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Anesthesia Pharmacology > IV Anesthetics- Sedatives/ Benzos & reversals > Flashcards

IV Anesthetics- Sedatives/ Benzos & reversals Flashcards

1
Q

what is precedex

A

Dexamdetomidine

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2
Q

Dexmedetomidine

class/ category

A

Adrenergic Agonist; Sedative, Analgesic

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3
Q

Dexmedetomidine

Uses-5

A
  • MAC
  • multimodal adjunct for general anesthesia
  • anxiolysis
  • analgesia
  • ICU sedation for mechanically ventilated patients
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4
Q

Dexmedetomidine

MOA

A

Selective α2 adrenergic agonist (1620 α2:1 α1)

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5
Q

Dexmedetomidine

Dose: bolus and infusion

A

Bolus: 0.5-1 mcg/kg/min over 10 min

Infusion: 0.4-0.7 mcg/kg/hr

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6
Q

dexmedetomidine

Onset

A

Onset: 10-20 min (with loading dose)

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7
Q

Dexmedetomidine

Peak and duration

A

Peak: 15-25 min

Duration: 60-120 minutes

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8
Q

Dexmedetomidine

metabolism/ elimination

A

Hepatic

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9
Q

Dexmedetomidine

CV effects

A

-↓ BP; ↓ HR typically after loading dose (up to 40%)
-Transient ↑ BP possible, especially after loading dose
-Possible cardiac arrest (if cannot tolerate bradycardia or take other medications that cause bradycardia)
-Heart block

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10
Q

Dexmedetomidine

Pulm effects

A

-Minimal ventilatory depressant effects; likely not clinically significant
-↓ ventilatory response to hypoxia, CO2 response preserved
-May decrease upper airway patency with light to moderate sedation

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11
Q

Dexmedetomidine

CNS effects

A
  • ↓ CBF ; ↓/↔ CMRO2
  • ↔ ICP
  • ↔/↓ CPP
  • Autoregulation preserved
  • Unable to produce EEG burst suppression or isoelectric EEG even at high doses, moderate EEG slowing, mimics normal sleep pattern on EEG
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12
Q

Dexmedetomidine

GI effects

A

nausea

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13
Q

What can Dexmedetomidine do to pt temperature

A

May promote perioperative hypothermia

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14
Q

T/F Precedex can cause xerostomia?

and what is xerostomia?

A

True (dry mouth)

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15
Q

What is not guarenteed because dexmedetomidine lacks these properties?
Can this be uses as a sole agent?

A

-Amnesia NOT guaranteed (lacks amnestic properties)

-Insufficient as a sole agent

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16
Q

Does precedex cause MH

A

NO, MH safe

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17
Q

What does precedex to do requirements of what type of agents?

A

Decreases requirements of IV and inhaled anesthetics

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18
Q

What is Versed

A

Midazolam

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19
Q

Midazolam

Class/ Category and MOA

A

-Class/Category: GABA agonist; Benzodiazepine

-Mechanism of Action: GABA agonist

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20
Q

Midazolam

Uses

A

Uses:
* Anterograde amnesia,
* preoperative anxiolysis,
* hypnosis,
* anticonvulsant;
* MAC

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21
Q

Versed

Onset, peak, duration

A

Onset: 30-60 sec

Peak: 2-3 min

Duration: 15-60 min

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22
Q

Midazolam

Active metabolites and metabolism

A

Active metabolites: 1-hydroxymidazolam (50% potency)

Metabolism: Hepatic

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23
Q

Versed

CV effects

A

-Minimal CV depression,
↔ CO
-Especially at induction doses (0.1-0.3 mg/kg IV): ↓ SVR → ↓ BP (may be pronounced with hypovolemia)

