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Pain and Anxiety > L5 Oral Sedation > Flashcards

L5 Oral Sedation Flashcards

1
Q

What is the most common route of drug administration?

A

Oral

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2
Q

7 advantages of oral sedation

A
  1. Almost universally accepted
  2. Ease of administration
  3. Low cost
  4. Decreased incidence of adverse effects
  5. Decreased severity of adverse effects
  6. No needle fear
  7. No specialized training
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3
Q

6 disadvantages of oral sedation

A
  1. Patient compliance
  2. Prolonged latent period
  3. Erratic GI absorption
  4. Can’t titrate it
  5. Once taken, unable to readily lighten or deepen
  6. Prolonged duration of action
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4
Q

What happens if a patient takes too much oral sedation

A

Can lead to general anesthesia - now you need to know how to get the patient out of this.

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5
Q

Influences on the absorption of drugs

A
  1. Lipid solubility
  2. Bioavailability of the drug
  3. First pass effect
  4. Drug inactivation
  5. Dosage of the drug
  6. Mucosa surface area
  7. pH of tissues
  8. Gastric emptying time
  9. Presence of food in the stomach
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6
Q

What happens to acidic drugs vs basic drugs in absorption?

A

Acidic drugs - ex. ASA - freely diffuse across stomach mucosa (pH of 1.4)

Basic drugs - ex. codeine - poorly absorbed in stomach, but absorbed in small intestine (pH 4-6)

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7
Q

Where are most drugs absorbed?

A

Small intestine, fewer in the stomach - (except alcohol and ASA)

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8
Q

What is the peak effect of most oral drugs?

A

1 hour

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9
Q

What are the usual gastric emptying times for drug types?

A

Liquid alone - 90 minutes
Mixed meals - 4 hours
Fatty meals - very slow

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10
Q

What can have an impact on gastric emptying?

A

Anxiety - can delay emptying by 2x

Extremely fearful patients may be better served without in office oral sedation

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11
Q

What format of dosing has the best absorption

A

Aqueous solution > oily solution/tab/capsule

Tabs have to be dissolved in stomach first

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12
Q

What affect can the liver have on drugs?

A

First pass effect

Transformation of drugs into inactive byproducts
- ex. lidocaine

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13
Q

What is bioavailability?

A

Diff prep of same drug has diff bioavailability

Related to the size of the particles or shape of crystals –> rate of disintegration and dissolution

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14
Q

What is the general duration of oral drugs?

A

3-4 hours, aka significantly longer than a 1 hour dental appt

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15
Q

What type of patient would benefit from oral sedation?

A

A patient with slight anxiety that wants to take the edge off - not for patients with severe phobias, they should be treated with something deeper

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16
Q

What does it mean to have titration in oral sedation?

A

Titration by appt - see how the dose worked in first appt, then “titrate” it by increasing or decreasing for next appt

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17
Q

4 types of oral sedatives

A
  1. Sedative hypnotic
  2. Antianxiety drugs
  3. Histamine blockers
  4. Opioid analgesics
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18
Q

What are 3 types of sedatives

A

Barbituates
Benzo’s
Non-benzo’s

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19
Q

What is the difference btwn a sedative and a hypnotic

A

Sedative - calming effect

Hypnotic - sleep effect

depends on the dose of the drug

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20
Q

What is a therapeutic index

A

Toxic Dose: Effective Dose

Closer to 1 = more dangerous

21
Q

Ethyl alcohol

A

An old form of sedation - uncommon now

22
Q

Barbiturates

A

First truly effective drug

At higher doses - depress medulla –> resp depression

23
Q

What is the biggest downside for dental use?

A

Not an analgesic!! doesn’t block pain
Need good anesthesia bc you can get hyper-reaction to noxious stimuli

NOT RECOMMENDED in Dent

24
Q

What is the long term effect of giving people barbiturates?

A

Dependence

Tolerance build up

25
Q

What’s an example of a barbiturate?

A

Hexobarbital, Phenobarbital

26
Q

What are the effects of Benzo’s?

A

Mostly anxiolytic but can also be hypnotic

27
Q

What are examples of non-bento anxiolygtics/hypnotics

A

Zolipem (ambien)
Zaleplon (sonata)

still affect GABA receptor compels but diff than benzo’s

28
Q

How long to non-benzo’s work?

A

Rapid absorption, short half life

29
Q

What is the dental use of non-benzo’s?

A

Pre-op sleep help

Pre-op

30
Q

Where is chloral hydrate mostly used?

A

Most common in paediatric dentistry

31
Q

Side effects of chloral hydrate?

A

But can produce GI used - has to be diluted with glass of water or milk

32
Q

Who should chloral hydrate be avoided in?

A

Coumadin use
Allergic patients
Nursing women
Decrease dose in patients with use of other sedatives

33
Q

Where do Benzo’s target?

A

GABA
and parallel glycine in the spinal cord
A CNS effect

34
Q

What do Benzo’s lead to?

A
  1. Reduction in hostile and aggressive behaviour
  2. Disinhibition
  3. Paradoxic increase in aggression
  4. Skeletal muscle relaxant (CNS)
  5. Anticonvulsant (CNS)

Can lead to respiratory depression!

35
Q

Where does benzo biotransformation occur?

A

Liver

Does not stimulate induction of hepatic microsomal enzymes – can be given to those with liver dysfunction

36
Q

What is the peak plasma level of Benzo’s?

A

0.5-5 hours

37
Q

Where do the depressant and anxiolytic effects of Benzo’s occur? where are neuronal discharges inhibited?

A

Depressant - subcortical level of CNS

Anxiolytic - limbic system and thalamus (emotional area of brain)

Neuronal discharges - amygdala and amygdala-hippocampus nerve transmission

38
Q

What alters the rate of absorption of Benzo’s in the GI tract?

A

Usually absorbed readily and reliably from GI tract but the type has an affect on the absorption

39
Q

What are contraindications to giving Benzo’s?

A 
Allergy
Psychoses
Acute narrow-angle glaucoma 
1st trimester pregnancy 
Breast feeding 
Alcohol use, other drug use
Elderly pt - reduce dose, titrate
40
Q

Can Benzo’s be given under 6 months? 6 years?

A

Not usually
- not diazepam, maybe midazlolam in a very small dose

Not usually recommended under 6 years - except diazepam and midazolam maybe

41
Q

Drug interactions of Benzo’s?

A

Alcohol, psychotropic drugs, phenothiazines, opioids, barbiturates, MAO’s, anti-depressants

42
Q

What is the benefit of triazolam?

A

Very little residual drowsiness

short half life

43
Q

Triazolam effects

A

Drowsiness, headache, dizziness, nervousness

44
Q

Problem with lorazepam

A

Would need escort if used

longer half life

45
Q

Lorazepam effects

A

Sedation, dizziness, weakness, ataxia

46
Q

Midazolam main issue

A

Absorbed more rapid, so onset faster, very short working time, contra-indicated in HF, renal failure, hepatic failure, resp disease

47
Q

Mild to moderate pre-op anxiety

A

Diazepam - 5-10 mg

Oxazepam - 15-30 mg

48
Q

Induction of sleep night before appt

A

Flurazepam - 30 mg

Trizolam - 0.25-0.5 mg

49
Q

Can midazolam be given in another way?

A

Intranasal sedation - peak plasma level of 10 minutes

Pain and Anxiety (7 decks)

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