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Pharmacology - Chapter 11 - Anti-anxiety Drugs

1. Oral administration
2. IV sedation - Advantages / Diadvantages

Antianxiety drugs are usually administered by __?


Sedation =


Hypnotic Dose/state =

conscious sedation

Anesthesia =

Major: Sedation, like alcohol
Minor: Antipsychotics are included

Tranquilizer =

valium-like tranquilizers

Benzodiazepines are __?

nucleus plus added rings

The chemical makeup of benzodiazepines shows that all have the same __?

1. onset
2. duration
3. half life

Differences in benzodiazepines will be in __?

Librium, Valium, Triazolam, midazolam Flumazenil

Examples of benzodiazepines are:

1. Oral
2. Injectable
3. Gel Form

The pharmacokinetics of benzodiazepines are administered how?

protein bound

Benzodiazepines are highly lipid soluble and __?

Phase I - hard
Phase II - Easy
Execretion - Kidneys in urine

How are benzodiazepines metabolized?


Which demographic has the hardest time metabolizing benzodiazepines?


Excretion of benzodiazepines occurs in the __?

2-200 hrs

The half life of benzodiazepines is __?

neurotransmitter GABA

Benzodiazepines enhance/facilitate the action of the __?


This increases the opening of Chloride channels resulting in an enhanced inhibitory effect by GABA


There are 3 receptor subtypes for what anti-anxiety med?

1. Behavioral - reduces REM sleep
2. Anticonvulsant - increases the seizure threshold
3. Muscle relaxation

The pharmacologic effects of benzodiazepines are?

1. CNS depression, fatique, drowsiness
2. Alters preception of time, amnesia
3. Anterograde Amnesia (especially when used in conjunction with alcohol)
4. Respiratory effects minimal except in elderly
5. Cardiovascular - Decrease in BP and Heart Rate (none in low doses)
6. Vision - do NOT give to glaucoma patients
7. Increase or decrease in saliva flow -also can cause a metallic taste
8. Thrombophlebitis related to the glycol carrier
9. Cleft Lip and Palate potential if taken while pregnant

Some adverse reactions of benzodiazepines are?


Which anti anxiety agents can cause Physical and psychological dependence especially in large doses?


This is a benzodiazepine antagonist

1. Other CNS depressants
2. Alcohol
3. Barbiturates
4. Anticonvulsants
5. Phenothiazines
6. Potentiators
7. Valporic acid can increase sedation
8. Serotonin reuptake inhibitors

Some Drug Interactions with benzodiazepines include __?


What reduces the effects of benzodiazepines?

inhibit phase I metabolism

Benzodiazepine potentiators do what?

1. Cimetedine
2. Disulfiram
3. Isoniazid
4. Cisapride
5. Omeprazole

Benzodiazepine potentiator examples include?

Tagamet - Stomach Ulcers

Cimetedine =

Antabus - Alcoholism treatment

Disulfiram =

Treatment for TB (aka INH)

Isoniazid =

Propuisid - Treatment to increase GI motility

Cisapride =

Prilocec - Decreases stomach acid

Omeprazole =

Cause benzo levels to increase

Serotonin reuptake inhibitors do what to patients also taking "benzos?"

levodopa (used in parkinson's disease)

Benzodiazepines decrease effect of __?

digoxin (heart med,) phenytion(dilantin - seizures,) probenicid(treatment for gout)

Benzodiazepines increase the effect of __?

1. Anxiety
2. Insomia
3. Alcohol withdrawal
4. Seizures
5. Conscious sedation
6. General anesthesia
7. Muscle spasms

Uses for Benzodiazepines include __?

Midazolam (Versed)

Drugs of choice: Benzodizepines are?

1. Hypnotic dose
2. Premedication
3. Conscious sedation

Management of dental patients taking Benzodizepines includes:

1. orally
2. rectally

Barbiturates are best absorbed __?

inhancing GABA receptor binding

Barbiturates work by __?

1. CNS depression
a. Normal dose
b. Higher dose
2. Analgesia: Barbituates contain NO pain properties
3. Anticonvulsant effect: phenobarbital

Pharmacological effects of barbiturates include __?

1. Sedative/hypnotic effects
2. Anesthetic doses
3. Acute poisioning
4. Sedative/hypnotic effects (more in elderly)
5. Anesthetic doses
6. Acute poisioning (at 15x the normal dose)

Adverse reactions to barbiturates include:

15x the regular dose

Acute poisoning of barbiturates occurs at __?

1. epilepsy

Long term use of barbituates are common in which conditions?

IV sedation - dental work

Short term use of barbituates are common in what condition?


You should never prescribe a barbituate to a patient with __?

1. Zolpidem (Ambien)
2. Chloral Hydrate
3. Meprobamate

Some examples of a Nonbarbiturate Sedative-Hypnotic are __?


Another name for Ambien is __?

Nonbarbiturate Sedative-Hypnotic

Chloral Hydrate is a type of __?

In dentistry, given pre-op for kids

What is chloral hydrate used for?

50 mg/kg - mx 1 gram
Rapid onset-20-30min
4hr duration

What is the dosage of chloral hydrate for children?


What is a safer alternative to chloral hydrate?

1. Flexeril
2. Soma
3. Paraflex
4. Norflex
5. Valium

Some examples of central Acting Muscle Relaxants are?

1. CNS problems
2. Effects the skeletal muscles

Pharmacologic Effects of Central Acting Muscle Relaxants are __?


The most common cental acting muscle relaxant is called __?

Equanil (which is a minor tranquilizer)

Another name for Meprobamate is

1. back and neck pain
2. relief of muscle spasm
3. Pain associated with TMJ/TMD

Uses for central acting muscle relaxants are __?

Anxiolytic (anti-anxiety)

Buspirone (BuSpar) is a __?

1. Relief of pain and anxiety
2. Potentiation of the analgesia
3. Sedatives can induce excitation when given w/o analgesic to pt w/uncontrolled pain
4. Anxiety can lower pain threshold

Reasons to use Analgesic-Sedative combinations include?

Fiorinal and Fioricet

Some examples of Analgesic-Sedative combinations include __?

Anxiety Management

Drugs are not a substitute for __?

1. Pts w/impaired elimination
2. Additive depression
3. Unsafe 2 perform certain duties
4. Psychological & physical dependence
5. Suicide
6. Sedatives do NOT provide analgesia
7. Do not give to pregnant/lactating ♀

Analgesic-Sedative combination cautions include __?


Sedatives do NOT provide __?

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