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Review
Chapter 7
Are antibiotics useful in treatment caries?
BECAUSE…DECAY NEEDS TO BE TREATED WITH A FILLING NOT ANTIBIOTICS
PRODUCED BY: STREPTOCOCCUS MUTANS
NO
For a localized dental infection, when is drainage applied?
IF DRAINAGE CANNOT BE DONE OR IF THE CLIENT IS IMMUNOCOMPROMISED…ANTIBIOTICS ARE GIVEN
FIRST
WHAT IS Pseudomembranous colitis?
PSEUDOMEMBRANOUS COLITIS, A CAUSE OF ANTIBIOTIC-ASSOCIATED DIARRHEA (AAD) , IS AN
INFLAMMATION OF THE COLON
INFLAMMATION OF THE COLON WHEN GIVEN CLINDAMYCIN
Remember…
• Bactericidal: The ability to kill bacteria; effect is irreversible
• Bacteriostatic: The ability to inhibit or retard the multiplication or growth of bacteria; reversible
• Blood (serum) level: Concentration of the antiinfective agent present in the blood or serum.
• The importance of the serum level is that certain levels of an antibiotic are required to produce an effect on various types of organisms. For an antibiotic to be effective, the dose given must produce this concentration in the blood.
DEFINITIONS
• Superinfection, suprainfection:– Infection caused by proliferation of microorganisms different
from those causing the original infection
• Superinfection is more often caused by broad-spectrum antibiotics and increases when taken for a longer time period. – In this case, a reduction in the number of gram positive and gram-
negative bacteria allows the overgrowth of the fungus Candida albicans.
• The pathogenic organisms emerging in a superinfection generally are more difficult to eradicate than the original organism and more likely to exhibit resistance.– most are caused by Staph or Strep – The practitioner can cause and eliminate infections
DEFINITIONS
• Anti-infective agent: – substances that act against or
destroy infections– substance that inhibits or kills
organisms that can produce infection, such as bacteria, protozoa, viruses etc.
• Antibacterial agents:– Substances that destroy or
suppress the growth or multiplication of bacteria
• Antibiotic agents:― Chemical substances
produced by microorganisms that have the capacity, in dilute solutions, to destroy or suppress the growth or multiplication of organisms or prevent their action
DEFINITIONS
The difference among the terms
antibiotic, antiinfective, and
antibacterial is that antibiotics
are produced by microorganisms,
whereas the other agents
may be developed in a
chemistry laboratory (not
from a living organism).
WHAT DOES CULTURING MEAN?
CULTURE AND SENSITIVITY IS THE ONLY WAY TO BE SURE A DRUG WILL KILL OR INHIBIT THE GROWTH OF
THE INFECTING MICROORGANISMS.
Sensitivity involves exposing the organism to test antibiotics and determining whether the organism is sensitive or resistant
MEANS GROWING THE BACTERIA
CULTURE & SENSITIVITY
An antibiotic disk with a zone around it shows sensitivity. After the organism is identified, it is grown on culture medium.
Observing whether the organisms are sensitive or resistant to certain test
antibiotics assists in determining which antibiotic to use in difficult infections.
One to two days are required before the results of the test are available. Although antibiotic therapy can start before
this time, it may be changed after the results are available. THEREFORE, Antibiotic therapy CAN be initiated
BEFORE the results of the test are available. If clinical response has been adequate, the original antibiotic is often
continued despite sensitivity results.
CULTURE AND SENSITIVITY IS THE ONLY WAY TO BE SURE A DRUG WILL KILL OR INHIBIT THE GROWTH OF
THE INFECTING MICROORGANISMS.
Sensitivity involves exposing the organism to test antibiotics and determining whether the organism is sensitive or resistant
MEANS GROWING THE BACTERIA
WHAT IS SUPERINFECTION?
AN OVERGROWTH OF ORGANISMS PRODUCED
WHAT ANTIBIOTIC HAS THE HIGHEST INCIDENCE OF GI COMPLIANTS?
ERYTHROMYCIN
Pregnancy Considerations– Antimicrobial agents that can be used during pregnancy to
treat infections are limited• Penicillin and erythromycin have NOT been
associated with teratogenicity and are often used– Before any antibiotics are used in the pregnant dental
patient, the patient’s obstetrician should be contacted• Metronidazole is not usually used & Tetracyclines
are contraindicated – Tetracycline: because of their effect on developing teeth and
skeleton
GENERAL ADVERSE REACTIONS & DISADVANTAGES ASSOCIATED WITH ANTIINFECTIVE AGENTS
MUST KNOW..
