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Pharm Exam 4-OBI 836-Parkinson's/Schizo/Conscious Sedation/Herbs
Terms in this set (68)
A movement and cognitive disorder associated with too little DA in the CNS.
Pyschiatric disorder associated with too much DA in the CNS.
T/F: Dopamine cannot cross the BBB.
Increased DA in the mesocortical region is associated with what?
Increased DA in the mesolimbic pathway is associated with __________ symptoms of Schizophrenia. Increased DA in the mesocortical pathway is associated with ____________ symptoms of Schizophrenia.
Voluntary movement involves the ______________ pathway and degeneration of DA neurons in this region causes ___________ __________.
Treatment of parkinson's disease uses drugs that involve the use of a ____________, ____________, and ____________.
Drug reduces DA metabolism
Why were initial attempts to treat Parkinson's disease with L-DOPA unsuccessful?
L-DOPA is metabolized in the GI tract and peripheral tissues by DOPA decarboxylase to DA. Very little DA entered the CNS.
Why do current treatments require the co-administration of L-DOPA and DOPA decarboxylase inhibitor?
Reduces L-DOPA conversion to DA outside the CNS. Minimizes the peripheral actions of DA. Carbidopa can't cross the BBB allowing more L-DOPA to enter the CNS.
What are 2 implications in dentistry for pts with Parkinson's disease?
Causes excessive salivation, muscle rigidity, and limits good oral hygiene
______________ symptoms of Schizophrenia are: hallucinations, delusions, feelings of persecution, disorganized thinking.
_____________ symptoms of Schizophrenia are: blunt affect, withdrawn, paucity of speech, lack of motivation, lack of joy
_____________ ____________ is decreased attention, language, memory and higher functioning in pts with schizophrenia.
____________ _____________ is inappropriate & odd expression and mood disturbance.
Which drug used in conscious sedation will best cause amnesia during a procedure?
-causes anterograde amnesia at conscious sedation doses
The practitioner responsible for overall conduct of the conscious sedation is generally required to do the following within 30days prior to procedural sedation.
Sedation plan/Informed Consent
NPO status and interval changes if H&P not done immediately prior to procedure
A H&P should be focused on what 4 categories?
Sensitivity to sedative/analgesics
Risk of respiratory/cardiopulmonary complications
Risk for developing adverse event secondary to anesthesia
Difficulty managing complications
What are 4 special considerations to an H&P for conscious sedation?
Tobacco use: bronchospasm
Alcohol/Illicit drug use:
chronic use increases tolerance to sedatives
acute use synergistic w/ sedative agents
GERD pts-extend NPO duration
Pt Allergies: type of rxn
What are 4 things you should evaluate when performing an airway assessment in preparation for conscious sedation?
Cervical range of motion
Malampati classification: visualize soft palate, fauces, uvula, anterior/posterior pillars
Malampati classification: visualize soft palate, fauces, uvula
Malampati classificaiton: visualize soft palate and base of uvula
-Class 3&4 increase likelihood for a difficult airway to ventilate and intubate
Only hard palate is visible. Soft palate is not visible at all.
When performing a procedure with a patient under conscious sedation, what 4 things must be monitored?
For conscious sedation, desired patient's LOC should be between ________.
3:eyes closed but arousable to command
4:eyes closed but a rousable to mild physical stimulation
How do you know when a patient is no longer consciously sedated and is at risk for airway compromise?
Pt responds only to painful stimulus
Administration of incremental doses of a drug until a desired effect is reached?
-essential to avoid over sedation
-know drugs time of onset, peak response, DOA
Allowing a drug to exert full effect prior to administration of additional doses.
What is the BZDs antagonist (reversal)? What is opioids antagonist (reversal)?
What is enhanced both pre and post synaptically with benzodiazepines?
-absence of GABA means BZD has no intrinsic activity.
What is the hepatic clearance from the 1st pass effect of BZD?
50% of liver blood flow
How are BZDs eliminated and excreted?
Eliminated by oxidative metabolism
Excreted in urine
There is a close correlation btw clinical effect and plasma concentration. What are the 3 ranges of conscious sedation and receptors occupied?
What is significant about the half life of midazolam and its antagonist flumazenil
Midzolams half life is 1-5hrs and flumazenils is 0.7-1.3hrs= because antagonists half life is shorter, pts must be monitored because they can become resedated as flumazenil wears off but midazolam is still at therapeutic levels.
What are 2 main side effects of BZDs?
-0.15mg/kg of midazolam may cause resp depression
CV hypotension and tachycardia
-potentiated in combination with fentanyl
What are the absolute and relative contraindications for BZD use?
-acute narrow angled glaucoma, known allergies
-extremes of age, psychiatric factors
What is the MOA of flumazenil? What is its usual dose?
Competitively displaces BZD from GABA/BZD complex and reverses all BZD effects including amnesia.
What is the MOA of barbiturates? What is unique about barbiturates?
Enhances GABA effects w/in CNS, depresses sensory cortex and alters cerebellar fxn.
-they are a sedative but do not cause analgesia
What are examples of each of the following opioids: Natural, Semi-synthetic, synthetic, antagonist.
Semi-synthetic: hydrocodone, oxycodone, hydromorphone
Synthetic: meperidine, propoxyphene, fentanyl series
What are 4 properties of opioids?
