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45 Cards in this Set

  • Front
  • Back
What 7 factors influence the pediatric patient's response to dental treatment?
-parents
-peers
-doctor
-staff
-prior experience with health professionals
-time of appointment (am is better)
-office environment
What are the 4 goals of pediatric sedation
-make the child cooperative and comfortable
-decrease the child's anxiety
-decrease the anxiety and strain of the doctor and staff
-minimize the need for hospitalization
What 7 sedation techniques are availabl efor the pediatric patient
-inhalation sedation w/N2O
-oral sedation
-oral + inhalation
-IV w/ or w/o inhalation
-IM and IV sedation
-any of the above with body restraints (common w/IV)
-general anesthesia
How does a child differ in regards to:
metabolic rate
liver enzymes
emptying time
-increased in a child
-not fully functional until age 1
-not functional until age 1 (kidneys, endocrine, esophagus, GI)
How does a child differ in regards to:
drug redistribution
BP
trachea
-decreased due to less fate and muscle mass
-driven by heart rate
-more anterior
How does a child differ in regards to:
airway compliance
functional residual capacity
-more compliant than in adult
-reduced, decreases the amount of reserve oxygen available and leads to earlier desaturation
When do tonsils and adenoids reach their largest size
-b/t ages 4 and 10
-adds to the airway obstruction problem
Why is the fact that a kids BP is driven by HR a problem
-bradycardia can lead to hypotension
Why is the fact that the trachea is more compliant in kids a problem
-the trachea can collapse with negative pressure such as trying to overcome partial obstruction
Why does a child's increased metabolic rate matter
-medications are going to be metabolized at a higher rate
What 8 factors determine a pediatric drug dosage
-age
-weight
-emotional behavior/stress
-level of sedation desired
-physical activity of kid
-contents of stomach (PO)
-time of day
-ability to titrate
What is the standard dosing formula
mg/kg
What is young's rule
age of patient/age + 12 = fraction of adult dose
What is clark's rule
weight in pounds/150 = fraction of adult dose
What are 4 examples of physical restraints
-bed sheets
-papoose board
-rubber bite block
-molt mouth prop
What 2 things must you do when using restraints
-obtain parental informed conset prior to using
-be careful not to wrap too tightly - could potentially restrict respiration
Ad/Dis of oral sedation
-no needles, medicate in office while monitoring kids, can be mixed if taste is unpleasant
-variability of drug behavior results in failure rate as high as 40%
What should you do when an adequate level of sedation is not reached PO
-do NOT give more PO medication, you just proceed with less-than-ideal cooperation or reschedule
What are 5 common oral meds used for pediatric sedation
-chloral hydrate
-hydroxyzine
-midazolam
-meperidine
-promethazine
Oral Chloral Hydrate:
available forms
taste
effective for what
dosage
administer when
typical dosage
provides how much working time
can it be combined with N2O
-capsule, elixir, rectal suppositories
-bitter
-mild to moderate anxiety
-elixir = 500 mg/5mL
-45min-1hr before appointment
-30-50 mg/kg
-1 hour
-yes
Oral hydroxyzine comes in what 2 forms (and their doses)
-hydroxyzine hydrochloride (10 mg/5mL)
-hydoxyzine pamoate (25 mg/5mL)
Oral hydroxyzine:
effective for
useful for
dosage
duration
can you combine with N2O and opioids
-very apprehensive, agitate or disturbed children
-hyperatcitve children and kids with autism
-1-2 mg/kg 1 hour before appt
-1-2 hours
-yes
Oral pormethazine/phenergan
-used in combo with what drugs
-useful for
-dosage
-chloral hydrate, hydroxyzine, meperidine
-mild anxiety when used alone
-1-2 mg/kg
Oral midazolam
-effective for
-dosage
-onset
-duration
-hyperactive, mildly anxious patients
-0.5 mg/kg
-takes 15-20 min to take effect
-60-90 min
What are the two most common parenteral agents used in kids
-midazolam and ketamine
Parenteral midazolam:
-dose
-time to effect
-form commonly use
IM - .15-.2 mg/kg
-10 min
-IV than IM
Ketamine:
What type of anesthesia
used for what
Dosing
onset of effects
duration
-dissociative anesthesia
-when you can't get an IV - great IM choice
-IM 2-3 mg/kg
-less than 5 min
-15-30 min
T/F - when IM sedation is used you should still start an IV
-true, incase the patient needs more sedation or an emergency arises
What should you be aware of when giving ketamine
-it can produce general anesthesia
What is the max dose for lidocaine or mepivacaine
4 mg/kg or 2 mg/lb
What age is the beginning of the geriatric period
age 65
What are 8 cardiovascular changes in the geriatric patients
-coronary artery disease
-angina pectoris
-MI
-dysrhythmias
-decreased contractility
-hypertension
-renal vascular disease
-cerebrovascular disease
What are 4 respiratory changes in the geriatric patients
-emphysema/COPD
-interstitial fibrosis
-arthritic changes in thorax
-increase in airway closure capacity
What are three CNS changes in the geriatric patient
-decreased number of brain cells
-cerebral arteriorsclerosis (CVA, decreased memory, emotional changes, confusion, delirium, dementia)
-parkinsonism
What are 4 genitourinary system changes in the geriatric patient
-decreased renal blood flow (imp b/c penicillin is excreted thru kidneys)
-decreased number of functioning glomeruli
-decreased tubular reabsoprtion
-benign prostate hypertrophy
What are 2 endocrine system changes in geriatric patients
-decreased response to stress
-diabetes mellitus
What are 5 common health problems in the geriatric patient
-arthritis
-hypertension
-atherosclerosis
-emphysema
-glaucoma
What is contraindicated in a patient who has glaucoma
-valium --> will increase pressure in eye
What is more common in geriatric patients
-twice as likely to develop adverse drug reactions
-tend to hyper-respond to usual doses of meds
What are the 4 reasons for exaggerated effect of drugs in the elderly
-hepatic and renal dysfunction
-drug-drug interactions
-decreased drug binding due to decreased albumin
-lean body mass declines while fat increases which increases elimination half-life of lipid soluble drugs
What are 3 key factors when using oral sedation on the elderly
-titrate by appointment
-select small dosages
-BZDP w/o active metabolites are a good choice
What BZDP do not have active metabolites
-lorazepam
-oxazepam
-triazolam
IM sedation in the elderly
-good or bad and why
-drug of choice
-give pt
-not recommended b/c they easily bruise and you are unable to titrate
-midazolam
-supplemental oxygen as well
IV sedation in the elderly:
-drug of choice
-good b/c
-use caution
-keep pt at
-give pt
-can be difficult
-BZDPs
-you can titrate
-when titrating - go slowly
-a light level of sedation
-supplemental oxygen
-b/c veins tend to be fragile and have lost elasticity
inhalation sedation in elderly
-good for
-level of sedation
-provides
-mild to moderate anxiety
-light sedation
-supplemental oxygen