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24
Q

Midazolam

Premedication dose

A

Premedication: 0.02-0.04 mg/kg IV/IM, typically 2-5 mg IV

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25
Midazolam | Sedation and Induction doses
Sedation: 0.01-0.1 mg/kg IV Induction: 0.1-0.3 mg/kg IV
26
Midazolam | Pulm Effects
-Minimal ventilatory depressant effects -Ventilatory depressant effects may be **exaggerated with comorbidities (COPD**), especially in the presence of other CNS depressants or with concurrent opioids -**Relaxes upper airway** smooth muscle, *may depress upper airway reflexes*
27
Midazolam | CNS effects
-↓ CBF, ↓ CMRO2 -↓/↔ ICP -↓/↔ CPP -Dose-dependent **CNS depression** -Maintains CO2 responsiveness -Unable to produce EEG burst suppression or isoelectric EEG (ceiling effect)
28
Avoid versed in what conditions ## Footnote 2
-Avoid in pregnancy -Avoid with acute porphyrias
29
Benzo reversal
Flumazenil
30
Midazolam does what to the requirement of which agents?
Decreases requirements of IV and inhaled anesthetics in a dose-dependent fashion
31
Diazepam does what to the requirement of which agents?
Decreases requirements of IV and inhaled anesthetics in a dose-dependent fashion
32
Lorazepam does what to the requirement of which agents?
Decreases requirements of IV and inhaled anesthetics in a dose-dependent fashion
33
midazolam causes what with what type of medications?
Synergistic effect with other CNS depressants
34
Diazepam causes what with what type of medications?
Synergistic effect with other CNS depressants
35
Lorazepam causes what with what type of medications?
Synergistic effect with other CNS depressants
36
What is Valium
Diazepam
37
Diazepam | Class/ category and MOA
Class/Category: GABA agonist; Benzodiazepine Mechanism of Action: GABA agonist
38
Diazepam | Uses
Uses: * Anterograde amnesia, * preoperative anxiolysis, * anticonvulsant; * MAC
39
Diazepam | maintenance dose
Maintenance: 0.1 mg/kg as needed, may repeat **every 10-15 min** until seizures stop
40
Diazepam | Sedation and MAX dose
Sedation: 2 mg, titrated to effect Max Dose: 30 mg
41
Diazepam | Onse, Peak, duration
Onset: 1-5 min Peak: 15 min Duration: 15-60 min
42
Diazepam | metabolism and active metabolites
Metabolism: Hepatic Active metabolites: Desmethyldiazepam (return of drowsiness 6-8 hrs later), oxazepam, temazepam
43
Valium | CV effects
-Minimal ↓ BP, ↓ CO, ↓ SVR -Especially at **induction** doses: ↓ SVR → ↓ BP (may be pronounced with hypovolemia)
44
Diazepam | Pulm effects
-Minimal ventilatory depressant effects; may **depress** upper airway reflexes -Effects may be exaggerated with comorbidities (COPD), especially in the presence of other CNS depressants or with concurrent opioids -↓ Vt, may result in apnea -↑ PaCO2 at higher doses
45
Diazepam | CNS effects ## Footnote 6
-↓ CBF, ↓ CMRO2 -↓ ICP -↓/↔ CPP -Dose-dependent CNS depression -**Maintains CO2 responsiveness** -Unable to produce EEG burst suppression or isoelectric EEG (ceiling effect)
46
What affect does diazepam cause with what other medication?
Potentiates ventilatory depressant effects of opioids
47
Avoid Diazepam in what two conditions and what side effect could it cause?
-Avoid in pregnancy: Associated with cleft lip with or without cleft palate -Avoid with acute porphyrias
48
What affect does Lorazepam cause with what other medication?
Potentiates ventilatory depressant effects of opioids
49
What is Ativan
Lorazepam
50
Lorazepam | Class/ category and MOA
-Class/Category: GABA agonist; Benzodiazepine MOA: GABA agonist
51
Lorazepam | uses
Uses: Anterograde amnesia, preoperative anxiolysis, anticonvulsant
52
Lorazepam | dose
Bolus: 0.5-4 mg (0.03-0.1 mg/kg)
53
Lorazepam | Onset, Peak, duration
Onset: 1-2 min Peak: 20-30 min Duration: 6-10 hrs
54
Lorazepam | metabolism and elimination
Metabolism: Hepatic Elimination: Renal
55
Lorazepam | CV effects
-Minimal ↓ BP, ↓ CO, ↓ SVR -Especially at induction doses: ↓ SVR → ↓ BP (may be pronounced with hypovolemia
56
Lorazepam | Pulm effects
-Minimal ventilatory depressant effects; may depress upper airway reflexes -Effects may be exaggerated with comorbidities (COPD), especially in the presence of other CNS depressants or with concurrent opioids -↓ Vt, may result in apnea -↑ PaCO2 at higher doses
57
Lorazepam | CNS effects
-↓ CBF, ↓ CMRO2 -↓ ICP -↓/↔ CPP -Dose-dependent CNS depression -Maintains CO2 responsiveness -Unable to produce EEG burst suppression or isoelectric EEG (ceiling effect)
58
avoid lorazepam in what two conditions
Avoid in pregnancy Avoid with acute porphyrias
59
Remimazolam | Class/ category, uses, MOA
Class/Category: GABA agonist; Benzodiazepine Uses: Procedural sedation Mechanism of Action: GABA agonist
60
Remimazolam | Initial and subsqeuent doses
Initial: 5 mg IV over 1 min Subsequent: 2.5 mg IV over 15 sec, every 2+ minutes as needed
61
what is Byfavo
Remimazolam
62
Remimazolam | onset, peak, duration
Onset: 1 min Peak: 3-3.5 min Duration: 11-14 min
63
Remimazolam | metabolism
Metabolism: Plasma and Non-specific tissue esterases
64
Remimazolam | CV effects
↓ BP or ↑ BP ↓ HR
65
Remimazolam | Pulm effects
↓ SpO2 ↑ RR
66
Remimazolam | CNS and GI effects
CNS:Headache GI: Nausea
67
what patient population would you avoid remimazolam in?
Avoid in patients with hypersensitivity to dextran 40
68
What is Romazicon
Flumazenil
69
Flumazenil | Class/ category and MOA
Class/Category: GABA antagonist; Competitive/reversible benzodiazepine antagonist Mechanism of Action: GABA antagonist
70
Flumazenil | uses
Uses: Reversal of benzodiazepine sedative effects, benzodiazepine overdose, delayed emergence
71
Flumazenil | bolus and infustion dose
Bolus: 0.2 mg, repeat doses 0.1 mg every 60 sec, to total 1 mg; titrated to desired level of consciousness Infusion: 0.1-0.4 mg/hr
72
Flumazenil | onest, peak, duration
Onset: 1-2 min Peak: 1-3 min Duration: 45-90 min
73
flumazenil | metabolism
hepatic
74
Patients usually respond to what dose of flumazenil
0.6-1mg
75
Doses of flumazenil rarely exceed what dose for what type of use?
Doses rarely exceed: -1 mg for reversal of midazolam sedation -5 mg for reversal of ventilatory depressant effects -3 mg for benzodiazepine overdose
76
If you require more than what dose of flumazenil what should you suspect
If > 5 mg required in attempt at reversal, suspect other contributing agents
77
what are contraindidcations or population to avoid giving flumazenil to?
-Contraindication: Benzodiazepine dependent patients -Avoid if known history of seizures – **could precipitate withdrawal seizures**
78
what effect could you see with flumazenil for what medication and for how long?
Be aware for potential resedation effects from midazolam for up to 2 hrs

Anesthesia Pharmacology (7 decks)

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