IV SEDATION PHARMACOLOGY
- Location: On site training
- Price: $440
- Credits: 8
Description
YOU ARE REGISTERED
8 CE Credits
Category I
IV Sedation Pharmacology
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Information
DENTAL SEDATION PHARMACOLOGY
8 CE Credits: Category I, Sedation Specific Pharmacology
This on line sedation pharmacology series builds a strong working knowledge of sedation medication. Receptor interaction, mechanism of action, clinical duration, dosing, and detrimental side affects are reviewed in detail. A study guide is attached to this test. The study guide should be printed and read prior to taking the test. There is no time limit to take the test. In addition to the study guide, some study material is presented throughout the test. The study material presented in the test contains detailed pharmacologic information.
Upon completion of the test, please select the “QUESTION REVIEW” option. The test review will provide a correct explanation of incorrectly answered test questions. The ADMA Staff will be notified when the test is completed. A certificate of completion will be electronically sent to your registration email address.
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- Answered
- Review
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Question 1 of 86
1. Question
A GABA receptor has multiple sites that have the ability to bind other molecules that
affect the function of the receptor.Correct
A GABA receptor has multiple sites that have the ability to bind other molecules that
affect the function of the receptor. -
Question 2 of 86
2. Question
Benzodiazepines affect a GABA receptor by.
Correct
Benzodiazepines affect a GABA receptor by making it more permeable to Cl- ions.
Incorrect
Benzodiazepines affect a GABA receptor by making it more permeable to Cl- ions.
-
Question 3 of 86
3. Question
When GABA receptors become more permeable to Cl- ions, they have what affect on the neuron?
Correct
When GABA receptors become more permeable to Cl- ions, they hyper-polarize a neuron.
Incorrect
When GABA receptors become more permeable to Cl- ions, they hyper-polarize a neuron.
-
Question 4 of 86
4. Question
Benzodiazepine receptor binding facilitates GABA receptor binding, which increases the conductance of which ion across nerve cell membranes?
Correct
Benzodiazepine receptor binding facilitates GABA receptor binding, which increases the conductance of chloride.
Incorrect
Benzodiazepine receptor binding facilitates GABA receptor binding, which increases the conductance of chloride.
-
Question 5 of 86
5. Question
When a neuron is hyperpolarized (further from its resting potential) it:
Correct
When a neuron is hyperpolarized (further from its resting potential) it becomes less excitable.
Incorrect
When a neuron is hyperpolarized (further from its resting potential) it becomes less excitable.
-
Question 6 of 86
6. Question
Benzodiazepines potentiate the effects of GABA.
Correct
Benzodiazepines potentiate the effects of GABA.
Incorrect
Benzodiazepines potentiate the effects of GABA.
-
Question 7 of 86
7. Question
Barbiturates also bind GABA receptors and affect them almost identically to benzodiazepines.
Correct
Barbiturates do not bind GABA receptors and affect them almost identically to benzodiazepines.
Incorrect
Barbiturates do not bind GABA receptors and affect them almost identically to benzodiazepines.
-
Question 8 of 86
8. Question
Barbiturates open the receptor channel directly to Cl- ions thereby hyper-polarizing
the resting potential in a neuron.Correct
Barbiturates open the receptor channel directly to Cl- ions thereby hyper-polarizing
the resting potential in a neuron.Incorrect
Barbiturates open the receptor channel directly to Cl- ions thereby hyper-polarizing
the resting potential in a neuron. -
Question 9 of 86
9. Question
Mixing alcohol with benzodiazepines isn’t normally a problem because the two drugs act on different sets of neuronal receptors.
Correct
Mixing alcohol with benzodiazepines is a problem because of their synergistic effect that suppresses breathing.
Incorrect
Mixing alcohol with benzodiazepines is a problem because of their synergistic effect that suppresses breathing.
-
Question 10 of 86
10. Question
Benzodiazepines are known to cause drug dependency even in therapeutic doses and relatively short courses of treatment.
Correct
The useful clinical effects of Benzodiazepines are sedation, hypnosis, anti-anxiety, amnesia, muscle relaxation, and a potent anti-seizure effect. The detrimental clinical effects are respiratory depression and rapid physical dependence. Benzodiazepines are known to cause drug dependency even in therapeutic doses and relatively short courses of treatment.
Incorrect
The useful clinical effects of Benzodiazepines are sedation, hypnosis, anti-anxiety, amnesia, muscle relaxation, and a potent anti-seizure effect. The detrimental clinical effects are respiratory depression and rapid physical dependence. Benzodiazepines are known to cause drug dependency even in therapeutic doses and relatively short courses of treatment.
