nitrous oxide and carbamazepine Flashcards

1
Q

What is nitrous oxide also known as

A

Laughing gas

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2
Q

Why is nitrous oxide used in dentistry

A

Used fro inhalation sedation in children and adult patients

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3
Q

What properties does nitrous oxide have

A

It has anaesthetic and analgesic properties

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4
Q

What effect does nitrous oxide have on the bodys reaction time

A

Slows down reaction time

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5
Q

What does the mechanism of action of nitrous oxide

A

May involve NMDA glutamate receptor blockade so produce its general anaesthesia effect

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6
Q

What effect can nitrous oxide have on opioid receptors

A

has the potential to stimulate opioid receptors to produce analgesia

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7
Q

What effect can long term arise of nitrous oxide have on the body

A

May megaloblastic anaemia and spinal cord degeneration

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8
Q

Describe the pharmacokinetics of nitrous oxide

A

Nitrous oxide is more soluble in water than nitrogen on its own is

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9
Q

Where is nitrous oxide preferably exchanged

A

Exchanged at the alveolar membranes of the lungs and readily enters the bloodstream to exert its effect

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10
Q

How can nitrous oxide affect respiration

A
  1. Reduced total volume

2. Increases respiratory rate

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11
Q

How can nitrous oxide affect on the heart

A

Mild effects on heart rate and pulmonary vascular resistance

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12
Q

How can nitrous oxide affect the renal and hepatic system

A

Reduced renal and hepatic blood flow

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13
Q

How can nitrous oxide affection on blood flow

A

Increases cerebral blood flow metabolism and intracranial pressure

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14
Q

What can carbamazepine be used for

A
  1. Anti-epileptic drug/anticonvulsant
  2. Neuropathic pain
  3. Bipolar disorder
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15
Q

Describe the pharmacodynamics of carbamazepine

A

Sodium channel blockade treats seizures

Narrow therapeutic index

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16
Q

What is the mechanism of action of carbamazepine

A
  1. Reduces excitability of neurones by sodium channel blockade
  2. Lowers presynaptic nerve response and inhibits post synaptic potential
  3. Binds to voltage-gated sodium channels and prevents action potentials firing
17
Q

What can carbamazepine do in bipolar disorder

A

It increases metabolism of dopamine and increases transmission of GABA to treat mania an depressive symptoms

18
Q

What is carbamazepine known as

A

Enzyme inducer

19
Q

What do we mean by enzyme inducer

A

Means it potently induces the pathways of metabolism of numerous other drugs
this mean the second drug may have a lower effective dose

20
Q

what should we do if carbamazepine is administrated with another drug

A

We may need to increase the dose of the other drug which may have metabolised due to carbamazepine

21
Q

Where is carbamazepine metabolised

A

by the liver through the CYP P450 pathway

22
Q

What happens to carbamazepine in the liver

A

Undergoes hepatic glucuronidation resulting in minor hydroxy metabolites and quinone metabolites

23
Q

What induces carbamazepine metabolism and what does this mean

A

carbamazepine induces its own metabolism leading to enhanced clearance, reduced half-life and reduced serum levels

24
Q

What is the half life of carbamazepine

A

12-17 hours

25
What are the common side effects of carbamazepine
1. Drowsiness, 2. dizziness, 3. headaches, 4. nausea, 5. double vision, 6. unsteadiness, 7. memory/ concentration difficulties
26
What are the contra indications of carbamazepine
1. Allergy 2, Heart disease 3. Porphyria 4. Bone marrow disorders
27
In whom should we be cautious prescribing carbamazepine
Patients with: 1. Cardiac disease 2. Hx of haematological reactions to other drugs 3. Absence/myoclonic seizures 4. History of skin reactions 5. Angle-closure glaucoma
28
What are the serious side effects of carbamazepine
1. Agranulocytosis (rare/very rare) 2, Steven- Johnson syndrom e 3. Unusual bleeding/ bruising with mouth ulcers, high temp or sore throat 4. Suicidal ideation/ psychosis 5. Jaundice 6. Muscle and joint pain, molar rash, breathing difficulties
29
Should we prescribe carbamazepine in pregnancy patients
yes we can
30
What can carbamazepine interact with
1. Anticoagulants- warfarin, NOACs 2. Antibiotics- clarithromycin, erythromycin 3. Antifungals -fluconazole 4. Antidepressants 5. Cyclosporine 6. HIV medication 7. MAOIs 8. St johns wort 9. Alcohol