Walls of the Tympanic Cavity or Middle Ear
The Roof or Tegmental Wall
The Floor or Jugular Wall
The Lateral or Membranous Wall
The Medial or Labyrinthine Wall
The Posterior or Mastoid Wall
The Anterior Wall or Carotid Wall
Inferior alveolar- 25 G short (LLU technique)
PSA- 25 G short
Mental/Incisive- 25 G short
Palatal- 27/30 G short/ultrashort
Gow-Gates/Akinosi- 25 G long
Infraorbital- 25 G long
ASA 25/27 short
Infiltration/SP 25/27 short
PDL 27/30 short
Intraosseous 30 short/ultrashort
Lipoproteins Consist of a Nonpolar Core & a Single Surface Layer of Amphipathic Lipids
The nonpolar lipid core consists of mainly triacylglycerol and cholesteryl ester and is surrounded by a single surface layer of amphipathic phospholipid and cholesterol molecules .These are oriented so that their polar groups face outward to the aqueous medium. The protein moiety of a lipoprotein is known as an apolipoprotein or apoprotein,constituting nearly 70% of some HDL and as little as 1% of Chylomicons. Some apolipoproteins are integral and cannot be removed, whereas others can be freely transferred to other lipoproteins.
There re five types of lipoproteins, namely chylomicrons, very low density lipoproteins(VLDL) low density lipoproteins (LDL), high density Lipoproteins (HDL) and free fatty acid-albumin complexes.
The effect of histamine can be opposed in three ways:
1. Physiological antagonism: by using a drug to oppose the effect (e.g adrenaline). Histamine constricts bronchi,
causes vasodilatation which increases capillary permeability. Adrenaline opposes this effect by a mechanism unrelated to histamine.
2. By preventing histamine from reaching its site of action (receptors), By competition with H1-H2 receptors (Drug antagonisms).
3. By preventing the release of histamine. (adrenal steroids and sodium-cromoglycate can suppress the effect on the tissues)
Types of Anti-histamine drugs
Selected H1 antagonist drugs
First-generation H1 receptor antagonists:
Chlorpheniramine (Histadin) & Dexchlorpheniramine
Promethazine (Phenergan) - strong CNS depressants
These drugs bind to both central and peripheral H1 receptors and can cause CNS depression or stimulation.
- They usually cause CNS depression (drowsiness,sedation) with usual therapeutic doses
- Cause CNS stimulation (anxiety, agitation)
with excessive doses, especially in children.
They also have Anticholinergic effects (e.g. dry mouth, urinary retention, constipation, blurred vision).
Second-generation H1 receptor antagonists (non-sedating) agents
Acravistine and Cetirizine
They cause less CNS epression because they are selective for peripheral H1 receptors and do not cross the blood brain barrier.
Indications for use
The drugs can relieve symptoms but don’t relieve hypersensitivity.
1) Allergic rhinitis. Some relief of sneezing, rhinorrhea, nasal airway obstruction and conjunctivitis are with the use of antihistamine.
2) Anaphylaxis. Antihistamine is helpful in treating urticaria and pruritus.
3) Allergic conjunctivitis. This condition, which is characterized by redness, itching and tearing of the eyes.
4) Drug allergies. Antihistamines may be given to prevent or treat reactions to drugs (e.g, before a dignostic test that
uses an iodine preparation).
5) Transfusions of blood and blood products.
6) Dermatologic conditions. Antihistamines are the drug of choice for treatment of allergic contact dermatitis and
acute Urticaria. Urticaria often occurs because the skin has many mast cells to release histamine.
7) Miscellaneous. Some antihistamines are commonly used for non-allergic disorder such as motion sickness, nausea, vomiting, sleep, cough or add to cough mixtures.
hypersensitivity to the drugs, narrow-angle glaucoma, prostatic hypertroph, stenosing peptic ulcer, bladder neck obstruction, during pregnancy and lactating women
Drowsiness and sedation
Some antihistamines may cause dizziness, fatigue, hypotention, headache, epigastric distress and photosensitivity
Serious adverse reaction including cardiac arrest & death, have been reported in patients receiving high dose astemizole
Cimetidine (Tagamate), Ranitidine (Zantac), Fomatidine, Nizatidine.
