Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
83 Cards in this Set
- Front
- Back
|
name the top 5 anxiety disorders
|
general anxiety
post traumatic stress phobias panic disorders obsessive compulsive |
|
|
describe the clinical signs of hyperventilation
|
heart palpitations
carpopedal spasms chvosteks signs parasthesia hyperpnea |
|
|
what is hypercalcemia
|
symptom of hyperventilation involving:
carpopedal spasms- muscle spasm of hands and feet chvosteks signs- spams of the face muscles parasthesia- tingling and numbness of fingers and toes |
|
|
describe the pathophysiology of hyperventilation
|
anxiety increases resp rate
raises levels of norephinephrine in blood body responds with raised exchange of O2 and Co2 in lungs reduced Co2 creates condition known as HYPOCAPNIA this causes blood ph to reach 7.55- this is called respiratory alkilosis calcium metabolism is disturbed as a result of ph rising |
|
|
what is the difference between hyperpnea and tachypnea
|
hyperpnea- overbreathing (short, fast, hard breaths)
tachypnea- respiratory rate higher than normal |
|
|
what are the steps in the emergency management of a hyperventilating patient
|
R.E.P.A.I.R
recognize symptoms and evaluate resp. rate Position pt in upright position ABCs- check airways, breathing, monitor vitals Implement emergency protocol- no O2 for hyperventilating pts. attempt to control breathing by pt breathing into hands, count to ten, loosen tight clothing Refer pt to EMS if problem persists |
|
|
What are the different 5 types of sleep disorders
|
Narcolepsy
Sleep apnea Insomnia Restless leg syndrome Periodic limb movement |
|
|
What is the benzodiazepine prototype drug
|
CHLORDIAZEPOXIDE (librium)
|
|
|
Recognize the 8 benzodiazepines. What are 3 major ones
|
Oxazepam- serax
Chlorazepate-tranxene Chlordiazepoxide- PROTOTYPE Diazepam-valium Lorazepam-ativan Alprazolam-xanax Prazepam-centrax Halazepam-paxipam |
|
|
What are the 3 main benzodiazepines used in dentistry and what are their trade names
|
DLA
diazepam-valium lorazepam-versed alprazolam-xanax |
|
|
what are benzodiazepines primarily used for? what are their other purposes?
|
primarily used for treatment of anxiety (anxiolytic agent)
also used for: anticonvulsant, hypnotic sedative, muscle relaxer, alcohol withdrawal, induction agent in general anesthesia |
|
|
what is the drug schedule for benzodiazepines? are they safe?
|
drug schedule 4- low abuse potential
greater margin of safety than barbituates |
|
|
what is the gaba receptor? what is its main role?
|
anxiety neurotransmitter
controls fear or anxiety- by reducing activity of neurons that bind to it |
|
|
what is the mechanism of action (MOA) of benzodiazepines
|
-benzos increase activity of GABA receptor
-binds to benzo receptor on GABA receptor -allows GABA to open chloride channels to enter into cell and INHIBIT action potential -frequency of opening chloride channels that makes benzos safter than barbs, not duration |
|
|
what makes benzodiazepines safer than barbituates
|
the frequency of opening chloride channels is safer
the duration of chloride channels being open in barbituates increases risk |
|
|
describe the benzodiazepine:
absorption half life adverse effects |
absorption: lipid soluble, fast absorbing
half life: short-6hrs. intermed-6-12hrs; long-20hrs Psychomotor skills impaired, amnesia may occur |
|
|
what is the benzodiazepine antagonist/drug interaction
|
antagonist: flumazenil (romazicon) *antidote
reverses sedative effects of benzodiazepines antagonizes by directly competing with benzodiazepine receptors in CNS Drug interactions: smoking induces benzos, decreasing their effect potentiates other cns depressants like alcohol metabolism inhibited by cimetadine (tagamet) |
|
|
what are benzodiazepines used for in dentistry
|
used to reduce pre op anxiety and tension
shorter pt wait time and return to normal activity |
|
|
what are drugs used for concious sedation
