- minimum alveolar concentration that will inhibit movement in response to skin incision in 50% of pts

- measure of potency (lower MAC = more potent)

- inspired dose that will abolish fighting reflex in 50% of mice

- effective dose

- ratio of amt of inhaled anesthetic in blood to amt in tissue

- measure of solubility of gas in blood

- lower number (low in blood, high in tissue) = lower solubility in blood = faster acting

- must be soluble enough to cross BBB, but insoluble enough to leave blood to go to brain tissue

- 60-80% exhaled unchanged

- some by CYP450 in liver

 Halothane - trifluoroacetic acid

Sevoflurane - hexafluoroisopropanol

- bradycardia

- atrioventricular arrhythmia

- decreased BP and HR (due to attenuation of depolarization)

- dilation of vascular beds of skin and brain (systemic resistance unchanged)

- decreased in alveolar ventilation

- CO2 accumulation

- bronchodilation

- increase in intercranial pressure

- decrease in cerebral blood flow and metabolism

- relaxation

- trigger for malignant hyperthermia

- low partition coefficient (so rapid onset)

- metabolized slowly (only desflurane is slower) - 0.2%

- low partition coefficient (rapid onset, offset)

- 3% metabolized by CYP450

- reduction in tidal volume

- increase in respiratory rate

- bronchodilation

- increase in CO2 (measured w/ capnographer)

valium - seizures

morphine - myocardial infarction

 (Same as Halothane)

- increase in intercranial pressure

- decrease in cerebral blood flow and metabolism

(Same as Halothane)

- relaxation

- trigger for malignant hyperthermia

Desflurane = .42

Nitrous = .47

Isoflurane = 1.46

Halothane = 2.54

Nitrous = 104

Desflurane = 6

Isoflurane = 1.15

Halothane = .77

- low solubility in blood (.47), so can leave and enter spaces normally filled with air (middle ear or lung), causing increased pressure

- BUT, 35x more soluble than N2 and 100x more soluble than O2

- rapid release of N2O will cause vacuum effect in alveoli, causing 2nd gas to rush in

- increases onset time of other inhaled anesthetics

- vast majority exhaled w/ in 3-5 minutes (no reservoir)

- 1% eliminated thru skin and lungs

- small amt of degradation by anaerobic bacteria in gut

- N2O leaves lungs very rapidly upon termination, flushing other gases (O2) out with it

- pt may become hypoxic (accompanied by nausea) and pass out

- counteract w/ administration of 100% O2 for 3-5 min upon termination

- vasodilation

- mild depression of contraction

- non-irritating (OK for asthmatics)

- no increased risk of bronchospasm

- none

- BUT, may see bloating

- inhibits methionine synthetase (vitamin B12 metabolism)

- long term exposure = pernicious anemia

- chronic short term exposure = B12 deficiency w/ neuropathy

- none w/ scavenging

- w/o scavenging, 2.6 risk of spontaneous abortion

systemic - slight vasoconstriction

pulmonary capillaries - vasodilation

- start w/ 100% O2 at 6L / minute

- then introduce N2O at 20% for 2-5 min

- increase N2O in 10% increments as needed

- dentist's role in sedation

- calmness, gentleness, careful explanation, etc.

N2O = light blue

O2 = green (or white, internationally)

- includes 1 agent of oral sedation that does not exceed max recommended dose

- no loss of protective reflexes

- multiple agents exceeding MRD

- and/or IV

- minimal effect on protective reflexes

- partial loss of protective reflexes

- airway may be affected

- loss of all protective reflexes

- intubation

- ease of administration

- low cost

- decreased incidence/severity of adverse reactions

- reduced armamentarium

- prolonged latent period (b/w administration and effect: 30 min)

- incomplete/erratic absorption of drug

- inability to titrate

- prolonged duration

- desired depth of sedation

- procedure length

- half-life

- pt ASA status

-1st effective sedative used in dentistry

- CNS depressant

- no analgesic properties

- hepatotoxicity

- only use when benzodiazepines ineffective

- form of EtOH

- CNS depressant

- gastric irritant (vomiting common)

- dental dose = 500-1000mg, 1 hr before appt.

- primarily used in pediatrics

- opioid

- mix of meperidine (narcotic) and promethazine (antihistamine)

- CNS depressant

- should only be used for pain management

- decreased hangover

- fewer side effects

- wide safety margin at MRD

- CNS (limbic) depression by inhibiting GABA reuptake

- rapidly absorbed

- 1/2 life of 1.5-70 hrs

- reduces hostile/aggressive behavior

- muscle relaxant

- ataxia

- drowsiness

- fatigue

- excitement, hallucinations, insomnia, rage

- whatever was keeping their emotions in check has been eliminated

- good antianxiety med

- no active metabolites (few side effects)

