(1-25-17) Into to Oral, Sublingual, IM, IV, conscious sedation Flashcards
what % of ppl fear going to the dentist?
21% (3rd overall highest)
what all can sedation do for your patient?
- improve access to care
- reduce fear and anxiety
- influence tx options (more invasive procedures, longer appts, better operating conditions)
what constitutes conscious/sedation and anxiolysis?
- minimally depressed level of consciousness
- ability to maintain own airway
- responsive to stimulation
*THIS IS OUR GOAL (awake, breathing, calm, responsive)
what constitutes deep sedation?
- depressed consciousness
- partial loss of protective reflexes
- inability to continually maintain own airway
- unresponsiv to stimulation
can nitrous be titrated even with oral sedation?
YES
*significant additive sedation and muscle relaxation
what are some of the commonly used oral meds?
- sedative (hypnotics)
- benzodiazepines
- H1 antihistamines
- opioids
what are the advantages of the oral route?
- well accepted
- ease
- cost
- low adverse reaction
- no needles
what are the disadvantages of the oral route?
- compliance
- latent period
- erratic
- difficult to titrate
- difficult to alter
- prolonged duration
- first pass metabolism
which routes are enteral (pass through intestines)?
- oral, sublingual, rectal
* undergoes first pass metabolism
which routes are parenteral (administered not in the mouth)?
- intravenous, intramuscular, intralnasal, inhalation, transdermal, transmucosal
- not subjected to first pass metabolism
first pass metabolism
drug goes to the liver before the rest of the body
*done with enteral routes
characteristics of intranasal administration?
- usually administered by spray or atomizer (pt comfort)
- goes directly to systemic circulation and has rapid onset
what two types of metabolism happen in the liver?
- oxidation (CYP 450 system, enzymes)
- Conjugation (glucorination can undergo induction)
what 3 ways can a drug be eliminated?
- urine
- bile
- lungs
what factors influence sedation-absorption and blood levels?
- pH and pKa
- gastric emptying time
- anxiety
- speed through bowel
- presence of other foodstuffs
- first pass metabolism
is the titration of oral sedation given all at the same appt?
no!
titration over several appts
pregnancy drug that failed to demonstrate risk during any trimester
A
pregnancy drug that animal studies have failed to show risk but no human studies
B
pregnancy drug that you give only after risks considered. animal studies show adverse effects- no human studies available
C
pregnancy drug with definite human risks, may be useful in life threatening situations
D
pregnancy drug with absolute fetal abnormalities, Not to be used during pregnancy
X
what is the rule about combining oral agents?
all agents must be administered concomitantly on one treatment day
what are the advantages of sublingual?
- long hx
- enters systemic circulation
- low cost
- low adverse reaction
- no first pass effect
what are the disadvantages of sublingual?
- cooperation is essential
- difficult to titrate
- difficult to alter
- considered enteral
- may be dec time to sedation
- deeper level of sedation
- higher peak plasma levels
sublingual sedation
which is faster, sublingulal or subnasal?
subnasal
what are the adv. to intramuscular?
- quick onset
- max effect 30 min
- reliable
- coop not essential
what are the disadv. to intramuscular?
- cannottitrate
- does NOT have quick reversal
- prolonged
- injection
- injury
- needle
what is the difference when giving intramuscular injections in different parts of the body?
different ma dose volumes
what are the 4 IM injection sites
- deltoid
- gluteus
- vastus lateralis
what are come complications that could arise with IM injections?
- nerve injury
- periostitis
- hematoma
- abscess
- sloughing of tissue
what is the clarks rule for dosing?
(weight in lbs / 150) x adult dose
what is the young’s rule for dosing?
(age/ [age + 12]) x adult dose
what are the advantages of rectal?
- relatively effective
- side-effects
- cost/ease
- theory of less hepatic first pass effect
what are the disadvantages of rectal?
- inconvenience
- intestinal irritation
- difficult to titrate
- difficult to alter
- prolonged duration
- erratic
what are the adv of intravenous?
- rapid onset
- highly effective
- titration
- ability to redose
- ability to revese
- shorter recovery
- access
what are the disadv of intravenous?
- venepuncture
- inc monitoring
- pain of IV
- potential injury from catheter placement
- most IV meds cannot be reversed
- pt coop
when should a pt take diazepam
1 hr before appt
** no idea if they want us to know the specific drugs so….
sorry guys
