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benzo phas 2 Flashcards

1
Q

How does albumin binding affect a drug’s action?

A

High protein binding to albumin affects drug distribution and duration of action.

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2
Q

What are the cardioprotective effects of a certain drug?

A

Decreased heart rate, improved oxygen delivery, and coronary vasodilation.

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3
Q

What are the EEG effects of a certain drug?

A

It does not cause posterior EEG spread or induce EEG tolerance.

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4
Q

Does midazolam produce an isoelectric EEG?

A

No, midazolam does not produce an isoelectric EEG.

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5
Q

How do benzodiazepines affect blood pressure and heart rate?

A

Benzodiazepines have no significant impact on blood pressure, heart rate, or cardiac rhythm (neutral effect).

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6
Q

What is a caution for using a certain drug in patients with chronic lung disease?

A

Caution is advised due to minimal respiratory repression.

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7
Q

How do benzodiazepines interact with opioids regarding analgesia?

A

Benzodiazepines can reduce the analgesic efficacy of opioids.

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8
Q

Why are Lorazepam, Oxazepam, and Temazepam safer for elderly patients?

A

They are metabolized only by glucuronidation, making them safer for elderly patients with reduced liver function.

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9
Q

What risks are increased in elderly patients?

A

Accelerated cognitive decline, postoperative confusion, and delirium.

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10
Q

Why is midazolam easily dissolvable in water?

A

Its pKa of 6.15 allows it to be a water-soluble salt.

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11
Q

How is midazolam formulated in its vial?

A

It is a weak base salt buffered at an acidic pH (3.5) to maintain stability.

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12
Q

What does buffering at an acidic pH ensure for midazolam?

A

This ensures full ionization, making it ready for injection.

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13
Q

How does pH affect midazolam’s water solubility in solution?

A

In solutions with a pH < 4, midazolam maintains an open-ring structure, which keeps it highly water-soluble.

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14
Q

How does midazolam’s structure change upon injection?

A

Once injected, midazolam’s ring structure closes, making it highly lipid-soluble at physiologic pH.

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15
Q

How is midazolam primarily metabolized?

A

Primarily metabolized by cytochrome P450 enzymes and glucuronidation in the liver, producing both active and inactive metabolites.

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16
Q

What is the active metabolite of midazolam?

A

The active metabolite is 1-hydroxymidazolam.

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17
Q

How does renal failure affect midazolam clearance?

A

Midazolam’s clearance is not significantly affected by renal failure.

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18
Q

Is midazolam safe for end-stage renal patients?

A

Yes, because although metabolite accumulation may occur, the elimination half-life remains unchanged.

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19
Q

What is a consideration for using midazolam in short procedures?

A

Careful dosing is required due to the stacking effect, leading to cumulative sedation.

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20
Q

How does midazolam affect CO₂ response and respiratory depression?

A

Midazolam preserves CO₂ response in single doses but causes dose-dependent respiratory depression.

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21
Q

How does midazolam affect CBF and CMRO₂?

A

It reduces CBF and CMRO₂, making it useful in neurosurgical and seizure management.

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22
Q

How does midazolam compare to other benzodiazepines in placental transfer?

A

It has much lower placental transfer compared to other benzodiazepines.

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23
Q

What type of procedures is midazolam ideal for?

A

Procedures requiring patient cooperation, such as nerve blocks.

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24
Q

When does midazolam peak?

A

Midazolam peaks in 3-5 minutes.

