Chapter 11

Question 1

What are some anti-anxiety agents?

Answer 1

• Benzodiazepines
• Barbiturates
• Sedative-hypnotics
• Benzodiazepine receptor agonists
• Centrally acting muscle relaxants
• Miscellaneous agents

Question 2

What are the values of relaxation?

Answer 2

• more productive dental appointment
• patient benefits
• dental team benefits

Question 3

What percent of americans seek oral health care only when absolutely?

Answer 3

20%

Question 4

What percent of people refuse to seek any care because they are afraid?

Answer 4

7%

Question 5

It is important to look for what when treating a patient?

Answer 5

indications of fear or apprehension

Question 6

What are the most commonly prescribed anti-anxiety drugs?

Answer 6

Benzodiazepines

Question 7

What is the onset of action related to with Benzodiazepines?

Answer 7

lipid solubility

Question 8

How are Benzodiazepines available?

Answer 8

tablets, capsules, oral solution, rectal gel, and injectable form

Question 9

TRUE OR FALSE: Benzodiazepines cross the blood-brain and placental barriers to produce an effect on the CNS and the fetus

Answer 9

true

Question 10

Where are benzodiazepines metabolized?

Answer 10

liver

Question 11

Storage in ______ tissue prolongs the action of lipid-soluble benzodiazepines.

Answer 11

adipose

Question 12

Benzodiazepines act as what?

Answer 12

agonists at the receptor site and thereby reduce the symptoms of anxiety

Question 13

Benzodiazepines enhance the effect of what?

Answer 13

gamma-aminobutyric acid (GABA)

Question 14

What is GABA

Answer 14

a major inhibitory neurotransmitter in the brain

Question 15

GABA quiets the nerve endings and plays a role in what?

Answer 15

muscle tone

Question 16

What are the pharmacologic effects of Benzodiazepines?

Answer 16

• behavioral effects
• anti seizure effects
• muscle relaxation

Question 17

What two drugs have anti-seizure effects?

Answer 17

Diazepam

Clonazepam

Question 18

Repeated doses of benzodiazepines can lead to what?

Answer 18

a reduction in stages 3 and 4 sleep causing a reduction in restorative sleep

Question 19

Low doses of benzodiazepines cause what?

Answer 19

anxiety and panic reduction

Question 20

High doses of benzodiazepines cause what?

Answer 20

drowsiness or sleep

Question 21

what are the adverse reactions of Benzodiazepines?

Answer 21

• anterograde amnesia
• respiratory effects
• cardivascular effects
• visual effects
• dental effects
• thrombophlebitis
• Gi tract
• genitourinary tract
• allergies
• pregnancy/lactation

Question 22

What are the pregnancy and lactation considerations for Benzodiazepines?

Answer 22

• increased risk of congenital malformations

- floppy infant syndrome

Question 23

Can benzodiazepines be abused?

Answer 23

YES HUNNY

Question 24

TRUE OR FALSE: Physical dependence and tolerance have been documented for benzodiazepines

Answer 24

true

Question 25

Combining benzodiazepines mixed with alcohol can result in what?

Answer 25

- coma - respiratory depression - hypotension - hypothermia

Question 26

Benzodiazepines: Drug interactions

Answer 26

- Additive effect with other CNS depressants | - Smoking reduces their effectiveness

Question 27

What drugs may increase the effects of benzodiazepines?

Answer 27

Cimetidine (Tagamet) Omeprazole ( Prilosec ) * they also can increase the effect of digoxin and phenytoin

Question 28

What are Benzodiazepines medical uses?

Answer 28

- insomnia - acute seizures - alcoholism - muscle spasms - anxiety - panic attacked - cautious sedation, general anesthesia

Question 29

Benzodiazepines: Dental relevance

Answer 29

- avoid additive CNS depression - Avoid addicts and prego women - Document accurately in pt record - Use with caution with elderly and pt taking Tagamet - warn pt about sedation and amnesia - match onset/duration - provide postoperative instruction - monitor vitals

Question 30

The original sedative-hypnotic and have almost completely been replaced by benzodiazepines for treating anxiety and insomnia bc of the wider TI

Answer 30

barbiturates

Question 31

Barbiturates are still used as what?

Answer 31

anticonvulsants and to induce general anesthesia

Question 32

Where are barbiturates well absorbed?

Answer 32

orally and rectally

Question 33

What solutions are irritating with barbiturates?

Answer 33

injectables

Question 34

Rapidly and almost completely metabolized by the liver

Answer 34

short and intermediate acting barbiturates

Question 35

largely excreted through the kidneys

Answer 35

long acting barbiturates

Question 36

what do barbiturates enhance?

Answer 36

GABA receptor binding

Question 37

what do barbiturates prolong?

Answer 37

the opening of chloride channels

Question 38

What do barbiturates act directly on?

Answer 38

chloride channels

Question 39

Barbiturates mechanism of action is less specific than what?

Answer 39

benzodiazepines

Question 40

what are the pharmacologic effects of barbiturates?

Answer 40

- CNS depression - No analgesia effect - anticonvulsant effect

Question 41

What are the adverse reactions of barbiturates?

Answer 41

- stimulation - fetal harm - can lethal - coughing - depress liver/kidney function - lower body temo - acute poisoning - reduce GI motility

Question 42

What happens if you take barbiturates for a chronic ling term?

Answer 42

- physical/psychological dependence - tolerance develops except to lethal dose - cross tolerance occurs

Question 43

Barbiturates can stimulate and increase what?

Answer 43

the synthesis of porphyrins, which are already at the excessive level in this dsisease

Question 44

What are the contraindications of barbiturates?

Answer 44

Pt's with intermittent porphyria or a positive history of porphyria

Question 45

a genetic metabolic disorder affecting the production of heme, the oxygen-binding prostheitc group of hemoglobin

Answer 45

porphyria

Question 46

What are the uses for ultrashort acting barbiturates?

Answer 46

used in IV for induction of general anesthesia

Question 47

What are the uses for short and intermediate acting barbiturates?

Answer 47

little medical uses; replaced by benzodiazepines

Question 48

What are the uses for long acting barbiturateS?

Answer 48

used for treatment of epilepsy

Question 49

Receptor agonists

Answer 49

- used to treat insomnia - Zolpidem (ambian) - Zaleplon (sonata) - Eszopiclone (lunesta)

Question 50

What are some centrally acting muscle relaxants?

Answer 50

Carisoprodol ( Soma ) | Cyclobezanprine ( Flexeril)

Question 51

Where do centrally acting muscle relaxants exert their effects?

Answer 51

on the CNS to produce muscle relaxation

Question 52

- Indicated for spasticity from multiple sclerosis or spinal cord injuries or diseases - Treats trigeminal neuralgia

Answer 52

Baclofen (Lioresal)

Question 53

Tizanidine (Zanaflex)

Answer 53

muscle relaxant

Question 54

- Treatment of spasticity from upper motor neuron disorders | - Prevent and treat malignant hyperthermia

Answer 54

Dantrolene (Dantrium)