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Anesthesia > 2. Oral Sedation > Flashcards

2. Oral Sedation Flashcards

1
Q

What chemical propertie of drugs affects absorption properties

A
  • lipid solubility (because absorption is the drugs ability to traverse membranes which are composed of lipids)
  • Molecular weight (the smaller the better the absorption)
  • Degree of ionization (uncharged crosses membrane)
  • Drug release characteristics (i.e some drugs are sustained release)
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2
Q

What must a drug taken orally penetrate in order to be absorbed into the blood

A

gastrointestinal epithelium

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3
Q

T/F Sedatives must cross the blood brain barrier

A

t

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4
Q

sWhat are the patient specific factors that influence drug absorption

A
  • Surface area for absorption
  • Gastric and duodenal pH (pH and dissociation constant of the drug (or pKa) should be similar)
  • Gastric emptying time
  • Bile salt pool size (some drugs require bile salts for breakdown)
  • Bacterial colonization
  • Presence/extent of underlying disease
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5
Q

A person with gastric reflux has (faster/slower) gastric emptying

A

slower

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6
Q

What structure allows bile salts to enter the duodenum

A

ampulla of vader

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7
Q

Why is slow gastric emptying a disadvantage for drug absorption

A

the drug is inactivated when sitting in a pool of stomach acid

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8
Q

Most common causes of delayed gastric emptying

A
  • Peptic ulcers
  • DM
  • Anticholinergics
  • GERD
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9
Q

Define bioavailability

A

Fraction of drug dose reaching systemic circulation following administration

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10
Q

T/F Bioavailability is only influenced by the drug properties not the person

A

f both

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11
Q

What are the influences of bioavailability

A
  • Drug formulation
  • Particle size
  • Solubility
  • Degree of absorption from GI tract
  • Rapid metabolism during “first pass” through the liver with considerable degree of biotransformation
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12
Q

T/F You can titrate a drug into effect with drugs given both IV and orally

A

f- just IV

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13
Q

What are the different transport mechanisms of drugs

A
  • Passive diffusion
  • Ion pair transport
  • Pinocytosis
  • Receptor mediated
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14
Q

Define passive diffusion

A

Movement of molecules from high to low conc.

  • Nonpolar lipid soluble compounds diffuse more readily
  • Small molecule diffuse more readily than large
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15
Q

Describe ion pair transport

A

Anions combine with cations to form neutral molecules to diffuse via passive diffusion

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16
Q

Describe pinocytosis

A

engulfment by cell membrane/internalization

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17
Q

Describe receptor mediated transport

A
  • receptor control ion channels- ligand or voltage gated channels
  • Receptors coupled to G proteins (2nd messangers)
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18
Q

What factors influence drug distribution

A
  • Lipid solubility
  • Degree of ionization
  • Tissue perfusion (someone with atherosclerosis will not get as well sedated because they can’t distribute the drug as well
  • Biochemical composition of tissues
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19
Q

Binding of plasma protein to drugs is (reversible/irreversible)

A

reversible

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20
Q

T/F certain disease states may result in reduced production of plasma proteins

A

t

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21
Q

The drug with remain in the body for a (shorter/longer) duration if it binds plasma proteins

22
Q

Well perfused tissues of the body are… low perfused?