Penicillins• Divided into 4 groups:
1. Penicillin G and V **2. Penicillinase-resistant
penicillins3. Ampicillins – includes
amoxicillin **4. Extended-spectrum
penicillins
** most commonly used in dentistry
Within the group ONLY Penicillin G
is considered
to be the natural
penicillin
*See note
• See Table 7-3; Page 83 for FYI review
MUST KNOW..
WHAT IS THE MOST COMMON ANTIBIOTIC FOR DRUG ALLERGIES?
PENICILLIN
Specific Penicillins: Penicillin GTHE SALTS OF PENCILLIN G
• The potassium salt given intravenously produces the most rapid and highest blood level. • The penicillin’s duration of action is inversely proportional to the solubility of the
penicillin form: the least soluble is the longest acting.
• The benzathine salt given intramuscularly produces the lowest and most sustained blood level.
PENICILLINS
PENICILLIN
WHAT IS THE USUAL DOSE OF PEN V?
500 mg 4 times a day
Specific Penicillins: Penicillin V
• The usual adult dose of Pen V for treatment of an infection is:
–500 mg qid (4x a day) for the treatment of an infection
– for a minimum of 5 days and preferably for 7 to 10 days.
PENICILLINS
500 mg 4 times a day
WHAT IS CLEOCIN?
CLINDAMYCIN
RATIONAL USE OF ANTIINFECTIVE AGENTS IN
DENTISTRY
• Stage 1• Stage 2• Stage 3
Stage 1• Acute abscess and cellulitis are primarily
the result of gram-positive organisms– THE DRUG OF CHOICE IS: penicillin V for
patients who are not allergic to penicillin• 500 mg every 6 hours for 5 to 7 days
– Erythromycin ethylsuccinate or clindamycin for patients who are allergic to penicillin
RATIONAL USE OF ANTIINFECTIVE
AGENTS IN DENTISTRY
Stage 2• Infection is mixed; can be
handled by attacking either the gram (+) organisms or the (-) anaerobes– Gram-positive organisms can be managed
with the same drugs as in stage 1(Erythromycin or clindamycin for patients who are allergic to penicillin)
– For anaerobes, an antiinfective with good anaerobic coverage is needed • The two antibiotics with the most
anaerobic coverage are clindamycin and metronidazole
• Penicillin V also has anaerobic coverage
RATIONAL USE OF ANTIINFECTIVE
AGENTS IN DENTISTRY
Clindamycin or metronidazolewould be the
best choice to attack the
anaerobes in a stage 2
infection
Stage 3• The organisms have coalesced into one
area and are almost solely anaerobic– Most often, incision and drainage is
sufficient– If chronic infection persists or the patient is
immune compromised, use of antibiotic with anaerobic coverage is warranted
RATIONAL USE OF ANTIINFECTIVE
AGENTS IN DENTISTRY
Making Sense of the StagesExample: Oral Cavity Infections
• Oral-cavity infections are generally understood to advance through three stages. –The three stages are:
• (1) mixed aerobic and anaerobic infection, • (2) aerobic infection, • (3) anaerobic infection.
–YET, what order do these stages occur?
Making Sense of the StagesExample: Oral Cavity Infections
• THEREFORE, the order of the stages for oral infections occur as follows:
• (2) aerobic infection,• (1) mixed aerobic and anaerobic
infection,• (3) anaerobic infection.
Chapter 8
WHAT ARE ANTIBIOTICS AND ANTIINFECTIVES NOT AFFECTIVE AGAINST?
Fungal or Viral Infections
IS FUNGUS ACUTE, CHRONIC, OR BOTH?
CAN BE BOTH
• ANTIFUNGAL AGENTS: Substances that destroy or suppress the growth or multiplication of fungi
• Infrequent but when present, difficult to treat
• Insidious (sneaky and quick)• More likely to occur on
immunocompromised patients• Can become chronic (long-standing)
ANTIFUNGAL AGENTS
• Can be divided into 2 divisions:
ANTIFUNGAL AGENTS
FUNGAL INFECTIONS
Mucocutaneous Systemic
•skin or mucosa•commonly seen in the dental setting•treated with topical or systemic antifungal agents •also, commonly occur in the vaginal canal
•whole body•more serious in nature
HOW COULD AN ORAL CANDIDIASIS INFECTION BE TREATED IN THE MOUTH?
