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Pharmacology > LO 14 > Flashcards

LO 14 Flashcards

Anti Anxiety drugs

1
Q

How is the need for anty-anxiety drugs assessed?

A
  1. Objectively assessing the patient’s anxiety is necessary on both the first and subsequent visits
  2. The dosing of a particular antianxiety agent is vastly variable, involving intrapatient and interpatient variation
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2
Q

Anxiety is best managed by __________

A

A calm, confident approach

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3
Q

What are the signs of anxiety?

A
  1. clutching - “white knuckle”
  2. Low pain threshold with high anxiety
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4
Q

List the range of effects of anti-anxiety drugs with increasing dose

A
  1. Sedative (this is as far down the list as we want to get)
  2. Euphoria
  3. Lethargy
  4. Hypnosis
  5. Anesthesia
  6. Death

*Anti-anxiety drugs are CNS depressants

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5
Q

What are the 2 types of anti-anxiety drugs used in dental?

A
  1. Benzodiazepines (minor tranquilizers)
  2. Barbiturates (not used any longer in dentistry as anti-anxiety meds - addictive and often abused)
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6
Q

Describe Benzodiazepines

A
  1. Minor tranquilizers
  2. Less abuse than barbs
  3. Wide therapeutic index (TI)
  4. Valium (diazepam)
  5. Ativan (lorazepam)
  6. Taken 1/2 hr before the appointment
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7
Q

Describe the mechanism of action for Benzodiazepines

A
  1. Benzodiazepines enhance GABA action; a major inhibitory neurotransmitter. result: The inhibitor effect of GABA is enhanced
  2. Vary in onset and duration - can be short or long acting, can be rapid or slow onset
  3. Valium and Ativan are on the short, rapid side
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8
Q

Describe the pharmkinetics (ADME) of Benzodiazepines

A
  1. Absorption - GI (high lipid solubility)
    Cross all barriers (BBB and placenta)
  2. Metabolism - liver
  3. 1/2 life - anywhere from minutes to 200 hours
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9
Q

Describe the pharm effects and med uses for Benzodiazepines

A
  1. Behavioral management - short-term treatment of anxiety, panic attacks, insomnia, and alcohol withdrawal
  2. Anti-seizure (Increase the seizure threshold) - Tx of epilepsy
  3. Muscle relaxation of skeletal muscles - muscle control in multiple sclerosis & cerebral palsy; Used for conscious sedation, general anesthesia
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10
Q

List the adverse reactions of Benzodiazepines

A
  1. CNS - CNS depression (usually):
    manifested as fatigue, drowsiness, muscle weakness, and ataxia; CNS excitement (occasionally)
  2. Amnesia - give POI (post-operative instructions) in writing; warn against signing important papers under the influence
  3. Respiratory - Resp depression especially with diazepam
  4. CVS - Relief of anxiety may result in a fall in blood pressure and pulse rate (typically to a normal rate)
  5. Visual effects - do not use if pt has certain types of glaucoma - can produce diplopia (single object viewed as two)
  6. Dental/oral - Xerostomia, Macroglossia, Bitter metallic taste
  7. Thrombophlebitis - Parenteral (IV) diazepam may cause thrombophlebitis because propylene glycol is used to solubilize it
  8. Other - GI cramps; GU: decrease urination (Think “ anticholinergic” effects (anti SLUD)); Allergic reaction
  9. Pregnancy - Cross all barriers; Highly teratogenic (higher cleft lip/palate)
  10. Abuse/tolerance - With chronic use physical dependence and tolerance have been documented
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11
Q

What are the significant drug-drug interactions with Benzodiazepines?

A
  1. Benzodiazepines will interact in an additive fashion with other CNS depressants - Et-OH, Narcotics, phenothiazine (anti-psychotics)
  2. They will also - Increase efficacy of phenytoin; Increase digoxin toxicity
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12
Q

What are the special considerations of benzos?

A
  1. Patients who are to use antianxiety agents should be driven to and from the dental appointment
  2. Drugs are not a substitute for patient management
  3. Drugs should not be substituted for patient education or for the proper psychologic approach to patient care
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13
Q

Describe the treatment of bezo overdose

A
  1. Emesis - have patient vomit in a bowl so the number of intact pills can be counted
  2. Antidote (benzodiazepine antagonist):
    Flumazenil
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14
Q

Parenteral benzodiazepines have been associated with ___________ when used for conscious sedation. Therefore, patients require _________. Dentists without additional training cannot use conscious sedation

A
  1. respiratory depression and arrest
  2. continuous monitoring of respiratory and cardiac function
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15
Q

Describe Barbiturates

A
  1. Chronic use of barbiturates can lead to physical and psychologic dependence
  2. They cross all barriers
  3. Mech of action: enhance GABA receptor binding
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16
Q

What are the medical uses for Barbiturates?

A
  1. GA induction: (ultra short acting):
    thiopental
  2. Tx of epilepsy phenobarbital
17
Q

List the contraindications of Barbiturates

A
  1. Porphyria - a group of disorders involving heme biosynthesis
  2. Barbiturates are absolutely contraindicated in patients with intermittent porphyria or a positive family history of porphyria
  3. Barbiturates can stimulate and increase the synthesis of porphyrins which are already at an excessive level in this disease
18
Q

Describe the drug interactions of Barbiturates

A
  1. Additive drug interaction with other CNS depressants
  2. stimulators of liver microsomal enzyme production: increasing the rate of other drugs metabolism/ destruction and subsequently decreasing the duration of their action
  3. cross-tolerance with benzodiazepines (more barbiturates must be given to pt with previous exposure to benzodiazepines)
19
Q

Describe buspirone (BuSpar)

A
  1. Selective Anxiolytic - Selective means it is only blocking certain pathways and not others - good thing that allows people to function more normally while on it
  2. New medication and patients don’t particularly like it - therefore it is not widely prescribed -Most patients prefer the benzodiazepines
  3. Anxioselective without hypnotic, anticonvulsant, or muscle-relaxant properties
  4. No effect on CNS → driving is OK
20
Q

List the precautions of anti-anxiety drugs

A
  1. Patients with impaired elimination (kidney disfunction) may experience exaggerated effects of these medications
  2. Depression caused by all sedative-hypnotics will add to depression caused by other CNS depressants
  3. The patient should be accompanied by a responsible adult who can drive the patient home
  4. Psychic and physical dependence has been observed with almost all drugs used to allay anxiety
  5. Suicide may be attempted by taking sedative-hypnotic drugs
  6. These drugs should never be administered to pregnant women or to those who may be pregnant unless the potential benefit to the mother outweighs the risk to the fetus
  7. Sedatives do not provide analgesia

Pharmacology (15 decks)

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