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Spr24 Pharm II > Benzos (Ex1) > Flashcards

Benzos (Ex1) Flashcards

1
Q

Sedative/hypnotics definition

A

Drug that induces sleep, calm or hypnosis

Used fairly interchangeable

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2
Q

How is EEG monitoring used to measure drug effects

A

Anesthesia alters CBF and CMRO2
-CBF and CMRO2 relate to EEG activity

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3
Q

BIS monitoring explanation

A

Processed EEG compacted into one waveform
Helps determine level of sedation/consciousness

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4
Q

BIS # showing unconsciousness

A

Less than 58

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5
Q

BIS # less than 65

A

5% chance of consciousness within 50 seconds

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6
Q

SQI on BIS monitor

A

Signal quality index
-measures quality or lack of interference

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7
Q

SR on BIS monitor

A

Suppression Ratio
-number of times EEG flatlined

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8
Q

Examples of BIS suppressants (5)

A

Hypnotics, volatiles, NMBD, opioids, beta blockers

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9
Q

Examples of BIS stimulants (2)

A

Ketamine
Epinephrine

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10
Q

Ideal range for BIS# general anesthesia

A

40-60

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11
Q

Pharmacologic effects of BZDs (5)

A

-Anxiolytic
-Sedation
-Anterograde amnesia (forward)
-Anticonvulsant
-Skeletal muscle relaxation (not paralysis)

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12
Q

BZD benefit over barbiturates (3)

A

-Less tolerance or abuse potential
-Fewer/less severe side effects
-Don’t induce CYP450

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13
Q

BZD MOA

A

Facilitates actions of GABA-A => enhanced open of chloride channels => hyperpolarization of postsynaptic membrane

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14
Q

GABA alpha-1 effects (3)

A

Sedative
Amnesia
Anticonvulsant

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15
Q

GABA alpha-2 effects (2)

A

Anxiolytic
Skeletel muscle relaxation

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16
Q

Synergistic drugs also acting on GABA-A (4)

A

Barbiturates
Etomidate
Propofol
Alcohol

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17
Q

BZD EEG effects (2)

A

-Decrease alpha wave activity => relaxation
-Some able to flattened brain waves

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18
Q

Midazolam trade name

A

Versed

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19
Q

Versed amnesia vs sedation effects

A

Amnestic effects last longer than sedation effects

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20
Q

Versed solubility with pH

A

In less than 3.5 pH => water soluble (ring open)

In more than 4 pH => lipid soluble (ring closed)

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21
Q

Versed onset and peak effect

A

Onset: 1-2 min
Peak: 5 min

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22
Q

Versed protein binding

A

Extensively bound 96-98%

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23
Q

BZD reversal drug

A

Flumazenil (Romazicon)

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24
Q

Versed E 1/2 time

A

2 hours
Doubled in elderly pts

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25
Q

Versed Vd

A

Large

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26
Q

Versed metabolism

A

CYP3A4 (hepatic Microsomal enzymes)

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27
Q

Significant Drugs that can decrease BZD metabolism by CYP inhibition (3)

A

Cimetidine (Tagamet)
Calcium channel blockers
Fentanyl

28
Q

Versed cerebral flow effects

A

Decrease CMRO2
Decrease CBF
(Both dose related)

29
Q

Versed EEG effects

A

-Potential anticonvulsant
-Unable to produce isoelectric EEG (flatline)

30
Q

CO2 cerebral flow effects

A

High CO2 => cerebral vasodilation

Low CO2 => cerebral vasoconstriction

31
Q

Versed ICP effects

A

No effect on ICP (neuro-safe)

32
Q

Versed pulmonary effects

A

Dose dependent decrease in ventilation

33
Q

Versed airway effects

A

Depresses swallow reflex and upper airway activity => increased risk of aspiration

34
Q

Versed CV effects

A

Dose dependent increase HR and decreased BP
(CO unchanged d/t compensation)

35
Q

Versed sedation/anxiolysis dosing (adult)

A

1-5 mg IV
Peaks 5 min

36
Q

Versed sedation/anxiolysis children dose

A

0.25-0.5 mg/kg oral
Peak 20-30 min

37
Q

Versed induction dose

A

Not common as induction
0.1-0.2 mg/kg IV over 30-60 sec

38
Q

Versed Postoperative sedation dose

A

1-7 mg/hr IV
Not recommended for use more than 2 days d/t immune/T cell effects

39
Q

Diazepam trade name

A

Valium

40
Q

Valium protein binding

A

Highly protein bound

41
Q

Valium duration (comp)

A

More prolonged duration than versed
Rarely used in anesthesia

42
Q

Valium solubility

A

Insoluble in water
-need propylene glycol => pain on injection

43
Q

Valium onset and duration (comp)

A

Onset: 1-5 minutes
Duration longer than versed

44
Q

Valium E 1/2 time

A

20-40 hours

45
Q

Valium metabolism

A

CYP3A
-active metabolite nearly as potent (48-96 hr)

46
Q

Valium cerebral flow effects

A

Dose related decrease in CMRO2 and CBF

47
Q

Valium anticonvulsant dose

A

0.1 mg/kg IV

48
Q

Valium EEG effects

A

Can produce isoelectric EEG (flatline)

49
Q

Valium pulmonary effects

A

Minimal effects on ventilation
Slight decrease in Vt

50
Q

Valium CV effects

A

Minimal decrease in BP, CO, and SVR

51
Q

Valium induction dose

A

0.5-1 mg/kg IV
Decrease 25-50% in:
-elderly
-Liver disease
-Presence of opioids

52
Q

Lorazepam trade name

A

Ativan

53
Q

Ativan potency (comp)

A

More potent compared to other BZDs

54
Q

Ativan solubility

A

Insoluble in water
-requires polyethylene glycol => burns on injection

55
Q

Ativan onset (comp) and peak

A

-Slower onset than versed and Valium

Peak: 20-30 min with IV dose

56
Q

Ativan E 1/2 time

A

14 hours

57
Q

Ativan metabolism

A

Conjugated to inactive metabolites
-less dependent on hepatic enzymes

58
Q

Ativan dose

A

1-4 mg IV

59
Q

Flumazenil trade name

A

Romazicon

60
Q

Flumazenil MOA

A

Competitive antagonist for BZD receptor
-prevents/reverses BZD agonist activity

61
Q

Flumazenil metabolism

A

Hepatic Microsomal enzymes

62
Q

Flumazenil dose

A

0.2 mg IV
-repeat 0.1 mg q1 min to 1 mg total
To consciousness

63
Q

Flumazenil duration

A

30-60 min (shorter than BZD => resedation from BZD)

64
Q

Flumazenil side effects

A

No significant side effects

65
Q

Flumazenil cautions

A

Contraindicated in pt taking antiepileptic drugs

Spr24 Pharm II (32 decks)

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