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Pharmacology - Chapter 11 - Anti-anxiety Drugs

Pharmacology - Chapter 11 - Anti-anxiety Drugs
STUDY
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1. Oral administration
2. IV sedation - Advantages / Diadvantages
Antianxiety drugs are usually administered by __?
Drowsiness
Sedation =
Sleep
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?
elderly
Which demographic has the hardest time metabolizing benzodiazepines?
kidneys
Excretion of benzodiazepines occurs in the __?
2-200 hrs
The half life of benzodiazepines is __?
neurotransmitter GABA
Benzodiazepines enhance/facilitate the action of the __?
Benzodiazepines
This increases the opening of Chloride channels resulting in an enhanced inhibitory effect by GABA
Benzodiazepine
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?
Benzodiazepines
Which anti anxiety agents can cause Physical and psychological dependence especially in large doses?
Flumazenil
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 __?
nicotine
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 __?
Triazolam
Diazepam
Lorazepam
Alpprazolam
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?
porphyria
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 __?
Zolpidem
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?
Benzodizepines
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 __?
Flexeril
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 __?
analgesia
Sedatives do NOT provide __?