ORAL CANDIDAL INFECTIONS ARE OFTEN TREATABLE WITH ORAL ANTIFUNGAL LOZENGES AND RINSES
AN ANTIFUNGAL..
CANDIDA ALBICAN
• is part of the normal flora; overgrows if patient is on long term antibiotics or ill fitting denture
• is used for both the treatment and the prevention of oral candidiasis in susceptible cases.
• poor oral absorption:• is not absorbed from the mucous
membranes or through intact skin; taken orally, it is poorly absorbed from the GI tract.
NYSTATIN(Mycostatin, Nilstat)
ANTIFUN-GAL
AGENTS
HOW COULD AN ORAL CANDIDIASIS INFECTION BE TREATED IN THE MOUTH?
HOW LONG SHOULD A NYSTATIN RINSE REMAIN IN THE MOUTH?
2 minutes – for the BEST effect
WHAT IS NICKNAMED ‘AMPHOTERRIBLE’?
• Amphotericin B poorest safety profile• Also known as Fungizone
AMPHOTERICIN B
WHY ARE VIRUSES DIFFICULT TO TREAT?
MEANING…THEY WILL NOT DESTROY THE HOST OF A CELL
THEY CO-OPERATE WITH THE HOST CELLS
Remember also…
SUMMARY – KEY POINTS• Works by inhibiting replication of DNA• Food does not affect the drug’s absorption• The antiviral action of acyclovir includes
herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2), Epstein-Barr and varicella-zoster
• One of the most common adverse effects associated with oral acyclovir is headache. • Anorexia and a funny taste in the mouth have been reported rarely (not
common).
HERPES SIMPLEX: ACYCLOVIRANTIVIRAL AGENTS
Remember also…
BY TAKING ABREVA – HOW MUCH IS HEALING TIME REDUCED?
(NOT MUCH )
ONE HALF DAY
WHAT IS THE CATEGORY OF DRUGS CALLED WHEN TREATING HIV?
ANTI-RETROVIRAL DRUGS
• Nucleoside reverse transcriptase inhibitor (NRTI) zidovudine (AZT)
(Retrovir)
• Nonnucleoside reverse transcriptase inhibitor (NNRTI) nevirapine (Viramune) –
specific for HIV 1
• Protease Inhibitors saquinavir (Invirase)
ANTIVIRAL AGENTS
Examples of Drugs Used to Treat HIVSEE NOTE
CHAPTER 9
WHY IS EPI USED IN LOCAL ANESTHETICS?
MEANING. .THE LOCAL ANESTHETIC LASTS LONGER TO ENSURE PROPER FREEZING OF THE TOOTH AND TISSUES
PROLONG DURATION
WHAT ARE SOME EXAMPLES OF LOCAL ANESTHETICS USED
TODAY?
• The amide lidocaine (Xylocaine) was released in 1952
• mepivacaine (Carbocaine) was released in 1960
• More recently, bupivacaine (Marcaine) has been made available for dental use
HISTORY
potent local anaesthesia reversible local anaesthesia
should be followed by complete recovery without evidence of structural or functional nerve damage
absence of adverse systemic effects & allergic reactions
rapid onset & good duration should have moderate lipid solubility which allows an
anesthetic agent to diffuse across lipid membranes of all peripheral nerves (motor, sensory, autonomic)
adequate tissue penetration low cost long shelf life (stability in solution) ease of metabolism & excretion
IDEAL LOCAL ANESTHETIC PROPERTIES OF THE IDEAL
LOCAL ANESTHETIC
WHAT ARE THE TWO GROUPS OF LOCAL ANESTHETICS?
CROSS -HYPERSENSITIVITY BETWEEN AMIDES AND ESTERS IS UNLIKELY
AMIDES AND ESTERS
Absorption & L.A.
infection
tooth • ↓ pH• ↑ ionization
• ↑ [H+]
localanaesthetic
(L.A.)L.A.
L.A.
L.A.
In the presence of infection, there may be a reduced clinical effect of L.A. due to the ↓’d pH level. The infection site is
more acidic and more ionized and less likely to absorb the L.A drug (weak base).
*Weak bases are better absorbed when the pH is greater than
the pKa
EG: Lidocaine’s pKa =7.9(Weak
base drug)
IF INFECTION IS PRESENT, HOW DOES THE LOCAL ANESTHETIC
REACT?
