Download Chapter 11 Objectives

Chapter 11 Objectives
Definitions
AnxietyBarbiturates
Benzodiazipine
Insomnia
Nonbarbiturate
Nonbensodiazepine
On-Off Phenomenon
Parkinsonism- symptoms include restlessness, tremors, rigidity and lack of facial
expression
Parkinson disease- lack of brain dopamine; leads to muscle stiffness, weakness and
trembling
Sedative
1. Describe the antianxiety drugs as a group: The antianxiety drugs are sedativehypnotic agents that can produce varying degrees of CNS depression. Small doses
produce mild CNS depression known as sedation( reduction of activity and simple
anxiety) and larger doses produce greater CNS depression like inducing sleep.
This is referred to as the hypnotic dose. Even larger doses produce anesthesia and
finally death.
2. Describe the impact that dental treatment has on anxiety and insomnia:
Many people who require dental care never go to the dentist because of fear and
apprehension and for these patients antianxiety medicine may be necessary. The
dose of a particular antianxiety agent is vastly different for each patient. The
amount needed is poorly determined by the degree of anxiety or the dental
procedure. The normal sedative dose in not expected to produce calmness in a
dental patient, but the hypnotic dose which normally induces sleep would be more
apt to produce the desired affect (sedation) for the dental patient.
3. Describe the mechanism of action, adverse reactions and dental concerns of
benzodiazepines as sedative/hypnotics:


Mechanism of action: more specific anxiolytic (antianxiety) action than the
barbiturates; increases the potential or potentates the inhibitory
neurotransmitter gamma aminobutyric acid (GABA; the GABA-ergic
neurotransmission, produces more sedation (antianxiety).
Adverse reactions: xmas craid c (xmas crazy)
a) CNS depression; unsteady gait
b) Disorientation, confusion, aggressive behavior in elderly patients
c) Cardiovascular and respiratory depression minimal; monitored if pt
compromised
d) Amnesia (commonly reported)
e) Xerostomia, swollen tongue, increased salivation, metallic/bitter taste


f) Abuse potential
Dental Concerns:
a) Additive CNS depression with other CNS depressants
b) Avoid in addicts or woman that are pregnant, increased incidence of
birth defects
c) Warn about sedation and amnesia
d) Match onset and duration with dental procedure
e) Make sure patient has arranged for transportation to and from dental
appointment
Therapeutic Uses: Wide therapeutic index when ingested alone, much safer
than barbiturates.
4. Describe the mechanism of action, adverse reactions and dental concerns of
barbiturates as sedative/hypnotics:

Mechanism of action: Enhance GABA receptor binding. They prolong
the opening of the chloride channels. Less specific than that of the
benzodiazepines. They have the ability to induce surgical anesthesia and
produce pronounced generalized CNS depressant effects.
 Advers reactions: SAAC
a) CNS depression
b) Abuse
c) Acute overdose
d) Stimulate live microsomal enzymes
 Dental Concerns:
a) Additive CNS depressant effects when taken with alcohol, opiod
analgesics other CNS depressants
b) Make sure patient has arranged for transportation to and from
dental appointment
c) Instruct to avoid tasks that require thought or concentration
 Therapeutic uses:
a) Medical use: Treatment of epilepsy, sedation or anxiety
b) Dental use: Preoperatve anxiety reduction, induction of general
anesthesia
5. Describe the mechanism of action, adverse reactions and dental concerns of
nonbarbiturates as sedative/hypnotics:
The book doesn’t really talk about this in general just about each drug
individually and he doesn’t have much in his notes about this.
Chloral Hydrate (Nortec): Produces GI irritation, used with children
Meprobamate (Equanil, Miltown); just as addictive and dangerous as barbiturates
Zolpidem (Ambien), Zaleplon (Sonata): Newest nonbenzodiazepines
6. Describe the drug interactions that can occur with all classes of
sedative/hypnotic drugs:
7. Describe both the pharmacologic and nonpharmacologic treatments of
insomnia: Benzodiazepines are preferred over barbiturates because they are less
addictive and the risk of serious poisoning is less.
Nonpharmacologic Management: Page 210 blue box
8. Describe the mechanism of action, adverse reactions and dental concerns of
antiparkinsonism medications:

a)
b)
c)
d)
e)
Mechanism of action:
Dopaminergic Agents- effect the dopamine content of the brain
Anticholinergic Agents- Inhibit acetylcholine(a neurohormone produced in
excess in Parkinson disease) in the CNS
COMT Inhibitors- thought to prolong the effect of levodopa by blocking an
enzyme, COMT, which eliminates dopamine
 Adverse Reactions:
Dopaminergic Agents:
a) Xerostomia
b) Difficulty swallowing
c) Hand tremor
d) GI upset
e) Depression
f) Muscle twitching (including jaw and tongue)
Anticholinergic Agents:
a) Xerostomia
b) Blurred vision
c) Dizziness
d) Nausea
e) Nervousness
COMT Inhibitors:
a) Disorientation
b) Confusion
c) Dizziness
d) Dyskinesia
e) Nausea
f) Fever
Dental Concerns
Xerostomia
Emphasize the importance of good oral hygiene
Check TMJ for side effects
Use electric toothbrush if patient has difficulty holding conventional brush
Orthostatic hypotension
9. Describe important points to discuss when educating the patient about the
use of antiparkinsonism medications: