Ch. 30 & 31 Pharmacology/Medical Emergency - 104

Every member of the dental team must have the following credentials and skills as a practicing healthcare provider in a dental office

-ability to assess and record vital signs accurately -basic life support for healthcare providers (cardiopulmonary resuscitation CPR) -heimlich maneuver (abdominal thrusts) -operation of the automated external defibrillator (AED)

Factors that must be considered when the dentist and pharmacy determine the dosage of a drug are as follows

-age of the patient, with these affecting newborns and the aged the most (this is because the persons body system mat be immature or weakened) -weight of the patient has a direct relation to the effect of the medication -time of day the drug is to be taken is important because the bodys rhythm plays an important part in the effects of some drugs -patient tolerance to the drug can develop, especially if the patient has taken a specific drug over a period

Examples of IV Substances include

-alprazolam (xanax) -carisoprodol (soma) -clonazepam (klonopin) -clorazepate (tranxene) -diazepam (valium) -lorazepam (ativan) -midazolam (versed) -temazepam (restoril) -triazolam (halcion)

A drug can be identified by three names

-chemical name -generic name -brand name

The following guidelines apply to the dental assistant regarding telephone interaction with a pharmacy

-controlled substances cannot be called in over the phone -it is illegal for a dental assistant to call in a prescription -when a pharmacist calls notify the dentist, DO NOT try to relay information between them -if the dentist is unable to get the phone take their name and number -never attempt to evaluate a patients reaction to a drug (ONLY a dentist or pharmacist is qualified to evaluate drug effects)

For a prescription to be valid it must contain

-dentist name, address, and phone number -superscription -inscription -subscription -signature -dentists signature -dentists DEA number

Examples of Schedule I Substances

-heroin (diacetylmorphine) -LSD (lysergic acid diethylamide) -Marijuana (cannabis, THC) -Mescaline (peyote) -MDMA (ecstasy) -bath salts -methaqualone (quaalude)

The three most important measures in preventing airway obstruction during dental treatment include

-high velocity suction -use of dental dam during routine procedures -placement of a throat pack (gauze placed at base of throat)

Specific information commonly listed in the insert

-how the drug will affect the body -for what condition that drug is being prescribed -any adverse effects -any adverse or long term effects -special precautions to follow when taking the drug -contraindications to taking the drug -dosage and route for the drug

Examples of Schedule V substances include

-robitussin AC -phenergan with codeine -ezogabine

Examples of Schedule III NONNARCOTICS include

-tylenol with codeine -vicodin -benzphetamine (didrex) -phendimetrazine, ketamine -anabolic steroids such as depo-testosterone

Examples of Schedule II narcotics include

-vicodin -cocaine -methamphetamine -methadone (dolophine) -hydromorphone (dilaudid) -meperidine (demerol) -oxycontin (percocet) -fentanyl -adderall -ritalin

The most probable situations in which the dental assistant will be essential to identify drug types include

-when reviewing a patients medication history -when assisting in dental procedures that require premedication -when assisting in a specific dental procedure for which pain control is requires -when assisting in a medical emergency

If defibrillation is provided within the first

5 minutes of a cardiac arrest, the chance that the victims life can be saved is 50%, for each minute that passes during a cardiac arrest the chance reduces by 7-10%

Bases on the latest publication from the American Heart Association (AHA) and the American Red Cross, healthcare providers are to follow the

Cardiac Chain of Survival

All drugs must be recognized and defined by the

US Food, Drug, and Cosmetic Act before they can be marked for public use in the United States

Defibrillation must be started IMMEDIATELY to stop

VF and allow a normal heart rhythm to resume, the sooner defibrillation begins the better the victims chance of survival