IN THE PRESENCE OF AN ACIDIC ENVIRONMENT, SUCH AS INFECTION OR INFLAMMATION, THE AMOUNT OF
FREE BASE IS REDUCED
IT IS HARDER TO FREEZE –LIKELY INFECTION MUST BE CLEARED BEFORE
FREEZING IS DONE.
WHAT DOES ADME STAND FOR?
ABSORPTIONDISTRIBUTIONMETABOLISMEXCRETION
VERY IMPORTANT!
ABSORPTION
• Addition of vasoconstrictor to local anesthetic: Reduces the blood supply to the
areaso as to ↓ rate of diffusion of anaesthetic into the blood vessels
this also prolongs the duration & effectiveness of the desired action
decreases bleeding in the areaLimits systemic absorptionReduces systemic toxicity
PHARMACOKINETICS
METABOLISMLA agents are metabolized differently,
depending on whether they are amides or esters.
• AMIDES: are metabolized primarily by the liver
• In severe liver disease or with alcoholism, amides may accumulate and produce systemic toxicity
• ESTERS: are hydrolyzed by plasma pseudocholinesterases and liver esterases
PHARMACOKINETICS
ADVERSE REACTIONS
• Although toxicity to local anesthetics is rare in the doses normally used in dentistry, patients can still suffer from a classic toxic reaction.
ADVERSE REACTIONS
LOCAL ANESTHETIC TOXICITY causes stimulation of the CNS
including:restlessness, tremorsseizures followed by CNS depression and coma.
HOW MANY CARPS ARE MAX FOR LIDOCAINE?
8.5 CARPS
WHY WOULD A HEMATOMA BE PRODUCED?
POOR INJECTION TECHNIQUE OR EXCESSIVE VOLUME
MALIGNANT HYPERTHERMIA
• An autosomal dominant trait characterized by often fatal hyperthermia with rigidity of muscles occurring in affected people exposed to certain anaesthetic agents– particularly halothane & succinylcholine (G.A.’s)
• NOT related to amides!– In the past, the belief was that the amide local
anesthetics might precipitate malignant hyperthermia, but they are currently no longer implicated. Patients with a family history of malignant hyperthermia can be given amide local anesthetic agents.
ADVERSE REACTIONS
POOR INJECTION TECHNIQUE OR EXCESSIVE VOLUME
. .WHAT IS BEST?
IF A WOMAN IS PREGNANT AND ANESTHETIC MUST BE GIVEN…
LIDOCAINE
AMIDES OR ESTERS?
WHAT TYPE HAS A GREAT POTENTIAL FOR ALLERGY?
ESTERS
I. Amides (Only class of anaesthetics used parenterally)
i. Lidocaine (Xylocaine)ii. Mepivacaine (Carbocaine)iii. prilocaine (Citanest; Citanest Forte)iv. bupivacaine (bu·piv·a·caine)
I. Esters (No esters are currently available in a dental cartridge)
i. procaineii. propoxycaineiii. Tetracaine
LOCAL ANESTHETIC AGENTS
**Esters are not used in dentistry as local
anesthetics, but used topically.
eg. Benzocaine.
SOME COMMONLOCAL ANESTHETIC AGENTS
LA AGENT NOTES
• procaine • no longer used
• lidocaine (Xylocaine) • most common used• least painful• can only use 100,000epi
• mepivacaine (Carbocaine; Isocaine)
• shortest duration • when no epi is needed.
• bupivicaine (Marcaine) • Painful• longest duration 6-8
hours
• articaine (Septocaine) • the most potent
• prilocaine plain (Citanest)• Prilocaine epi (Citanest
Forte)
• similar to lidocaine• rapidly metabolized
SEE NOTE
WHAT IS THE MOST COMMON LA USED IN DENTISTRY?
LIDOCAINE 2% - (1:100 000 EPI)
WHICH ONE HAS THE LONGEST DURATION OF ACTION?
MARCAINE
buprivacaine(Marcaine)
• Has the longest duration of action.– major advantage greatly prolonged duration of action. – indicated in lengthy dental procedures when pulpal
anesthesia of greater than 1.5 hours is needed or when postoperative pain is expected.
• Related to lidocaine & mepivacaine• More potent but less toxic than the other amides• Available in dental cartridges as a 0.5% solution
with 1:200,000 epinephrine
LOCAL ANESTHETIC
AGENTS
AMIDES
WHAT IS BOTH AN ESTER AND AN AMIDE?
