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Pharm > IV Sedatives > Flashcards

IV Sedatives Flashcards

1
Q

Barbiturates increase the _____ of the opening of the chloride channel

A

duration

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2
Q

Thiobarbiturates have a ____ molecule in the 2nd position which increases lipid solubility and ____.

A

sulfur, potency

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3
Q

Oxybarbiturates have a ____ molecule in the 2nd position

A

oxygen

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4
Q

Adding a phenyl group at the 5th carbon increases the ______. Which med is this?

A

Anticonvulsant effect. Phenobarbital

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5
Q

What is Thiopental mechanism of action?

A

GABA-A agonist Depresses reticular activating system in the brainstem.

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6
Q 
What is the following for Thiopental:
Dose:
Onset:
Duration:
Clearance:
Side effects:
A 
Dose: 2.5-5mg
Onset: 30-60 sec
Duration: 5-10 min
Clearance: Liver P450 enzyme
S/E: hypotension, histamine release, respiratory depression, bronchoconstriction, decrease in cerebral blood flow and metabolic demand. No analgesia
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7
Q

What is the most common and dangerous type of porphyria

A

Acute Intermittent Porphyia

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8
Q

What causes porphyria?

A

Defect in heme synthesis that promotes the accumulation of heme precursors

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9
Q

What things make acute intermittent porphyria worse?

A

ALA synthase, emotional stress, prolonged NPO status, CYP450 induction

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10
Q

What are signs and symptoms of porphyria?

A

Severe abdominal pain, N/V, anxiety, muscle weakness, seizures, coma

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11
Q

What are drugs to avoid with porphyria?

A 
Barbs
Etomidate
Ketamine
Ketorolac
Amio
Many Ca Channel Blockers
Birth Control pills
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12
Q

What types of anesthetic management is done for porphyria?

A 
hydration!
Glucose
Heme arginate
Prevent Hypothermia
consider regional
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13
Q

What are the following for Propofol?

MOA:
Dose:
Onset:
Duration:
Clearance:
A 
MOA: GABA-A agonist
Dose: 1-2mg/kg
Onset: 30-60sec
Duration: 5-10 min 
Clearance: liver P450
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14
Q

What are side effects of Propofol:

A

Cardiac: Decreased BP, SVR, preload, contractility
Respiratory: less sensitive to increasing CO2, decreased TV
CNS: decreased CMRO2, ICP, IOP
green/cloudy urine

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15
Q

The clearance of Propofol exceeds what the liver is able to handle, how else is it excreted?

A

the lungs

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16
Q

About how long does it take to have peak brain concentration with Propofol?

A

1 min

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17
Q

What are risk factors for Propofol Infusion Syndrome (PIS)

A 
Propofol dose >4mcg/kg/hr (67mcg/kg/min)
Infusion >48hr
Sepsis
Continuous catecholamine infusions
high-dose sterioids
significant cerebral injury
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18
Q

What are s/s of propofol infusion syndrome?

A 
acute, refractory bradycardia that leads to asystole plus one of the following:
metabolic acidosis
rhabdo
enlarged fatty liver
renal failure
HLD
lipemia**early clinical sign
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19
Q

What is the treatment for propofol infusion syndrome?

A 
stop propofol
maximize gas exchange
cardiac pacing
Glucagon
ECMO
CRRT
Phosphodiesterase inhibitors
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20
Q

What is Methohexital used for?

A

ECT

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21
Q

Phenobarbital is excreted through the ___ which is different than other barbiturates, which are metabolized by______

A

urine, P450 enzymes

22
Q

What is the following for Propofol:

MOA:
Dose:
Onset:
Duration:
Clearance:
A 
MOA: GABA-A agonist
Dose: 1-2mg/kg
Onset: 30-60 sec
Duration: 5-10 min
Clearance: P450 and lungs
23
Q

What are risk factors for propofol infusion syndrome (PIS)?

A 
High propofol dosing (>4mcg/kg/hr or 67mcg/kg/min)
Duration >48hr
Sepsis
Continuous catecholamine infusions
High dose sterioids
Significant cerebral injury
24
Q

What are side effects of propofol infusion syndrome?

A

Acute refractory bradycardia that leads to asystole + one of the following:

Metabolic acidosis
Rhabdo
Enlarged fatty liver
Renal failure
HLD
lipemia (early sign)
25
Q

What is the treatment for propofol infusion syndrome?

