ECT drugs Flashcards
Like Mario & Luigi…
Bini & Cerletti! Inventors of ECT
ECT has been used for over…
50 Years!
T/F The APA considers ECT safe.
TRUE
They believed that these two couldn’t coexist together, so they’d force one out:
Schizophrenia & Epilepsy
What reduced the use of EXT?
Criticism & Psyhotropic Drugs
ECT is still a useful treatment for:
Depression - when everything else is ineffective.
ECT can also be used to help people suffering:
Suicidal ideation
Mania
Catatonia
& Some types of schizophrenia
How many treatments does the patient normally receive?
6-12
How long is electric current passed through the brain?
.5-2 seconds
Not the current that treats, but the seizure activity!
Current desirably induces a…
Grand Mal Seizure lasting 30-60 seconds
ECT patient’s shouldn’t take these drugs. Why?
Benzos - raise seizure threshold
Today, ECT is administered under:
Short-term anesthesia, modifying seizure activity
The five drugs used in ECT are: (msagp)
methohexital succinylcholine atropine glycopyrolate propofol
Methohexital is a very…
Short-acting barbiturate
Methohexital is used here to…
Anesthetize patient & reduce pre-treatment anxiety
Methohexital is administered:
IV by anesthesiologist
Dose for methohexital in ECT?
1.5mg per kg of body weight (50-120)
Methohexital works quickly by:
Passing blood brain barrier and quickly depressing CNS
Duration of the effect of methohexital?
5-7 minutes! ACT FAST!
Methohexital is excreted by…half-life?
Urine - half life of 3-8 hours.
Major side effects of methohexital?
Resp. depression Hypotension Myocardial depression Anaphylactic reactions Dyspnea Prolonged unconsciousness
Minor side effects?
N/V
Headache/restlessness
Skin rash
HICCUPS
Methohexital interacts with..
Other CNS depressions
Methohexital can cause hypotension when mixed with…
Furosemide - diuretic
This next drug killed MJ!
Propofol
Propofol is used as an alternative to…
Methohexital
Propofol produces effects in only..
40 seconds
Usual dose of propofol?
.75-1.5mg per kg of body weight
Duration of effect of propofol?
5-10 minutes
If we were to put someone into a drug induced coma, we would do so with:
Propofol
Propofol is beneficial over methohexital because it is less likely to:
Produce cardiovascular & N/V effects
Propofol is known to affect the length of seizure by:
Reducing it!
Propofol also _____ _______ @ injexn site.
Causes pain
Propofol, while a better symptom profile may interact with _____ ________ and produce:
Irreversible MAOI’s hyper/hypotension
We should wait how long between MAOI & ECT?
Couple of weeks
This next drug is used because to control muscle contraction during seizure.
Succinylcholine
Succinylcholine is an:
Ultrashort acting neuromuscular blocker
The paralysis caused by succinylcholine is effective in:
Preventing or significantly reducing muscle contractions with seizure
T/F Succinylcholine effects seizure activity in brain.
FALSE - no changes
Dose for succinylcholine? (Small)
0.6mg per kg of body weight
Succinylcholine is given Before or After methohexital?
AFTER - One minute!!!
Succinylcholine is effective by…
Interfering with action of acetylcholine in muscle cells.
Initial stimulation by succinylcholine causes.
Depolraizations - which then develop into paralysis as binding to receptor sites prevents further depolarization.
Complete paralysis effect in…
30-60 seconds
T/F Succinylcholine can be reversed by other drugs.
FALSE - Cannot be reversed
Side effects of succinylcholine include:
Extensions of paralysis Prolonged respiratory depression & apnea Cardiac arrest & changes in rhythm Hypotension Skin rashes!
These drugs can prolong paralysis with succinylcholine:
Lithium
Promazine (Phenothiazine)
Furosemide
Phenelzine (Irrev MAOI)
This drug is used to decrease production of saliva & respiratory secretions. Dry you out. Like a bone.
Atropine
In addition to drying out, it is useful to decrease…
potential of CV depression
Atropine is given by..and when?
SQ or IM 1/2 hour to 1 hour before
Dose range is…(small)
.4-.6mg
Duration of effect of atropine?
4 hours
Common side effects of atropine?
Anticholinergic effects
Atropine will potentiate other drugs with:
Anticholinergic properties (psych meds & antihistamines)
An alternate to atropine?
Glycopyrolate
In addition to drying saliva & secretions it will prevent:
Bradycardia
Glycopyrolate can be given…
IM or IV
IV onset is within:
1 minute
IM onset is within..
20-40 minutes, peaking 30-35
Dose range (sooo small)
.1-.4mg
Compared to atropine, glycopyrolates action is:
Longer
The benefit of being longer is:
Longer time frame of protection against bradycardia.
Side effects of glycopyrolate?
Anticholinergic Sfx
Glycopyrolate will also:
Interact and potentiate anticholinergic effects of other drugs.