ARTICAINE
IF A CLIENT HAS UNCONTROLLED BLOOD PRESSURE – CAN LA BE GIVEN IN A
CONTROLLED DOSE?
NO – IT IS BEST TO DELAY TREATMENT
OVERVIEW
A CARDIAC PATIENT can be given
2.0 CARTRIDGES of
1:100,000 epinephrine without
exceeding the cardiac dose.
VASOCONSTRICTORS
WHAT IS THE MAXIMAL SAFE DOSE FOR A HEALTHY CLIENT?
THE MAXIMAL SAFE DOSE OF EPINEPHRINE FOR THE HEALTHY PATIENT IS 0 .2 MG AND FOR THE CARDIAC
PATIENT IS 0 .04 MG
0.2 MG OF EPI
WHAT IS ORAQIX?
SOMETHING THE RDH CAN USE TO FREEZE THE GUMS
CHAPTER 10
CAN NITROUS OXIDE BE USED ALONE AS AN ANESTHETIC?
NO!
WHAT ARE THE STAGES/PLANES OF ANESTHESIA?
STAGE I – ANALGESIASTAGE I I – DELIRIUM OR EXCITEMENTSTAGE I I I – SURGICAL ANAESTHESIA
STAGE IV – RESPIRATORY OR MEDULLARY PARALYSIS
STAGES…
VERY IMPORTANT…
STAGES AND PLANES OF ANESTHESIA
MECHANISM OF ACTION
Stage I – Induction PeriodNitrous oxide, as used in the dental office, maintains the patient in STAGE I
Analgesia AnalgesiaAmnesiaEuphoriaconsciousness
Stage II – Induction Period Excitement ExcitementDeliriumcombativeness
Stage IIIWhere most major surgery is performedDivided into four planes
Surgical Anesthesia
UnconsciousnessRegular respirationDecrease in eye movementloss of respiratory control
Stage IV Medullary Depression
Respiratory arrestCardiac depression and arrestNo eye movement
VERY IMPORTANT…
WHAT IS NITROUS OXIDE?
ANTIANXIETY AGENT + ANALGESIC AGENT
COLORLESS AND ODOURLESS GAS
WHY IS NITROUS OXIDE NOT GOOD TO USE AS A GENERAL ANESTHETIC ALONE?
B E C A U S E O F I T S L O W P O T E N C Y ( M A C > 1 0 0 ) , I T I S U NS AT I S FA C T O RY A S A G E N E R A L A NE S T H E T I C W H E N U S E D A L O N E
I F, H O W E V E R , A N E S T H E S I A I S F I R S T I ND U C E D W I T H A R A P I D LY A C T I N G I V A G E N T A N D N 2 O / O 2 I S A D M I N I S T E R E D I N
C O M B I N AT I O N W I T H A VO L AT I L E A N E S T H E T I C , E XC E L L E NT B A L A N C E D A NE S T H E S I A I S P R O D U C E D
MAC > 100
NITROUS OXIDE
THEREFORE,
Nitrous oxide combined with a halogenated inhalational
anesthetic (N2O/O2)
DECREASES THE MAC
• N2O/O2 is given throughout most surgical procedures that necessitate the use of general anesthesia because it reduces the concentration of other agents needed to obtain the desired depth of anesthesia.
GENERAL ANESTHETICS
NITROUS OXIDE
The average percentage of nitrous oxide required for patient comfort is 35%.
• DELIVERY: 100% O2 (2-3 minutes) → N2O added in
5-10% increments → until patient response indicates level of sedation reached→ after termination of N2O, 100% O2 (at least 5 minutes)
GENERAL ANESTHETICS
WHY SHOULD THE CLIENT BE PLACED ON 100% OXYGEN
AFTERWARDS?
TO AVOID DIFFUSION HYPOXIA
WHAT COLOR IS THE NITROUS TANK?
* *REMEMBER THIS!
BLUE
NITROUS OXIDE
• Complications have been the result of misuse or faulty installation of equipment
GENERAL ANESTHETICS
ADVERSE REACTIONS
• NO2 tank → blue
• O2 tank → green
DON’T GET THESE MIXED UP!!
• Cylinders are “pin coded” to prevent mixing of cylinders and lines
• NO2 concentration should be automatically limited and have a fail-safe system that shuts off automatically if the O2 runs out
WHEN SHOULD NITROUS NOT BE USED?