A 
stop propofol
maximize gas exchange
cardiac pacing
Glucagon
ECMO
CRRT
Phosphodiesterase inhibitors
26
Q

What is the following for Etomidate:

MOA:
Dose:
Onset:
Duration:
Clearance:
A 
MOA: GABA-A agonist
Dose: 0.2-0.4mg/kg
Onset: 30-60 sec
Duration: 5-15 min
Clearance: P450 and plasma esterases
27
Q

What are the benefits of Etomidate?

A

More cardiac stability than propofol, less respiratory depression, short half life

28
Q

When should you use caution with Etomidate?

A

It decreases adrenocortical function for 5-8 hr so use with causes in pts with sepsis or acute adrenal failure. increased mortality rate. Also avoid if patient has had acute intermittent porphyria

29
Q

What do benzos do to let Chloride in?

A

The frequency of the channel opening increases

30
Q

What is the following for Midazolam:

MOA:
Dose:
Onset:
Duration:
Clearance:
Metabolite:
A

MOA: GABA-A agonist, increased frequency of channel opening
Dose: 0.1 mg/kg
Onset: 30-60 sec
Duration: 20-60 min
Clearance: Liver & intestines P450 enzymes
Metabolite: 1-hydroxymidazolam (half potency, renal failure prolongs effect)

31
Q

Respiratory effects of midazolam:

A

induction dose causes respiratory depression. Opioids potentiate effect.

32
Q

CNS effects of midazolam:

A

Anticonvulsant
Antianxiety
amnesia
antispasmodic

33
Q

Uses for diazepam:

A

anticonvulsant, antispasmodic, prevent emergence delirium after ketamine

34
Q

How long does it take for Lorazepam to reach peak effect?

A

20-30 min (slow onset)

35
Q

How long does Lorazepam work?

A

6-10 hrs

36
Q

What is a short acting benzo that is used for helping fall asleep?

A

Triazolam

37
Q

What is the reversal for benzos and what is the MOA?

A

Flumazenil, GABA-A antagonist

38
Q

What is the dosing for Flumazenil?

A

0.2mg IV, titrated to 0.1mg Q1min.

39
Q

What is the following for Ketamine:

MOA:
Dose:
Onset:
Duration:
Clearance:
Metabolite:
A 
MOA: NMDA antagonist
Dose: Induction: 1-2mg/kg, Maint: 1-3mg/kg
Onset: 30-60 sec
Duration: 10-20 min
Clearance: Liver P450 
Metabolite: Norketamine
40
Q

Does ketamine decrease the respiratory drive?

A

No!

41
Q

What are cardiac effects of Ketamine?

A 
increased:
SNS tone
Cardiac output
HR
SVR
PVR

myocardial depressant

42
Q

What are respiratory effects of Ketamine?

A

Bronchodilation
Maintains respiratory drive
Increased oral and pulmonary secretions (may give glyco to avoid)

43
Q

What are CNS effects of Ketamine?

A 
Increased:
CMRO2
blood flow
ICP
IOP
EEG activity
Nystagmus
Emergence Delirium
44
Q

What are some other uses and effects of Ketamine?

A

Treatment of depression, chronic use can cause ulcerative colitis, avoid with pts with porphyria, lowest amount of protein binding, relieves somatic pain >visceral pain, good for frequent dressing changes and pre-existing chronic pain syndromes

45
Q

What is the following for Dexmedetomidine?

MOA:
Dose:
Onset:
Duration:
Clearance:
A

MOA: Alpha-2 agonist, decreased norepi released and inhibits locus coeruleus in the Pons
Dose: bolus: 1mcg/kg over 10 min, maint: 0.4-0.7 mcg/kg/hr
Onset: 10-20 min
Duration: 10-30 min after infusion
Clearance: liver P450 enzymes

46
Q

What are cardiac effects of Dex?

A

bradycardia and hypotension. Can get hypertension right after bolus dose

47
Q

What are respiratory effects of Dex?

A

None

48
Q

What are CNS effects of Dex?

A

decreased blood flow, easily aroused, no amnesia

49
Q

What are some other effects of Dex?

A

impairs thermoregulatory response (should shiver but dont)
decreased emergence delirium in children
analgesia d/t decreased substance P and glutamate release in dorsal horn
Useful for wake up tests

50
Q

What is the reversal for Scopolamine?

A

Physostigmine

Pharm (12 decks)

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