-
Question 11 of 86
11. Question
Increased production of cAMP upon cessation of regular opioid use contributes to the sensation of craving the drug.
Correct
Increased production of cAMP upon cessation of regular opioid use contributes to the sensation of craving the drug.
Incorrect
Increased production of cAMP upon cessation of regular opioid use contributes to the sensation of craving the drug.
-
Question 12 of 86
12. Question
Benzodiazepines are effective for all of the following except:
Correct
Benzodiazepines have NO ANALGESIC (pain relief) EFFECT.
Incorrect
Benzodiazepines have NO ANALGESIC (pain relief) EFFECT.
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Question 13 of 86
13. Question
Benzodiazepines react with specific receptors in the:
Correct
Benzodiazepines react with specific receptors in the CEREBRAL CORTEX.
Incorrect
-
Question 14 of 86
14. Question
Benzodiazepines are primarily metabolized where?
Correct
Benzodiazepines are primarily metabolized in the liver.
Incorrect
Benzodiazepines are primarily metabolized in the liver.
-
Question 15 of 86
15. Question
Flumazenil is primarily a:
Correct
Flumazenil is primarily a Benzodiazepine receptor antagonist.
Incorrect
Flumazenil is primarily a Benzodiazepine receptor antagonist.
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Question 16 of 86
16. Question
Which drug will produce secondary metabolites in the blood stream and having effect hours after leaving the clinical setting?
Correct
Benzodiazepines will produce secondary metabolites in the blood stream and having effect hours after leaving the clinical setting.
Incorrect
Benzodiazepines will produce secondary metabolites in the blood stream and having effect hours after leaving the clinical setting.
-
Question 17 of 86
17. Question
Metabolites of the benzodiazepines are excreted mainly in:
Correct
Metabolites of the benzodiazepines are excreted mainly in Urine.
Incorrect
Metabolites of the benzodiazepines are excreted mainly in Urine.
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Question 18 of 86
18. Question
Benzodiazepines depress ventilator response to:
Correct
Benzodiazepines depress ventilator response to CO2.
Incorrect
Benzodiazepines depress ventilator response to CO2.
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Question 19 of 86
19. Question
Which drug has been associated with increased dementia in the elderly?
Correct
Benzodiazepines have been associated with increased dementia in the elderly.
Incorrect
Benzodiazepines have been associated with increased dementia in the elderly.
-
Question 20 of 86
20. Question
In general, large doses of benzodiazepines can cause all of the following except:
Correct
In general, large doses of benzodiazepines can cause all of the following except decreasing pain levels.
Incorrect
In general, large doses of benzodiazepines can cause all of the following except decreasing pain levels.
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Question 21 of 86
21. Question
How do benzodiazepines lower a patient’s ventilation?
Correct
Benzodiazepines depress the ventilatory response to CO2 in the brainstem.
Incorrect
Benzodiazepines depress the ventilatory response to CO2 in the brainstem.
-
Question 22 of 86
22. Question
Benzodiazepines are effective for all of the following except:
Correct
Benzodiazepines have the following properties:
- Anxiolysis
- Amnesia
- Sedation
- Anti siezure
Incorrect
Benzodiazepines have the following properties:
- Anxiolysis
- Amnesia
- Sedation
- Anti siezure
-
Question 23 of 86
23. Question
Which property makes Diazepam a dangerous choice for sedation?
Correct
Enterohepatic circulation produces a secondary peak in diazepam plasma concentration 6 – 12 hours following administration. This makes Diazepam a dangerous choice for sedation.
Incorrect
Enterohepatic circulation produces a secondary peak in diazepam plasma concentration 6 – 12 hours following administration. This makes Diazepam a dangerous choice for sedation.
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Question 24 of 86
24. Question
What is the typical midazolam dosing range for oral sedation in adult patients?
Correct
The typical midazolam dosing range for oral sedation in adult patients is 0.25 mg/kg to .75 mg/kg not to exceed 20 mg.
Incorrect
The typical midazolam dosing range for oral sedation in adult patients is 0.25 mg/kg to .75 mg/kg not to exceed 20 mg.
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Question 25 of 86
25. Question
What is the maximum midazolam oral dose that most dentists do NOT exceed?
Correct
The maximum midazolam oral dose that most dentists do NOT exceed is 20 mg.
Incorrect
The maximum midazolam oral dose that most dentists do NOT exceed is 20 mg.
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Question 26 of 86
26. Question
Should a dentist mix midazolam in a cherry flavored over-the-counter Tylenol solution provided it is within the Tylenol dosing guidelines?
Correct
A dentist can mix midazolam in a cherry flavored over-the-counter Tylenol solution provided it is within the Tylenol dosing guidelines.
