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5th yr- AMS > Medication considerations and drug interactions in sedation > Flashcards

Medication considerations and drug interactions in sedation Flashcards

1
Q

Define conscious sedation

A

A technique in which the use of a drug or drugs produces a state of depression of the CNS enabling treatment to be carried out
But during which verbal contact is maintained

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2
Q

What should the drugs used to provide conscious sedation carry

A

A wide margin of safety to render loss of consciousness unlikey

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3
Q

Name the most common drugs used for inhalation sedation

A

Nitrous oxide and oxygen

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4
Q

Name the most comely used drugs for intravenous sedation

A

midazolam

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5
Q

What class of drugs does midazolam fall under

A

Benzodiazepines

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6
Q

What do we want to figure out/ gather by the end of a pre sedation assessment

A
  1. Is the pt suitable for sedation
  2. The degree of the patients anxiety
  3. Nature of the dental treatment required
  4. The nature severity and stability of patients medical conditions
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7
Q

What questions do we need to ask during a medical history

A
  1. Cardiovascular
  2. Respiratory
  3. Neurological
  4. Endocrine
  5. Haematological
  6. Hepatic
  7. renal
  8. Medication
  9. other
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8
Q

What do we want o come to by the end of a medical history

A

Patients ASA classification

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9
Q

What is the ASA classification split into

A

6 grades:
I- VI

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10
Q

Define a grade I ASA classification

A

A normal healthy patients

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11
Q

Define a grade II ASA classification

A

A patient with mild systemic disease

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12
Q

Define a grade III ASA classification

A

A patient with severe systemic disease

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13
Q

Define a grade IV ASA classification

A

A patient with severe systemic disease that is a constant threat to life

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14
Q

Define a grade V ASA classification

A

A moribund patient who is not expected to survive without the operation

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15
Q

Define a grade VI ASA classification

A

A declared brain dead patient who’s organs are being removed fro donor purposes

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16
Q

Give an example of a patient that would fall under grade I ASA classification

A

Non smoker with no or minimal alcohol use

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17
Q

Give examples of a patient that would fall under grade II ASA classification

A
  1. Smoker and social alcohol drinker
  2. Pregnant pt
  3. obese pt (30
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18
Q

Give examples of a patient that would fall under grade III ASA classification

A
  1. Pt with one or more moderate to severe disease
  2. Poorly controlled diabetic
  3. Pt with poorly controlled hypotension
  4. Pt who is morbidly obese (BMI>40)
  5. Pt with a pacemaker
  6. PT who has had a myocardial infarction more than 3 months ago
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19
Q

Give examples of a patient that would fall under grade IV ASA classification

A
  1. Pt who has had a recent MI in the last 3 months
  2. Pt suffering from transient ischaemic attack
  3. Pt who has ongoing cardiac ischemia
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20
Q

Give examples of a patient that would fall under grade V ASA classification

A
  1. Trauma pt
  2. Multiple oral/ system dysfunction
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21
Q

When giving sedation in general practice which ASA grade patients would we treat

A

ASA I or II

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22
Q

What is coronary artery disease

A

Plaque build up in an artery

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23
Q

What is angina

A

Build up of plaque in artery making it harder for blood to get through

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24
Q

What is a heart attack

A

When plaque cracks and a blood cloth blocks the artery

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25
Q

How do we calculate cardiac output

A

Heart rate X stroke volume

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26
Q

What is blood pressure

A

Cardiac output X vascular resistance

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27
Q

State a normal blood pressure reading

A

Systolic 90-120
and
Diastolic 60-80

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28
Q

State a low blood pressure reading

A

Systolic <90
or
Diastolic <60

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29
Q

State a pre hypertensive blood pressure reading

A

Systolic 120-139
or
Diastolic 80-89

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30
Q

State a stage 1 hypertensive blood pressure reading

A

Systolic 140-159
or
Diastolic 90-99

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31
Q

State a stage 2 hypertensive blood pressure reading

A

Systolic more than 160
or
Diastolic more than 100

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32
Q

If a patient has a blood pressure of 143 systolic and 88 diastolic what does that suggest

A

Stage 1 hypertension

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33
Q

If a patient has a blood pressure of 68 systolic and 78 diastolic what does that suggest

A

Low blood pressure

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34
Q

If a patient has a blood pressure of 90 Systolic and 65 diastolic what does that suggest

A

Normal

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35
Q

If a patient has a blood pressure of 165 systolic and 102 diastolic what does that suggest

