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Special Care Dentistry > The Anxious Patient - Psycho and Pharma Support > Flashcards

The Anxious Patient - Psycho and Pharma Support Flashcards

1
Q

What procedures tend to cause the most anxiety among patients

A
  • Extractions
  • Injections
  • Fillings
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2
Q

Name some forms of behavioural change that can happen as a result of anxiety

A
  • Verbal abuse
  • Excessive talking as a delay tactic
  • Cancelling appointments frequently
  • Arriving late
  • Missing appointments
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3
Q

Name some physiological signs and symptoms of anxiety

A
  • Pallor
  • Sweatiness
  • Dry mouth
  • Knotted stomach
  • Flushed face
  • Extreme muscle tension
  • Fainting
  • Increased heart rate
  • Sweaty palms
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4
Q

What can we use to measure dental anxiety

A

5 questions that forms an overall anxiety score, each question is marked out of 5

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5
Q

Name some of the questions in the dental anxiety questionnaire

A
  • If you had treatment tomorrow how’d you feel?
  • If sitting in a waiting room how would you feel?
  • If you were about to have a tooth drilled how would you feel?
  • If you were about to have your teeth scaled and polished how would you feel?
  • If you were about to have LA how’d you feel?
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6
Q

What score on the dental anxiety questionnaire would indicate a highly anxious dental patient

A

19 or above

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7
Q

What is the definition of pharmacodynamics

A

What a drug does to the individual?

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8
Q

What is the definition of pharmacokinetics

A
  • What the body does to the drug, this can be divided into a 2 part curve:
  1. Distribution
  2. Elimination
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9
Q

What is the definition of drug distribution

A

This refers to the movement of a drug to and from the blood and various tissues of the body like: fat, muscle and brain tissue and the relative proportion of the drug in the tissues

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10
Q

What is the definition of Drug Clearance

A

This the rate at which the drug is removed from the body

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11
Q

What can you see on a plasma concentration curve of a drug during the distribution and elimination phases of a drug

A

Distribution: The plasma conc. of the drug falls quickly for about 6-15minutes

Elimination: The plasma conc. falls at a much slower rate for 1-3 hours

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12
Q

What kinds of drugs are 100% bioavailable and which are not

A

IV drugs are 100% bioavailable

Orally administered drugs depend on absorption from the gut and its metabolism during the first pass through the liver

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13
Q

What is the distribution half line for midazolam

A

6-15 minutes

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14
Q

What is the elimination half line for midazolam

A

1-3 hours

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15
Q

What are the mechanisms of action of benzodiazepines

A
  • BZDs act on receptors to enhance the effect of GABA

- BZD mimics the effects of glycine

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16
Q

What happens when a GABA receptor is activate using BZDs

A

When a GABA receptor is activated, Chlorine ions flood in and cause inhibition of the cell
BZDs are agonists and so they potentiate the inhibitory effects of GABA

17
Q

What is Flumazenil an antagonist for and what effect does this have

A

Flumazenil is a competitive antagonist at the BZD receptor and reverses the effects of Midazolam except retrograde amnesia

18
Q

What are the effects of Midazolam

A
  • Anterograde amnesia
  • Muscle relaxant
  • Anxiolysis
  • Anticonvulsant
  • Sedative
19
Q

What is the benefit of the anterograde amnesia effects of Midazolam

A
  • Reduces the patient’s memory of the treatment
20
Q

What is the unhelpful aspect of the anterograde amnesia effects of Midazolam

A

It is difficult to ‘wean’ patients away from treatment with sedation

21
Q

What are the unhelpful aspects of the muscle relaxant effect of midazolam

A
  • Over sedation can cause airway obstruction and patient is prone to snoring (relaxed tongue falling back
  • Loss of protective gag reflex
22
Q

Whatre the 2 mechanisms of respiratory depression caused by Midazolam

A
  • Relaxation of the muscles of respiration causes a dose-related reduction in the rate and depth of breathing
  • Reduction in the sensitivity of the central CO2 and O2 chemoreceptors

Therefore monitoring using a pulse oximeter is mandatory

23
Q

Name some of the properties of an ideal sedative agent

A
  • Painless injection characteristics
  • Anxiolysis
  • Analgesia
  • Cardio/resp stable
  • Ease of titration
  • Rapid induction
  • Wide therapeutic index
  • Reversible
  • Low/no toxicity
24
Q

Does Midazolam satisfy any of the properties of the ideal sedative agent

A

It fulfils all of them except for analgesia

25
Q

What are the indications for inhalation sedation

A
  • Children
  • Mild/moderate anxiety
  • Long cases (no sedation window)
  • Needle phobia
  • Gagging
  • Medical conditions aggravated by stress
  • Unaccompanied adults requiring sedation
26
Q

What are the good properties of Nitrous Oxide as a sedative

A
  • Colourless
  • Odourless
  • Non-irritant
  • Low blood solubility
  • Ease of titration
  • Rapid recovery
27
Q

What are the clinical effects of Nitrous Oxide

A
  • Euphoria
  • Anxiolysis
  • Analgesia
  • Tingling
28
Q

What is titration

A

This is the process of adjusting the dose of a medication for the maximum benefit without adverse effects

29
Q

How can you do titration for midazolam in fit and healthy adults

A
  1. Inject 2mg over 30 seconds
  2. Pause for 60-90 seconds
  3. Further increments of 1mg every 30 seconds until sedation is adequate
30
Q

What is the mean dose for midazolam

A

2-7.5mg

31
Q

How can you do titration for midazolam in elderly patients

A
  1. 1mg over 30 seconds
  2. Pause for 120-240 seconds
  3. Further increments of 0.5mg every 30 seconds until adequately sedated
32
Q

How can you do titration for midazolam in over weight patients

A
  1. 2 mg injection over 30 seconds
  2. Pause for 60-90 seconds
  3. Further increments of 0.5 mg every 30 seconds, paying attention to noisy breathing sounds and corresponding stops in O2 saturation
33
Q

Describe what the sedated patient should and what they should be able to do

A
  • Retain consciousness
  • Retain protective reflexes
  • Able to understand and respond to verbal commands
  • Is relaxed and cooperative
  • Has decreased awareness of their surroundings
  • May demonstrate diminished responses to stimuli e.g. pain
34
Q

What is the normal respiration rate that should be maintained in the sedated patient

A

12-20 breaths/minute

35
Q

Name some signs of over sedation in a patient

A
  • Consciousness is lost
  • Irregular respiratory pattern
  • Hyperactive reflexes
36
Q

How can you manage a small amount of over sedation in a patient

A
  • Poor patient cooperation may occur and cause a delay in the treatment, waiting a few minutes usually resolves any difficulty
37
Q

How can you manage a gross amount of over sedation in a patient

A
  • Profound respiratory depression or apnoea means you should stop the procedure and secure the airway and ventilate if the patient stops breathing
  • Reverse sedation

Special Care Dentistry (5 decks)

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