USE OF NITROUS OXIDE IS CONTRAINDICATED IN PATIENTS WITH ANY TYPE OF
UPPER RESPIRATORY OR PULMONARY OBSTRUCTION
IF THEY HAVE TROUBLE BREATHING…
CHAPTER 11
KEEP IN MIND…
• Stress or anxiety due to dental treatment can be treated with both pharmacologic and nonpharmacologic methods.
• The treatment of choice is often dependent upon the patient and his or her stress level.
• The normal sedative dose (calms normal patient without dental appointment) is not expected to produce calmness in the dental patient, • but the hypnotic dose (that which
induces sleep in the normal patient) can often produce the desired degree of sedation before dental treatment
INTRODUCTION
KEEP IN MIND…
ORAL SEDATIVES OR IV?
WHAT IS THE MOST COMMON WAY TO TREAT ANXIOUS PATIENTS?
ORAL SEDATIVES
However, the dose of a particular
antianxiety agent effective for a particular patient is vastly
variable and thus, is NOT predictable.
INTRODUCTION
WHAT DOES A LARGER DOSE OF ANT-ANXIETY AGENTS PRODUCE?
(A SMALL DOSE PRODUCES SEDATION)
INDUCES SLEEP
INTRODUCTION
Antianxiety Agents
Sedatives** Hypnotics
** can be sedative or hypnotic – depending on
dose; larger doses provide hypnotic effect
WHAT ARE THE MOST COMMON PRESCRIBED ANTI-ANXIETY DRUGS?
BENZODIAZEPINES!!!
BENZODIAZEPINESEXAMPLES
alprazolam (Xanax)chlordiazepoxide (Librium) clonazepam (Klonopin)chlorazepate (Tranxene)diazepam (Valium) – very popularestazolam (ProSom)flurazepam (Dalmane)halazepam (Paxipam)lorazepam (Ativan) -newer form of benzodiazepines -
popularmidazolam (Versed) oxazepam (Serax) quazepam (Doral)temazepam (Restoril)triazolam (Halcion)
SEE NOTE
WHAT IS THE PREFERRED AGENT USED FOR THE ELDERY?
LORAZEPAM
WHAT IS PTOSIS?
DROOPING OF THE UPPER EYELID
IF DRUGS ‘NEED’ TO BE TAKEN DURING PREGNANCY, WHEN IS THE BETTER TIME?
DURING THE 1 S T TRIMESTER, MALFORMATIONS HAVE BEEN REPORTED
2ND TRIMESTER
Remember..
ABUSE AND TOLERANCEOVERVIEW• Abuse & Addiction potential is less than that of
the barbiturates• Physical dependence and tolerance can develop• Combining with other CNS depressants can
reduce the safety and can become lethal• Overdose poisoning is rare; difficult to achieve
when used alone • The addition of alcohol can result in coma,
respiratory depression, hypotension, or hypothermia
BENZODIAZEPINES
WHAT IS EMESIS?
USED WITH OVERDOSE – SUCH AS ACTIVATED CHARCOAL AND SALINE
INDUCED VOMITTING
WHAT CAN BE USED TO REVERSE THE EFFECTS OF BENZODIAZEPINES?
IN THE IV FORM
flumazenil (ROMAZICON),
WHAT ARE SOME WAYS TO MANAGE INSOMNIA?
MEDICAL USESInsomnia Management
The following habits should be followed to minimize insomnia :
A.Light snack (warm milk) at
bedtimeB.Awake at 6 AM even if sleep only
began at 5 AMC.Exercise during the day, but NOT
within 3 hours of bedtime. D.Remaining in bed no longer than
20 minutes without sleepingE.No smoking within 8 hours of
bedtime
BENZODIAZEPINES
WHAT ARE SOME WAYS TO MANAGE INSOMNIA?
This next slide will likely be on the exam ..…
PHARMACOKINETICSBARBITURATES
• Absorption: barbiturates are well absorbed orally and rectally; used intravenously but not intramuscularly
• Distribution: IV agents are inactivated by redistribution from site of action in the CNS, to muscles, and adipose tissue
• Metabolism: short- and intermediate-acting barbiturates are rapidly and almost completely metabolized by the liver
• Excretion: long-acting barbiturates are largely excreted through the kidneys as a free drug
WHAT ARE LONG ACTING BARBITURATES USED FOR?
USED FOR EPILEPSY
USES
phenobarbital (Luminal) most commonly used for its anticonvulsant effect
because of its long-acting effects
BARBITURATES
USED FOR EPILEPSY