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70 Cards in this Set
- Front
- Back
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Most frequent & debilitating sequelae of HNC radiation
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Oral Complications
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HNC represents ____% of cancer cases
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3
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Complications of XRT are related to three things:
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1.Site radiated
2.Total radiation dose 3.Fraction rate of doses |
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Most common dose to tumor & surrounding tissues of XRT:
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Tumor - 3000-8000 cGy (Rads)
Surrounding - 2000-5000 cGy (Rads) |
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Computer directed radiation source that targets the cancer more accurately with higher doses
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Intensity Modulated Radiation Therapy (IMRT)
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Following XRT, mucositis occurs as a result of early cell death in the ________.
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epithelial basement membrane.
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Clinical manifestations of mucositis following XRT usually begin within the ______.
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second week
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Usually the earliest chief complaint in regards to oral complications following XRT.
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Mucositis
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Permanent taste loss may result after _____ if tongue is in primary field
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6000 cGy
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Dentinal Hypersensitivity following XRT is a result of the _____ of saliva
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lowering of the oral pH
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Salivary glands most affected by radation.
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Serous glands (Parotids)
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Current model of radiation caries:
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A microbial disease significantly compounded by hyposalivation
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Trismus can occur _____ after XRT, and is usually seen in high doses to the _____ areas.
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3-6 months
pterygoid |
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Osteoradionecrosis is associated with XRT doses > _____.
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6000 cGy
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Radiographically, ORN gives a ____ appearance.
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'moth-eaten'
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Hours of training required in Al for minimal sedation
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16
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Five factors you use to match right sedative to each patient
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Pt Health
Pt Anxiety Appt Length Your Training Staff Training |
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Dental dose of ethyl alcohol
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2 oz 20 minutes prior
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Clinical sedation involved with ethyl alcohol
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60 minutes
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First truly effective oral drug for sedation in dentistry
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Barbiturates
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Barbiturates produce reversible depression of ______.
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excitable tissue (ie. GABA)
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Barbiturates work in the CNS _______.
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reticular formation
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Barbiturates should only be used in dentistry when _________ have proven to be ineffective.
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benzodiazepines
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Two drawbacks of Barbiturates use:
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1.Respiratory Depression
2.Non-Reversible |
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Chloral Hydrate has no ______ properties.
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analgesic
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Active ingredient in chloral hydrate.
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Trichloroethanol
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Dental dose of chloral hydrate:
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500-1000mg 1 hour before appointment
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Mepergan Fortis is a mixture of _______ & ______.
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meperidine (narcotic)
promethazine (antihistamine) |
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_______ potentiates opioids.
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Promethazine
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Malamed suggests opioid regimens to be used in dentistry as...
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oral narcotics for pain management only
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Three benzodiazepines commonly used as dental oral minimal sedatives.
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Triazolam (Halcion)
Lorazepam (Ativan) Midazolam (Versed) |
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GABA is the major ______ amino acid transmitter in the mammalian CNS.
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inhibitory
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GABA receptors regulate the flow of _____.
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chloride ion conductance
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Benzo's act by intensifying the physiologic inhibitory effect of GABA by _______.
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interfering with GABA uptake
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Benzo dosages should be ______ in elderly & debilitated.
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decreased
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Adverse reactions to benzo's:
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transient drowsiness
fatigue ataxia |
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Diazepam (Valium) has a plasma half-life of _____.
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20-70 hours (prolonged)
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Half-life of Lorazepam (Ativan)
Peak = |
9-14 hours
2 hours |
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Dental dose of Lorazepam (Ativan)
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2-3 mg hs
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Half-life of Triazolam (Halcion)
Peak = |
2-4 hours
1.3 hours |
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At therapeutic doses, _______ has been reported with Triazolam (Halcion)
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anterograde amnesia
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Dental dose of Triazolam (Halcion)
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0.25-0.50 mg 1 hour before appt.
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Maxiumum Recommended Dose of Triazolam (Halcion)
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FDA dose and one supplemental dose not to exceed one-half the initial dose
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Benzo that is only given in IV & oral liquid form
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Midazolam (Versed)
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Half-life of Midazolam (Versed)
Peak = |
2-4 hours
0.5 hour |
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TIme of onset of Midazolam (Versed)
Usual duration |
10-20 minutes
1-2 hours |
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Midazolam (Versed) can be reversed with ______.
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Romazicon
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Half-life of Ambien
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2-2.5 hours
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99% of N2O is eliminated via exhalation within ______ minutes.
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3-5
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N2O is though to effect both _______ and _______ receptors weakly
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Opioid
GABA |
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Safe to use N2O during these trimesters of pregnancy:
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2nd & 3rd
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Tool Kit for Minimal Sedation:
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Triazolam (Halcion)
Lorazepam (Ativan) Midazolam (Versed) Z-Drugs - Zolpidem/Zaleplon N2O |
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Required monitors for minimal sedation:
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Pulse-Ox
Pulse Recording NIBP EKG |
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Gold standard of monitoring:
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Pulse Ox
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Pulse Ox is a measurement based on the different absorption of _______ light by ______.
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read & infrared
oxyHb & deoxyHb |
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Age-Related changes to consider with the elder patient
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Distribution of Drug
Metabolism of Drug Excretion of Drug Multiple Disease States of Patient Multiple Medications of Patient |
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Over _____ current smokers.
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43 million
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Of current smokers in the US, _____ are men & ____ women.
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24%;
18% |
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Percentage of adults who smoke in Al
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22.5%
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_______ deaths annually related to smoking.
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419,000
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____% of oral cancer cases are related to smoking.
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90
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_____% of smokers would like to quit.
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80
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Only ____% of smokers quit after a heart attack.
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50
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carbon monoxide level drop to normal ____ after smoking cessation.
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12
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Coughing & shortness of breath decrease & cilia regain normal function ____ after smoking cessation.
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1-9months
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Stroke risk is reduced to that of a non-smoker ____ after smoking cessation.
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5-15
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Risk of coronary heart disease is the same as a non-smoker ____ after smoking cessation.
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15
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The _____ pH of smokeless tobacco facilitates direct nicotine absorption via oral mucosa.
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alkaline
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_______ daily consumption of ST is equal to one pack of cigarettes.
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10 grams
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Highest risk of oral cancer with this type of smokeless tobacco
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Dry Snuff
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