|
diazepam-valium
midazolam-versed lorazopam-ativan |
|
|
what are the differences between hypnotic, sedative, and anxiolytic drugs
|
sedative- able to sedate and relax
hypnotic- prescribed for sleep anxiolytic- used to treate anxiety |
|
|
what is a long acting benzodiazepine sedative-hypnotic drug
|
FLURAZEPAM (trade name- dalamane)
|
|
|
what is an intermediate acting benzo sedative/hypnotic
|
TEMAZEPAM (restoril)
|
|
|
what is a short acting benzo sedative/hypnotic drug
|
TRIAZOLAM (halcion)
|
|
|
what are nonbenzodiazepine sedative-hypnotic drugs
|
zolpidem (ambien)
eszopiclone (lunesta) |
|
|
what is a barbituate-like drug used in pediatric sedation
|
chloral hydrate (Notec)- try not to use anymore due to cancerous side effects
|
|
|
what barbituate drugs are
ultrashort: short acting: intermediate: long acting: |
ultrashort: thiopental "truth serum"
short: pentobarbital (Nembutal) secobarbital (Seconal) intermed: butabarbital (Butisol) long: phenobarbital (Solfoton, Luminal) |
|
|
Describe the barbituate MOA
|
binds to barbiturate receptor on GABA receptor
-open chloride channels to enter into cell and inhibit action potential - duration of opening of chloride channels that makes barbs greater risk for adverse reactions |
|
|
what effect do enzyme enducers have on drugs
|
cause ddrugs to be converted more quickly into active substances so they have a faster onset of action
- shorter duration of action -warfarin, phenytoin |
|
|
what are central acting muscle relaxant drugs
|
-adjunct to rest and physical therapy for relief of muscle spasms associated with TMD
-cyclobenzaprine (Flexeril) -carioprodol (Soma) |
|
|
how are the peripheral nerves divided up
|
8-cervical
12-thoracic 5-lumbar 5-sacral 1- coccygeal |
|
|
what are the differences btwn structural features of the autonomic system and somatic system
|
somatic- cell body originates in spinal cord. axons sent directly to muscle
ans- has synaptic jxn known as ganglion. pre ganglion and post ganglion synapses |
|
|
what are the 5 key steps in neuron transmission
|
SSRAM
1. synthesis 2. store 3. release 4. action 5. metabolism (synapse cessation) |
|
|
are sympathetic nerves adrenergic or cholinergic
|
adrenergic
SNS- sympathetic nervous system fight or flight adrenergic-adrenalin |
|
|
are parasympathetic nerves adrenergic or cholinergic
|
cholinergic
PNS- parasympathetic rest and digest cholinergic-colon-digest |
|
|
SNS:
pre G: Neurotransmitter: Receptor: |
Thoracic-Lumbar
Short pre g neutransmitter: acetylcholing (AcH) receptor: nicotinic |
|
|
SNS
post g: neurotransmitter: receptor: |
SNS
long post g neurotransmitter: norepinephrine receptor: alpha/beta |
|
|
PNS
pre G: neurotransmitter: receptor: |
PNS
long pre g neurotransmitter: acetylcholine receptor: nicotinic |
|
|
PNS
post g neurotransmitter: receptor: |
PNS
short post g neurotransmitter: acetylcholine receptor: muscarinic |
|
|
PNS CHOLERGINIC SYNAPSE:
sythesized: activate what receptors: inactivated by: |
PNS CHOLINERGIC
synthesized: Ach activate: nicotinic and muscarinic receptors inactivated by: degeneration, breakdown of ACh by AChE |
|
|
SANS ADRENERGIC
synthesize: axn of what receptors: inactivation: |
SANS ADRENERGIC
synthesize: norepinephrine bind to: alpha2 PREsynapse, alpha and beta POST synapse inactivate: presynaptic reuptake |
|
|
what stimulates parasympathetic nervous system
|
parasympathomimetics or cholinergic-agonists
(rest and relax response) |
|
|
what inhibits PANS
|
anticholinergics or cholinergic blockers
|
|
|
what stimules SANS
|
sympathomimetic or adrenergic agonists
(fight or flight) |
|
|
what inhibits SANS
|
adrenergic blockers
|
|
|
What are PANS CHOLINERGIC drugs therapeutic use
examples? |
mimics ACh when body doenst make enough
blockes AChE Pilocarpine (Salagen): mgmt of dry mouth due to radiation therapy Donepezil (Aricept): alzheimers |
|
|
What are pharmacological effects of ANTICHOLINERGIC drugs?
