Course - PGI MDS TOPICS

Benzodiazepines


Benzodiazepines
All metabolites are active sedatives except the final glucuronide product. Elimination half-life varies a great deal from drug to drug.

α-Hydroxylation is a rapid route of metabolism that is unique to triazolam, midazolam, and alprazolam.
This accounts for the very rapid metabolism and short sedative actions of these drugs.

Pharmacological effects of benzodiazepines

- Antianxiety.
- Sedation.
- Anticonvulsant (including drug-induced convulsions).
- Amnesia, especially drugs like triazolam.
- Relax skeletal muscle (act on CNS polysynaptic pathways).

Indications

- IV sedation, (e.g., midazolam, diazepam, lorazepam).
- Antianxiety.
- Sleep induction.
- Anticonvulsant (e.g., diazepam, clonazepam).
- Panic disorders.
- Muscle relaxation.


Adverse effects

- Ataxia, confusion.
- Excessive sedation.
- Amnesia (not a desired effect with daytime sedation).
- Altered sleep patterns (increase stage 2 and decrease stage 4 sleep).

Relationship Classification


Angle classified these relationships by using the first permanent molars

Normal or neutral occlusion (ideal):

Mesiobuccalgroove of the mandibular first molar align with the mesiobuccal cusp of the max laxy first permanent molar

ClassI  malocclusion  normal molar relationships with alterations to other characteristics of the occlusion such as versions, crossbites, excessive overjets, or overbites

 

Class II malocclusion a distal relation of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary first permanent molar

 

Division I: protruded maxillary anterior teeth

Division II: one or more maxillary anterior teeth retruded

Class III  malocclusion a mesial relation of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary molar

Hydromorphone


Hydromorphone

  • About 8-10 times more potent than morphine when given intravenously.
  • Slightly shorter duration of action.
  • More soluble than morphine, thus higher concentrations may be injected if necessary.
  • Better oral/parenteral absorption ratio than morphine, but not as good as codeine or oxycodone.
  • It is used for the treatment of moderate to severe pain

FLUXING


FLUXING
To prevent oxidation of gold alloys during melting always use a reducing flux .
Boric acid & borax are used .

ESSENTIAL FATTY ACIDS


ESSENTIAL FATTY ACIDS (EFAs) Polyunsaturated FAs,such as Linoleic acid and g(gamma)- Linolenic acid, are ESSENTIAL FATTY ACIDS — we cannot make them, and we need them, so we must get them in our diets mostly from plant sources.

Cardiac Control


Cardiac Control: The Cardiac Center in the medulla.

Outputs:

The cardioacceleratory center sends impulses through the sympathetic nervous system in the cardiac nerves. These fibers innervate the SA node and AV node and the ventricular myocardium. Effects on the SA and AV nodes are an increase in depolarization rate by reducing the resting membrane polarization. Effect on the myocardium is to increase contractility thus increasing force and therefore volume of contraction. Sympathetic stimulation increases both rate and volume of the heart.

The cardioinhibitory center sends impulses through the parasympathetic division, the vagus nerve, to the SA and AV nodes, but only sparingly to the atrial myocardium, and not at all to ventricular myocardium. Its effect is to slow the rate of depolarization by increasing the resting potential, i.e. hyperpolarization.

The parasympathetic division controls the heart at rest, keeping its rhythm slow and regular. This is referred to as normal vagal tone. Parasympathetic effects are inhibited and the sympathetic division exerts its effects during stress, i.e. exercise, emotions, "fight or flight" response, and temperature.

Inputs to the Cardiac Center:

Baroreceptors in the aortic and carotid sinuses. The baroreceptor reflex is responsible for the moment to moment maintenance of normal blood pressure.

Higher brain (hypothalamus): stimulates the center in response to exercise, emotions, "fight or flight", temperature.

Intrinsic Controls of the Heart:

Right Heart Reflex - Pressoreceptors (stretch receptors) in the right atrium respond to stretch due to increased venous return. The reflex acts through a short neural circuit to stimulate the sympathetic nervous system resulting in increased rate and force of contraction. This regulates output to input

The Frank-Starling Law - (Starling's Law of the Heart) - Like skeletal muscle the myocardium has a length tension curve which results in an optimum level of stretch producing the maximum force of contraction. A healthy heart normally operates at a stretch less than this optimum level and when exercise causes increased venous return and increased stretch of the myocardium, the result is increased force of contraction to automatically pump the increased volume out of the heart. I.e. the heart automatically compensates its output to its input.

An important relationship in cardiac output is this one:

Blood Flow =  D Pressure / Resistance to Blood Flow      

Achrondroplasia


Achrondroplasia 
is a major cause of dwarfism. The underlying etiology is a point mutation in the fibroblast growth factor receptor, which causes inhibition of chondrocyte proliferation, which is associated with suppression of the normal epiphyseal growth plate expansion. Thus, long bone growth is markedly shortened.
The most conspicuous changes include disproportionate shortening of the proximal extremities, bowing of the legs, and a lordotic posture. 

Microscopically, the cartilage growth plates are disorganized and hypoplastic. 

FUNCTIONS OF PERIODONTIUM


FUNCTIONS OF PERIODONTIUM

Tooth support
Shock absorber
Sensory (vibrations appreciated in the middle ear/reflex jaw opening)

Antiarrhythmic Drugs - Class III Potassium Channel Blockers


Class III Potassium Channel Blockers

Prolong effective refractory period by prolonging Action Potential

Treatment: ventricular tachycardia and fibrillation, conversion of atrial fibrillation or flutter to  sinus rhythm, maintenance of sinus rhythm
– Amiodarone (Cordarone) – maintenance of sinus rhythm
– Bretylium (Bretylol) 
– Ibutilide (Corvert) 
– Dofetilide (Tykosyn) 
– Sotalol (Betapace) 

 

 Amiodarone 
- Has characteristics of sodium channel blockers, beta blockers, and calcium channel blockers 
- Has vasodilating effects and decreases systemic vascular resistance 
- Prolongs conduction in all cardiac tissue 
- Decreases heart rate 
- Decreases contractility of the left ventricles 

Class III - Adverse Effects 
- GI- Nausea vomiting and GI distress 
- CNS- Weakness and dizziness
- CV-Hypotension, CHF, and arrhythmias are common. 
- Amiodarone associated with potentially fatal Hepatic toxicity, ocular abnormalities and serious cardiac arrhythmias. 

Drug – Drug Interactions
These drugs can cause serious toxic effects if combined with digoxin or quinidine. 
 

Temporary Filling Materials


Temporary Filling Materials

Applications / Use

While waiting for lab fabrication of cast restoration
While observing reaction of pulp tissues


Objectives

Provide pulpal protection
Provide medication to reduce pulpal inflammation
Maintain the tooth position with an aesthetic restoration

Classification

Temporary filling cements
Temporary filling resins


Components

Temporary filling cements

1. Zinc oxide-eugenol cement with cotton fibers added
2. Polyme r powder-reinforced zinc oxide eugenol cement

Temporary filling resins

•    MMA / PMMA filling materials
•    Polyamide filling materials
•    BIS-GMA filling materials