Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

TxWes Spring '25: Anesthesia Pharm > Benzodiazepines (2) Exam 1 > Flashcards

Benzodiazepines (2) Exam 1 Flashcards

1
Q

Differentiate sedatives and hypnotics.

A
  • Sedatives: induce calm/sleep
  • Hypnotics: induce hypnosis/sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is anesthesia awareness most common?

A
  • During sedation cases and during emergence.
  • 1:1000 (or 1:10,000 per some studies)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the mechanism for less EEG activity seen during anesthesia/sedation?

A

Less cerebral blood flow (CBF) and cerebral metabolic requirement of oxygen (CMRO₂) = less metabolism = less EEG activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What was the first compressed EEG?

A
  • Bispectral analysis
  • 1500 subjects w/ 5000 hours of EEG signaling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drugs were utilized in the bispectral analysis study?

A
  • Isoflurane/ O₂
  • Propofol/nitrous
  • Propofol/alfentanil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which drug exhibited a strong correlation between BIS change and patient movement?
Which drug had less correlation?

A
  • Hypnotic drugs strong correlation
  • Narcotics less correlation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In the BIS study, what reading indicated that a patient was for sure unconscious?

A

<58

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In the BIS study, a reading of <65 indicated a ___% of return to consciousness within the minute.

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a normal BIS range?

A

40-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the four parameters (other than the BIS itself) noted on a BIS monitor?

A
  • SQI (signal quality index)
  • EMG (electromyogram)
  • EEG (electroencephalogram)
  • SR (suppression ratio)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the SR noted on a BIS monitor?

A

Suppression Ratio (percentage of time that the EEG is flat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name drugs that could suppress EEG activity.

A

Hypnotics, volatiles, NMBDs, Opioids
β-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name drugs that could enhance EEG activity.

A

Ketamine, epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the five main functions of a benzodiazepine?

A
  • Anxiolysis
  • Sedation
  • Anterograde amnesia
  • Anticonvulsant
  • Spinal-cord mediated muscle relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the only “thing” that can cause retrograde amnesia?

A

ECT (electroconvulsive therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why are written instructions given to a patient after waking up from benzodiazepine sedation?

A

Anterograde amnesia effects last longer than sedative effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Can benzodiazepines be substituted for NMBs due to their spinal-cord mediated skeletal muscle relaxation?

A

No; not adequate for true paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

__________ drugs can induce CYP450’s.

A

Barbiturates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the mechanism of action of benzodiazepines?

A

Enhancement of GABA affinity to GABA-A receptor. Allows for greater Cl⁻ influx and thus hyperpolarization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which GABA site do benzodiazepines bind to?

A

Trick question. Benzo’s do not bind directly to GABA sites, they bind to BZD sites which activate GABA sites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How many subunits are present in a GABA receptor?

A

Five
In-between the α1 & β2 subunits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What subunits do Benzodiazepines bind to on the GABA receptor?

A

In-between α1 & γ2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GABA receptors with α1 subunits exhibit what properties when bound?

A
  • Sedation, amnesia, & anticonvulsion
  • Most abundant: cerebral cortex, cerebellar cortex, & thalamus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

GABA receptors with α2 subunits exhibit what properties when bound?

A

Anxiolysis & skeletal muscle relaxation
Less abundant: hippocampus & amygdala

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What other drugs bind to GABA receptors besides benzodiazepines? (4)

A

Barbiturates, Etomidate, Propofol, & EtOH
Risk of overdose & cross-tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Benzodiazepines are highly _____ soluble and highly _______ bound.

A

Lipid; protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What factors cause differing effects amongst benzodiazepines?

A
  • Potency
  • Lipid solubility
  • Redistribution (to peripheral tissues)
  • Pharmacokinetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List EEG waves from greatest activity to least activity.

A

Gamma → Βeta → Αlpha → Theta → Delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What general effect(s) do benzodiazepines have on EEG activity?

A

Decreased αlpha activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What platelet effects do benzodiazepines have?

A

Inhibitory towards platelet aggregation (very slight, only in vitro studies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What structural characteristic of midazolam stabilizes structure and allows for rapid metabolism?

A

Imidazole Ring (lots of nitrogens)

32
Q

What two situations is midazolam primarily used for?

A

Preop anxiolysis & conscious sedation

33
Q

How much more/less potent is midazolam than diazepam? Why is this?

A

2-3x more potent due to greater receptor affinity.

34
Q

What facilitates water solubility of midazolam?

A
  • pH dependent ring opening
  • pH < 3.5 = open ring = water soluble & protonated.
  • pH > 4 = closed ring = lipid soluble & unprotonated.
35
Q

Why is midazolam non-irritating upon injection?

A

No propylene glycol needed for stabilization

36
Q

What is the onset and peak of midazolam (versed)?

A

Onset: 1-2 minutes.
Peak: 5 minutes

37
Q

Why is midazolam’s duration of action short?

A

Short due to rapid redistribution.

38
Q

What is the Elimination ½-time of midazolam?

A

2 hours
Doubled in elderly patients (4 hours-ish)

39
Q

What is the Vd (volume of distribution) of midazolam?

A

1-1.5 L/kg (large due to lipid-solubility)

40
Q

What metabolizes midazolam?

A

CYP3A4
1-hydroxmidazolam (½ the activity of midazolam)

41
Q

What clears the active metabolite of midazolam?

