Disorders of the Mouth and esophagus
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| What percentage of americans are affected by Cold Sores, Canker Sores, Aphthous Ulcers? | 20% - 50%
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| What size do Cold Sores, Canker Sores, Aphthous Ulcers range? | 0.5cm - 3cm
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| What is the treatment of aphthous ulcers in people with normal immune systems? | amlexanox (Aphthasol) anti-inflammatory
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| Adverse effects of amlexanox (Aphthasol) | *Transient pain *Stinging and/or burning at the site of application
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| Less than 1% of PTs on amlexanox (Aphthasol) experience what adverse effects? | *Contact mucositis. *Nausea. *Diarrhea.
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| In the event that a rash or contact mucositis occurs from the use of amlexanox (Aphthasol), what should be done? | Discontinue use
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| When should amlexanox (Aphthasol) first be used? | ASAP after noticing symptoms of an aphthous ulcer.
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| amlexanox (Aphthasol) should be used how often? | four times daily, preferably following oral hygiene after breakfast, lunch, dinner, and at bedtime
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| True or False: When the symptoms of aphthous ulcers heal, amlexanox (Aphthasol) use can be discontinued. | True.
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| If significant healing or pain reduction has not occurred whithin how long, what must be done? | 10 days, consult dentist or physician.
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| The acid that causes erosion in dental carries is produced by the breakdown of what by bacteria? | Carbohydrates
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| True or False: Candida is a normal flora of the mucous membranses of the mouth, intestinal tract, vagina and skin of healthy people | True.
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| Aside from newborns, who else is candidiasis often seen in? | Patients with leukemia, DM, ABX, or on steroids
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| What is the prefered treatment of candidiasis in infants and vaginal infections? | nystatin (Mycostatin)
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| What are the treatments of candidiasis? | *nystatin (Mycostatin) *ketoconazole (Nizoral) *amphotericin B *1/2 strength hydrogen peroxide/saline rinses
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| In adults with candidiasis, what foods should be eaten and what toothbrushes used? | eat soft foods and use soft-bristled toothbrush
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| How long can amphotericin B be found in the urine AFTER discontinuation? | Up to 7 weeks after.
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| List 3 side effects of amphotericin B. | *CNS: headache. *CV: hypotension. *GI: diarrhea, nausea, vomiting. *GU: nephrotoxicity. *F&E: hypokalemia
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| What is the dosage and frequency of amphotericin B PO? | 1-4 mg q 4 hours
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| What should the PT be instructed to do while taking amphotericin B? | Instruct patient to swish medication around in mouth as long as possible before swallowing.
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| How should PTs with dentures be instructed to take Nystatin? | Presoak dentures in nystatin suspension
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| What are the side effects of Nystatin? | *GI: D/N/V. *Derm: contact dermatitis.
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| What may indicate the need to discontinue the use of Nystatin? | Increased irritation.
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| How should PO Nystatin be administered? | Suspension should be administered by placing half a dose on each side of the mouth.
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| For how long after symptoms disappear should Nystatin be taken to prevent relapse? | Continue for 48 hours after symptoms have disappeared and cultures are negative
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| What are the contraindications of ketoconazole (Nizoral)? | *Pregnancy or lactation. *Concurrent triazolam.
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| What are the adverse reactions of ketoconazole (Nizoral)? | *CNS: dizziness, drowsiness. *EENT: photophobia. *GI: drug-induced hepatitis, n/v/d. *GU: decreased male libido, menstrual irregularities.
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| How can you administer ketoconazole (Nizoral) to prevent nausea and vomiting? | administer with meals or snacks
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| What must not be administered within 2 hours of taking ketoconazole (Nizoral)? | histamine H2 antagonists or antacids
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| What are the adverse effects of topical anesthetics? | *CNS: confusion, drowsiness, dizziness, nervousness, tremor. *EENT: (mucosal) decreased or absent gag reflex. *GI: nausea and vomiting. *Local: stinging, burning, contact dermatitis, erythema.
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| What drugs when used while taking topical anesthetics can lead to increased cardiac depression and toxicity? | *phenytoin *amiodarone *quinidine *procainamide
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| What is the dosage and administration of topical anesthetics for oral surfaces? | 20 mg as 2 sprays/quadrant (not to exceed 30 mg/quadrant)
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| 60% of PTs who c/o GERD have what? | delayed gastric emptying
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| How much of the population is affected somewhat by GERD? | 45%
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| GERD pain can mimic what? | Angina
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| How long can the pain from GERD last after meals? | 20min to 2hrs
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| Define Odynophagia: | Painfull swallowing
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| What percentage of adult asthmatics may have GERD? | >80%
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| What are the diagnostic tests that can confirm GERD? | *Barium swallow *Endoscopy with biopsy *Esophageal-monitoring test
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| Test that measures how often and for how long stomach acid enters the tube that leads from the mouth to the stomach (Esophagus) | Esophageal pH monitoring
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| Simple GERD may be resolved if the PT does what? | Avoid problem foods or beverages, stop smoking, or lose weight.
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| Severe GERD can cause what? | Asthma attacks *Severe chest pain *Bleeding *Chronic irritation of the esophagus.
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| Drugs of choice in the treatment of GERD | Prilosec & Prevacid
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| What drug is given for moderate to severe GERD? | Reglan
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| What does Reglan do? | Increases peristalsis without simulating secretions
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| What is Fundoplication? | A procedure that is performed to wrap the gastric fundus around the lower esophagus and suturing it is in place
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| GERD diet instructions | *4-6 small meals per day *Thoroughly chew food *No snacks/meals 2-3h before HS *Reduce foods with caffeine *Low fat, adequate PROTEIN diet
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| How should a GERD patients bed be placed? | Head of bed elevated 6-8 inches, and dont sleep in flat position.
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| What is the primary symptom of Achalasia? | Difficulty swallowing
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| Due to absence of peristalsis of the esophagus int the PT with Achalasia, the PT may experience the sensation of what? | food sticking to the lower portion of the esophagus
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| True or False: One treatment of Achalasia is FORCEFUL dilation of the esophagus | True
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| What can a PT with Achalasia do to increase the peristalsis movement to the lower esophageal spincter? | Drink fluids with meals. The pressure exerted by the fluids will assist food into the stomach.
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