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Peds III > Premedication > Flashcards

Premedication Flashcards

1
Q

What do we use for mild conscious sedation? (3)

A
  • antihistaminics
  • benzodiazepines
  • nitrous oxide
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2
Q

What do we use for deep conscious sedation?

A

Benzodiazepines (intranasally)

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3
Q

What type of analgesia does conscious sedation have?

A

mild

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4
Q

What type of analgesia does unconscious sedation have?

A

deep

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5
Q

What type of consciousness does conscious sedation have? (2)

A
  • light/moderate depression of conciousness

- responds to verbal commands

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6
Q

What type of consciousness does unconscious sedation have? (2)

A
  • deep depression of consciousness

- responds to painful stimulus

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7
Q

What type of consciousness does general anesthesia have?(2)

A
  • Loss of consciousness

- No response to stimuli

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8
Q

Ventilation in conscious sedation?

A

Spontaneous ventilation

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9
Q

Ventilation in unconscious sedation?

A

Airway may be compromised

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10
Q

Ventilation in general anesthesia ?

A

air permeability compromised

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11
Q

Cardiac function in conscious sedation?

A

Correct cardiac function

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12
Q

Cardiac function in unconscious sedation?

A

Non-cardiovascular

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13
Q

Cardiac function in general anesthesia?

A

Cardiovascular alteration may exist

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14
Q

Which drug used for conscious sedation must be in the consultation of the pediatric dentist?

A

Benzodiazepines

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15
Q

What are the general recommendations for conscious sedation? (3)

A
  • never increase dose in the same appointment
  • administer outside postprandial (after eating) period (absorption/vomiting)
  • remain at home under supervision for 3-4 hours after
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16
Q

What medication is needed for mild conscious sedation? (3)

A

Premedication:

  • antihistaminics
  • Benzodiazepines (o.v)

Inhaled sedation:
- nitrous oxide

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17
Q

What medication is used for deep conscious sedation?

A

Premedication: benzodiazepines (intranasal)

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18
Q

Indications for conscious sedation? (4)

A
  • anxiety disorders
  • very small children (1-3y/o)
  • psychic or maturity delay when general anesthesia is contraindicated/can be avoided
  • hyperactive/unstable children
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19
Q

Conscious sedation disease contraindications? (6)

A
  • respiratory dysfunction / anomalous airway (hypertrophic tonsils)
  • intracranial hypertension. Depression of conciousness
  • cardiac dysfunction
  • neuromuscular disease
  • intestinal obstruction
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20
Q

Conscious sedation other contraindications? (6)

A
  • drug allergies
  • older children with severe behavioural problems
  • children under 1 years old
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21
Q

drug contraindications for Mild conscious sedation?

A
  • hypotensives
  • anticoagulants
  • CNS depressants
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22
Q

What antihistaminics do we use for conscious sedation? (3)

A
  • Hydrxyzine (atarax)
  • deschlorpheniramine (polaramine)
  • alimemacin (variargil)
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23
Q

What benzodiazepines do we use for conscious sedation? (2)

A
  • Diazepam (valium)

- midazolam (dormicum)

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24
Q

Antihistaminics for conscious sedation are derived from… (2)

A
  • phenothiazines: piperazine, alkylacine
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25
Q

Antihistaminics for conscious sedation mechanism of action

A

inhibit histamine receptors involved in allergy

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26
Q

Antihistaminics for conscious sedation mechanism maximum effect?

A

1-2 hours

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27
Q

Antihistaminics for conscious sedation mechanism duration?

A

3-6 hours

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28
Q

Antihistamine effects? (5)

A
  • antiallergic
  • antipruritic
  • antispasmodics (muscle relaxant)
  • antiemetic
  • anxiolytics (secondary effect : drowsiness)
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29
Q

very high doses of antihistamines can produce…? (4)

A
  • CNS depression
  • convulsions
  • arrhythmias
  • hypotension
30
Q

contraindications for antihistaminics conscious sedation? (6)

A
  • under age of 2
  • allergy to phenothiazines
  • liver/kidney disease
  • hypersensitivity to its components
  • porphyria
31
Q

Antihistaminics for conscious sedation should never be associated with…

A

CNS depressors

32
Q

Dosage of hydroxycine? (3)

A

2mg/kg. 2 intakes. 1 the night before and one 1h before treatment

*if only doing one intake you can increase the dose by 50%

33
Q

Hydroxycine maximum effect?

A

1-2 h

34
Q

Hydroxycine average duration?