- rapid onset

- short-term retrograde amnesia

- IV or oral liquid

- sedation and profound amnesia

- interacts w/ many other drugs

alprazolam/xanax - 8-12 hrs

triazolam/halcion - 2-3 hrs

midazolam/versed - 2-4 hrs

alprazolam/xanax - .5-1mg at bedtime or 1 hr before appt

triazolam/halcion - .25-.5mg 1 h before appt (after 1/2 life expires, may supplement w/ 1/2 of initial dose)

midazolam/versed - IV = 5-10mg, Oral = 15-20mg

- reverses effect of benzodiazepine

- sublingual injection

- could cause seizures in epileptics

- sleeping pills

- approved for sedation

- rapid onset (30-60 min)

- short duration (4 hrs)

- inhibit GABA reuptake

short term - headache, myalgia, dizziness, nausea

long term - xerostomia

zolpidem/ambien - 1.5 hr

zaleplon/sonata - 1-2 hrs

- used for their side effects

- antiemetic

- analgesic at high doses

- postural hypotension

- xerostomia

- blurry vision

- syncope

- reacts w/ other CNS depressants

- may lower seizure thresholds

- decongestant

- minimal/moderate sedation

promethazine/phenergan - 20-50mg

hydroxyzine/atarax - 10-50mg

I - analgesia/sedation (dental use)

II - delirium/excitement (might be mistaken for insufficient dose)

III - surgical anesthesia (loss of protective reflex, spontaneous respiration)

IV - medullary paralysis / death

- gold standard of pt monitoring

- measures amt of oxygenated blood in circulation (via red and infrared light absorption by oxyHb and deoxyHb)

- do not use exclusively

- use broad spectrum (but don't want to wipe out everything)

- use bactericidal ove bacteriostatic (e.g., PCN over tetracyclene)

- use correct dosage for pt's weight

- use drugs with least side effects / lowest cost

- appropriate length of therapy, intervals b/w doses

- nausea, vomiting, diarrhea, allergic rxn (cross allergy w/ cephalosporins)

- 500mg qid

- 250 or 500mg capsules

- less bactericidal than PenVK

- side effects similar to PCN, but most common cause of pseudomembranous colitis due to high Fx

- 500 mg tid

- 250 or 500 mg capsules

- amoxicillin + clavulanate (B-lactamase inhibitor)

- similar to amoxicillin and PenVK, but more nausea and vomiting

- 500mg bid

- variety of capsules, chewables, suspensions

- 1st generation cephalosporin

- good 2nd option after PCN

- cross allergy w/ PCN

- good for skin wounds

- prescribed as capsule AND suspension

- 1st generation cephalosporin

- longer 1/2 life than Keflex

- cross allergy w/ PCN

- 500mg bid

- 500mg tablets

- poor choice for odontogenic infections

- inactivated by stomach acid

- GI disturbance common; cardiotoxicity (macrolide); affects liver metabolism of theophylline, digoxin, tegretol, coumadin, cephalosporin

- 250mg qid

- good coverage for odontogenic infection

- associated w/ pseudomembranous colitis

-300mg qid

- pelvic infections

- used in combo w/ PCN for head/neck infections

- vomiting when mixed w/ OH

- 500mg qid

- BACTERIOSTATIC

- broad spectrum

- hypersensitivity, photosensitivity, GI upset, delayed clotting, discolors teeth, avoid during pregnancy

- 500mg qid

- macrolide (like erythromycin)

- very long 1/2 life

- 500mg 1st day, 250mg/day afterwards

- macrolide (like erythromycin and zithromax)

- broader spectrum and 1/2 life

- works well for chronic sinusitis

- GI upset, competitive metabolism w/ other drugs

- 500mg bid

- depression of ventilation

- miosis

- bradycardia

- hypothermia

- indifference and eupohoria, physical dependence

- analgesia

- sedation

- miosis

- dysphoria

- tachycardia

- tachypnea

- mydriasis

- alter PERCEPTION of pain at spinal cord and CNS

- alter emotional response to pain

- do NOT alter response at afferent nerve ending

- increases GI smooth muscle tone, decreases vasomotor tone

- analgesia, sedation, mood alteration, respiratory and cough suppression

- naturally occurring opioid

- decreases GI motility (nausea and vomiting)

- true allergy rare

- given w/ 300mg acetaminophen in increasing doses (15mg, 30mg, etc.), or by itself

- hydrocodone

- less GI stress than codeine

- given w/ 500mg acetaminophen in increasing doses (2.5mg, 5mg, etc.)

- darvocet

- given w/ acetaminophen

- 50-100mg

- dilaudid

- 1-8mg

- very long 1/2 life (25 hrs)

- dolophine

- 5-10 mg

- opiate ANTAGONIST

- used to counter effects of opiate agonists

- no effect on normal person

- highest affinity for mu receptor

- greater analgesia, fewer side effects in combo w/ narcotic

- antidote to hepatotoxicity = acetylcysteine

- 325-1000 mg

- NSAID

- GI irritation and bleeding

- watch out w/ pregnancy

- NSAID

- inhibits prostaglandins

- selective activity at mu receptor

- inhibits reuptake of serotonin and NE

- may lower seizure threshold

- ANTAGONIST at mu receptor

- agonist at kappa and sigma receptors

- about 1/4 as potent as morpine

- musculoskeletal pain

 - arthritis

- rheumatic fever

- thrombosis

- gout

- Kawasaki syndrome