Incorrect
A dentist can mix midazolam in a cherry flavored over-the-counter Tylenol solution provided it is within the Tylenol dosing guidelines.
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Question 27 of 86
27. Question
IV sedation can be titrated predictably.
Correct
IV sedation can be titrated predictably.
Incorrect
IV sedation can be titrated predictably.
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Question 28 of 86
28. Question
A dentist takes 35 minutes to locate the appropriate instruments for his case. N2O (50%) has been delivered for the last 15 minutes. 50 mcg of fentanyl was administered 12 minutes ago. This patient partially obstructs their airway and pulse oximetry reads 89%. What should the primary response be?
Correct
The primary response should be to stimulate the patient and anatomically adjust the airway.
Incorrect
The primary response should be to stimulate the patient and anatomically adjust the airway.
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Question 29 of 86
29. Question
What reverses the respiratory effects of midazolam?
Correct
Flumazenil reverses the respiratory effects of midazolam.
Incorrect
Flumazenil reverses the respiratory effects of midazolam.
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Question 30 of 86
30. Question
What are the appropriate reversal doses for Flumazenil?
Correct
For the emergent reversal of the sedative effects of benzodiazepines administered for conscious sedation in adult patients; give 0.2 – 0.3 mg SL or IM.
Incorrect
For the emergent reversal of the sedative effects of benzodiazepines administered for conscious sedation in adult patients; give 0.2 – 0.3 mg SL or IM.
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Question 31 of 86
31. Question
What adjuncts to benzodiazepine sedation (medicines combined with benzodiazepines to potentiate sedation) synergistically depress a pediatric patients respiratory drive.
Correct
When combined with benzodiazepines to potentiate sedation, Chloral Hydrate, Meperidine, and N2O all synergistically depress a pediatric patients respiratory drive.
Incorrect
When combined with benzodiazepines to potentiate sedation, Chloral Hydrate, Meperidine, and N2O all synergistically depress a pediatric patients respiratory drive.
-
Question 32 of 86
32. Question
Can standard IV doses of benzodiazepines (within the FDA dosing guidelines) typically cause apnea in patients?
Correct
Standard IV doses of benzodiazepines (within the FDA dosing guidelines) cannot typically cause apnea in patients.
Incorrect
Standard IV doses of benzodiazepines (within the FDA dosing guidelines) cannot typically cause apnea in patients.
-
Question 33 of 86
33. Question
What are the typical midazolam dosing increments used in IV sedation?
Correct
1 mg, 2 mg, and 2.5 mg are the typical dosing increments used in dental sedation.
Incorrect
1 mg, 2 mg, and 2.5 mg are the typical dosing increments used in dental sedation.
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Question 34 of 86
34. Question
Opioids primarily effect all of these receptors except:
Correct
Opioids primarily effect all of the aforementioned receptors except GABA.
Incorrect
Opioids primarily effect all of the aforementioned receptors except GABA.
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Question 35 of 86
35. Question
Generally, exogenous opioids are medicines and endogenous opioids are neurotransmitters.
Correct
Generally, exogenous opioids are medicines and endogenous opioids are neurotransmitters.
Incorrect
Generally, exogenous opioids are medicines and endogenous opioids are neurotransmitters.
-
Question 36 of 86
36. Question
Exogenous opioids bind to a different class of receptor in the brain but produce the same result.
Correct
Exogenous opioids bind to the same class of receptor in the brain; producing the same result.
Incorrect
Exogenous opioids bind to the same class of receptor in the brain; producing the same result.
-
Question 37 of 86
37. Question
Which class of drugs came into use first?
Correct
Opioids came into use first.
Incorrect
Opioids came into use first.
-
Question 38 of 86
38. Question
Endogenous opioids include:
Correct
Endogenous opioids include Dynorphin.
Incorrect
Endogenous opioids include Dynorphin.
-
Question 39 of 86
39. Question
Opioid receptors in the brain include all but.
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Question 40 of 86
40. Question
Opioids are most effective at producing:
Correct
Opioids are most effective at producing analgesia.
Incorrect
Opioids are most effective at producing analgesia.
-
Question 41 of 86
41. Question
The pharmacodynamic properties of specific opioids depends on all of the following EXCEPT:
Correct
The pharmacodynamic properties of specific opioids depends on all of the aforementioned EXCEPT whether the receptor is activated.
Incorrect
The pharmacodynamic properties of specific opioids depends on all of the aforementioned EXCEPT whether the receptor is activated.
-
Question 42 of 86
42. Question
In general, opioids do not seriously impair cardiovascular function:
Correct
In general opioids do not seriously impair cardiovascular function.