|
prevent action of AcH at post g (doesnt prevent release, just blocks it)
limits sweating, drying of glands |
|
|
what are therapeutic uses of anticholinergics
|
atropine: produces dry field
- blocks ach; induces symptoms of fight or flight (heart rate up, bronchodilation,) scopolamine (Transderm-Scop): tx motion sickens benztropine (Cogentin): parkinsons disease Ipratropium (Atrovent): asthma |
|
|
what are side effects of anticholinergics
|
dry mouth, dry eyes, constipation, elevated temp, hallucinatinos
|
|
|
what do the SANS receptors effect:
alpha: beta1: beta2: |
alpha: located in skin and skeletal muscle
beta1: heart beta2:lungs |
|
|
What are the pharmacological effects badrenergic agents
|
cardiac stimulation
- heart attack (bp raised) increasead blood to skeletal muscles peripheral vasoconstriction - raise blood pressure |
|
|
what are the therapeutic uses of adrenergic agents on CARDIAC
|
epinephrine (adrenalin)
- congestive heart failure (increase its force and strenght of contraction tx of shock local anesthesia hemorrhage control dobutamine (dobutrex); dopamine (intropin) -shock, CHF |
|
|
what are therapeutic uses of adrenergic agents on LUNGS/UTERUS
|
relaxes smooth muscles
bronchial asthma/bronchitis/emphysema albuterol (proventil, ventolin, provax) terbutaline (brethine) epinephrine (adrenalin) premature labor ritodrin (yutopar) |
|
|
therapeutic uses of adrenergics on NASAL
|
cough, cold, nasal decongestant
phenylephrine (neo-synephrine) pseudoephedrine (sudafed) sameterol (severent) |
|
|
adverse effects of adrenergic agents
|
anxiety tremors palpitations
dangerous high BP, cardiac arrhythmias caution in pts with: hypertension, angina, hyperthyroid |
|
|
therapeutic uses of adrenergic blockers?
|
slow hear rate, lower BP, treat angina, migraine headaches
|
|
|
define epilepsy
|
epilepsy is a seizure disorder
- symptom of a disease not specific diease like cancer - disturbance of electrical activity in brain |
|
|
what are the differences btwn convulsions and seizures
|
convulsions- involuntary violent muscle spasm, all convulsions are seizures
seizures- may involve convulsions, not all do. |
|
|
What are the characteristics of epilepsy
|
sensory, motor, autonomic, consciousness distrubances
(blurred vision, thrashing limbs, incontinence) |
|
|
what is the etiology of epilepsy
|
idiopathic (unknown)
infectious diseases trauma smetabolic disorders vascular disease |
|
|
what are triggers of epilepsy
|
stress, no sleep, booze, light patterns, fodo
|
|
|
what is the main purpose of anticonvulstants
|
suppress neuronal activity
(just enough to prevent it from abnormal firing) |
|
|
what role do drugs have on chloride ions, sodium, and calcium relating to epilepsy
|
drugs to stimulate chloride ions (associate wwith gaba)
delay sodium delay calcium |
|
|
what are the different types of seizures
|
partial seizures (simple and complex)
general seizures (petit mal and tonic clonic) status epilepticus |
|
|
where do partial seizures arise from?
