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;
60 Cards in this Set
- Front
- Back
Apnea
|
Breathing stops for either a short or long period.
Can be drug or disease induced |
|
Cleft Lip
|
Birth defect in which the upper lips is split vertically; often associated with cleft palate.
|
|
Cleft Palate
|
Birth defect in which the roof of the mouth is split, extending from behind the teeth to the nasal cavity. Often occurs with other birth defects such as cleft lip & partial deafness.
|
|
Infusion
|
Introduction of a substance such as a drug or nutrient, into the bloodstream or body cavity
|
|
Intubation
|
Passage of a tube into an organ or structure; used to refer to the passage down trachea for artifical respiration (ie during general anesthesia).
|
|
Nystagmus
|
Persistant, rapid, rhythmic, involuntary movement of the eyes. Used by police to check for the effect of drugs.
|
|
Panic disorder
|
Attacks of anxiety, made worse by stress; Pt focuses on avoiding situation in which it occurs.
|
|
Pharyngitis
|
Inflammation of the throat (pharynx), causing sore throat, fever, earache & swollen glands.
|
|
Anxiolytics
|
A reduction in anxiety. In a dental office, an oral anxiolytic is most often utilized.
|
|
Does the dosing of antianxiety agents vary from one Pt to another? Why?
|
Yes,
medication they may be on tollerance build up Body weight |
|
What type of anti-anxiety medication is most used in dentistry?
|
Benzodiazepines
|
|
Benzodiazepines are well _________ when administered orally.
|
absorbed
|
|
What is the onset of action (of benzodiazepines) related to?
|
Their lipid solubility
|
|
What form are benzodiazepines usually administered in?
|
Tablets, capsules are most common.
Oral solution, rectal gel and injectable form are seen occasionally. |
|
What can be said about the IV routhe for benzodiazepines?
|
Produces a rapid, predictable response. It's ideal for conscious sedation.
|
|
What impact can benzodiazaepines have on a fetus?
|
They cross the blood brain barier and placental barier to produce a depressed CNS effect on the fetus.
|
|
Briefly, what does Phase I metabolism involve?
|
Oxidation, Reduction, Hydrolysis, De-alkylation, & Hydroxylation (It’s a hard metabolism with is affected by external factors like drugs and hepatic disease.)
|
|
Briefly what does Phase II metabolilsm involve?
|
Glucuronidation
(It’s an easy metabolims; unaffected by external factors.) |
|
How are benzodiazpenes metabolized?
|
by Phase II alone or... by Phase I followed by Phase II
|
|
Benzodiazepines __________ or _________ the action of the neurotransmitter by exerting their effects in the CNS.
|
Enhance or Facilitate
|
|
What is the major inhibitotory neurotransmitter that Benzodiazepines work on?
|
GABA (y-aminobutyric acid)
|
|
What does the GABA receptor regulate?
|
The passing of the Chloride Ion.
When more chloride is put into the cell, it inhibits the cells excitability. |
|
When Benzo..binds with receptors, chemically what is happening?
|
A sudden influx of chloride ion-->resulting in the inhibition of the cell
(Alcohol works on the same receptor) |
|
When you hear the word GABA; what should you think of?
|
Inhibitatory
|
|
What are the 3 primary pharmacologic effects of Benzodiazepines?
|
1) Behavioral (less anxiety)
2) Antiseizure effects (increase the threshold) 3) Muscle relaxation |
|
What are the behavior effects of Benzodiazpenes?
|
Anxiety and panic reduction at low doses.
At higher doses; drowsiness and sleep |
|
What is the "general" safety margin of Benzo's?
|
When used alone they have a WIDE margin of safety. Therapeutic Index TI = LD/ED.
**All benzo's have similar adverse effects they differ in their frequency.** |
|
What is the most common side effect of Benzo's?
How is it manifested? |
Depression (not emotional)
Manifested as: fatigue drowsiness, muscle weakness & ataxia. |
|
What are some negative side effects of Benzo's in elderly adults?
|
Disorientation, confusion, aggressive behavior & excitement.
|
|
From a dental perspective what are some negative side effects of Benzo's?
|
Xerostomia,
Swollen Tongue, Increased salivation metalic/bitter taste |
|
Why are benzo's used to treat anxiety?
|
They have a fast onset of action & their duration of action can be short, intermediate or long.
