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Anes. Pharm. Me > Benzodiazepines > Flashcards

Benzodiazepines Flashcards

1
Q

What is anxiety defined as?

A

This fear of suffering and death loss of control and frustration.

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2
Q

What are the symptoms of anxiety? (9)

A 
Headache
Insomnia
Nausea
Dry mouth
Anorexia
Dizziness
Difficulty breathing
Palpitations
Chest pain
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3
Q

What is the onset for midazolam?

What is the peak?

What is the duration?

A

30 to 60 seconds

3 to 5 minutes

15 min to 1.5 hours

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4
Q

What is the tradename for lorazepam?

A

Ativan

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4
Q

What is the onset of lorazepam?

What is the peak?

What is the duration?

A

1 to 2 minutes

20 to 30 minutes

6 to 10 hours

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4
Q

What is the trade name for diazepam?

A

Valium

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5
Q

What effects do benzodiazepines cause? (4)

AAAS

A

Sedation
Anxiolysis
Anticonvulsant
Anterograde amnesia

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6
Q

What do benzodiazepines not do? (4)

A

Analgesic effects
Antidepressant effects
Antipsychotic effects
Protect against stress of intubation!

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6
Q

Versed will not prevent sympathetic response. True or false?

A

True

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6
Q

What are the anesthesia related clinical uses of benzodiazepines? (2)

A

Relief of anxiety

Sedation and amnesia before/during medical and surgical procedures

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7
Q

What are other clinical uses for benzodiazepines? (6)

A

Insomnia
Treatment of epilepsy and seizure states
Control of alcohol or other sedative hypnotic withdrawal states
Muscle relaxation of specific neuromuscular disorders
Diagnostic aids for treatment and psychiatry

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8
Q

What receptor do benzodiazepines work on?

A

GABA receptors

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9
Q

What is the mechanism of action for benzodiazepines?

A

Postsynaptic neurons in the cerebral cortex

Chloride channels that control inhibitory state of CNS

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10
Q

What is the route of administration for versed, Lorazepam, Diazepam?

A

IV
IV
Preop PO

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11
Q

What part of the brain do benzodiazepines work on?

A

Cerebral cortex

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12
Q

What determines the affects of the mechanism of action?

A

Receptor occupancy

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13
Q

Preop dose of Versed for kids and when is it taken?

A

.5 mg per kilogram PO 30 min. prior

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14
Q

What is the total IV dose of Versed?

A

1 to 5 mg

15
Q

What is the ICU IV sedation dose of Midazolam?

A

0.5 to 4 mg IV load

1-7 mg per hour IV

16
Q

What is the Versed IV induction dose of anesthesia?

A

.1 - .2 mg per kilogram

17
Q

What is the Diazepam dose for suppression of seizure activity?

A

.1 mg/kg

18
Q

What percent of Versed receptor occupancy provides anxiolysis?

A

20%

~2 mg

19
Q

What percent of receptor occupancy of Versed provides sedation?

A

30-50%

~3-5 mg

20
Q

What percent of receptor occupancy of Versed provides loss of consciousness?

A

60%

~6 mg

21
Q

What problems may arise from Benzodiazepine use? (3)

A

CAT

Cross tolerance
Addiction
Tolerance/abuse

22
Q

What are the routes of administration for Versed?

A

PO first pass metabolism
IV
IM

23
Q

What are the pharmacokinetics of Versed?

Routes of administration? (3)
Distribution? (4)

A

PO, IV, IM

Dependent on lipid solubility
Rapid redistribution from brain
Volume of distribution
Protein binding

24
Q

What percent bound to plasma proteins?

A

90 - 98%

25
Q

What drug is contraindicated neurosurgery to treat seizure?

A

Do not give Versed to suppress seizure activity if mapping for example.

26
Q

What occurs as a result of hypoalbemia when given Versed?

A

Less bound drug so more drug is bioavailable. More free drug to give effect!

27
Q

Drugs that inhibit cytochrome 450 will reduce/increase effects of Versed?

A

Increase

28
Q

Alcohol tolerance will increase or decrease clearance of Versed?

A

Increase

29
Q

Are there active metabolites for Versed?

A

No

30
Q

For end-stage renal disease patient is Versed OK?

A

Yes because there are no active metabolites.

Even though the drug may not be cleared by the kidneys very well the effects of Versed will go away because it’s metabolized in the liver.

31
Q

What is the effect of versed on CNS? (4)

A

decreased CMRO AND CBF
No isoelectric change on ECG
No change in ICP
Potent anticonvulsant

32
Q

What are the cardiovascular effects of Versed? (2)

A

Minor effects are decreased blood pressure and decreased heart rate

33
Q

What is the treatment for delirium tremens?

A

Versed

34
Q

What is Diazepam IV dose for lidocaine toxicity DTs and status epilepticus?

A

0.1 mg/kg IV

35
Q

How many times more potent is Versed than diazepam?

A

2-3

36
Q

Versed is better than diazepam and lorazepam because: (4)

A

Causes thrombophlebitis and venous irritation
Those drugs have active metabolites
Slow onset
Long elimination

37
Q

What is flunitrazepam?

A

Rohypnol

38
Q

What drug is an antagonist for benzodiazepines?

A

Flumazenil

39
Q

Re-sedation can occur when flumazenil inhibits what? Why?

A

Ativan because can reattach to GABA receptors

40
Q

What is the dose for flumazenil?

A

.1 - .2 mg IV up to 3 mg

Anes. Pharm. Me (15 decks)

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