What is ventricular fibrillation (VF)

abnormal, chaotic heart rhythm that prevents the heart from pumping blood

A sudden coughing spasm or movement by the patient during a dental procedure may cause the

accidental aspiration of a foreign object

N-(4-hydroxyphenyl) acetamide is the CHEMICAL name for

acetaminophen

Tylenol is the BRAND NAME for

acetaminophen

Schedule VI Drugs (controlled substances act)

added classification only in a few states, marijuana has become legal in several states for medical, personnel, or recreational use (this drug has a relatively low potential for abuse in terms of risk to public health and producing psychological dependence, presenting the need for more scientific evidence of its pharmacologic effects)

p.c (common prescription abbreviations)

after meals

prn (common prescription abbreviations)

as needed

The AED is basically an advanced computer microprocessor that

assess the patients cardiac rhythm and identifies any rhythm for which shock is indicated

h.s (common prescription abbreviations)

at bedtime

Chemical name (3 drug identifications)

atomic or molecular structure of the drug

a.c (common prescription abbreviations)

before meals

In an emergency in which the patient is not breathing and the heart is not beating

cardiopulmonary (CPR) must be initiated immediately (time is critical in a cardiac arrest)

Ventricular fibrillation (VF) causes more cardiac arrests than are

caused by ANY other rhythm (80-90% of cases)

Follow the major sequence of steps for adults and pediatric patients (infants and children) which include

chest compressions, airway, breathing (CAB); this sequence allows the chest compressions to be initiated immediately and then followed by ventilation

An example of a schedule V drug is a cough medicine with

codeine because the misuse and illict distribution of methamphetamine (pseudoephedrine) many sates have passed a law requiring prescription or requiring the customer to show a photo ID and sign a book before pharmacies will dispense any COLD REMEDY containing pseudoephedrine

Printed drug references such as the Physicians Desk Reference and dental specific sources such as Mosbys Dental Drug Reference are

comprehensive

Brand Name/Trade Name (3 drug identifications)

controlled by a pharmaceutical company as a registered trademark

Training must be kept

current

A mock emergency should be scheduled monthly in the dental office so that

dental team members can practice their roles, take on additional roles, and refine the offices emergency plan

If a medical emergency involving the patient arises the

dentist and staff members are responsible for providing emergency care until more qualified personnel arrive

Organic drugs (drug sources)

derived from living organisms such as plants or animals

Subscription on a prescription

directions to the pharmacist for mixing the medication (this is seldom completed by the pharmacist anymore so you do not see this routinely on a prescription)

disp. (common prescription abbreviations)

dispense

The manufacturer of the drug has calculated the exact time required for the drug to take effect and compiles the

dosage, or the dose administered during a specific period

The amount of drug a patient takes is termed a

dose

It is essential that a dental office stay up to date with its

drug reference materials

Patent medicines

drugs that can be obtained without a prescription; these are also referred to as over the counter drugs (OTC)

In the management of an emergency the combined efforts of trained persons are more efficient when

each person takes on a specific, assigned role (it is the responsibility of the dentist to assign these roles)

A list of emergency numbers should be posted next to

each phone in the office, it is also very important for these numbers to maintain CURRENT as a part of emergency preparedness

Emergency telephone numbers should include

emergency medical services (EMS) personnel, local police, and firefighters (in areas of the US and Canada all THREE of these numbers can be reached by dialing 911)

Ongoing observation of the patient is an important part of

emergency preparedness, a calm, well functioning staff can handle an emergency in the dental office without complicating the seriousness of the situation by frightening the patient

EVERY member of the dental team must be prepared for an

emergency when one occurs in the dental office

A standardized procedure for the management of emergencies must be

established and followed

q. (common prescription abbreviations)

every

The dental assistant can dispense medicine according to

explicit instructions and under direct supervision of the dentist

Under the law any professional who is authorized to prescribe medications is issued a

federal drug enforcement agency (DEA) identification number which is to be printed on the dentists prescription pad

The dentist must comply with the provisions of the

federal law and those of the state, province, or territory in which they practice (always following the most restrictive guidelines when the laws differ)