Incorrect
In general opioids do not seriously impair cardiovascular function.
-
Question 43 of 86
43. Question
Endogenous opioids regulate all but.
Correct
Incorrect
Endogenous opioids modulate our reactions to painful stimuli. They also regulate vital functions such as hunger and thirst and are involved in mood control, immune response, and other processes.
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Question 44 of 86
44. Question
Which opioid has the lowest lipid solubility and is therefore metabolized more quickly?
Correct
Alfentanil has the lowest lipid solubility and is therefore metabolized more quickly.
Incorrect
Alfentanil has the lowest lipid solubility and is therefore metabolized more quickly.
-
Question 45 of 86
45. Question
Opioids depress respiratory rate primarily by affecting the:
Correct
Opioids depress respiratory rate primarily by affecting the apneic threshold.
Incorrect
Opioids depress respiratory rate primarily by affecting the apneic threshold.
-
Question 46 of 86
46. Question
It generally takes a larger dose of which class of drug to render a patient unconscious?
Correct
It generally takes a larger dose of opioids to render a patient unconscious.
Incorrect
It generally takes a larger dose of opioids to render a patient unconscious.
-
Question 47 of 86
47. Question
The humane body uses opiate-like substances as neurotransmitters.
Correct
The human body naturally produces its own opiate-like substances and uses them as neurotransmitters. These substances include endorphins, enkephalins, and dynorphin, often collectively known as endogenous opioids. Endogenous opioids modulate our reactions to painful stimuli. They also regulate vital functions such as hunger and thirst and are involved in mood control, immune response, and other processes.
Incorrect
The human body naturally produces its own opiate-like substances and uses them as neurotransmitters. These substances include endorphins, enkephalins, and dynorphin, often collectively known as endogenous opioids. Endogenous opioids modulate our reactions to painful stimuli. They also regulate vital functions such as hunger and thirst and are involved in mood control, immune response, and other processes.
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Question 48 of 86
48. Question
In moderate doses, opioids can cause all of the following except:
Correct
In moderate doses, opioids can cause all of the aforementioned except unconsciousness.
Incorrect
In moderate doses, opioids can cause all of the aforementioned except unconsciousness.
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Question 49 of 86
49. Question
What are the appropriate reversal doses for Narcan?
Correct
The appropriate reversal doses for Narcan are 0.1-0.2 mg SL or IM.
Incorrect
The appropriate reversal doses for Narcan are 0.1-0.2 mg SL or IM.
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Question 50 of 86
50. Question
Reversal agents such as Narcan and Flumazenil can safely be used to facilitate emergence from oral sedation in order to discharge patients more quickly from dental facilities.
Emergence is the process of awakening from sedation or anesthesia.
Discharge is the process of allowing the patient to leave the facility safely after treatment.
Correct
Reversal agents such as Narcan and Flumazenil cannot safely be used to facilitate emergence from oral sedation in order to discharge patients more quickly from dental facilities, as they do not last as long as the sedatives used in dental procedures.
Incorrect
Reversal agents such as Narcan and Flumazenil cannot safely be used to facilitate emergence from oral sedation in order to discharge patients more quickly from dental facilities, as they do not last as long as the sedatives used in dental procedures.
-
Question 51 of 86
51. Question
What is an analgesic?
Correct
An analgesic is a drug used to diminish the intensity of perceived pain.
Incorrect
An analgesic is a drug used to diminish the intensity of perceived pain.
-
Question 52 of 86
52. Question
What is the typical dosing range of Hydrocodone used for post-dental procedure pain relief?
Correct
The typical dosing range of Hydrocodone used for post-dental procedure pain relief is 5 mg – 10 mg orally every 4 – 6 hours.
Incorrect
The typical dosing range of Hydrocodone used for post-dental procedure pain relief is 5 mg – 10 mg orally every 4 – 6 hours.
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Question 53 of 86
53. Question
What is the maximum dose that should not be exceeded with Hydrocodone every 4 – 6 hours when administered for oral post dental procedure pain in adults? (Excluding patients with chronic opiate use)
Correct
The maximum dose that should not be exceeded with Hydrocodone every 4 – 6 hours when administered for oral post dental procedure pain in adults (excluding patients with chronic opiate use) is 10 mg.
Incorrect
The maximum dose that should not be exceeded with Hydrocodone every 4 – 6 hours when administered for oral post dental procedure pain in adults (excluding patients with chronic opiate use) is 10 mg.
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Question 54 of 86
54. Question
What medicine can be used as a reversal agent when Hydrocodone is administered as an adjunct for sedation?