A

Stage 2 hypertension

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36
Q

If a patient has a blood pressure of 125 systolic and 75 diastolic what does that suggest

A

Pre hypertension

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37
Q

If a patient has a blood pressure 125 systolic and 95 diastolic what does that suggest

A

stage 1 hypertension

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38
Q

If a patient has a blood pressure 99 systolic and 55 diastolic what does that suggest

A

low

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39
Q

If a patient has a blood pressure 110 systolic and 88 diastolic what does that suggest

A

Pre hypertension

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40
Q

If a patient has a blood pressure of 105 Systolic and 70 diastolic what does that suggest

A

normal

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41
Q

If a patient has a blood pressure of 170 Systolic and 110 diastolic what does that suggest

A

stage 2 hypertension

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42
Q

Why might a healthy patients have a low blood pressure

A

They may be very athletic

43
Q

What percentage of the UK is estimated to have hypertension

44
Q

What can untreated hypertension lead to

A
  1. Atherosclerosis
  2. Aneurysm
  3. Stroke
  4. Kidney failure
  5. heart failure and heart attack
  6. Liver disease
45
Q

In which patients is hypertension more common

A
  1. Older aged patients
  2. Secondary to other disease
46
Q

What is the blood pressure cut off for sedation

A

Stage 2 hypertension so anything over 160/100

47
Q

If a patient comes in with a BP higher than 200/110 what should we do

A

Refer them to their GP urgently

48
Q

What are patients taking antihypertensive mediations More susceptible to

A

Postural hypotension

49
Q

If a patient has hypertension can we offer them sedation treatment

A

Yes as own as their disease is stable

50
Q

What can angina be induced by

A

Stress
Exercise
Hypertension

51
Q

What can angina cause

A

Imbalance in myocardial oxygen supply vs demand leadign to myocardial ischemia

52
Q

If a patient has stable angina what ASA category to they fall under

53
Q

What questions do we ask a patient who has angina

A
  1. What triggers it
  2. When was your last angina attack
  3. How often do you suffer
  4. Do you carry a GTN spray
  5. Does the GTN spray help relieve the symptoms
  6. Who takes care of your angina a nurse or cardiologist?
54
Q

Which type of sedation do we tend to offer patients with angina

A

Inhalation sedation

55
Q

What can inhalation sedation provide to patients with angina

A

Stress reduction
Analgesia
Oxygenation

56
Q

What precautions can we take prior to sedation to help minimise complications in patients with angina

A
  1. Oral pre medication
  2. Consider GTN spray before starting
  3. Oxygen prophylactically
57
Q

If a patient has unstable angina what ASA category to they fall under

58
Q

What would we do if a patient with unstable angina needed sedation

A

We would refer to the hospital for a anaesthetist input

59
Q

How does sedation effect the respiratory system

A

All sedation causes a degree bof respirant depression

60
Q

Give examples of respirate diseases we need to consider prior to offering sedation

A
  1. Asthma
  2. COPD
  3. Upper respiratory tract infection
61
Q

What happens to asthmatic patients

A

Constriction
Inflammation
Secretion build up in lungs

62
Q

What can trigger or make asthma worse

A
  1. Anxiety
  2. Stress
  3. Exercise
  4. Infection
  5. Allergy to irritant
63
Q

If a patient has asthma what ASA category to they fall under

A

ASA II-IV as asthma is a dynamic disease

64
Q

What patents would we ask a patient with asthma

A
  1. What triggers it
  2. When was your last asthma attack
  3. have you ever been hospitalised because of your asthma
  4. are you reviewed by the hospital
  5. What medication do you take for your
65
Q

Which sedation would we offer to an asthmatic patients

A

Can provide wither inhalation or intravenous sedation
As long as the disease is STABLE

66
Q

What can we do pre op to minimise the chances of an asthma attack

A

Consider asking the patient to take their bronchodilator

67
Q

What does COPD stand for

A

Chronic obstructive pulmonary disease

68
Q

If a patient has COPD what ASA category to they fall under

A

ASA II-IV as COPD slowly progresses

69
Q

Which sedation would we offer to a COPD patients

A

Inhalation sedation

70
Q

What can be a problem with COPD patients and sedation

A

They rely on a low oxygen drive and giving them oxygen coudl lead to complications however not usually the problem

