pharma sheet #24 - Muan Sawan

بسم الله الرحمن الرحيم

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http://www.freefileconvert.com/converted/4cfbd8c7e18bb/pharma_22_11.doc
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Anxiolytic and hypnotic drugs

Anxiolytic: anti anxiety drugs.
Hypnotic: sedative drugs.
Some times as a dentist you need to prescribe a drug if the patient was so anxious and afraid (anxiolytic) or to let him be asleep ( but not to be unconscious )and maintain normal breathing (hypnotic).
Anxiety :unpleasant condition that seen to be arise from unknown source (in dental clinic the source is well known :D ) ,,,, unknown source : some people used to be anxious and angry without reason ,,always sympathetic is activated,, y3ne bl 3rbe daymn m8ab3a m3hom,, daymn mstnfereen :S ).
Symptoms of severe anxiety are similar to the fear :tachycardia , palpitation, involved sympathetic activity.
In general (in medicine) we treat anxiety if it was severe type, while normal anxiety (every-day anxiety )we don’t treat it.
Very imp note: anxiety drugs is the same of sedative hypnotics ( because all antianxietic drugs cause sedation,,, any drug often function chemically on both ;anxiolytic and hypnotic.)…soooo, dosing is important : if the dose is less, then its anxiolytic…but if the dose is higher then its hypnotic).
Two important grps of anxiolytic and hypnotic ( valium o a5awateha ):
Benzodiazepines drug (A): (main grp)
*zman kano yest3melo drug esmoh parpetuarate !!!!! bs hll2 best3mlo benzodiazepines.
Mechanism of action of benzodiazepines:
In C.N.S there are channels that allow Cl ions to cross through the membrane,,
In normal situation GABA activate these channels then Cl ions cross the membrane>>HYPERPOLARIZATION ,,,, so keep patient away from depolarization ,, keep him away from action potential ,,, Soooo GABA is inhibitory.
Benzodiazepines increase the affinity of receptors to GABA so increase the frequency of opening the channel, and so, it increase INHIBITORY activity.
NOTE: parpiturate increase the DURATION of channel opening ,while benzodiazepine increase affinity,,, but the end result is the same ,, bs a7sn nest3ml benzodiazepine l2enno they are not the same at chemical manifestation .
Benzodiazepines have 5 imp. Applications : "but the most imp. Are #1 and #3 in the slides )anxiolytic and hypnotic )"
Applications :
1)anxiolytics :imp. Application un dentistry
Used to relieve anxiety,, but as we said before we don’t use it to treat every day anxiety.
** these drugs must be used for a short time bcoz of its high addiction potential,, so we have to be aware from with-drawal syndrome.. and should be used with caution in the clinic, especially if it used for sedation (bcoz we use higher doses)…..dr. b7kelkom : ma t5llo maree9' ye9'7ak 3lekom o y5llekom tktoboloh dawa enno 5ayef,,,, y3ne act enno afraid bs 3ashan ya5d dawa,, had bekoon mdmen,, so deero balkom .
We said that doses vary according to the usage :
>>> anxiolytic>>less dose >>less probability to addiction ,, while hypnotic >>high doses >> hight addiction probability.
>>> tolerance: remember that any drug that cause addiction,, tolerance may be part of its action >>reduction of response to these drugs so patient start increasing the dose to have the effect "asking for it".
>>>cross tolerance may occur.
2)muscle relaxant :
e.g multiple sclerosis >>demylination >> so muscle spasm may occur,,,,, we use benzodiazepines in high doses to relieve the spasm :
a) increase pre-synaptic inhibition.
b)used before surgery.
3) integrated amnesia. (# 5 in the slides) :
Cause temporarily,, impairment of the memory,,very imp. In angioplasty and stents
يعني في حالات الشبكات..لان المريض بكون صاحي خلال العملية وشايف شو عم يصير ..لذلك عشان ما يصير عنده اكتئاب كل ما يتذكر شو اللي صار معو..بعطوه ادوية عشان ينسى..يعني مجرد ما يطلع بنسى شو اللي صار .
4) sedation (2 parts) :
Note: its imp. To balance the sedation effect needed at bed time with residual sedation of hang over.
Three most commonly prescribed drugs for sleep disprders are:
Long acting>>Florazepam.
Intermediate action>>Diazepam
Short acting >> triazolam.
Sometimes you prescribe such a drug for a patient who cant sleep at the night before the clinic day ,so you give him sedation,,, or you give a patient sedation before surgery.
Note: hypnotic drugs must be given for a short time (from 2-4 weeks,,, l2ennoh mmkn y3ml addiction).
Back to drugs>> they have different sedation applications,,
i.e : 1) if a patient has difficulty to sleep, but once he is a sleep, he goes through deep sleep (REM) sooooo, we give him short acting drugs.
2)if the patient cant keep sleeping for a long time (y3ne he sleep 4 hours then wakeup again) then you should give himlong acting drugs.
3)some patients (benamooo bs sa3teen b3deen beb2oo 9a7yeeen o ma be2dro yerj3o ynamoo ) you give them intermediate,,,,, 5a99a heavy smokers .
** plz read the slides concerning this,,, dr. 8r2hom 3l saree3 
5)Anticonvulsion: (anti-epileptic drugs ) >> u may use these drugs but rarely.
Epilepsy : first level >> petit mal epilepsy.
2nd level : Grand mal >> 2-4 min.
3rd level: status epilepticus seizure >> up to 15 min.
We use benzodiazepine (specially to terminate Grand mal) IV or IM but not orally.
Advers effect of benzodiazepines:
1)Drowness and convulsions: i.e if the patient take the drug before the clinic , he must not drive his car by himself, bcoz he is confused.
2)Ataxia: like alcoholic person
Occur in high doses and affect high motor coordination.
فقدان القدرة على التعامل مع الأمور اللحظية لذلك ما منخلي المريض يقود سيارته.
3) Cognitive impairment.>> so we have to avoid giving children these drugs ( ella eza shwy o lefatra 8aleeleh )
-patients with liver diseases should avoid using these drugs.
-these drugs may increase intraocular pressure >>glaucoma
4)the most imp. Side effect >> respiratory depression (just like opioids)
But its occurs in high doses so we must avoid giving it to patients with respiratory problems like COPD,bronchitis,emphysema,asthma or sleep apnea : is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep.
Physiological and physical dependence:
If this occur,, with-drawal syndrome will occur with bad symptoms ( anxiety , tension,insomnia or agitation. Sooo we have to do titration (although with-drawal symptoms may occur but less.)
If over dose occur you give the patient benzodiazepine ANTAGONIST. (Flumazenil)
The end
المحاضرة كانت الأولى بعد الحج،لذلك.....مبينة كإنها ملاحظات  بس اقرؤوا السلايدات ( وما تخافوا لاني كتبت كل شي حكاه الدكتور  )
Good luck 
Done by : Muna jamal sawwan
Mon. lec. On 22-nov-10