Correct
Narcan can be used as a reversal agent when Hydrocodone is administered as an adjunct for sedation.
Incorrect
Narcan can be used as a reversal agent when Hydrocodone is administered as an adjunct for sedation.
-
Question 55 of 86
55. Question
Increased excitability of neurons produces the euphoric effect of opioids.
Correct
Increased excitability of neurons produces the euphoric effect of opioids.
Incorrect
Increased excitability of neurons produces the euphoric effect of opioids.
-
Question 56 of 86
56. Question
What are three life-threatening side effects from high doses of Hydrocodone?
(1) Hypoxia, (2) Dysphoria, (3) Seizures, (4) Apnea
Correct
Three life-threatening side effects from high doses of Hydrocodone are hypoxia, seizures, and apnea.
Incorrect
Three life-threatening side effects from high doses of Hydrocodone are hypoxia, seizures, and apnea.
-
Question 57 of 86
57. Question
Opioid receptors act through second messengers and affect the permeability of ion channels.
Correct
Opioid receptors act through second messengers and affect the permeability of ion channels.
Incorrect
Opioid receptors act through second messengers and affect the permeability of ion channels.
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Question 58 of 86
58. Question
Which of the following drugs are opioids? (Check all that apply.)
Correct
Hydrocodone, Oxycodone, and OxyContin are opioids.
Incorrect
Hydrocodone, Oxycodone, and OxyContin are opioids.
-
Question 59 of 86
59. Question
Diazepam and Triazolam are in which category of drugs?
Correct
Diazepam and Triazolam are benzodiazepines.
Incorrect
Diazepam and Triazolam are benzodiazepines.
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Question 60 of 86
60. Question
Hydrocodone provides amnesia.
Correct
Hydrocodone does not provide amnesia.
Incorrect
Hydrocodone does not provide amnesia.
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Question 61 of 86
61. Question
Which of the following patients should never be sedated in an office:
Correct
A patient with moderate sleep apnea should never be sedated in an office.
Incorrect
A patient with moderate sleep apnea should never be sedated in an office.
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Question 62 of 86
62. Question
It can be said that dopamine is central to many important functions of an organism.
Correct
Dopamine is central to many important functions of an organism.
Incorrect
Dopamine is central to many important functions of an organism.
-
Question 63 of 86
63. Question
Dopamine is involved in all of these functions except.
Correct
Dopamine is involved in all of the aforementioned functions except bowel motility.
Incorrect
Dopamine is involved in all of the aforementioned functions except bowel motility.
-
Question 64 of 86
64. Question
All substances that trigger dependencies in humans inhibit the release of dopamine in the nucleus accumbens.
Correct
Not all substances that trigger dependencies in humans inhibit the release of dopamine in the nucleus accumbens.
Incorrect
Not all substances that trigger dependencies in humans inhibit the release of dopamine in the nucleus accumbens.
-
Question 65 of 86
65. Question
Substances modulate dopamine in the brain in all of these ways except:
Correct
Substances modulate dopamine in the brain in all of the aforementioned ways except decreasing the secretion of natural neuromediators.
Incorrect
Substances modulate dopamine in the brain in all of the aforementioned ways except decreasing the secretion of natural neuromediators.
-
Question 66 of 86
66. Question
Chronic use of opioids reduces the production of which of the following?
Correct
Chronic use of opioids reduces the production of cAMP.
Incorrect
Chronic use of opioids reduces the production of cAMP.
-
Question 67 of 86
67. Question
Substances like morphine that imitate natural neuromediators do so by:
Correct
Substances like morphine that imitate natural neuromediators do so by activating the receptor in a similar manor as the neuromediator.
Incorrect
Substances like morphine that imitate natural neuromediators do so by activating the receptor in a similar manor as the neuromediator.
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Question 68 of 86
68. Question
When a neuron is hyperpolarized (further from its resting potential) it:
Correct
Incorrect
Benzodiazepines are a class of agents that work on the central nervous system, acting selectively on gamma-aminobutyric acid-A (GABA-A) receptors in the brain. It enhances response to the inhibitory neurotransmitter GABA, by opening GABA-activated chloride channels and allowing chloride ions to enter the neuron, making the neuron negatively charged and resistant to excitation.
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Question 69 of 86
69. Question
Benzodiazepines potentiate the effects of GABA.
Correct
Incorrect
Benzodiazepines are a class of agents that work on the central nervous system, acting selectively on gamma-aminobutyric acid-A (GABA-A) receptors in the brain. It enhances response to the inhibitory neurotransmitter GABA, by opening GABA-activated chloride channels and allowing chloride ions to enter the neuron, making the neuron negatively charged and resistant to excitation.
