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Dental Nurse Sedation > IV sedation M9 > Flashcards

IV sedation M9 Flashcards

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1
Q

What family of drugs does Midazolam belong to?

A

Benzodiazepines

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2
Q

What does Anxiolytic mean?

A

Reduces anxiety

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3
Q

What does Hypnotic mean?

A

Induces sleep

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4
Q

What does Anticonvulsant mean?

A

Reduces the risk of convulsive fit

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5
Q

What does Anterograde amnesia mean?

A

The patient may not remember treatment after the drug has been administered

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6
Q

What three concentrations can Midazolam be obtained in?

A

10mg in 5ml
10mg in 2ml
5mg in 5ml

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7
Q

What is the most common concentration of Midazolam in a dental surgery?

A

5mg in 5ml, reduces risk of over sedation

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8
Q

Midazolam binds to which receptors in the CNS?

A

Benzodiazepine receptors

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9
Q

Benzodiazepine receptors run parallel to which other receptors?

A

Gamma-aminobutyric acid (GABA)

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10
Q

Benzodiazepine enhances the effect of neurotransmitters on the GABA receptors leading the brain to do what?

A

Decreased brain activity

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11
Q

What is half-life?

A

The time it takes for plasma levels of the drug to drop in half

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12
Q

Name the two stages that form the Benzodiazepines half-life?

A

Alpha & Beta

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13
Q

What does the Alpha half-life do?

A

Distribution and redistribution - travels to the brain and then from the brain to other tissues in the body.

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14
Q

How long is the Alpha half-life?

A

4-18 minutes

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15
Q

What does the Beta half-life do?

A

Metabolism & Excretion (the body breaks down so it is no longer active, then removed from the body)

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16
Q

How long is the Beta half-life?

A

1-4 hours (can be longer for elderly/teens)

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17
Q

What is the standard dose of Midazolam with an ASA I?

A

Initial: 2mg over 30secs - monitored for 2 mins
Further: 0.5-1mg

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18
Q

What is the usual total dose for ASA I of Midazolam?

A

2.5mg-7.5mg

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19
Q

What is the standard dose of Midazolam for an elderly patient?

A

Initial: 1mg - 1.5mg over 2 mins
should not exceed 3.5mg

20
Q

Why is midazolam not recommended for pregnant women?

A

Because the drug passes through the placental barrier and enters the fetal bloodB

21
Q

Why is midazolam not recommended for children?

A

Due to the paradoxical effect (agitation, involuntary movements & hyperactivity)

22
Q

Why would someone with a kidney or liver impairment possibly have issues during/after sedation?

A

May lead to a slower excretion rate, effects may be enhanced or prolonged

23
Q

If a patient has an adverse reaction to Midazolam, due to a known benzodiazepine allergy, what would you do?

A

Administration stopped
Airway maintained
Oxygen provided
Adrenaline administered

24
Q

What opiate is occasionally used in conjunction with midazolam to enhance the sedation effects?

A

Nubain / Nalbuphie

25
Q

What is Nubians reversal drug?

A

Narcan

26
Q

This drug inhibits the metabolism of Midazolam resulting in a prolonged effect?

A

Erythromycin

27
Q

This supplement enhances the effect of Midazolam reducing the effect?

A

St Johns Wart

28
Q

What drug is used for the treatment of over sedation?

A

Flumazenil

29
Q

What is the maximum does of Flumazenil?

A

1mg

30
Q

Flumazenil is obtained in which concentration?

A

500mcg in 5ml

31
Q

How is Flumazenil titrated?

A

200 mcg over 15 seconds
further 100 mcg every minute

32
Q

What is the normal dose of Flumazenil?

A

300 mcg - 600 mcg

33
Q

What is the half life of Flumazenil?

A

50 minutes

34
Q

Name two contraindications of Flumazenil?

A

Coronary heart disease
Epileptic patients on medication

35
Q

What is Propofol?

A

Amnesic and hypnotic drug used to maintain general anaesthetic

36
Q

How does Propofol work?

A

By strengthening the effect of the GABA to depress the CNS - does not use receptors directly

37
Q

What concentration is Propofol obtained in?

A

200mg in 20 ml (white liquid)

38
Q

What is the half-life of Propofol?

A

2-24 minutes with 5 min recovery time

39
Q

How is Propofol given to the patient?

A

Electronic fusion pump, at intervals. Too painful to push through smaller veins

40
Q

Name the three contraindications of Propofol?

A

Patients taking respiratory depressants
Pregnancy/Nursing
Egg allergy

41
Q

What is Eve sign positive?

A

The patient is unable to touch their nose

42
Q

What is Eve sign negative?

A

The patient is able to touch their nose

43
Q

How quickly does the patient reach stage IV, after the drug has been administered?

A

approx. 1 hour

44
Q

What is the phase of sedation when the drug within the brain is at its highest? What are the effects?

A

Phase I
Behaviour changes
Slurred speech
Unaware of surroundings

45
Q

What is the phase of sedation when the drug in the body starts to decrease, which is caused by the redistribution of the drug within the body?

A

Phase II
Patient becomes more aware
Amnesic effect decreases

46
Q

What is the phase of sedation is it when the patient will appear relaxed and begin to feel normal?

A

Phase III
Patient will not be anxious
Anxiolytic effect still present

47
Q

What is the phase of sedation when the patient will appear recovered? But only the Alpha half-life has occurred.

A

Phase IV
Amnesic effect has been know to last until this phase.

Dental Nurse Sedation (11 decks)

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