Pharmacology Lec 5 Antianxiety Agents

Front 1

Apnea

Back 1

Breathing stops for either a short or long period.
Can be drug or disease induced

Front 2

Cleft Lip

Back 2

Birth defect in which the upper lips is split vertically; often associated with cleft palate.

Front 3

Cleft Palate

Back 3

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.

Front 4

Infusion

Back 4

Introduction of a substance such as a drug or nutrient, into the bloodstream or body cavity

Front 5

Intubation

Back 5

Passage of a tube into an organ or structure; used to refer to the passage down trachea for artifical respiration (ie during general anesthesia).

Front 6

Nystagmus

Back 6

Persistant, rapid, rhythmic, involuntary movement of the eyes. Used by police to check for the effect of drugs.

Front 7

Panic disorder

Back 7

Attacks of anxiety, made worse by stress; Pt focuses on avoiding situation in which it occurs.

Front 8

Pharyngitis

Back 8

Inflammation of the throat (pharynx), causing sore throat, fever, earache & swollen glands.

Front 9

Anxiolytics

Back 9

A reduction in anxiety. In a dental office, an oral anxiolytic is most often utilized.

Front 10

Does the dosing of antianxiety agents vary from one Pt to another? Why?

Back 10

Yes,
medication they may be on
tollerance build up
Body weight

Front 11

What type of anti-anxiety medication is most used in dentistry?

Back 11

Benzodiazepines

Front 12

Benzodiazepines are well _________ when administered orally.

Back 12

absorbed

Front 13

What is the onset of action (of benzodiazepines) related to?

Back 13

Their lipid solubility

Front 14

What form are benzodiazepines usually administered in?

Back 14

Tablets, capsules are most common.
Oral solution, rectal gel and injectable form are seen occasionally.

Front 15

What can be said about the IV routhe for benzodiazepines?

Back 15

Produces a rapid, predictable response. It's ideal for conscious sedation.

Front 16

What impact can benzodiazaepines have on a fetus?

Back 16

They cross the blood brain barier and placental barier to produce a depressed CNS effect on the fetus.

Front 17

Briefly, what does Phase I metabolism involve?

Back 17

Oxidation, Reduction, Hydrolysis, De-alkylation, & Hydroxylation (It’s a hard metabolism with is affected by external factors like drugs and hepatic disease.)

Front 18

Briefly what does Phase II metabolilsm involve?

Back 18

Glucuronidation
(It’s an easy metabolims; unaffected by external factors.)

Front 19

How are benzodiazpenes metabolized?

Back 19

by Phase II alone or... by Phase I followed by Phase II

Front 20

Benzodiazepines __________ or _________ the action of the neurotransmitter by exerting their effects in the CNS.

Back 20

Enhance or Facilitate

Front 21

What is the major inhibitotory neurotransmitter that Benzodiazepines work on?

Back 21

GABA (y-aminobutyric acid)

Front 22

What does the GABA receptor regulate?

Back 22

The passing of the Chloride Ion.
When more chloride is put into the cell, it inhibits the cells excitability.

Front 23

When Benzo..binds with receptors, chemically what is happening?

Back 23

A sudden influx of chloride ion-->resulting in the inhibition of the cell
(Alcohol works on the same receptor)

Front 24

When you hear the word GABA; what should you think of?

Back 24

Inhibitatory

Front 25

What are the 3 primary pharmacologic effects of Benzodiazepines?

Back 25

1) Behavioral (less anxiety)
2) Antiseizure effects (increase the threshold)
3) Muscle relaxation

Front 26

What are the behavior effects of Benzodiazpenes?

Back 26

Anxiety and panic reduction at low doses.
At higher doses; drowsiness and sleep

Front 27

What is the "general" safety margin of Benzo's?

Back 27

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.**

Front 28

What is the most common side effect of Benzo's?
How is it manifested?

Back 28

Depression (not emotional)
Manifested as: fatigue drowsiness, muscle weakness & ataxia.

Front 29

What are some negative side effects of Benzo's in elderly adults?

