(1-25-17) Into to Oral, Sublingual, IM, IV, conscious sedation

Question 1

what % of ppl fear going to the dentist?

Answer 1

21% (3rd overall highest)

Question 2

what all can sedation do for your patient?

Answer 2

• improve access to care
• reduce fear and anxiety
• influence tx options (more invasive procedures, longer appts, better operating conditions)

Question 3

what constitutes conscious/sedation and anxiolysis?

Answer 3

• minimally depressed level of consciousness
• ability to maintain own airway
• responsive to stimulation

*THIS IS OUR GOAL (awake, breathing, calm, responsive)

Question 4

what constitutes deep sedation?

Answer 4

• depressed consciousness
• partial loss of protective reflexes
• inability to continually maintain own airway
• unresponsiv to stimulation

Question 5

can nitrous be titrated even with oral sedation?

Answer 5

YES

*significant additive sedation and muscle relaxation

Question 6

what are some of the commonly used oral meds?

Answer 6

• sedative (hypnotics)
• benzodiazepines
• H1 antihistamines
• opioids

Question 7

what are the advantages of the oral route?

Answer 7

• well accepted
• ease
• cost
• low adverse reaction
• no needles

Question 8

what are the disadvantages of the oral route?

Answer 8

• compliance
• latent period
• erratic
• difficult to titrate
• difficult to alter
• prolonged duration
• first pass metabolism

Question 9

which routes are enteral (pass through intestines)?

Answer 9

• oral, sublingual, rectal

* undergoes first pass metabolism

Question 10

which routes are parenteral (administered not in the mouth)?

Answer 10

• intravenous, intramuscular, intralnasal, inhalation, transdermal, transmucosal
• not subjected to first pass metabolism

Question 11

first pass metabolism

Answer 11

drug goes to the liver before the rest of the body

*done with enteral routes

Question 12

characteristics of intranasal administration?

Answer 12

• usually administered by spray or atomizer (pt comfort)

- goes directly to systemic circulation and has rapid onset

Question 13

what two types of metabolism happen in the liver?

Answer 13

• oxidation (CYP 450 system, enzymes)

- Conjugation (glucorination can undergo induction)

Question 14

what 3 ways can a drug be eliminated?

Answer 14

• urine
• bile
• lungs

Question 15

what factors influence sedation-absorption and blood levels?

Answer 15

• pH and pKa
• gastric emptying time
• anxiety
• speed through bowel
• presence of other foodstuffs
• first pass metabolism

Question 16

is the titration of oral sedation given all at the same appt?

Answer 16

no!

titration over several appts

Question 17

pregnancy drug that failed to demonstrate risk during any trimester

Answer 17

A

Question 18

pregnancy drug that animal studies have failed to show risk but no human studies

Answer 18

B

Question 19

pregnancy drug that you give only after risks considered. animal studies show adverse effects- no human studies available

Answer 19

C

Question 20

pregnancy drug with definite human risks, may be useful in life threatening situations

Answer 20

D

Question 21

pregnancy drug with absolute fetal abnormalities, Not to be used during pregnancy

Answer 21

X

Question 22

what is the rule about combining oral agents?

Answer 22

all agents must be administered concomitantly on one treatment day

Question 23

what are the advantages of sublingual?

Answer 23

• long hx
• enters systemic circulation
• low cost
• low adverse reaction
• no first pass effect

Question 24

what are the disadvantages of sublingual?

Answer 24

• cooperation is essential
• difficult to titrate
• difficult to alter

Question 25

• considered enteral
• may be dec time to sedation
• deeper level of sedation
• higher peak plasma levels

Answer 25

sublingual sedation

Question 26

which is faster, sublingulal or subnasal?

Answer 26

subnasal

Question 27

what are the adv. to intramuscular?

Answer 27

• quick onset
• max effect 30 min
• reliable
• coop not essential

Question 28

what are the disadv. to intramuscular?

Answer 28

• cannottitrate
• does NOT have quick reversal
• prolonged
• injection
• injury
• needle

Question 29

what is the difference when giving intramuscular injections in different parts of the body?

Answer 29

different ma dose volumes

Question 30

what are the 4 IM injection sites

Answer 30

• deltoid
• gluteus
• vastus lateralis

Question 31

what are come complications that could arise with IM injections?

Answer 31

• nerve injury
• periostitis
• hematoma
• abscess
• sloughing of tissue

Question 32

what is the clarks rule for dosing?

Answer 32

(weight in lbs / 150) x adult dose

Question 33

what is the young’s rule for dosing?

Answer 33

(age/ [age + 12]) x adult dose

Question 34

what are the advantages of rectal?

Answer 34

• relatively effective
• side-effects
• cost/ease
• theory of less hepatic first pass effect

Question 35

what are the disadvantages of rectal?

Answer 35

• inconvenience
• intestinal irritation
• difficult to titrate
• difficult to alter
• prolonged duration
• erratic

Question 36

what are the adv of intravenous?

Answer 36

• rapid onset
• highly effective
• titration
• ability to redose
• ability to revese
• shorter recovery
• access

Question 37

what are the disadv of intravenous?

Answer 37

• venepuncture
• inc monitoring
• pain of IV
• potential injury from catheter placement
• most IV meds cannot be reversed
• pt coop

Question 38

when should a pt take diazepam

Answer 38

1 hr before appt

Question 39

** no idea if they want us to know the specific drugs so….

Answer 39

sorry guys