A

3-6 hours

35
Q

Dexchlorpheniramine (polaramine) dosage? (2)

A
  • under 6: 0.5mg/8 hours

- over 6: 2mg/8 hours

36
Q

Alimemacina (variargil) dosage? (3)

A
  • under 2: maximum 2 drops
  • 2-6: 2-4 drops
  • 6-12: up to 8 drops
37
Q

Dexchlorpheniramine & alimemacina maximum effect>

A

1-2 hours

38
Q

Dexchlorpheniramine & alimemacina average duration?

A

3-6 hours

39
Q

Mild sedation with benzodiazepines acts on…

A

CNS - enhances action of GABA (neurotransmitter inhibitors)

40
Q

Mild sedation with benzodiazepines actions: (5)

A
  • Anxiolytic
  • sedative
  • amnesiac
  • anticonvulsant
  • muscle relaxant
41
Q

Mild sedation with benzodiazepines indications? (4)

A
  • psychoneurotic disorder with agitation and tension
  • alcohol withdrawl (tremor and agitation)
  • adjuvant treatment of musculo-skeletal pain
  • sedative premedication
42
Q

Mild sedation with benzodiazepines secondary effects?

A

High dose seizures:

  • tolerance
  • dependece (Deprivation has to be slow
  • do not use more than 2-4 weeks
  • hypotension & breathing depression (CNS depression)
43
Q

Mild sedation with benzodiazepines contraindications? (5)

A
  • respiratory dysfunction (anomalous airway, sleep apnea)
  • cardiac dysfunction
  • intracranial hypertension
  • intestinal onstruction
  • neuromuscular disease
44
Q

Types of benzodiazepines? (2)

A
  • diazepam

- midazolam

45
Q

Diazepam average life?

A

40-100 h

46
Q

Which drug is a great hypnotic with muscle relaxing and anticonvulsant effects?

A

diazepam

47
Q

Diazepam start of action?

A

45 mins

48
Q

Diazepam maximum peak?

A

1-2 hours

49
Q

Diazepam lasts…?

A

6-8 hours and there may be active metabolites at 20-70 hours

50
Q

Diazepam antagonist?

A

Flumazenil (anexate) used in hospital environment

51
Q

Diazepam dosage for mild sedation? (2)

A
  1. 1-0.5 mg/kg orally one hour before appointment

* given AT the clinic

52
Q

Diazepam dosage for children?

A

weight * 2 = number of drops

53
Q

What advantages does midazolam have over diazepam? (4)

A
  • starts at 20 mins (greater amnesic effect and shorter letency time)
  • twice as powerful
  • shortest halflife (1-4 hrs)
54
Q

Dosage of midazolam for mild sedation?

A
  • 0.5mg/kg single dose 20-30 mins before treatment
55
Q

Deep sedation midazolam indications?

A

Patients with little to no cooperation (rare in dentistry)

56
Q

How do we administer benzodiazepines for deep sedation? which one?

A

MIDAZOLAM intranasaly

57
Q

Action of midazolam intranasal?

A

fast: 10-15 mins

58
Q

Dosage of midazolam instranasal?

A

0.2-0.5mg/kg

59
Q

Nitrous oxide mild sedation induction time?

A

2-3 mins

60
Q

Nitrous oxide mild sedation recovery time?

A

3 mins

61
Q

Nitrous oxide mild sedation therapeutic index?

A

narrow

62
Q

Nitrous oxide mild sedation absorption and elimination?

A

pulmonary

63
Q

Nitrous oxide effects? (2)

A

analgesic and sedative

64
Q

Nitrous oxide mild sedation advantages? (4)

A
  • FAST and gentle
  • staggered administration
  • short recovery time
  • no injection
65
Q

Nitrous oxide mild sedation disadvantages? (4)

A
  • small therapeutic index
  • cost of equipment
  • monitoring oxygen concentrations (should not be less than 30%)
  • nausea and vomiting
66
Q

Nitrous oxide mild sedation indications? (5)

A
  • children with anxiety
  • semi-cooperative children
  • phobia of local anesthesia
  • increased vomiting reflex
  • physically handicapped
67
Q

Nitrous oxide contraindications?

A
  • breathing problems: sinusitis

- non-response capacity: mentally handicapped, very young children

68
Q

Nitrous oxide technique: (4)

A
  • start with 85%02 and 15% N2o for 2-3 mins
  • increase 5% at intervals
  • mixture >65% o2 and = 35% n2o
  • when done, administer 100% O2 for 5 mins
69
Q

20% concentration of nitrous oxide produces.. (2)

A

Paresthesias

pleasant sensation

70
Q

40% concentration of nitrous oxide produces.. (2)

A

Good pain tolerance

patient collaboration

71
Q

40-70% concentration of nitrous oxide produces.. (5)

A
  • high psychosedation
  • loss of verbal contact
  • uncontrolled movements
  • amnesia
  • spasms

Peds III (9 decks)

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