(They are considered "SAFE") |
|
From a memory standpoint, what can be said about Benzo's?
|
They are associated with amnesia…the memory loss is limited to events occurring after drug administration.
*Need to counsel PT about this* Don't go sign contracts after Tx or do anything that requires concentration/thought. |
|
Should a Pt drive home after an appointment where they have used Benzo's?
|
NO!
|
|
Should Benzo's be given IM?
|
NO!
|
|
What are some pregnancy concerns with Benzo's?
|
Need to ensure Pt is NOT pregnant…check the HH and confirm with Pt!
There are risks of congenetal malformations if drug is taken in 1st trimester. 3rd trimester-->floppy baby syndrome |
|
What can be said about addiction to Benzo's?
|
If its only taken for the occasional appointment…no big deal.
Physiologic addiction occurs after large doses taken for an extended period of time. |
|
Benzo's will interact with other CNS depressors and _______ to the overall effect.
|
ADD
|
|
Benzo's are "safe" for _________-term TX of anxiety & panic attacks.
|
short-term
|
|
Benzo's are taken as a _________ to allay anxiety for dental procedures.
|
pre-med (1 hour proir to Tx)
|
|
In dental procedures how are Benzo's usually administered?
|
Orally
|
|
If utilizing conscious sedation, how are benzo's administered?
|
IV administration
*PT will look and act awake but have no memory of time together* |
|
What are some common benzo's (5)
|
1) alprazolam (Xanax)
2) diazepam (Valium) 3) midazolam (Versed) 4) lorazepam (Activan) 5) clonazepam (Klonopin) |
|
What type of drug have Benzo's almost completely replaced?
|
Barbiturates
|
|
How are Barb's best absorped?
|
Orally, Rectally and IV.
Not good absorption intramuscularly IM |
|
Where are Barbiturates metabolized?
|
Mostly in the liver
|
|
Since Barb's stimulte liver enzymes what does this mean for the metabolization in general?
|
The increase of liver enzymes can lead to an increase in the rate of drug destruction…drug doesn't last as long.
|
|
How do Barb's produce their effect?
|
They enhance the GABA receptor binding and prolong the opening of the chloride channels
(lack of excitability in the cell) |
|
What can be said about the analgesic effect of Barbiturates?
|
They have no significant analgesic effect.
|
|
What is porphyria?
|
A group of disorderes involving heme (in hemoglobin) biosynthesis.
|
|
When are barbiturates absolutely contraindicated?
|
In Pt's who have intermittent porphyria or any family history of porphyria.
(Barbs can stimulate an increase in the synthesis of porphyrins, which are already at excess with this disease.) |
|
Barbs stimulate liver enzymes of what important complex? What is the outcome of this action?
|
P450 system…it can increase the metabolism of other drugs.
** Can increase the rate of drug descrution and decrease the duration of action.** |
|
How are therapeutic uses of Barbs determined?
|
By their duration of action.
(ultrashort, short/intermediate, long-acting) Ultrashort is what would be utilized for general anesthesia. |
|
Why is about the only reason that Chloral hydrate is used in dentistry anymore?
|
Tradition
Rarely used anymore…bad taste, and needs to be mixed with juice |
|
What is another name for zolpidem?
|
Ambien
|
|
What can be said about zaleplon compared to zolpidem?
|
It’s a newer drug and shorter acting than zolpidem (Ambien)
|
|
Why would IV thiopental be used before beginning surgery?
|
It's a barbiturates that is given to help the Pt relax before general anesthesia.
|
|
Both sedation and analgesia can be obtained from ________ analgesics alone.
|
Opioid (might be used instead of benzo)
|
|
Pt's who are to use antianxiety agents should be ________ to and from the dental appointment.
|
driven
|
|
What should be known about female Pt's before giving any antianxiety med?
|
Is she pregnant?
|
|
Sedatives (do/do not) provide analgesia?
|
DO NOT!
|