
    Correct answer : e
  30. CREST
    • C: Calcium deposits
    • R: Raynaud’s syndrome: brittle fingernails, discoloration of fingers
    • E: Esophageal dysmotility. Could her explain him being thin
    • S: Sclerodactyly: tightening of skin, leads to ulcerations
    • T: Telangiectasia
  31. Bosentan
    • WHAT:
    • Competitive antagonist of endothelin-1 at ET-A and ET-B
    • Normally ET-1 binding to ET-A and ET-B causes pulmonary vasoconstriction
    • Blocking this interaction will decrease pulmonary vascular resistance
    • USED FOR:
    • Indicated mainly for treatment of pulmonary hypertension.
    • WARNINGS:
    • Potential hepatotoxicity and possible anemia could result.
    • Want to ask if she’s getting monthly monitoring of liver function
    • Ask if she is getting hematocrit monitoring
    • Very teratogenicity, Category X
    • Want to ask if she’s on menopause
    • Ask if she knows she is pregnant or not
  32. Nifedipine
    • WHAT:
    • Dihydropyridine Calcium channel blocker
    • Lowers blood pressure by relaxing blood vessels and reduces how much work heart must work
    • USED FOR:
    • Used as an antianginal and antihypertensive
    • Used for Raynaud’s phenomenon as well as pulmonary hypertension
    • WARNINGS:
    • Do not consume grapefruit or grapefruit juice
    • Possible teratogen, Category C
    • Similar questions apply
  33. Furosemide
    • WHAT:
    • Loop diuretic
    • USED FOR:
    • Used for hypertension and edema
    • WARNINGS:
    • Ototoxic
    • Can lead to gout due to hyperuricemia
    • Hyperglycemia as a side effect
    • Possible hypokalemia
    • Possible teratogen, Category C
    • Similar questions apply
  34. Wilsons disease-
    • An autosomal recessive genetic disorder in which there is too much copper in the body's tissues.
    • The excess copper damages the liver and nervous system.
    • It’s treated with medication that reduces copper absorption or removes the excess copper from the body, but occasionally a liver transplant is required
  35. allergy
    aberrant TH2 and IgE
  36. Local anesthetic reactions
    • toxic: IV ->mental
    • vasoconstrictor: sympathetic
    • anxiety: fight or flight
    • allergy: beware esters (procaine, tetracaine), use diphenhydramine (benadryl w/epi as LA)
  37. LA alternative
    benadryl (diphenhydramine w epi
  38. most latex allergies are ___
    Type IV
  39. restorative material rxn
    • amalgam: LP
    • acrylic: uclerative conditions
  40. Type III hypersensitivity
    • immune complex
    • RAS or EM(bullseye) like
  41. Type IV
    • cell mediated, delayed 2-3 days contact stamatitis
    • dental materials/chemicals
    • tx: removal of allergen and systemic ond topical
  42. Cyclic neutropenia H&N presentation
    ANUG or oral ulcers
  43. B-cell abnormalities H&N presentations
    • recurrent sinopulmonary infactions
    • infections w/ encapsulated bacteria (Strep pnemoniae, or H. influenzae)
  44. T-cell defects H&N presentations
    oral fungal & viral
  45. agammaglobulinemia
    x-linked autosomal recessive IgA deficiency
  46. DiGeorge's
    • CATCH 22
    • cardiac (tetrology)
    • abnormal facies
    • thymic aplasia
    • cleft palate
    • hypocalcemia (hypoPTH)
  47. long term immunosuppressive tx increase
    • infection
    • tumors (SCC, uterine, lymphoma, KS, renal
    • delayed healing
  48. HIV labs
    • CD4: immune status
    • Viral load: ART effectiveness
    • neutropenia <500 -> prohy AB!
  49. AB prophy is routine for HIV
    no dependent on neutropenia <500
  50. dental tx HIV
    • tooth by tooth to assess bleeding
    • avoid deep block
    • hospital setting?
    • pre-tx AB rinse
  51. HIV dental recall
    • 6 month unless CD4 < 100, then 3 month
    • lesions should be monitored
    • assess xerostomia (Fl?)
  52. ARV side effects
    • mitochondrial damage (NRTI): neuropathy, myopathy, acidosis
    • endocrine (PI): glucose intolerance insulin, testostrerone

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