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Question 70 of 86
70. Question
Barbiturates also bind GABA receptors and affect them almost identically to benzodiazepines.
Correct
Incorrect
-
Question 71 of 86
71. Question
Barbiturates open the receptor channel directly to Cl- ions thereby hyper-polarizing
the resting potential in a neuron.Correct
Incorrect
-
Question 72 of 86
72. Question
Mixing alcohol with benzodiazepines isn’t normally a problem because the two drugs act on different sets of neuronal receptors.
Correct
Incorrect
-
Question 73 of 86
73. Question
Benzodiazepines interact with which receptor?
Correct
Benzodiazepines interact with the GABA receptor.
Incorrect
Benzodiazepines interact with the GABA receptor.
-
Question 74 of 86
74. Question
In a nerve, the dendrite:
Correct
In a nerve, the dendrite is the receiving part that binds the transmitter.
Incorrect
In a nerve, the dendrite is the receiving part that binds the transmitter.
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Question 75 of 86
75. Question
GABA:
Correct
GABA is an inhibitory neurotransmitter. This means that it makes it more difficult for the nerve to reach its threshold potential, inhibiting activity.
Incorrect
GABA is an inhibitory neurotransmitter. This means that it makes it more difficult for the nerve to reach its threshold potential, inhibiting activity.
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Question 76 of 86
76. Question
To reverse an opiate, administer:
Correct
Naloxone is administered to reverse the effects of an opiate.
Incorrect
Naloxone is administered to reverse the effects of an opiate.
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Question 77 of 86
77. Question
To reverse a benzodiazepine, administer:
Correct
Flumazenil is administered to reverse a benzodiazepine.
Incorrect
Flumazenil is administered to reverse a benzodiazepine.
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Question 78 of 86
78. Question
BENZODIAZEPINE RECEPTOR QUESTION
Benzodiazepines are used as sedatives, hypnotics, anxiolytics, anticonvulsants and muscle relaxants. Benzodiazepines are similar in pharmacological action but have different potencies. Some benzodiazepines work better in the treatment of particular conditions. The useful clinical effects of benzodiazepines are sedation, hypnosis, anti-anxiety, amnesia, muscle relaxation, and a potent anti-seizure effect. Their detrimental clinical effects are respiratory depression, rapid physical dependence, and an absence of analgesia.
Mechanisms of Action:
Benzodiazepines are a class of agents that work on the central nervous system, acting selectively on gamma-aminobutyric acid-A (GABA-A) receptors in the brain. It enhances response to the inhibitory neurotransmitter GABA, by opening GABA-activated chloride channels and allowing chloride ions to enter the neuron, making the neuron negatively charged and resistant to excitation.
The GABA(A) receptors are membrane protein complexes that are composed of α, β, and γ subunits. The membrane receptors are mainly expressed in the brain but can also be found in different tissue such as muscle and immune cells. γ-aminobutyric acid (GABA) is the endogenous ligand for the GABA(A) receptors inhibiting the signaling transduction mediated by these receptors by hyper-polarization (increase of chloride ion efflux). Other molecules are known to modulate GABA(A) receptor actions such as alcohol, steroids and barbiturates.
Where are the GABA receptors mainly distributed in the human body?
Correct
GABA receptors mainly distributed in the brain. The membrane receptors are mainly expressed in the brain but can also be found in different tissue such as muscle and immune cells.
Incorrect
GABA receptors mainly distributed in the brain. The membrane receptors are mainly expressed in the brain but can also be found in different tissue such as muscle and immune cells.
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Question 79 of 86
79. Question
Clinical Receptor Summary:
The GABA receptor is the major molecular target for the action of many drugs in the brain. Among these are benzodiazepines, intravenous anesthetics (barbiturates and propofol), volatile anesthetics, and ethanol. GABA receptors have been identified electrophysiologically and pharmacologically in all regions of the brain. The complex includes five major binding domains with binding sites localized in or near the Cl− channel. Benzodiazepines, barbiturates as well as anesthetic steroids (propofol) bind to sites on the GABA receptor. The domains modulate the receptor response to GABA stimulation. In addition, other drugs, including volatile anesthetics and ethanol have been reported to have an effect on this receptor. An integral part of this complex is the Cl− channel. The GABA specific binding site is directly responsible for opening the Cl− channel.
Benzodiazepine agonists represent the largest group of agents in this general class of depressant drugs. They show anticonvulsant, anxiolytic and sedative—hypnotic activity. Well known examples include diazepam and Xanax, which often are prescribed for their anti-anxiety effects. Halcion is known for its sedative and anxiolytic properties. The mechanism of action of benzodiazepine agonists is to enhance GABAergic transmission. The advantage of benzodiazepines is that they do not open the Cl- channels directly. Instead they act more subtly by potentiating the effect of GABA.