Back 29

Disorientation, confusion, aggressive behavior & excitement.

Front 30

From a dental perspective what are some negative side effects of Benzo's?

Back 30

Xerostomia,
Swollen Tongue,
Increased salivation
metalic/bitter taste

Front 31

Why are benzo's used to treat anxiety?

Back 31

They have a fast onset of action & their duration of action can be short, intermediate or long.

(They are considered "SAFE")

Front 32

From a memory standpoint, what can be said about Benzo's?

Back 32

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.

Front 33

Should a Pt drive home after an appointment where they have used Benzo's?

Back 33

NO!

Front 34

Should Benzo's be given IM?

Back 34

NO!

Front 35

What are some pregnancy concerns with Benzo's?

Back 35

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

Front 36

What can be said about addiction to Benzo's?

Back 36

If its only taken for the occasional appointment…no big deal.
Physiologic addiction occurs after large doses taken for an extended period of time.

Front 37

Benzo's will interact with other CNS depressors and _______ to the overall effect.

Back 37

ADD

Front 38

Benzo's are "safe" for _________-term TX of anxiety & panic attacks.

Back 38

short-term

Front 39

Benzo's are taken as a _________ to allay anxiety for dental procedures.

Back 39

pre-med (1 hour proir to Tx)

Front 40

In dental procedures how are Benzo's usually administered?

Back 40

Orally

Front 41

If utilizing conscious sedation, how are benzo's administered?

Back 41

IV administration

*PT will look and act awake but have no memory of time together*

Front 42

What are some common benzo's (5)

Back 42

1) alprazolam (Xanax)
2) diazepam (Valium)
3) midazolam (Versed)
4) lorazepam (Activan)
5) clonazepam (Klonopin)

Front 43

What type of drug have Benzo's almost completely replaced?

Back 43

Barbiturates

Front 44

How are Barb's best absorped?

Back 44

Orally, Rectally and IV.

Not good absorption intramuscularly IM

Front 45

Where are Barbiturates metabolized?

Back 45

Mostly in the liver

Front 46

Since Barb's stimulte liver enzymes what does this mean for the metabolization in general?

Back 46

The increase of liver enzymes can lead to an increase in the rate of drug destruction…drug doesn't last as long.

Front 47

How do Barb's produce their effect?

Back 47

They enhance the GABA receptor binding and prolong the opening of the chloride channels
(lack of excitability in the cell)

Front 48

What can be said about the analgesic effect of Barbiturates?

Back 48

They have no significant analgesic effect.

Front 49

What is porphyria?

Back 49

A group of disorderes involving heme (in hemoglobin) biosynthesis.

Front 50

When are barbiturates absolutely contraindicated?

Back 50

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.)

Front 51

Barbs stimulate liver enzymes of what important complex? What is the outcome of this action?

Back 51

P450 system…it can increase the metabolism of other drugs.
** Can increase the rate of drug descrution and decrease the duration of action.**

Front 52

How are therapeutic uses of Barbs determined?

Back 52

By their duration of action.
(ultrashort, short/intermediate, long-acting)

Ultrashort is what would be utilized for general anesthesia.

Front 53

Why is about the only reason that Chloral hydrate is used in dentistry anymore?

Back 53

Tradition
Rarely used anymore…bad taste, and needs to be mixed with juice

Front 54

What is another name for zolpidem?

Back 54

Ambien

Front 55

What can be said about zaleplon compared to zolpidem?

Back 55

It’s a newer drug and shorter acting than zolpidem (Ambien)

Front 56

Why would IV thiopental be used before beginning surgery?

Back 56

It's a barbiturates that is given to help the Pt relax before general anesthesia.

Front 57

Both sedation and analgesia can be obtained from ________ analgesics alone.

Back 57

Opioid (might be used instead of benzo)

Front 58

Pt's who are to use antianxiety agents should be ________ to and from the dental appointment.

Back 58

driven

Front 59

What should be known about female Pt's before giving any antianxiety med?

Back 59

Is she pregnant?

Front 60

Sedatives (do/do not) provide analgesia?

Back 60

DO NOT!