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109 Cards in this Set
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- Back
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What is the typical onset of actions for the oral route, IM, IV and inhalation?
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30 min; 10-15 min; 1 minute; 3-5 minutes
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What are the typical peak effects for drugs given by the oral route, IM, IV and inhalation?
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60 min; 30 min; 1-20 min; 3-5 min
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Name 3 indications for use of nitrous?
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anxiety, the medically compromised patient, and to diminish gagging
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To achieve adequate sedation without decreasing the amount of O2 to less than room air, what percentage of oxygen must be used?
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at least 20.9%
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Nitrous is safe in pregnant women when delivering what % of oxygen?
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at least 20%
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In what stage of anesthesia does nitrous take place?
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stage 1
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What is the blood gas solubility coefficient of of nitrous?
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0.47
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What is the optimal concentration of N2O for production of analgesia while still maintaining patient cooperation?
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35%
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Prolonged use of N2O can inhibit the actions of the enzyme __ which is involved in __. This affects __ which can lead to __.
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methionine synthetase; B12 metabolism; DNA metabolism; pernicious anemia and bone marrow suppression
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N2O gases are dispensed at a pressure greater than __ psi at __ degrees celsius. The cylinders are checked every __ years.
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25; 25; 5
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Which letter designates N2O cylinders? Oxygen cylinders?
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G; H
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H cylinder pressure is __ while the O2 E cylinder is __. G cylinder pressure is __ while the E nitrous cylinder is __.
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2200 psig; 1900 psig; 750; 750
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Central system regulators reduce the gas to __ psig while cylinder systems reduce it to __
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50-55; 45-55
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What size reservoir bag for nitrous is most commonly used? What is the minimum oxygen liter flow? Min. oxygen percentage?
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3L; 2.5-3 L/min; 30%
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The flow of oxygen when delivering N2O should be started at __ L/min.
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6
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What is the first clinical evidence of sedation when giving nitrous? What signs show the pt. is at the ideal level?
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lightheadedness; feeling of warmth, floating or heaviness
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What is the oldest and most commonly used route of sedation?
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oral
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What is the most convenient and economic route of sedation?
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oral
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What is the latent period for oral sedation meds?
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30 min
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What is the primary use of oral meds in dentistry?
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to reduce anxiety prior to dental treatment
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What are the drugs of choice for anxiety control in dentistry and nighttime sedation?
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benzodiazepines
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What schedule do benzodiazepines fall in? What level of the brain do they suppress? The calming effect is a result of action on the __ and __, areas of the brain that control __ and __.
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Schedule IV; subcortical; limbic system and thalamus; emotion and behavior
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Which benzo's are commonly used for pretreatment anxiety? Anxiety reduction for sleep?
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oxazepam and diazepam; flurazepam and triazolam
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List 3 contraindication for benzo use?
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allergy, glaucoma, and psychoses
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Use of benzos in the __ trimester can cause congenital malformations such as __.
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1st; cleft palate
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Which benzo should you not give in kids <6 months old? <6 years? <18 years?
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diazepam; oxazepam and chlorodiazepoxide; chlorazepate
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What was the first FDA approved benzo?
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chlordiazepoxide
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What makes chlordiazepoxide less attractive than other benzos?
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slow onset of action with peak plasma levels at 4 hours
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Max clinical effect of diazepam is seen in __? It has a plasma half-life of __. Adult dose is __. Elderly is __. Pedo dose is __.
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1 hr; 20-70 hrs; 5-10mg 1hr before treatment or sleep; elderly dose is half the adult dose; pedo dose is 0.15-0.3 mg/kg
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What is the half life of oxazepam? Duration of action? Adult dose? Elderly?
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6-11 hrs; 1-4 hrs; 10-15mg; 10mg for elderly
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When are the peak plasma levels for flurazepam? Half life? Adult dose? Elderly?
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30-60 min; 47-100 hrs; 30 mg 1 hr before bedtime; 15 mg
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What is the adult dose of temazepam? What is it used for?
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30 gm 1 hr before bed; sleep aid for pts having trouble staying asleep
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What is the most prescribed psychoactive drug marketed in the US?