Mechanism of action
Numerous factors influence acid secretion by the stomach, including food, physiological condition and drugs. H2 receptor blockers reduce basal acid-secretion by about 95% and food stimulated acid-secretion by about 70%. Both conc. and vol. of H ions will decrease.
1) They are all well absorbed after oral dose.
2) Antacids decrease their absorption in about 10-20%
Cimetidine - reduction of gastric secretion is beneficial, these are in main duodenal ulcer, benign gastric ulcer, stomach ulcer and reflux eosophagitis.
Rantidine -used as alternative for duodenal ulcer
headache, dizziness, constipation, diarrhoea, tiredness and muscular pain.
Periodontics: Dental specialty deals with the supporting and surrounding tissues of the teeth.
1. Periodontium: tissues that invest and support teeth Includes Gingiva, Alveolar mucosa Cementum, Periodontal ligament, Alveolar bone, Support bone
2. Periodontal disease: changes to periodontium beyond normal range of variation
a. Specific plaque hypothesis: specific microorganisms cause periodontal disease; mostly anaerobes. Three implicated: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteriodes forsythus
b. Contributing factors: often a combination of factors
i. Local: calculus (tarter, home for bacteria, with age), traumatic occlusal forces, caries (root caries), overhangs and over-contoured restorations, open contacts with food impaction, missing/malaligned teeth
Invasion of biological width: from free gingival margin -> attached gingiva need ~ 3 mm. If enter this area -> problems (e.g., resorption)
ii. Host factors: exacerbate periodontal problems; e.g., smoking/tobacco use, pregnancy and puberty (hormonal changes, blood vessel permeability), stress, poor diet
iii.Medications: often -> tissue overgrowth; e.g., oral contraceptives, antidepressants, heart medicines, transplant anti-rejection drugs
iv.Systemic diseases: e.g., diabetes, immunosuppression
B. Gingivitis: inflammation of gingiva; with age; generally reversible
C. Periodontitis: inflammation of supporting tissues of teeth, characterized by loss of attachment (PDL) and bone; generally irreversible
D. Periodontal disease as risk factor for systemic diseases:
1. Causes difficulty for diabetics to control blood sugar
2. Pregnant women with periodontal disease ~ 7 times more likely to have premature and/or underweight baby
3. Periodontal diseased patients may be at risk for heart disease
Types of neurons based on structure:
a multipolar neuron because it has many poles or processes, the dendrites and the axon. Multipolar neurons are found as motor neurons and interneurons. There are also bipolar neurons with two processes, a dendrite and an axon, and unipolar neurons, which have only one process, classified as an axon.. Unipolar neurons are found as most of the body's sensory neurons. Their dendrites are the exposed branches connected to receptors, the axon carries the action potential in to the central nervous system.
Types of neurons based on function:
-Corticoid effect (Cushing's syndrome or therapy).
Bronchitis is an obstructive pulmonary disease characterized by inflammation of the bronchi of the lungs
Signs and symptoms
persistent cough that produces sputum
shortness of breath (dyspnea) on exertion
insufficient oxygenation of the blood hypoxemia leading to cynosis
Severe chronic bronchitis will commonly lead to cor pulmonale and heart failure.
an increase in the number of goblet cells with mucus blocking the airway clusters of pigmented alveolar macrophages
the presence of inflammatory cells (e.g. neutrophils) scarring (fibrosis) of the walls of the bronchioles
Quit smoking, Oxygen therapy, bronchodilator drugs
Pulmonary hypertension, cor pulmonale, and chronic respiratory failure are possible complications of chronic bronchitis
In severe chronic bronchitis is poor
Class IV Calcium Channel Blockers
• Block the movement of calcium into conductile and contractile myocardial cells
• Treatment: treatment of supraventricular tachycardia
• Adverse effects associated with vasodilation of blood vessels throughout the body.
• CNS – dizziness, weakness, fatigue, depression and headache,
• GI upset, nausea, and vomiting.
• Hypotension CHF, shock arrhythmias, and edema