|
partial seizures arise from localized areain brain
may spread through the entire brain |
|
|
where do complex partial seizures arise from
|
begin in temporal lobe, may progress to both sides of brain and may become generalized
-lose consciousness |
|
|
where are generalized seizures in brain
|
not localized to one area of brain, travel throughout entire brain on both sides
|
|
|
what are the characteristics of status epilepticus
|
-tonic clonic seizure lasting over 10 mins
- DOC parentheral benzodiazepines (Valium) intentional overdose for mgmt of uncontrollable seizure |
|
|
how do drugs with gaba action effect seizures
|
drugs with gaba action increase action of inhibitory neurotransmitter gaba, abnormal neuronal activity can be suppressed
|
|
|
what are some gaba action drugs used for seizures
|
benzodiazepines
-diazepam (valium) -clonazepam (klonopin) -lorazepam (ativan) barbiturates -phenobarbital (luminal)- long acting - primidone (mysoline) |
|
|
how do drugs delay sodium influx
|
sodium channels are made less sensitive to delay influx of sodium ions into the cell
phenytoin (dilantin) |
|
|
describe characteristics of phenytoin (dilantin)
|
tx of tonic clonic, partial seizures, trigem neuralgia
highly protein bound (90%) to plasma proteins adverse: drowsiness, hirsutism (weird hair growth) |
|
|
what are some dental considerations for pts using phenytoin (dilantin)
|
gingival enlargement
delayed healing and gingival bleeding vitamin d folate deficiency-> ulcerations and glossitis |
|
|
what are the characteristics of the phenytoin-like drug carbamazepine (tegretol)
|
carbamazepine (tegretol) - 75% bound
- tx for trigeminal neuralgia and manic depression -dry mouth, delayed healing, gingival bleeding, glossitis, stomatitis - 63% of chewable tablets containing sugar-->caries -hematologic: (leukopenia and thrombocytopenia) |
|
|
what are characteristics of phenytoin-like drug divalproex (depakote) and valproic acid (depakene)
|
divalproex (depakote) valproic acid (depakene)
- tx for manic depression, migraines - drug interxns with alcohol, aspirin and anticoags - excessive bleeding and petechiae |
|
|
how do drugs that delay calcium influx work
|
delay entry of calcium into neurons by blocking calcium channels
- succinimides -ethosuximide (zarontin) -gi stress, impaired mental and physical - conjunction with another anticonvulsant |
|
|
what are some dental therapy considerations for patients with epilepsy
|
psychosedation- nitrous and oxygen therapy recommended
stress reduction- meds like benzos used. (diazepam, oxazepam, flurazepam) deep sedation safe alcohol precipitates seizures asa II controlled, asa III or IV not controlled orofacial trauma |
|
|
what are the lcinical manifestations of petit mal
|
suppressed mental functions
immobility and blank stare blinking rolling eyes minor facial mvmts 5-30 seconds |
|
|
what are the phases of generalized tonic clonic seizures
|
prodromal phase
preictal phase ictal (convulsive phase) postictal phase |
|
|
what are characteristics of the prodromal phase
|
subtle of obvious changes in emotional reactivity
onset of seizure is an 'aura' ringing in ears, seeing spots, smell something weird, bad taste |
|
|
what are characteristics of preictal stage
|
pt loses consciousness
myoclonic jerks epileptic cry increase heart rate and blood pressure |
|
|
what are characteristics of convulsive (ictal) phase
|
tonic contractions of skeletal muscles or characterized by continuous tension
clonic- alternating muscular relaxation and violent flexor contractions characterize clonic activity may see blood as result of injury, frothing at mouth |
|
|
what are characteristics of post ictal phase
|
pt relaxes or sleeps
wakes up confused, cant count backwards incontinence recovery takes 2 hours secondary drugs can be used if seizure lasts more than 5 minues |
|
|
describe the mgmt of tonic clonic seizures
|
lower chair to floor
oxygen 4-6L with nasal cannula (postictal stage) monitor time- past 5 mins summon ems secondary meds given if necessary (valium) (versed) |
