SPECIAL CARE oral and premed Flashcards
(25 cards)
how is oral sedation delivered?
as a drink - usually midazolam in juice
why do you still need to cannulate a pt with oral sedation?
for safety - may need reversal
what is a premedication for conscious sedation?
antianxiety agent - a drug administered for such a purpose
usually 5-10mg diazepam
what is the instruction for premed diazepam?
5-10mg
take last thing at night
take another 60-90 before appt
what are diazepam drug interactions?
antibacterials - isoniazid inhibits metabolism, rifampicin increases metabolism
antivirals - ritonavir
PPIs - omeprazole
indications for premed diazepam?
very anxious pts - may aid them attending the surgery/ sleeping the night before
pts when sedation is contraindicated
- medical reasons
- inability to get venous access
- inability to breath through nose
to take the edge off before more complex and prolonged procedures
contraindications of premed diazepam?
hepatic impairment
renal impairment
pregnancy
breast feeding
why is premed diazepam contraindicated for pts with hepatic and renal failure?
the family of drugs are broken down in the liver and extracted through the kidneys
why should premed diazepam be avoided in pregnancy?
neonatal withdrawal symptoms
cautions of premed diazepam?
avoid prolonged use
reduce dose in debilitated pts
reduce dose in elderly
respiratory disease
pt compliance - taking at wrong time!
why should you avoid prolonged use of diazepam?
it is addictive
also abrupt withdrawal may cause withdrawal
why should diazepam be used with caution in pts with resp disease?
it causes resp depression
list the benzodiazepines and their use?
diazepam - premed
temazepam - alternative premed
midazolam - conscious sedation
flumazenil - reversal agent
what is another name for diazepam?
valium
how does flumazenil work as a reversal agent?
it is a benzodiazepine receptor antagonist
through competitive inhibition
it has a higher affinity for the GABA receptors
what are the different uses of benzodiazepines?
anxiolytics - low dose premed
anticonvulsant - to prevent and terminate seizures
sedation
explain benzodiazepines and amnesia?
most intense with IV, anterograde anaesthesia
this is why people report being unable to remember most of what happened during IV sedation appt
how do benzodiazepines cause muscle relaxation? and what specifics to dentistry
central effect
depression of spinal reflex activity
partly responsible for resp depression
reduces trismus
what can benzodiazepines cause at large doses?
anaesthesia - sometimes used as an IV induction agent in specific GA cases
what are the short term side effects of benzodiazepines?
drowsiness
dizziness
reduced concentration and coordination
hypotension
resp depression
sexual fantasy (always have a chaperone present)
what are the long term side effects of benzodiazepams?
building up a tolerance
dependence and withdrawal
what is drug tolerance?
a pharmacological concept describing subjects reduced reaction to a drug following its repeated use
what is drug dependence?
a state of needing a certain drug to function normally and would cause withdrawal symptoms when not taken
what are examples of withdrawal symptoms?
sleep disturbance
irritability
tension
anxiety
shaking
sweating
cant concentration
nausea
headaches
paranoia
mood swings