The drugs and drug products covered under the Federal Comprehensive Drug Abuse Prevention and Control Act are divided into

five classifications of drugs with an addition of a sixth classification in some states (these are referred to as schedule drugs)

q.i.d (common prescription abbreviations)

four times a day

The attentive dental team observes the patients

general appearance and gait (walking) as they enter the clinical area

Acetaminophen is an example of a

generic name

The availability of the emergency contacts and their response time emergencies vary widely according to the

geographic area and the population served

Schedule III Drugs (controlled substances act)

have less abuse potential than the drugs in schedule I and II and have accepted medical usefulness (these prescriptions can be renewed)

CPR combines external cardiac compressions to simulate the

heart with rescue breathing to ensure that adequate air is entering the lungs, this is initiated immediately so that the flow os oxygen carrying blood quickly reaches the brain

H (common prescription abbreviations)

hour

A medical emergency is a condition or circumstance that requires

immediate attention toward a person who has been injured or suddenly becomes ill

When a patient is choking their discomfort is

immediate, their hands move to the throat as spasms of coughing or chocking occur

The AED shock is an

immense jolt of electricity that is sent to the heart muscle to reestablish the proper rhythm of the heart

Individual state laws regulate the format and

information to be included on a prescription

Every over the counter (OTC) or prescription filled by a pharmacist includes an

insert, or information sheet, that describes the drug

Signature on a prescription

instructions for the patient on how to take the medicine, when to take it, and how much to take (dentist signature, dentists DEA number)

The cells of the brain are the most sensitive tissue in the body that easily result in

irreversible damage after 4-6 minutes without oxygen

Generic name (3 drug identifications)

is the shorthand version of the drugs chemical name, structure, or formula, which may be used by any company

Signs and Symptoms (recognizing a medical emergency)

it is important to be attentive and take notes of the patients response to a symptom and your observation of the signs

One of the most important ways to prevent a medical emergency is to

know your patient, meaning establishing open communication with the patient about their health and maintaining a completed and updated medical history BEFORE dental procedure begins

Prescription Drugs/ Ethical Drugs

licensed medicines that are regulated by legislation; a prescription is required before they can be obtained from a pharmacist

Schedule II Drugs (controlled substances act)

limited medical use, high potential for abuse, and high risk for physical or psychological dependence (prescriptions for these drugs are given only in writing and cannot be renewed)

Prescription pads are to be kept in a

locked drawer and should never be visible or available to use as notepaper

Schedule IV Drugs (controlled substances act)

low abuse potential and have accepted medical usefulness (these prescriptions can be renewed, allowing the patient up to 5 refills in a 6 month period before requiring the patient to be seen for renewal)

Schedule V Drugs (controlled substances act)

lowest abuse potential and have accepted medical usefulness (some states require these drugs be dispensed only by prescription, but under federal law they are available under controlled circumstances)

Inscription on a prescription

main body of the prescription (name and quantity of the drug)

Pharmacology is the science or branch of

medicine that includes research, development, and manufacture of drugs

a.m (common prescription abbreviations)

morning

Chemical drugs (drug sources)

most drugs today are derived from a chemical source which makes them purer in form than those derived from an original natural source that mat be contaminated or polluted

Schedule I Drugs (controlled substances act)

no currently accepted medical use in treatment in the US and have a high potential for abuse

NPO (common prescription abbreviations)

nothing by mouth

a.a (common prescription abbreviations)

of each

q.d (common prescription abbreviations)

once a day

Each classification of the control act has specific requirements for

ordering, storing, prescribing, dispensing, and destroying the scheduled drugs within its definition

Drugs are derived from

organic, inorganic, and chemical sources

In most dental offices a standardized emergency kit is

organized and equipped with emergency supplies (a clinical assistant or hygienist is assigned with the responsibility of maintaining and updating these supplies)

