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