Oral Sedation

Question 1

pentobarbital

Answer 1

barbiturate
short acting
high therapeutic index

100mg 1 h prior to appt

Question 2

secobarbal

Answer 2

barbiturates
reds on the street
higher TI - less safe

100mg 1 h prior to appt

Question 3

hexobarbital

Answer 3

rapid onset so give at the dental office
ultrashort acting
250-500mg

Question 4

flurazepam

Answer 4

benzo
works in hypothalamus and amygdala
effects in 30-60 min
biotransformed in liver so use caution with hepatic patients
30mg 1 hr before bed

contraindications - pregnancy

Question 5

temazepam

Answer 5

benzo
absorbed slower than fluazepam
2-3 hr plasma peak
use for patients unable to maintain sleep
30mg 1 h prior to bed 
contraindication - pregnancy

Question 6

triazolam (halcion)

Answer 6

benzo
half life = 1.5-5 hours
no active metabolites
anterograde amnesia
0.25mg 1 hr prior to bed or 1hr prior to appt.

Question 7

lorazepam (Ativan)

Answer 7

benzo
comes in oral and IV forms
12 hr half life
no active metabolite
ok to use with hepatic dysfunction patients
contraindicated for pregnancy, narrow angle glaucoma and patients with depressive disorders
give 2-3mg 1h prior to bed or 1 hr prior to appt

Question 8

midszolam (versed)

Answer 8

benzo
fast onset - peak action in 30 minutes
15mg prior to bed or 7.5mg 1 h prior to appt
children get 0.2-0.75mg/kg

Question 9

chloral hydrate

Answer 9

no analgesic properties
minimal effects on cardio and respiratory systems
half life -7-9.5 hrs
trichloroethanol is active metabolite
can use with moderate hepatic and renal dysfunction
bad taste, nausea, flatulence,
toxic dose = 10gm
50mg/kg
contraindications = severe heart disease, gastritis, nursing mothers

Question 10

chlorodiazepoxide (librium)

Answer 10

beno
inactivated when exposed to UV light
absorbed well from GI tract
peak levels in 4hrs, effects may be seen in 1-2h
hypotension and syncope with higher doses
dose = 5-10mg tid or qid one day prior to appt

Question 11

diazepam (Valium)

Answer 11

benzo
greater antianxiety, muscle relaxing, and anticonvulsant properties than librium
rapidly absorbed, peaks in 2 h
-but active metabolites might be around for 20h
dose = 5-10mg at bed or 1 hr prior to appt
half dose for debilitated patients
don’t use in kids younger than 6
this is a good drug for perio because it lasts a long time

Question 12

promethazine (phenergan)

Answer 12

antihistamine
antiemitc
lytic cocktail = phergan, demerol, and thorazine
no respiratory depression, no addiction,
can cause tardive dyskinesia, akathisia, dystonias, parkinsoniasm,
if they get side effect, give 50mg benadryl IV
dose = 25-50mg 1 h prior to tx

Question 13

zolpidiem (ambien)

Answer 13

non-benzo
onset in 30 minutes
duration = 1h
can be used in pregnant females
dose = 5-10mg