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triazolam
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What is the half life of triazolam? Peak plasma levels? Dose?
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1.5-5.5 hrs; 1 hr; 0.25mg 1 hr before bedtime or treatment
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Which benzos have no active metabolites?
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oxazepam, triazolam and midazolam
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What is the onset of midazolam? Syrup dosage? Pedo dose?
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30 min; 2mg/cc; 0.25-0.5mg/kg
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Name the 2 most commonly used antihistamines?
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promethazine and hydroxazine
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Promethazine is commonly used in conjunction with what other drug? What is the doseage?
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demerol; 25-50mg 1 hr before tx for adults; 12.5-25mg for children; 2.2mg/kg for pedo preop sedation and 1.1mg/kg when used in combo
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What is the most popular oral sedative used in pediatric dentistry?
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hydroxazine
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Clinical actions for hydroxazine are observed in __. Max clinical effect? Duration of action? Dose?
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15-30 min; 2 hrs; 2-4 hrs; same as promethazine
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What is the weakest of all the general anesthetic drugs?
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nitrous
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Name 3 rectal sedation drugs?
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pentobarbital, secobarbital, and promethazine
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Name 4 drugs that can be given sublingually.
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nitroglycerine, nifedipine, opioids, and fentanyl lollipop
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Which 2 drugs have been studied the most for intranasal sedation?
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midazolma and sulfentanil
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What size syringe and needle are used when giving a deltoid IM injection?
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3cc syringe with a 20-23 ga needle 1-2 inches long
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Name 4 indications for IM sedation.
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lack of superficial veins, IV contraindicated, inability to breathe through nose, adverse clinical experience to nitrous
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What is Clark's rule? What % will be sedated, over, under?
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child's weight (lb) x adult dose/150; 70% will be properly sedated, 15% each under and oversedated
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Name 3 of the most commonly used IM Group A drugs.
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diazepam, midazolam, and promethazine
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Name the common IM injection site of diazepam in dentistry. Dosage.
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deltoid; 10mg 30-60 min prior to tx
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Which IM sedation drugs is water soluble?
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midazolam
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What is the IM sedation dose for midazolam?
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0.15mg/kg
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Which class of drugs belong in Group B IM drugs and name the 2 most common?
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opioids, agonists and antagonists; fentanyl and merperidine
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Name the 2 locations in the body of morphine receptors and the 4 types?
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CNS and GI tract; Mu, kappa, sigma delta
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Name the pupillary response, respiratory and GI during opioid use.
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constriction (miosis), respiratory depression by decreasing medullary response to CO2, and decreases gut motility
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What is the typical onset for IM meperidine? Duration? What dose is equal to 10mg morphine? What drugs is it reversible with? Adult dose? Pedo dose?
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10-15 min, 2-4 hrs, 80-100mg; Narcan; 50-100mg 30-90 min before tx; 1-2mg/kg for peds
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Which drug is stiff chest syndrome common with?
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fentanyl
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What is the onset for IM fentanyl? Duration? What dose is equal to 10mg morphine? Dose?
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5-15min; 1-2 hr duration; 0.1mg; 0.05-0.1mg 30-60 min before tx
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What type of drugs fit in Group C of IM drugs? Name the 2 most common.
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anticholinergics; atropine and glycopyrrolate
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What makes glycopyrrolate more desired than other anticholinergics?
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does not cause tachycardia and dysrhythmias like the others
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Name the eye responses seen when taking anticholinergics? Resp? CV?
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pupillary dilation with the inability to acommodate; bronchodilation and a decrease in secretions; inc HR
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What is the IM combination of drugs used for the uncooperative child?
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promethazine and an opioid
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Name the 2 physiological changes seen when taking ketamine?
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increased salivation and increased HR and CO
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What was the first drugs used IV?
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chloral hydrate
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Consultation is always required for which type of pts before using IV sedation?
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ASA II or II CV risk, previous CVA, epilepsy
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In an IV drip chamber how many drops equal 1ml for adults? pedos?
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10 drops; 60 drops
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What is the favorite IV injections site for anesthesiologists?
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dorsum of the hand
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The wrist for IV injections has difficult mobilization problems if what type of needs is used?
