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Pharm 2 > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

Oral Sedation Advantages

A 
Well accepted
Easy
Cost Effective
Low Adverse Reaction
No needles
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2
Q

Oral Sedation Disadvantages

A 
Compliance
Latent Period
Erratic
Difficult to titrate
Difficult to alter
Prolonged duration- may need escort home
1st Pass Metabolism
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3
Q

Enteral Absorption

A

Oral, Sublingual, Rectal

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4
Q

Parenteral

A

IV, IM, IN, inhalation, Transdermal, Transmucosal

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5
Q

Bioavailability

A

The fraction of drug that reaches the central circulation

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6
Q

Proteins that drugs bind to

A

Most common: Albumin

2nd most common: a-acid glycoprotein

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7
Q

Where is the drug metabolized?

A

Most often in LIVER

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8
Q

CYP 450

A

Cleaves prodrug into active drug or further metabolizes drug

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9
Q

Common Ways of Metabolizing Drugs

A

CYP 450 and Glucoronidation

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10
Q

Acidic drugs better absorbed in _______ environment, like the _________

A

acidic; stomach

Basic better metabolize in more basic places like small intestine

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11
Q

Rationale for oral sedation

A

Good nights sleep, decrease pre-op anxiety, decrease intraoperative anxiety/pain
NOT for making uncooperative patients cooperative

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12
Q

Oral agents rules in Ohio

A

All agents must be administered concomitantly- and can only prescribe ONE dose

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13
Q

Sublingual Advantages

A

Enters systemic circulation
Cost
Low adverse rxn
No 1st pass effect

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14
Q

Sublingual Disadvantages

A

Cooperation needed
Difficult to titrate
Difficult to alter

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15
Q

Sublingual

A

Considered Enteral

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16
Q

Sublingual Characteristics

A

Deeper level of sedation
Higher peak plasma levels
Decreased time to sedation

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17
Q

Examples of Sublingual Meds

A

Nitroglycerin, Nifedipine, Fentanyl lollipop

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18
Q

Intranasal

A

Rapid onset, goes directly into systemic circulation

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19
Q

IM advantages

A

Quick onset
Max effect at 30 min
Reliable and predictable
Cooperation not essential

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20
Q

IM Disadvantages

A 
Not titratable
Not very reversible
Prolonged
Injection--> painful
Injury--> nerve damage
Have to use needle!
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21
Q

Sites for IM

A

Gluteal, Ventrogluteal, Vastus Lateralis, Deltoid

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22
Q

Gluteal IM

A

Least well perfused
Can cause damage to Sciatic N
Don’t do in little kids!
Do in Gluteus Medius, NOT gluteus maximus

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23
Q

Deltoid IM

A

Best perfused, best absorption, holds 4mL

Don’t do in little kids

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24
Q

Vastus Lateralis IM

A

Do for kids!!

Holds 15 mL, quicker uptake than Deltoid

25
Q

IM Complications

A 
Nerve damage
Periostitis
Hematoma
Abscess
Sloughing of tissue
26
Q

Clark’s Rule of Dosing

A

Weight/150 * Adult dose

27
Q

Young’s Rule of Dosing

A

Age/Age+12 * Adult dose

28
Q

Most accurate dosing for children

A

Age related body surface area as a percent of average adult body surface area

29
Q

Rectal Advantages

A

Relatively rapid
Less SE’s and lower intensity SE’s
Cost and Ease - higher acceptance
Less hepatic 1st pass effect (only 1/3)

30
Q

Rectal Disadvantages

A 
Inconvenient
Intestinal irritation
Difficult to titrate
Difficult to alter
Prolonged Duration
Erratic- variable absorption
31
Q

Superior vs Middle vs Inferior Rectal veins

A

Superior enters portal system/Liver via inf mesenteric

Middle and Inferior empty into circulation w/ internal iliac V

32
Q

Drugs to use with Rectal

A

Midazolam or Diazepam

33
Q

IV advantages

A 
Rapid onset
Highly effective
Shorter recovery
ABILITY TO REDOSE
Ability to reverse
Titratable
34
Q

IV disadvantages

A 
Venipuncture
Inc monitoring
Pain from needle
Potential catheter injury
Most cannot be reversed
Pt cooperation
35
Q

Drugs that reverse benzodiazepines

A

Miloxam and Flumazenil

36
Q

Benzodiazepines: Site of Action

A

GABA and how Cl is transferred into cell

37
Q

Benzodiazepines Physio effects

A

Reduction of hostile and aggressive behavior, reduces fear, relaxes skeletal muscles, anticonvulsant, sedation, and hypnosis

38
Q

Contraindications to Benzodiazepines

A

Allergy to them

Acute Narrow angle glaucoma

39
Q

Benzodiazepines: Uses

A

Sedative
Anxiolysis
Anticonvulsant
Amnesia

40
Q

Benzodiazepines effects on Respiration

A

Little when used alone and orally
Mild when used alone and slowly titrated IV
Unconsciousness and loss of airway in high or bolus dose

41
Q

Benzodiazepines effects on CV

A

Minimal

42
Q

Benzodiazepines Adverse Effects

A

Disinhibition
Ataxia
Prolonged drowsiness or amnesia

43
Q

Benzodiazepines drug interactions

A

Opioids- additive resp depression
Other CNS sedatives - barbiturates, antidepressants, clonidine- synnergistic
Cimetidine- Inc T1/2 of Diazepam

44
Q

Half life of Midazolam

A

1-4 hrs

45
Q

Half life of Diazepam

A

Pt’s age

46
Q

Oral Benzo drugs

A

Diazepam, Midazolam, Flumazenil, Lorazepam

47
Q

Flow of Benzodiazepines throughout body

A

Go first (75%) to vessel rich tissues like brain, then (19%) to muscles, then (6%) to far, and finally (1%) to vessel-poor group

48
Q

Diazepam Characteristics

A

Dissolved in organic solvent- propylene glycol
Sodium Benzoate
Burns on injection
5-15 mg for 1 hr appointment

49
Q

Midazolam

A

Rapid absorption orally
50% lost to 1st pass effect
Slow effect-site equilibration time
Short duration of action

50
Q

Midazolam risk

A

Greater risk of early respiratory depression

51
Q

Titrate how much Diazepam or Midazolam

A

2.5mg Diazepam or 1 mg Midazolam

52
Q

Diazepam Oral Dosing

A

2-10 mg tabs for adults

1-2 mg for children > 6mo

53
Q

Midazolam Oral Dosing

A

250-500 mcg/kg (

54
Q

Lorazepam

A

For pts w/ impaired liver fxn because does not require hepatic oxidation
0.05 mg/kg IM/IV so

55
Q

Triazolam

A 
Transient anterograde amnesia
Cat X 
May cause higher freq of psychiatric SE's
0.125-0.25 mg orally
Long half life
56
Q

Zaleplon

A

10 mg orally
NOT a benzodiazepine
Metabolized by Aldehyde Oxidase

57
Q

Zolpidem

A

10 mg orally
NOT a benzodiazepine
Short T1/2, potentiates GABA

58
Q

Temazapam

A

For sleeping

7.5-15mg orally

Pharm 2 (11 decks)

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