Barbiturates comprise another class of drugs commonly used therapeutically for anesthesia and control of epilepsy. Barbiturates bind to another site on the GABA receptor. This opens the Cl- channels directly and causes similar clinical effects. Phenobarbital and pentobarbital are two of the most commonly used barbiturates. Phenobarbital was used to treat patients with epilepsy since 1912. Pentobarbital is also an anticonvulsant and has useful sedative properties.
A variety of agonists bind to this site and elicit GABA-like responses. One of the most useful agonists is the compound muscimol, a naturally occurring GABA analog isolated from the psychoactive mushroom Amanita muscaria. It is a potent and specific agonist at GABA receptors and has been a valuable tool for pharmacological and radioligand binding studies.
Which of the following statements is true?
Correct
Both Benzodiazepines and alcohol affect the GABA receptor. The downstream clinical effects are very similar. There are differences in onset and duration of action. Somnolence, anxiolysis, and ataxia, however, are common effects of both drugs.
Incorrect
Both Benzodiazepines and alcohol affect the GABA receptor. The downstream clinical effects are very similar. There are differences in onset and duration of action. Somnolence, anxiolysis, and ataxia, however, are common effects of both drugs.
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Question 80 of 86
80. Question
Clinical Receptor Summary:
The GABA receptor is the major molecular target for the action of many drugs in the brain. Among these are benzodiazepines, intravenous anesthetics (barbiturates and propofol) volatile anesthetics, and ethanol. GABA receptors have been identified electrophysiologically and pharmacologically in all regions of the brain. The complex includes five major binding domains with binding sites localized in or near the Cl− channel. Benzodiazepines, barbiturates as well as anesthetic steroids (propofol) bind to sites on the GABA receptor. The domains modulate the receptor response to GABA stimulation. In addition, other drugs, including volatile anesthetics and ethanol have been reported to have an effect on this receptor. An integral part of this complex is the Cl− channel. The GABA specific binding site is directly responsible for opening the Cl− channel.
Benzodiazepine agonists represent the largest group of agents in this general class of depressant drugs. They show anticonvulsant, anxiolytic and sedative—hypnotic activity. Well known examples include diazepam and Xanax, which often are prescribed for their anti-anxiety effects. Halcion is known for its sedative and anxiolytic properties. The mechanism of action of benzodiazepine agonists is to enhance GABAergic transmission. The advantage of benzodiazepines is that they do not open the Cl- channels directly. Instead they act more subtly by potentiating the effect of GABA.
Barbiturates comprise another class of drugs commonly used therapeutically for anesthesia and control of epilepsy. Barbiturates bind to another site on the GABA receptor. This opens the Cl- channels directly and causes similar clinical effects. Phenobarbital and pentobarbital are two of the most commonly used barbiturates. Phenobarbital was used to treat patients with epilepsy since 1912. Pentobarbital is also an anticonvulsant and has useful sedative properties.
A variety of agonists bind to this site and elicit GABA-like responses. One of the most useful agonists is the compound muscimol, a naturally occurring GABA analog isolated from the psychoactive mushroom Amanita muscaria. It is a potent and specific agonist at GABA receptors and has been a valuable tool for pharmacological and radioligand binding studies.
Anxiolysis is best described by which of the following statements:
Correct
Anxiolysis is commonly misunderstood in dental sedation. Anxiolysis is the process by which a patient begins to feel a lack of inhibition. This is clinically seen as a patient that begins to talk more than usual and appears to be very comfortable in the environment they are placed in. This is actually a very useful clinical marker that the Benzodiazepine is working.
Incorrect
Anxiolysis is commonly misunderstood in dental sedation. Anxiolysis is the process by which a patient begins to feel a lack of inhibition. This is clinically seen as a patient that begins to talk more than usual and appears to be very comfortable in the environment they are placed in. This is actually a very useful clinical marker that the Benzodiazepine is working.
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Question 81 of 86
81. Question
THE OPIOID RECEPTOR
Opioids are among the world’s oldest known drugs; the therapeutic use of the opium poppy predates recorded history. The analgesic (painkiller) effects of opioids are due to decreased perception of pain, decreased reaction to pain as well as increased pain tolerance. The human body naturally produces its own opiate-like substances and uses them as neurotransmitters. These substances include endorphins, enkephalins, and dynorphin, often collectively known as endogenous opioids. Endogenous opioids modulate our reactions to painful stimuli. They also regulate vital functions such as hunger and thirst and are involved in mood control, immune response, and other processes. The reason that medicine based opiates affect us so powerfully is that these exogenous substances bind to the same receptors as our endogenous opioids.
