Chapter 11 Flashcards
What are some anti-anxiety agents?
- Benzodiazepines
- Barbiturates
- Sedative-hypnotics
- Benzodiazepine receptor agonists
- Centrally acting muscle relaxants
- Miscellaneous agents
What are the values of relaxation?
- more productive dental appointment
- patient benefits
- dental team benefits
What percent of americans seek oral health care only when absolutely?
20%
What percent of people refuse to seek any care because they are afraid?
7%
It is important to look for what when treating a patient?
indications of fear or apprehension
What are the most commonly prescribed anti-anxiety drugs?
Benzodiazepines
What is the onset of action related to with Benzodiazepines?
lipid solubility
How are Benzodiazepines available?
tablets, capsules, oral solution, rectal gel, and injectable form
TRUE OR FALSE: Benzodiazepines cross the blood-brain and placental barriers to produce an effect on the CNS and the fetus
true
Where are benzodiazepines metabolized?
liver
Storage in ______ tissue prolongs the action of lipid-soluble benzodiazepines.
adipose
Benzodiazepines act as what?
agonists at the receptor site and thereby reduce the symptoms of anxiety
Benzodiazepines enhance the effect of what?
gamma-aminobutyric acid (GABA)
What is GABA
a major inhibitory neurotransmitter in the brain
GABA quiets the nerve endings and plays a role in what?
muscle tone
What are the pharmacologic effects of Benzodiazepines?
- behavioral effects
- anti seizure effects
- muscle relaxation
What two drugs have anti-seizure effects?
Diazepam
Clonazepam
Repeated doses of benzodiazepines can lead to what?
a reduction in stages 3 and 4 sleep causing a reduction in restorative sleep
Low doses of benzodiazepines cause what?
anxiety and panic reduction
High doses of benzodiazepines cause what?
drowsiness or sleep
what are the adverse reactions of Benzodiazepines?
- anterograde amnesia
- respiratory effects
- cardivascular effects
- visual effects
- dental effects
- thrombophlebitis
- Gi tract
- genitourinary tract
- allergies
- pregnancy/lactation
What are the pregnancy and lactation considerations for Benzodiazepines?
- increased risk of congenital malformations
- floppy infant syndrome
Can benzodiazepines be abused?
YES HUNNY
TRUE OR FALSE: Physical dependence and tolerance have been documented for benzodiazepines
true
Combining benzodiazepines mixed with alcohol can result in what?
- coma
- respiratory depression
- hypotension
- hypothermia
Benzodiazepines: Drug interactions
- Additive effect with other CNS depressants
- Smoking reduces their effectiveness
What drugs may increase the effects of benzodiazepines?
Cimetidine (Tagamet)
Omeprazole ( Prilosec )
* they also can increase the effect of digoxin and phenytoin
What are Benzodiazepines medical uses?
- insomnia
- acute seizures
- alcoholism
- muscle spasms
- anxiety
- panic attacked
- cautious sedation, general anesthesia
Benzodiazepines: Dental relevance
- avoid additive CNS depression
- Avoid addicts and prego women
- Document accurately in pt record
- Use with caution with elderly and pt taking Tagamet
- warn pt about sedation and amnesia
- match onset/duration
- provide postoperative instruction
- monitor vitals
The original sedative-hypnotic and have almost completely been replaced by benzodiazepines for treating anxiety and insomnia bc of the wider TI
barbiturates
Barbiturates are still used as what?
anticonvulsants and to induce general anesthesia
Where are barbiturates well absorbed?
orally and rectally
What solutions are irritating with barbiturates?
injectables
Rapidly and almost completely metabolized by the liver
short and intermediate acting barbiturates
largely excreted through the kidneys
long acting barbiturates
what do barbiturates enhance?
GABA receptor binding
what do barbiturates prolong?
the opening of chloride channels
What do barbiturates act directly on?
chloride channels
Barbiturates mechanism of action is less specific than what?
benzodiazepines
what are the pharmacologic effects of barbiturates?
- CNS depression
- No analgesia effect
- anticonvulsant effect
What are the adverse reactions of barbiturates?
- stimulation
- fetal harm
- can lethal
- coughing
- depress liver/kidney function
- lower body temo
- acute poisoning
- reduce GI motility
What happens if you take barbiturates for a chronic ling term?
- physical/psychological dependence
- tolerance develops except to lethal dose
- cross tolerance occurs
Barbiturates can stimulate and increase what?
the synthesis of porphyrins, which are already at the excessive level in this dsisease
What are the contraindications of barbiturates?
Pt’s with intermittent porphyria or a positive history of porphyria
a genetic metabolic disorder affecting the production of heme, the oxygen-binding prostheitc group of hemoglobin
porphyria
What are the uses for ultrashort acting barbiturates?
used in IV for induction of general anesthesia
What are the uses for short and intermediate acting barbiturates?
little medical uses; replaced by benzodiazepines
What are the uses for long acting barbiturateS?
used for treatment of epilepsy
Receptor agonists
- used to treat insomnia
- Zolpidem (ambian)
- Zaleplon (sonata)
- Eszopiclone (lunesta)
What are some centrally acting muscle relaxants?
Carisoprodol ( Soma )
Cyclobezanprine ( Flexeril)
Where do centrally acting muscle relaxants exert their effects?
on the CNS to produce muscle relaxation
- Indicated for spasticity from multiple sclerosis or spinal cord injuries or diseases
- Treats trigeminal neuralgia
Baclofen (Lioresal)
Tizanidine (Zanaflex)
muscle relaxant
- Treatment of spasticity from upper motor neuron disorders
- Prevent and treat malignant hyperthermia
Dantrolene (Dantrium)
