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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

A

longer

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
Q

Chemical reactions of metabolism are divided into two phases, describe them

A

Phase I

  • Oxidation, Reduction and hydrolysis
  • Oxidation performed by cytochrome P450 mixed function oxidase

Phase II
-Conjugation

26
Q

Factors affecting metabolism rate

A
  • Competition between drugs for same enzyme

- Enzyme induction (CYP450 inducers and inhibitors)

27
Q

What is conjugation

A

combination of drug with activated glucuronic acid to form water soluble components

28
Q

Elimination of drugs are primarily through

A

renal route

29
Q

Other routes of drug elimination are

A
  • biliary, fecal (enterohepatic cycling)– conjugation with biliary salts then recycled
  • Lungs (via volatile/gaseous agents)
30
Q

What are the 4 stages of anesthesia and describe them

A
  • 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
Q

What is the most common complication of sedation

A

people stop breathing

32
Q

Define minimal sedation

A

-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
Q

Define moderate sedation

A
  • 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
Q

Define deep sedation

A
  • 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
Q

Define general anesthesia

A
  • 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
Q

What patient paramenters should be obtained and monitored throughout the procedure

A
  • Vital signs (BP, Pulse, Respiraiton) Both pre-op and intra-op
  • Respiratory (Pulse oximetry (oxygenation), end tidal CO2(ventilation))- Must have supplemental O2
37
Q

Describe how pulse oximetry works

A

Oxygenated and deoxy blood differ in absorption or red and infrared light

38
Q

Oxy blod absorbs (red/infrared) light? Deoxy?

A 
Oxy= infrared 
Deoxy= Red
39
Q

What wavelength is absobed by oxy blood in pulse oximetry? Deoxy?

A

990 nm (infrared) and 660 nm (red)

40
Q

What is used to ID arterial pulse

A

Plethysmography

41
Q

What are the three stages of recovery

A
  • Early= awaken from sedation
  • Intermediate= Regain full psychomotor function and resume physical activity
  • Late= regain full psychological and physical capacity
42
Q

Vital signs in recovery are monitored how frequently

A

Every 15 mins

43
Q

Supplemental O2 is given to pateints in recovery until when

A

they reach baseline (maintain O2 saturation >95% on room air)

44
Q

What are the two systems that outline discharge criteria

A

Wetchler Guidelines

Aldrete Scoring System

45
Q

When discharge criteria system is more rigorous and which more vague

A

Wetchler= vague and Aldrete Scoring System= rigorous

46
Q

Describe Wetchler Guidelines

A
  • Absence of respiratory distress
  • Alert and oriented x3
  • Stable vitals
  • Ability to swallow and cough
  • Ability to ambulate
  • Minimal nausea, vomiting or dizziness
47
Q

Describe the Aldrete Scoring System

A

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
Q

Score of _ according to the aldrete scoring system indicates the patient is ready for discharge

A

10

49
Q

Advantages of oral sedation

A
  • Patient acceptability
  • Ease of administration
  • Inexpensive
  • No specialized equipment needed
50
Q

Disadvantages of oral sedation

A
  • 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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