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butterfly
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For IV diazepam what is the dosage? Amnesia occurs within the first __ min. Pts feel recovered within __ min.
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2-20mg; 15min; 45-60 min
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For which IV drug is a rebound effect commonly seen with?
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diazepam
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For which drug is pain during injection commonly seen?
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diazepam
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What is the most commonly used IV sedative drug used in dentistry?
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midazolam
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By which process is IV midazolam metabolized and where? Distribution half life? Elimination half life?
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microsomal oxidation in the liver; 15 min; 1-4 hours
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What is the most commonly used opioid in dentistry?
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meperidine
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What is the max dose for IV meperidine?
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50mg
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Medical history should be check before giving IV meperidine for what?
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MAOI taken within 14 days, history of seizures, asthma, and COPD and decreased resp reserve
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What is the IV dosage for fentanyl?
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0.05mg/ml
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Name 3 reasons why IV alfentanil would be used over fentanyl? Dosage? Duration?
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quicker onset, less resp depression and well suited for continuous infusion; 500mcg/ml; 11 minutes
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Which IV drug should be prepared just before injection?
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propofol
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Which IV drug should not be given to pts with an egg allergy?
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propofol
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For which IV drug are laryngospams common if secretions are not kept off the vocal cords?
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methohexital
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For which IV drugs uses the Brevital bump?
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methohexital
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What is the max adult dose for Naloxone? Pedo?
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0.4mg; 0.01mg/kg
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Which drug is a benzo antagonist?
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Flumenazil
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What is the max single dose for flumazil? Total dose?
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0.2 mg every 60 sec with a max total of 1 mg
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The avg dose of IV midazolam is?
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6-8mg
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What is the test dose during IV administration? How many cc's/min should be given thereafter?
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0.2ml; 1cc/min
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What is the max dose of IV valium?
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30mg
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Which IV drug should be given for procedures between 1.5-2 hrs? Dosage?
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promethazine; 32.5mg
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Which 3 drugs are used for the Jorgenson method?
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pentobarbital, meperidine, and scopolamine
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What is the tx for cellulitis?
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antibiotics and warm moist heat
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What is the most common venipuncture complication?
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hematoma/brusing
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What is the tx for extravisation?
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pressure plus infiltration with 1% procaine
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What is the most serious venipuncture complication?
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IA injection
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How can resp depression be avoided?
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slow titration of drug
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What drug and its dosage can be used to treat laryngospams?
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20-40mg succinyl choline
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Name 5 contraindications to outpatient general anesthesia.
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Some ASA II and all ASA III and IV, hx of polio, mysthenia gravis, low cardiac and pulmonary reserve, and obese pts
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Name the depolarixing neuromuscular agent? Nondepolarizing?
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succinylcholine; pancuronium
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Relaxation develops after __ min of IV succinylcholine using a dose of __. It may produce __ and is implicated in __.
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1 min; 60-80 mg; hyperkalemia; malignant hyperthermia
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What is the most frequent means of achieving GA?
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inhalation
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Name 5 common findings with isoflurane.
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depresses the myocardium, postop shivering, may cause hepatotoxicity, avoid in renal impaired pts, BP decreased as dosage increases
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What is the MAC of sevoflurane? MAC awake?
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2%; 0.6 %
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Which drugs are recommended immediately prior to beginning of GA procedure? Induction started with a __ or __. May start IV on child after induction with __.
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anticholinergics; short acting barbiturate or inhalation agent; inhalation agent
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What 2 common IV drugs are used for outpatient GA procedures?
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methohexital and propofol
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What is the best sedation technique for geriatric pts?
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inhalation
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Requirements for IV sedation include at least __ hrs of training and __ pts.
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60; 20
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What is the analgesic activity range for NSAIDs? Duration? Peak effects?
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200-800mg; 4-6 hrs; 2-3hrs
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What is the only NSAID containing opioid concentration?
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Vicoprofen with 200mg IB and 7.5mg HC
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Name 3 functions of COX1.
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maintain GI mucosa integrity, initiates platelet aggregation, and regulates renal blood flow
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Why are the selective COX2 inhibitors Vioxx and Bextra taken off the market?
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1% occurrence of CV problems
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