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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
Q

Midazolam

Sedation and Induction doses

A

Sedation: 0.01-0.1 mg/kg IV
Induction: 0.1-0.3 mg/kg IV

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26
Q

Midazolam

Pulm Effects

A

-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

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27
Q

Midazolam

CNS effects

A

-↓ CBF, ↓ CMRO2
-↓/↔ ICP
-↓/↔ CPP
-Dose-dependent CNS depression
-Maintains CO2 responsiveness
-Unable to produce EEG burst suppression or isoelectric EEG (ceiling effect)

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28
Q

Avoid versed in what conditions

2

A

-Avoid in pregnancy
-Avoid with acute porphyrias

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29
Q

Benzo reversal

A

Flumazenil

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30
Q

Midazolam does what to the requirement of which agents?

A

Decreases requirements of IV and inhaled anesthetics in a dose-dependent fashion

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31
Q

Diazepam does what to the requirement of which agents?

A

Decreases requirements of IV and inhaled anesthetics in a dose-dependent fashion

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32
Q

Lorazepam does what to the requirement of which agents?

A

Decreases requirements of IV and inhaled anesthetics in a dose-dependent fashion

33
Q

midazolam causes what with what type of medications?

A

Synergistic effect with other CNS depressants

34
Q

Diazepam causes what with what type of medications?

A

Synergistic effect with other CNS depressants

35
Q

Lorazepam causes what with what type of medications?

A

Synergistic effect with other CNS depressants

36
Q

What is Valium

A

Diazepam

37
Q

Diazepam

Class/ category and MOA

A

Class/Category: GABA agonist; Benzodiazepine

Mechanism of Action: GABA agonist

38
Q

Diazepam

Uses

A

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

39
Q

Diazepam

maintenance dose

A

Maintenance: 0.1 mg/kg as needed, may repeat every 10-15 min until seizures stop

40
Q

Diazepam

Sedation and MAX dose

A

Sedation: 2 mg, titrated to effect
Max Dose: 30 mg

41
Q

Diazepam

Onse, Peak, duration

A

Onset: 1-5 min

Peak: 15 min

Duration: 15-60 min

42
Q

Diazepam

metabolism and active metabolites

A

Metabolism: Hepatic

Active metabolites: Desmethyldiazepam (return of drowsiness 6-8 hrs later), oxazepam, temazepam

43
Q

Valium

CV effects

A

-Minimal ↓ BP, ↓ CO, ↓ SVR
-Especially at induction doses: ↓ SVR → ↓ BP (may be pronounced with hypovolemia)

44
Q

Diazepam

Pulm effects

A

-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
Q

Diazepam

CNS effects

6

A

-↓ CBF, ↓ CMRO2
-↓ ICP
-↓/↔ CPP
-Dose-dependent CNS depression
-Maintains CO2 responsiveness
-Unable to produce EEG burst suppression or isoelectric EEG (ceiling effect)

46
Q

What affect does diazepam cause with what other medication?

A

Potentiates ventilatory depressant effects of opioids

47
Q

Avoid Diazepam in what two conditions and what side effect could it cause?

A

-Avoid in pregnancy: Associated with cleft lip with or without cleft palate
-Avoid with acute porphyrias

48
Q

What affect does Lorazepam cause with what other medication?

A

Potentiates ventilatory depressant effects of opioids

49
Q

What is Ativan

A

Lorazepam

50
Q

Lorazepam

Class/ category and MOA

A

-Class/Category: GABA agonist; Benzodiazepine

MOA: GABA agonist

51
Q

Lorazepam

uses

A

Uses: Anterograde amnesia, preoperative anxiolysis, anticonvulsant

52
Q

Lorazepam

dose

A

Bolus: 0.5-4 mg (0.03-0.1 mg/kg)

53
Q

Lorazepam

Onset, Peak, duration

A

Onset: 1-2 min

Peak: 20-30 min

Duration: 6-10 hrs

54
Q

Lorazepam

metabolism and elimination

A

Metabolism: Hepatic

Elimination: Renal

55
Q

Lorazepam

CV effects

A

-Minimal ↓ BP, ↓ CO, ↓ SVR
-Especially at induction doses: ↓ SVR → ↓ BP (may be pronounced with hypovolemia

56
Q

Lorazepam

Pulm effects

A

-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
Q

Lorazepam

CNS effects

A

-↓ CBF, ↓ CMRO2
-↓ ICP
-↓/↔ CPP
-Dose-dependent CNS depression
-Maintains CO2 responsiveness
-Unable to produce EEG burst suppression or isoelectric EEG (ceiling effect)

58
Q

avoid lorazepam in what two conditions

A

Avoid in pregnancy
Avoid with acute porphyrias

59
Q

Remimazolam

Class/ category, uses, MOA

A

Class/Category: GABA agonist; Benzodiazepine

Uses: Procedural sedation

Mechanism of Action: GABA agonist

60
Q

Remimazolam

Initial and subsqeuent doses

A

Initial: 5 mg IV over 1 min

Subsequent: 2.5 mg IV over 15 sec, every 2+ minutes as needed

61
Q

what is Byfavo

A

Remimazolam

62
Q

Remimazolam

onset, peak, duration

A

Onset: 1 min

Peak: 3-3.5 min

Duration: 11-14 min

63
Q

Remimazolam

metabolism

A

Metabolism: Plasma and Non-specific tissue esterases

64
Q

Remimazolam

CV effects

A

↓ BP or ↑ BP
↓ HR

65
Q

Remimazolam

Pulm effects

A

↓ SpO2
↑ RR

66
Q

Remimazolam

CNS and GI effects

A

CNS:Headache

GI: Nausea

67
Q

what patient population would you avoid remimazolam in?

A

Avoid in patients with hypersensitivity to dextran 40

68
Q

What is Romazicon

A

Flumazenil

69
Q

Flumazenil

Class/ category and MOA

A

Class/Category: GABA antagonist; Competitive/reversible benzodiazepine antagonist

Mechanism of Action: GABA antagonist

70
Q

Flumazenil

uses

A

Uses: Reversal of benzodiazepine sedative effects, benzodiazepine overdose, delayed emergence

71
Q

Flumazenil

bolus and infustion dose

A

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
Q

Flumazenil

onest, peak, duration

A

Onset: 1-2 min

Peak: 1-3 min

Duration: 45-90 min

73
Q

flumazenil

metabolism

A

hepatic

74
Q

Patients usually respond to what dose of flumazenil

A

0.6-1mg

75
Q

Doses of flumazenil rarely exceed what dose for what type of use?

A

Doses rarely exceed:
-1 mg for reversal of midazolam sedation
-5 mg for reversal of ventilatory depressant effects
-3 mg for benzodiazepine overdose

76
Q

If you require more than what dose of flumazenil what should you suspect

A

If > 5 mg required in attempt at reversal, suspect other contributing agents

77
Q

what are contraindidcations or population to avoid giving flumazenil to?

A

-Contraindication: Benzodiazepine dependent patients

-Avoid if known history of seizures – could precipitate withdrawal seizures

78
Q

what effect could you see with flumazenil for what medication and for how long?

A

Be aware for potential resedation effects from midazolam for up to 2 hrs

Anesthesia Pharmacology (5 decks)

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