Medicine based opioids bind to specific receptors located throughout the central nervous system and other tissues. Four major types of opioid receptor have been identified: mu, kappa, delta, and sigma. While opioids provide some degree of sedation, they are most effective at producing analgesia. The pharmacodynamic properties of specific opioids depend upon which receptor is bound, the binding affinity, and whether the receptor is activated.
These four receptors, through second messengers, influence the likelihood that ion channels will open, which in certain cases reduces the excitability of neurons. This reduced excitability is the likely source of the euphoric effect of opiates and appears to be mediated by the mu and delta receptors. This euphoric effect also appears to involve another mechanism in which the GABA-inhibitory interneurons come into play. By attaching to their mu receptors, exogenous opioids reduce the amount of GABA released. Normally, GABA reduces the amount of dopamine released in the nucleus accumbens. By inhibiting this inhibitor, the opiates ultimately increase the amount of dopamine produced and the amount of pleasure felt.
Which of the following statements best describes a clinical benefit of opioids?
Correct
The downstream effect of an opioid is the release of dopamine. When a patient is experiencing euphoria, the perception of pain is decreased. This provides a notable clinical benefit in dental sedation.
Incorrect
The downstream effect of an opioid is the release of dopamine. When a patient is experiencing euphoria, the perception of pain is decreased. This provides a notable clinical benefit in dental sedation.
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Question 82 of 86
82. Question
CLINICAL EFFECTS OF OPIOIDS
Cerebral:
- Opiates produce a potent analgesic effect. Intravenous opioids have been the mainstay of pain control for more than a century.
- Opiates are very predictable when used as a primary or secondary sedative. Mild to moderate dose dependent sedation occurs with all opiates . Unlike barbiturates or benzodiazepines, relatively large doses of opioids are required to render patients unconscious.
- Regardless of the dose, opioids do not reliably produce amnesia.
Respiratory:
- Opioids depress ventilation, particularly respiratory rate. Resting PaCO2 increases and the response to a CO2 challenge is blunted, resulting in a shift of the CO2 response curve downward and to the right. These effects are mediated through the respiratory centers in the brainstem. The apneic threshold, the highest PaCO2 at which a patient remains apneic, is elevated, and hypoxic drive is decreased.
- Morphine and meperidine can cause histamine-induced bronchospasm in susceptible patients.
- Opioids (particularly fentanyl, Sufentanil, and Alfentanil) can induce chest wall rigidity severe enough to prevent adequate ventilation. This centrally mediated muscle contraction is most frequent after large drug boluses and is effectively treated with muscle relaxants.
- Opioids can effectively blunt the broncho-constrictive response to airway stimulation such as that occurring during intubation.
Opioids decrease ventilation in the human body through which mechanism?
Correct
When the CO2 centers in the brain stem are exposed to opioids, they require a higher level of CO2 to function. The clinical profile of ventilation in a human that is exposed to opioids reveals a slower respiratory rate with higher tidal volumes. The total ventilation is decreased because the higher tidal volumes do not fully compensate for the lower respiratory rate.
Remember: Ventilation = Respiratory Rate x Tidal Volume.
Incorrect
When the CO2 centers in the brain stem are exposed to opioids, they require a higher level of CO2 to function. The clinical profile of ventilation in a human that is exposed to opioids reveals a slower respiratory rate with higher tidal volumes. The total ventilation is decreased because the higher tidal volumes do not fully compensate for the lower respiratory rate.
Remember: Ventilation = Respiratory Rate x Tidal Volume.
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Question 83 of 86
83. Question
Nitrous Oxide is:
Correct
Nitrous Oxide is both an analgesic and an anxiolytic.
Incorrect
Nitrous Oxide is both an analgesic and an anxiolytic.
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Question 84 of 86
84. Question
Nitrous Oxide reduces the drive to breathe.
Correct
Nitrous Oxide reduces the drive to breathe.
Incorrect
Nitrous Oxide reduces the drive to breathe.
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Question 85 of 86
85. Question
Opiates can stimulate a nauseous reaction.
Correct
Opiates can stimulate a nauseous reaction.
Incorrect
Opiates can stimulate a nauseous reaction.
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Question 86 of 86
86. Question
To help reduce a patient’s nauseous reaction, you can:
Correct
Zofran is an effective anti-emetic. Antihistamines, while beneficial in treating nausea, are not to be administered intravenously.
Incorrect
Zofran is an effective anti-emetic. Antihistamines, while beneficial in treating nausea, are not to be administered intravenously.