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25
What increases the risk of respiratory depression with midazolam?
Opioid use and elderly or COPD patients.
26
Why is midazolam rarely used for anesthesia induction?
Due to its slower onset compared to other induction agents.
27
How does midazolam affect cardiovascular function?
Minimal cardiovascular depression but reduces systemic vascular resistance (SVR), causing peripheral vasodilation.
28
What is the benefit of midazolam in anesthesia?
Enhances overall anesthesia depth while minimizing individual drug side effects.
29
What factors prolong emergence time with midazolam?
Elderly, obese, or liver-impaired patients.
30
What is the dosage for Paradoxical Vocal Cord Motion using midazolam?
0.5 – 1 mg IV.
31
What is the dose of Diazepam?
0.3-0.6 mg/kg
32
What is the onset and DOA of Diazepam?
Onset: 45-60 seconds and DOA of 15-30 minutes
33
What are the disadvantages of Diazepam?
Painful injection, Prolonged duration compared to preferred induction agents.
34
Is Lorazepam used for induction?
No, Lorazepam is not used for induction because it is too slow & has a prolonged duration.
35
What is the dose and onset of Lorazepam?
Dose: 0.03-0.06 mg/kg and Onset: 60-120 seconds
36
What is the DOA of Lorazepam?
DOA: 60-120 minutes
37
What are the disadvantages of Lorazepam?
Painful injection and slow onset.
38
What makes Diazepam injections painful?
Diazepam contains propylene glycol & sodium benzoate.
39
What are the characteristics of Diazepam?
Cloudy and Viscous with a pH of 6.6 - 6.9.
40
Does Diazepam cross the placenta?
Yes, it crosses the placenta (uteroplacental barrier).
41
How is Diazepam metabolized?
It undergoes N-demethylation in the liver, producing desmethyldiazepam (active metabolite).
42
What are the primary metabolites of Diazepam?
Desmethyldiazepam, oxazepam, and temazepam.
43
How does aging affect Diazepam?
Prolonged elimination and increased sedative sensitivity.
44
What are the cardiovascular and respiratory effects of Diazepam?
Minimal cardiovascular effects but can cause respiratory depression when combined with alcohol or opioids.
45
How is Lorazepam metabolized?
Metabolized in the liver via glucuronidation, producing inactive metabolites with Minimal interaction with cytochrome P-450 enzymes.
46
What is the volume of distribution of Lorazepam?
Larger volume of distribution → prolonged sedative effects.
47
What is the elimination half-life of Lorazepam?
Longer elimination half-life → extended recovery time.
48
What is Flumazenil used for?
Treatment of overdoses, including non-BZD hypnotics like zolpidem (Ambien).
49
How does Flumazenil enhance benzodiazepine binding?
Enhances benzodiazepine binding at GABA receptors, potentially reversing receptor downregulation from long-term benzodiazepine use.
50
What is the continuous infusion rate of Flumazenil?
Continuous infusion: 0.1 – 0.4 mg/hr if prolonged reversal is needed.
51
How does Flumazenil compare to Narcan?
Unlike Narcan, it does not cause hypertensive or tachycardic stress responses.
52
When is Dexmedetomidine ideal?
Ideal for neurosurgery cases requiring evoked potential monitoring.
53
What type of sedation does Dexmedetomidine induce?
Induces sedation that mimics natural sleep, rather than deep anesthetic unconsciousness.
54
What are the benefits of Dexmedetomidine?
Sedated yet responsive, making it ideal for Procedural sedation. Intubated patients who need to cooperate without respiratory compromise.
55
What is the distribution and elimination half-life of Dexmedetomidine?
Distribution ½ life: 6-8 min, elimination ½ life is 2-3 hours.
56
How is Dexmedetomidine metabolized and excreted?
Hepatic metabolism via methylation & glucuronide conjugation and 97% excreted in urine.
57
How does Dexmedetomidine affect opioid levels?
Inhibits cytochrome P450 enzymes, increasing opioid plasma levels.
58
What are the respiratory effects of Dexmedetomidine?
Minimal respiratory depression but slightly reduces the body's response to hypoxia.
59
How does Dexmedetomidine affect ketamine?
Attenuates ketamine’s cardiostimulatory and postanesthetic delirium effects.
60
How does Dexmedetomidine affect IV regional anesthesia?
Enhances the effectiveness of IV regional anesthesia (Bier block).
61
When is Dexmedetomidine used instead of opioids?
Used in cesarean sections & hysterectomies (≤10 mcg intrathecally).
62
What are the respiratory effects of Dexmedetomidine?
Can Mild increase in respiratory rate (RR), Decreased tidal volume (Vt), Reduced hypoxic drive, but hypercapnic response remains intact.
63
How does Dexmedetomidine affect alcohol withdrawal and emergence delirium?
Reduces symptoms of alcohol withdrawal syndrome and emergence delirium.
64
What are the anti-inflammatory properties of Dexmedetomidine?
Anti-inflammatory properties by activating anti-apoptotic signaling pathways.
65
How does Dexmedetomidine affect anesthesia?
Enhances neuraxial, epidural, and general anesthesia.
66
How does Clonidine work?
Acts on both peripheral and central α₂-receptors decreases HR and BP.
67
What are the risks of Clonidine when administered neuraxially?
Requires continuous monitoring when administered neuraxially, due to risks of Hypotension and bradycardia.
68
How does Clonidine affect postoperative symptoms?
Reduces postoperative nausea, shivering, and delirium.
69
What is Droperidol?
A dopamine-2 (D₂) receptor antagonist in the chemoreceptor trigger zone (CTZ).
70
How does Droperidol affect CNS activity?
Suppresses CNS activity, inducing a tranquil mood and, at high doses, cataleptic immobility.
71
What are the properties of Droperidol?
Anti-emetic Mild sedative properties, antipyretic (fever-reducing) effects, and Anti-itch properties.
72
What is Scopolamine?
An anticholinergic alkaloid derived from belladonna, Lipid-soluble tertiary amine.
73
How does Scopolamine affect elderly patients?
Profound sedation (especially in elderly patients) and Potential for delirium and postoperative cognitive dysfunction.
74
What are the effects of IV administration of Scopolamine?
May cause excessive sedation (“snowing” a patient), restlessness or somnolence.

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