A

Highly perfused
-Brain, heart, liver, and kidneys

Less perfused
-Skin, muscle, bone and fat

23
Q

Metabolism of a drug can involve two different processes, what are they

A
  • Conversion of an inactive “prodrug” to the active drug

- Conversion of the non-polar lipid soluble drug to water soluble form

24
Q

For most drugs metabolism most commonly occurs where? Other places also include

A

liver… lung, kidney, GI tract, GI bacteria, and placenta

25
Chemical reactions of metabolism are divided into two phases, describe them
Phase I - Oxidation, Reduction and hydrolysis - Oxidation performed by cytochrome P450 mixed function oxidase Phase II -Conjugation
26
Factors affecting metabolism rate
- Competition between drugs for same enzyme | - Enzyme induction (CYP450 inducers and inhibitors)
27
What is conjugation
combination of drug with activated glucuronic acid to form water soluble components
28
Elimination of drugs are primarily through
renal route
29
Other routes of drug elimination are
- biliary, fecal (enterohepatic cycling)-- conjugation with biliary salts then recycled - Lungs (via volatile/gaseous agents)
30
What are the 4 stages of anesthesia and describe them
- Stage I= analgesia (less responsive to noxious stimuli) - Stage II= Delirium/excitement (overreacting) - Stage III= Surgical anesthesia (Plane 1-4) (People still follow commands but are calm) - Medullary Paralysis (Stop breathing- need AED and amboo bag)
31
What is the most common complication of sedation
people stop breathing
32
Define minimal sedation
-Minimally depressed level of consciousness -Responds normally to verbal and tactile stimuli -Independent and continuous maintenance of airway -Cognition and coordination impaired modestly -Ventilatory and cardiovascular function unimpaired - initial dosing of enteral drug no more than the maximum recommended dose that can be prescribed for home unmonitored use
33
Define moderate sedation
- Patients respond to purposeful verbal commands alone or by light tactile stimulation - Independently maintain airway and ventilatory drive - CV function maintained - Wide enough margin of safety to avoid loss of consciousness - Enteral moderate sedation not recommended for kids 12 and under
34
Define deep sedation
- Patients not easily aroused - Respond purposefully to repeated verbal or painful stimuli - May require assistance with airway and spontaneous ventilation may be inadequate - CV function ususally maintained
35
Define general anesthesia
- Only done with IV agents - Patients not arousable even with painful stimuli - Require device or assistance with airway maintenance - Positive pressure ventilation may be needed due to depression of spontaneous ventilation or pharmacologic depression of neuromuscular function - CV function may be impaired
36
What patient paramenters should be obtained and monitored throughout the procedure
- Vital signs (BP, Pulse, Respiraiton) Both pre-op and intra-op - Respiratory (Pulse oximetry (oxygenation), end tidal CO2(ventilation))- Must have supplemental O2
37
Describe how pulse oximetry works
Oxygenated and deoxy blood differ in absorption or red and infrared light
38
Oxy blod absorbs (red/infrared) light? Deoxy?
``` Oxy= infrared Deoxy= Red ```
39
What wavelength is absobed by oxy blood in pulse oximetry? Deoxy?
990 nm (infrared) and 660 nm (red)
40
What is used to ID arterial pulse
Plethysmography
41
What are the three stages of recovery
- Early= awaken from sedation - Intermediate= Regain full psychomotor function and resume physical activity - Late= regain full psychological and physical capacity
42
Vital signs in recovery are monitored how frequently
Every 15 mins
43
Supplemental O2 is given to pateints in recovery until when
they reach baseline (maintain O2 saturation >95% on room air)
44
What are the two systems that outline discharge criteria
Wetchler Guidelines | Aldrete Scoring System
45
When discharge criteria system is more rigorous and which more vague
Wetchler= vague and Aldrete Scoring System= rigorous
46
Describe Wetchler Guidelines
- Absence of respiratory distress - Alert and oriented x3 - Stable vitals - Ability to swallow and cough - Ability to ambulate - Minimal nausea, vomiting or dizziness
47
Describe the Aldrete Scoring System
Activity -Can move voluntarily on command (number of extremities) Respiration -Can breath and cough freely Circulaiton -How close is the BP to baseline Conciousness -Fully awake, arousable to voice, no response Color -Normal, pale, cyanotic
48
Score of _ according to the aldrete scoring system indicates the patient is ready for discharge
10
49
Advantages of oral sedation
- Patient acceptability - Ease of administration - Inexpensive - No specialized equipment needed
50
Disadvantages of oral sedation
- Lack of control (inability to titrate and rely on pt compliance) - Delayed onset - Prolonged duration - Erratic and incomplete absorption - First pass effect

Anesthesia (12 decks)

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