What are the 5 opioid receptor subtypes and what does each cause?
Mu1-analgesia, bradycardia, sedation, miosis
Mu2-resp depression, euphoria, dependence
Kappa-resp depression, sedation, dysphoria, miosis
Sigma-dysphoria, hallucination, tachy
What is unique about fentanyl and sufentanil when compared to morphine?
Fentanyl and Sufentanil are more lipid soluble than morphine. This means they tend to accumulate more in fatty reservoirs potentially producing long lasting effects.
What is the order from least to most potent opioid?
Meperidine<Morphine<Hydromorphone<<<<<<Fentanyl (100x more potent than morphine)
What side effect can occur with 50mcg of fentanyl that is related to the speed of administration and the dose.
Chest wall and glottic rigidity
-may make manual ventilation of pt difficult
-easily relieved with succinylcholine
What drug is an opioid only antagonist that reverses respiratory depression and sedation and is titrated 0.1-0.2mg slowly to effect?
-onset is 1-2min
-duration: 30min IV
-may not outlast narcotic effect which warrants an additional dose
-contraindicated in chronic pain abusers and chronic pain patients
This drug is most frequently administered for induction of anesthesia and is formulated in a lipid emulsion due to its insolubility in aqueous solution.
-must be used within 6hrs due to potential for bacterial growth
-caution with pts allergic to sulfite
What is the MOA of propofol?
Potentiates Cl- current mediated through a GABA type A receptor complex.
It is rapidly metabolized in the liver and excreted in the kidneys
DOA is 3-8min
This drug is associated with a cataleptic state and is a dissociative anesthetic.
-strong analgesic with minimal respiratory properties
-post-op emergence rxn limits its use
What is the MOA of ketamine?
Inhibits N-methyl-D-aspartate receptor (non-competitive)
-responsible for excitatory transmission and sensory input
If a patient goes into laryngospasm, how is it treated?
Ambu bag ventilation or pressure point behind mandible to break them of laryngospasm
-If persistent: IV succinylcholine (10-20mg for partial, 20-40mg for complete)
If a patient goes into bronchospasm, how is it treated?
Inhaled beta agonist: 1st line tx
0.3-0.5mg SC epi (1:1000)
Products used together with conventional medicine are considered what? Whereas products used in place of conventional medicine are considered what?
In a study done on patients taking CAM (Complementary and Alternative Medicine) what were the top two reasons for taking using these products?
1-Prevent illness/general wellness (77%)
2-Reduce pain/treat pain condition (73%)
What was the #1 CAM taken in a study done on the top 10 natural products?
Fish oil/Omega 3
What is a major issue with patients taking CAM?
There are no requirements to prove safety and efficacy Few have undergone clinical trials.
Products contain adulterants and contaminants
What are 3 companies that can provide their seals of approval?
What are 4 common drug interactions with CAM that are relevant to dental practice?
Effects on drug metabolizing enzymes
What are 5 herbs that affect blood clotting? (GGGGF). What should you recommend patient do that are taking these before surgery?
Gingko (inhibits platelet aggregation)
Ginseng (inhibits platelet agg, decrease INR and warfarin effect)
Garlic (inhibits platelet agg)
Ginger (inhibits thromboxane)
-discontinue use 10-14days prior to surgery
What are 6 herbs that may have additive effects with anxiolytics or analgesics?
Valerian (insomnia, anxiety)
St Johns Wart (depression)
SAMe (depression, OA)
Passion Flower (anxiety, mood)
What are 4 herbs that affect immune system and inflammatory responses?
Golden Seal-increases AB production
Evening Primrose Oil-gamma/linolenic acid
What are 2 herbs that affect metabolizing enzymes and which enzymes do they affect?
St John's Wort- induces Cyt P450 (decrease levels of cyclosporin, protease inhibitors, erythromycin)
Goldenseal-inhibits CYP3A-increases serum levels of erythromycin
What is an effective use of probiotics in dentistry?
Live microorganisms that can provide health benefits by competing against pathogens and colonizing the oral cavity. Adhere to oral surfaces, survive salivary defense mech, form biofilms, no odor.
In a study what was identified that reduces oral Candida counts in elderly individuals?
L. Rhamnosus GG
What probiotic microorganism can be used to reduce gingivitis and dental plaque in patients with moderate to severe gingivitis?
What probiotic microorganism has anti-inflammatory effects that are beneficial in patients with periodontitis?
L. Brevis: lactobacillus reduces inflammation by causing decreased salivary prostaglandin E2 and MMPs.
What probiotic microorganism was found in higher amts in healthy adults and has been found to inhibit the growth of P. Ging, P. Intermedia, and A.A.?
What are 5 probiotic example products that are available for dental use?
Lozenge-S. Salivarius (reduces oral VSC)
Yogurt-L. Reuteri (reduces S. Mutans)
Rinse Solution-W. Cibaria (Reduces VSC)
Cheese- L. Rhamnosus GG (reduced yeast counts)
Chewing Gum - L. Reuteri Prodentis (reduced S. Mutans)
Studies indicate that what fruit may provide antioxidant effects, reduce plaque, and prevent formation of biofilm and bacterial adhesion?
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