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Pharm Test I
Oral Sedatives/Hypnotic Agents
27
Pharmacology
Post-Graduate
10/24/2010

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Term
Sedative/Hypnotic Drugs- produce what effect and characterized by what?
Definition
produce a NONSELECTIVE depression of the CNS which is characterized by:
low doses - 1) drowsiness 2)slowing of reaction timse
high doses- 1) loss of consciousness and sleep
highest doses- 1) surgical anesthesia 2)coma 3) respiratory arrest
Term
barbituate prototype
Definition
secobarbital (seconal7)
Term
what is seconal's dental application
Definition
1)night before appointment sedative to provide good rest- used with middle aged patients- puberty to 65
Term
barbituates mechanism of action
Definition
binds to specific receptors that enhance the affinity of GABA for GABA receptors and open Cl- channels
this prolongs the time the Cl- channels stay open
at high doses can act without GABA binding and open Cl- channels
inihibits glutamate AMPA receptors (these are excitatory NT)
Term
pharmacodynamics of barbituates
Definition
1)has low degree of selectivity and a low therapeutic index compared to benzodiazipines
2)pharmacokinetics (increase in metabolism) and pharmacodynamics( decrease in receptor sensitivty) tolerances develop
Term
how do the kinetic tolerance and dynamic tolerance differ with barbiutates?
Definition
kinetic tolerance peaks in a few days, dynamic tolerance climbs for weeks
Term
barbitol contraindications
Definition
1) patients in pain- can cause hyperalgesia
2)acute intermittant porphyria or variegate porphyria - can trigger attacks
Term
barbitol bad side effects
Definition
paradoxical excitement
2)stomatitis medicamentosa
Term
what are antihistamines?
Definition
H1 receptor antagonists
Term
promethazine (phenergan)
Definition
antihistamine- also used for schizos
Term
hydroxyzine (atarax, vistaril)
Definition
antihistamine
Term
what is the dental application of antihistamines?
Definition
1) sedation
2) antiemetic
3)allergies
Term
what is the mechanism of action of antihistamines?
Definition
thought to be related to their abilities to inhibit alpha 1 adregergic, muscarinic, and seratonergic receptors in the CNS
Term
who are antihistamines as sedatives primarily used for?
Definition
children and geriatrics
Term
antihistamine antiemetic mechanism of action
Definition
inhibition of activity of the chemoreceptive trigger zone (CTZ) antimuscarinic actions
Term
what are antihistamine antiemetics generally used before?
Definition
opioids
Term
diphenhyramin (benadryl)
Definition
antihistamine used for minor drug induced allergic reactions
Term
chlorpheniramine (chlorotab)
Definition
antihistamine used for minor drug induced allergic reactions
Term
contraindications of antihistamines
Definition
1)breastfeeding- hyperexcitability and seizure in infant
2)history of SIDS- can cause respiratory depression in children
3)narrow angle glaucoma
4)patients with COPD - can thicken bronchial secretions
Term
antihistamines bad side effects
Definition
paradoxical excitements
cardiac effects- those patients with cardiac problems
Term
which antihistamine seems to cause fewer untoward effects than the other
Definition
hydroxyzine seems to produce less than promethazine
Term
chloral hydrate (notec) dental application
Definition
to sedate young children
Term
chloral hydrate (noctec) mechanism of action
Definition
is it rapidly reduced by alcohol dehydrogenase to trichloroethanol, which exerts barbiturate-like effects on GABA receptor channels
Term
chloral hydrate contraindications
Definition
ulcer patients
Term
chloral hydrate untoward effects
Definition
gastric irritation - nausea and vomiting
dependence
carcinogenicity- a number of its metabolites are known carcinogens
Term
what DEA schedule is chloral hydrate?
Definition
DEA schedule IV
Term
what drugs (all of them) are contraindicated for narrow angle glaucoma patients?
Definition
diazepam, cholinergic blocking agents
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