A

Kidneys

42
Q

What drugs will inhibit CYP450’s?

A
  • Cimetidine
  • Erythromycin
  • CCBs
  • Antifungals
  • Fentanyl
43
Q

What is midazolam’s clearance in comparison to lorazepam and diazepam?

A

5x faster than lorazepam and 10x faster than diazepam.

44
Q

How does midazolam produce an isoelectric EEG?

A

Trick question. No isoelectric EEG capabilities.

45
Q

Midazolam inhibits/preserves the vasomotor response to CO₂. What does this mean?

A

Preserves: (↑CO₂ = vasodilation; ↓CO₂ = vasoconstriction)

46
Q

Why is midazolam a good choice for neuro cases?

A

No change in ICP with administration.

47
Q

What are the pulmonary effects of midazolam?

A

Dose-dependent respiratory depression (increased with COPD).
Swallow reflex depression (aspiration).
Upper airway depression (aspiration).

48
Q

What are the cardiovascular effects of midazolam?

A

Dose-dependent ↑HR & ↓BP.

49
Q

How much does midazolam depress cardiac output?

A

Trick Question. No CO depression;
↓SVR = ↓BP, hence the increased HR compensation

50
Q

Significant hypotension can occur with midazolam administration in the presence of _____________.

A

hypovolemia.

51
Q

What is the preop/intraop sedation dosing for midazolam in pediatric populations? When do effects peak and what is the consequence of this?

A

0.25 - 0.5 mg/kg PO route.
Peaks in 20-30 min (give 30 min prior to OR).

52
Q

What is the preop/intraop dosing of midazolam in adult populations? When does the effect peak?

A

1-5mg IV.
Peaks in 5 minutes.

53
Q

What is the induction dose for midazolam? What drug is usually 1-3 minutes prior to this?

A

0.1-0.2 mg/kg IV over 30-60 seconds.
Fentanyl 50-100mcg.

54
Q

What is the postoperative sedation dose of midazolam? How long should midazolam be used for long-term sedation? Why is this?

A

1-7 mg/hr IV.
2-3 days due to unclear effects on T-cell response.

55
Q

Why does diazepam (valium) burn on injection? Is there a better formulation?

A

insoluble in water so it’s dissolved in propylene glycol.
Soybean formulation available but more expensive.

56
Q

What is the onset of diazepam? What is the E ½ time of diazepam? What is the Vd of diazepam?

A
  • Onset: 1-5 minutes.
  • E ½ = 20-40 hours (very protein-bound).
  • Vd = 1-1.5 L/kg.
57
Q

What metabolizes diazepam? What are its primary metabolites and what is its significance?

A

CYP3A4.
Desmethyldiazepam & oxazepam.
Metabolites are nearly as potent as diazepam and hit 6-8 hours after administration.

58
Q

What is the seizure dosing for diazepam? What seizures is it utilized for?

A

0.1 mg/kg IV.
DT’s, status epilepticus, lidocaine toxicity seizures.

59
Q

What are the EEG effects of diazepam?

A

Can produce isoelectric EEG.

60
Q

What are the pulmonary effects of diazepam?

A

Minimal; any depressant effects are reversed by surgical stimulation.

61
Q

What are diazepam’s effects on the cardiovascular system? What effects would be seen with adjunct opioids?

A

Minimal decreases in BP, CO, and SVR (used be agent for cardiac cases).
Additive BP changes when used with opioid.

62
Q

What are diazepam’s effects on the musculoskeletal system?

A

Decreases skeletal muscle tone.

63
Q

What is the induction dose of diazepam? When would one decrease the dose by 50%?

A

0.5-1 mg/kg IV.
50% cut with elderly, liver patients, and with concurrent opioid use.

64
Q

Of midazolam, diazepam, and lorazepam, which is the most potent sedative/amnestic?

A

Lorazepam.

65
Q

Which benzodiazepine has the slowest onset of action?

A

Lorazepam.

66
Q

When is peak effect seen with lorazepam?

A

20-30 min with IV dose (1-4mg).

67
Q

What is the E ½ time of lorazepam?

A

14 hours.

68
Q

Which benzodiazepine’s metabolism is less dependent on CYP450’s?

A

Lorazepam (better drug for liver patients).

69
Q

When is lorazepam most useful?

A

Post-operative sedation.

70
Q

What is flumazenil (Romazicon)?

A

Competitive antagonist for benzodiazepine receptor. (preventative and reversal).

71
Q

What metabolizes flumazenil? What are its metabolites?

A

CYP450’s.
No active metabolites.

72
Q

What is the dosing of flumazenil?

A

0.2mg IV titrated to consciousness (repeat 0.1mg q1min til 1mg total).

73
Q

What is the sedation reversal dose range of flumazenil?

A

0.3 - 0.6 mg.

74
Q

What is the complete reversal dose range of flumazenil?

A

0.5 - 1 mg.

75
Q

If the patient is still unconscious after 0.5 - 1mg of flumazenil has been given, what should be considered?

A

Other intoxicants (opioids, EtOH, etc).

76
Q

What is the duration of flumazenil?

A

30 - 60 min.
May need repeated doses

77
Q

When is flumazenil contraindicated?

A

When needed antiepileptics are being given.
If it precipitates acute withdrawal seizures

TxWes Spring '25: Anesthesia Pharm (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions