(1-25-17) Into to Oral, Sublingual, IM, IV, conscious sedation Flashcards Preview

Pharm II > (1-25-17) Into to Oral, Sublingual, IM, IV, conscious sedation > Flashcards

Flashcards in (1-25-17) Into to Oral, Sublingual, IM, IV, conscious sedation Deck (39)
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1
Q

what % of ppl fear going to the dentist?

A

21% (3rd overall highest)

2
Q

what all can sedation do for your patient?

A
  • improve access to care
  • reduce fear and anxiety
  • influence tx options (more invasive procedures, longer appts, better operating conditions)
3
Q

what constitutes conscious/sedation and anxiolysis?

A
  • minimally depressed level of consciousness
  • ability to maintain own airway
  • responsive to stimulation

*THIS IS OUR GOAL (awake, breathing, calm, responsive)

4
Q

what constitutes deep sedation?

A
  • depressed consciousness
  • partial loss of protective reflexes
  • inability to continually maintain own airway
  • unresponsiv to stimulation
5
Q

can nitrous be titrated even with oral sedation?

A

YES

*significant additive sedation and muscle relaxation

6
Q

what are some of the commonly used oral meds?

A
  • sedative (hypnotics)
  • benzodiazepines
  • H1 antihistamines
  • opioids
7
Q

what are the advantages of the oral route?

A
  • well accepted
  • ease
  • cost
  • low adverse reaction
  • no needles
8
Q

what are the disadvantages of the oral route?

A
  • compliance
  • latent period
  • erratic
  • difficult to titrate
  • difficult to alter
  • prolonged duration
  • first pass metabolism
9
Q

which routes are enteral (pass through intestines)?

A
  • oral, sublingual, rectal

* undergoes first pass metabolism

10
Q

which routes are parenteral (administered not in the mouth)?

A
  • intravenous, intramuscular, intralnasal, inhalation, transdermal, transmucosal
  • not subjected to first pass metabolism
11
Q

first pass metabolism

A

drug goes to the liver before the rest of the body

*done with enteral routes

12
Q

characteristics of intranasal administration?

A
  • usually administered by spray or atomizer (pt comfort)

- goes directly to systemic circulation and has rapid onset

13
Q

what two types of metabolism happen in the liver?

A
  • oxidation (CYP 450 system, enzymes)

- Conjugation (glucorination can undergo induction)

14
Q

what 3 ways can a drug be eliminated?

A
  • urine
  • bile
  • lungs
15
Q

what factors influence sedation-absorption and blood levels?

A
  • pH and pKa
  • gastric emptying time
  • anxiety
  • speed through bowel
  • presence of other foodstuffs
  • first pass metabolism
16
Q

is the titration of oral sedation given all at the same appt?

A

no!

titration over several appts

17
Q

pregnancy drug that failed to demonstrate risk during any trimester

A

A

18
Q

pregnancy drug that animal studies have failed to show risk but no human studies

A

B

19
Q

pregnancy drug that you give only after risks considered. animal studies show adverse effects- no human studies available

A

C

20
Q

pregnancy drug with definite human risks, may be useful in life threatening situations

A

D

21
Q

pregnancy drug with absolute fetal abnormalities, Not to be used during pregnancy

A

X

22
Q

what is the rule about combining oral agents?

A

all agents must be administered concomitantly on one treatment day

23
Q

what are the advantages of sublingual?

A
  • long hx
  • enters systemic circulation
  • low cost
  • low adverse reaction
  • no first pass effect
24
Q

what are the disadvantages of sublingual?

A
  • cooperation is essential
  • difficult to titrate
  • difficult to alter
25
Q
  • considered enteral
  • may be dec time to sedation
  • deeper level of sedation
  • higher peak plasma levels
A

sublingual sedation

26
Q

which is faster, sublingulal or subnasal?

A

subnasal

27
Q

what are the adv. to intramuscular?

A
  • quick onset
  • max effect 30 min
  • reliable
  • coop not essential
28
Q

what are the disadv. to intramuscular?

A
  • cannottitrate
  • does NOT have quick reversal
  • prolonged
  • injection
  • injury
  • needle
29
Q

what is the difference when giving intramuscular injections in different parts of the body?

A

different ma dose volumes

30
Q

what are the 4 IM injection sites

A
  • deltoid
  • gluteus
  • vastus lateralis
31
Q

what are come complications that could arise with IM injections?

A
  • nerve injury
  • periostitis
  • hematoma
  • abscess
  • sloughing of tissue
32
Q

what is the clarks rule for dosing?

A

(weight in lbs / 150) x adult dose

33
Q

what is the young’s rule for dosing?

A

(age/ [age + 12]) x adult dose

34
Q

what are the advantages of rectal?

A
  • relatively effective
  • side-effects
  • cost/ease
  • theory of less hepatic first pass effect
35
Q

what are the disadvantages of rectal?

A
  • inconvenience
  • intestinal irritation
  • difficult to titrate
  • difficult to alter
  • prolonged duration
  • erratic
36
Q

what are the adv of intravenous?

A
  • rapid onset
  • highly effective
  • titration
  • ability to redose
  • ability to revese
  • shorter recovery
  • access
37
Q

what are the disadv of intravenous?

A
  • venepuncture
  • inc monitoring
  • pain of IV
  • potential injury from catheter placement
  • most IV meds cannot be reversed
  • pt coop
38
Q

when should a pt take diazepam

A

1 hr before appt

39
Q

** no idea if they want us to know the specific drugs so….

A

sorry guys