The US Food and Drug Administration (FDA) regulates the sale of

patent medicines and evaluates their safety and effectiveness for daily use

Drugs are classified into two categories according to the way an individual can purchase them:

patent medicines and prescription drugs

Each drug prescribed must be documented in the

patient record for future reference

If a medical emergency happens and your are the only person in the room your first response is to the

patient until the dentist, dental team, or medical assistance arrives for support, so it is YOUR responsibility to use well chosen words of support, to show a willingness to help, and to demonstrate capable lifesaving skills

Superscription on a prescription

patients name, address, date, and the symbol from the latin recipe (meaning take)

The front desk assistant (business assistant) is responsible for ensuring that

patients update their information as they enter the office

Recognition of a change in either

physical or emotional presence is critical

A standard 110-Volt current or battery powers the

portable defibrillator (AED)

The controlled substances act is referred to as schedule drugs and are classified based on their

potential for abuse, their medical usefulness, and the extent to which they may lead to physical and psychological dependence or addiction

Successful management of medical emergencies in the dental office requires

preparedness, prompt recognition, and effective treatment

Under NO circumstance can any member of the dental team

prescribe medications

Normally schedule I drugs cannot be

prescribed

A drug is a substance taken for the

prevention, diagnosis, and treatment of a disease

Examples of Schedule III narcotic drugs include a combination of

products

The dental staff must remain alert knowing a medical emergency could occur at any time, so ongoing observation of the patient in the

reception area, in the dental chair, or leaving the office cannot be overemphasized

SL (common prescription abbreviations)

sublingual

Inorganic drugs (drug sources)

synthesized in the laboratory or extracted from inorganic comounds

T, tbs (common prescription abbreviations)

tablespoon

t, tsp (common prescription abbreviations)

teaspoon

A list of the telephone numbers of the nearest hospital, physicians, and oral surgeons should also be available because

these professionals would be able to offer the life support needed while waiting for EMS personnel or another type of emergency response

t.i.d (common prescription abbreviations)

three times a day

b.i.d (common prescription abbreviations)

twice a day

Most sudden cardiac arrest victims are experiencing

ventricular fibrillation (VF)

After 10 minutes without defibrillation the patient has

very little chance of successful rescue

Symptom in a medical emergency

what the patient is telling you about how they feel or what they are experiencing (I feel dizzy, Im having trouble breathing, or My arm hurts)

Sign in a medical emergency

what you observe in a patient, such as a change in skin color or an increase in respiratory rate (since they are observed by the dental team they are more consistent than the symptoms expressed by the patients)

Front desk staff or business assistant (Assigned Roles)

will call emergency services and remain on the telephone until appropriate medical assistance arrives

Dentist OR Clinical Assistant OR Dental Hygienist (Assigned Roles)

will remain with the patient to assist in assessment or with basic life support

Additional dental team members (Assigned Roles)

will respond to the needs of other patients in the office

Clinical Assistant or Dental Hygienist (Assigned Roles)

will retrieve the oxygen unit and emergency drug kit and prepare for use

A prescription is a

written instruction provided by a physician or dentist for the preparation and administration of a medicine

The severity of choking depends on

1. how forcefully the item is lodged into the persons throat 2. how much of the airway is blocked

The fundamental aspect of basic life support include

1. immediately recognizing an emergency 2. activating the emergency response system (ERS) 3. accurately performing CPR 4. applying defibrillation when appropriate

The AED does three things

1. monitors the patients heart rhythm 2. distinguishes VF from other abnormal heart rhythms through computed analysis 3. automatically defibrillates if needed

Steps involved in the Cardiac Chain of Survival

1. recognizing the signs of cardiac arrest and then activating the ERS 2. providing CPR with an emphasis on chest compressions 3. rapid defibrillation 4. the inclusion of advanced emergency medical services 5. advanced life support and post cardiac care

Two important factors in emergency preparedness to know are

1. the time it takes for local EMS personnel to reach the dental office 2. the life support capabilities that are available on arrival of the EMS staff (not all EMS personnel carry the same equipment or provide the same level of care)