71
Q

What precautions can we take before sedating a patient with COPD

A
  1. Consider salbutamol pre op
  2. Keep emergency drugs ready available
72
Q

Give examples of upper respiratory tract infections

A
  1. Cold
  2. Acute/chronic sinusitis
  3. Chronic mouth breathing
  4. Chronic nasal obstruction
  5. Sleep apnoea
73
Q

Give examples of common neurological disorders

A
  1. Epilepsy
  2. Cerebral palsies
  3. Multiple sclerosis
  4. Parkinsons
74
Q

How is epilepsy usually managed

A

Through administration of anticonvulsant medication

75
Q

Name the different types of fit a patient with epilepsy can have

A
  1. Grand Mal
  2. Petite mal
  3. Status epilepticus
76
Q

If a patient has epilepsy what ASA category to they fall under

A

Well controlled: ASA II
Poorly uncontrolled ASA III

77
Q

What can trigger epilepsy

A
  1. Stress
  2. Alcohol
  3. Hypoxia
  4. Sleep deprivation
  5. Fasting
  6. Infection
78
Q

What patents would we ask a patient with epilepsy

A
  1. What triggers it
  2. When was your last seizure
  3. How often do you get seizures
    4.do you usually sense an aura
  4. are you in hospital care
79
Q

Can we perform sedation on patients with epilepsy

A

Only if the epilepsy is very well controlled

80
Q

What precautions can we take before sedating a patient with epilepsy

A
  1. Ensure patient has followed the pre op instruction
  2. Give them the sedation drug in small increments to avoid over sedation
  3. Consider oxygen via nasal cannulation
81
Q

Give examples of involuntary movement disorders

A
  1. Cerebral palsies
  2. Multipel sclerosis
  3. Parkinsons
  4. Huntingtons disease
82
Q

Which form of sedation would we give to patients with involuntary movement disorders

A

Intra venous sedation if they have tremors

83
Q

What is myasthenia graves

A

An autoimmune neuromuscular disease that causes weakness of facial and respiratory muscles

84
Q

Which form of sedation would we give to patients with myasthenia graves

A

Inhalation sedation

85
Q

Give examples haematological diseases that we must consider prior to offering patient sedation

A
  1. Severe anaemia
  2. Sickle cell disease
  3. Thalassaemia
86
Q

Which form of sedation would we give to patients with haematological diseases

A

Inhalation sedation

87
Q

Give examples endocrine diseases that we must consider prior to offering patient sedation

A
  1. Diabetes
  2. Adrenal insuffiecny
  3. Thyroid disorders
88
Q

Which form of sedation would we give to patients with diabetes

A

Either Inhalation or intravenous can be offered as long as the patients diabetes is WELL CONTROLLED

89
Q

What happens in adrenal insuffiecny

A

Response to stress is suppressed and may lead to secondary hypertension and diabetes

90
Q

Do we tend to offer sedation in primary care to patients with adrenal insufficiency

A

No we refer to an anaesthetist

91
Q

how does having liver disease affect drugs in the body

A

Can reduce drug metabolism

92
Q

how does having kidney disease affect drugs in the body

A

Can reduce drug excretion

93
Q

Do we tend to offer sedation in primary care to patients with kidney or liver disease

A

No we prefer to refer to an anaesthetist and contact the patients constant

94
Q

Do we tend to offer sedation in primary care to patients WHO ARE pregnant

A

We avoid offering sedation to pregnant patients until baby is born

95
Q

Which drugs can benzodiazepines interact with

A
  1. Alcohol
  2. Analgesics
  3. Erythromycin
  4. Antidepressants
  5. Anti-epileptics
  6. Antihistamins
  7. Anti hypertensives
  8. anti ulcer drugs
96
Q

How effect can benzodiazepines have on alcohol

A

Enhanced sedative effect

97
Q

How effect can benzodiazepines have on analgesics

A

Enhanced sedative effect

98
Q

How effect can benzodiazepines have on erythromycin

A

Inhibits metabolism of midazolam

99
Q

How effect can benzodiazepines have on antidepressants

A

Enhanced sedative effect

100
Q

How effect can benzodiazepines have on anti epileptics

A

May reduce the effect of the anti epileptic medication

101
Q

How effect can benzodiazepines have on antihistamines

A

Enhanced sedative effect

102
Q

How effect can benzodiazepines have on antihypertensives

A

Enhanced hypotensive effect

103
Q

How effect can benzodiazepines have on anti ulcer drugs

A

Cimetidine inhibits metabolism of benzodiazepines

5th yr- AMS (11 decks)

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