Antianxiety Medications

Question 1

What are anti-anxiety medications also called?

Answer 1

• Sedative hyponotics
• Minor tranquilizers

Question 2

What are among the most widely used drugs in medicine?

Answer 2

Benzodiazepines

Question 3

What accounts for 75% of 100 million prescriptions written for sedatives/tranquilizers?

Answer 3

• diazepam (Valium) and
• chlordiazepoxide (Librium

Question 4

What are the popular benzodiazepams?

Answer 4

• diazepam (Valium)
• lorazepam (Ativan)
• alprazolam (Xanax)
• midazolam (Versed) = “dazzle”

Question 5

Are benzo’s addictive?

Answer 5

Yes - highly! Schedule IV/V opiates

Question 6

What 3 effects do Benzodiazepines produce?

Answer 6

1. Effects on behavior
2. Anticonvulsant effects
3. Muscle relaxation

Question 7

What do Benzo’s do at low/high doses regarding behavior?

Answer 7

• Low - anxiety reduction
• High - drowsiness/depression

Question 8

What two anticonvulsants can be used to prevent and arrest local anesthetic-induced seizures in dentistry?

Answer 8

V.V. = no seizure

• diazepam (Valium) - IV 5mg/min
• midazolam (Versed) - IV 1mg/min

Question 9

Which Benzos are the most potent muscle relaxers?

Answer 9

• diazepam (Valium)
• chlordiazepoxide (Librium)

Question 10

How do benzo’s cause muscle relaxation?

Answer 10

They depress the motor nerve and muscle function

Question 11

What is the mechanism of action of BDZ’s?

Answer 11

• They enhance the inhibitory effect on GABA on neuronal excitability
  
  • Remember GABA = inhibitory and decreases excitation on brain
• Causes hyperpolarization and neuronal stabilization

Question 12

What are the binding characteristics of Benzodiazepines to their receptor sites?

Answer 12

• Rapid
• Reversible
• Stereospecific
• Saturable

Question 13

How long are most benzo’s half lifes? And what are they metabolized into?

Answer 13

• Most have very long half-lives
• Most are metabolized to active compounds

Question 14

What benzodiazepine is metabolized into inactive compounds, which makes it a great choice for dentistry?

Answer 14

lorazepam (Ativan)

Question 15

What are the uses for benzos in medicine?

Answer 15

• Anxiety relief
• Skeletal muscle relaxation
• Hypnotic to treat insomnia
• Treatment of alcohol withdrawal
• Pre-operative medication

Question 16

What are the uses of Benzo’s in dentistry?

Answer 16

• Reduce pre-operative anxiety
  
  • Valium, Ativan, Xanax, Halcion
• IV sedative and amnesiac
• Emergency intervention for seizures

Question 17

What are some adverse effects of benzodiazepines?

Answer 17

• CNS depression
• Xerostomia
• Abuse & addiction
• Additive effects with other CNS depressants, especially alcohol

Question 18

What do you do when a benzodiazepine has to be given to a patient that is already taking opiates?

Answer 18

Reduce dose of opiates by 1/3 of normal dose

Question 19

What is a very dangerous drug interaction of benzodiazepines?

Answer 19

Alcochol - results in severe CNS depression –> respiratory depression

The long half-life of benzo’s mean the risk persists for days after dose (20-50 hours)

Question 20

What is a miscellaneous anti-anxiety agent?

Answer 20

buspirone (BuSpar)

Question 21

What drugs do you avoid when taking BuSpar?

Answer 21

The red flag drugs:

• ciprofloxacin
• clarithromycin
• erythromycin
• doxycycline
• systemic antifungals

Question 22

What drugs are known to cause xerostomia?

Answer 22

• Antidepressants & anti-anxiety meds

Question 23

With what drugs do you have to be cautious with epinephrine?

Answer 23

Tricyclics & MAOIs

Question 24

What’s known to cause bruxism?

Answer 24

SSRI’s