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Sedation > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is pharmacokinetics?

A

The process that influences the concentration of drugs in the body
(Absorption, distribution, metabolism or excretion)

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2
Q

What is pharmacodynamics?

A

How drugs effect the body

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3
Q

What are the drugs mainly used in oral sedation?

A

Midazolam, temazepam and diazepam

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4
Q

What gas is used in Inhalation sedation?

A

Nitrous oxide

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5
Q

What drugs are used in transmucosal sedation?

A

Midazolam and lidocaine

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6
Q

What drug is used in a hospital for Inhalation sedation to induce general anaesthesia?

A

Sevoflurane

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7
Q

What does GABA stand for?

A

Gamma-aminobutyric

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8
Q

What are the advantages of Intravenous sedation?

A 
Has a rapid onset
Short acting
Amnesic
Titratable
Reduces gag reflex
Non irritant when injected
Cannula stays in throughout which is helpful in an emergency
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9
Q

What are the disadvantages of intravenous sedation?

A 
Not for people with liver/kidney disease
Not for people with drug/alcohol abuse
Not for people with respiratory problems
Not suitable for pregnant women
Difficult for needles phobics
Sometimes difficult to find vein to cannulate
Not suitable for children/elderly
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10
Q

What does half life mean?

A

The time it takes for the plasma level of the drug to drop by half

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11
Q

What does alpha half life mean?

A

The time it takes to distribute the drug around the body and to the brain

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12
Q

What does beta half life mean?

A

The times it takes for the drug to be broken down and eliminated by the body

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13
Q

How long does it take for Midazolam to take effect on the between

A

4-18 minutes

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14
Q

How long does it take the body to eliminate Midazolam?

A

1-4 hours

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15
Q

What is the usual dose given of Midazolam?

A

2.5 - 7.5mg

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16
Q

What are the pre-operative instructions for Intravenous sedation?

A 
Have a light meal
Wear loose clothing
Wear flat shoes
No nail polish or false nails
No alcohol for 24 hours before appointment
Bring an escort
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17
Q

What are the post-operative instructions for Intravenous sedation?

A 
Responsible adult must be present for 24 hours after
Arrange childcare
Don’t sign legal documents
No doing DIY or operating machinery
Avoid alcohol for 24 hours after
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18
Q

What is the usual dose given of Flumazenil?

A

300mcg-600mcg

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19
Q

How is Flumazenil titrated?

A

200mcg over 15 seconds, then 100mcg every minute until fully conscious

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20
Q

What is the maximum dose that can be administered of Flumazenil?

A

1mg (2 ampoules)

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21
Q

What is the half life of Flumazenil?

A

50 minutes

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22
Q

Who is Flumazenil not suitable for?

A

Patients who take benzodiazepine medication
Patients with coronary heart disease
Patients with epilepsy

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23
Q

What is the half life of propofol?

A

2-24 minutes

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24
Q

Who is propofol not suitable for?

A

People with an egg allergy

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25
Q

How long does it take for Inhalation sedation to take effect on the body?

A

3-5 minutes

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26
Q

What state does nitrous oxide come as?

A

Compressed at 800psi - liquid with a vapour on top

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27
Q

What colour gas cylinder holds nitrous oxide?

A

Blue

28
Q

What are the 2 types of scavenging system?

A

Active - pumps gases away

Passive - one entry and one exit route for the gas

29
Q

What are the advantages of Inhalation sedation?

A 
No cannula needed so good for needle phobics
Rapid onset
Rapid recovery
Can be used for only short procedures
Titratable
No need for an escort
30
Q

What are the disadvantages of inhalation sedation?

A

Not for psychiatric patients (can change state of mind)
Not for people with a cold/flu
Untolerated by claustrophobic patients
Reliant on psychological support to calm the patient down
Not for pregnant patients
Not strong enough for some
Not for people with breathing difficulties

31
Q

What is stage 1 plane 1 in Inhalation sedation?

A

Relative/moderate analgesia
5-25% nitrous oxide administered
Patient is relaxed

32
Q

What is stage 1 plane 2 in Inhalation sedation?

A

Dissociation analgesia
20-55% nitrous oxide administered
Patient is relaxed and detached from surroundings with a husky voice

33
Q

What is stage 1 plane 3 in Inhalation sedation?

A 
Total amnesia
50-70% nitrous oxide administered
Pain/fear is completely gone 
Patient can become agitated and nauseous
Fixed stare
Too deep
Reduce nitrous oxide by 10%
34
Q

What is stage 2 in Inhalation sedation?

A 
The excitement stage
Loss of consciousness
May vomit, hold breath, cannot control movements
Heart rate and breathing is irregular
Pupils dilate
35
Q

What is stage 3 plane 1 in Inhalation sedation?

A

The surgical stage

Muscles relax, breathing normal, eyes roll and become fixed

36
Q

What is stage 3 plane 2 in Inhalation sedation?

A

The surgical stage
Muscles relax, breathing normal
Corneal and laryngeal reflex is lost

37
Q

What is stage 3 plane 3 in Inhalation sedation?

A

The surgical stage
Muscles relax, breathing normal
Reflex is lost completely, pupils dilate

38
Q

What is stage 3 plane 4 in Inhalation sedation?

A

The surgical stage
Intercostal muscles paralysed
Respiration is shallow
Pupils dilate

39
Q

What is stage 4 in inhalation sedation?

A

Overdose stage
Pupils fully dilate
Breathing stops

40
Q

What percentage of gases should the patient receive in Inhalation sedation

A

A maximum is 70% nitrous oxide and minimum of 30% oxygen

41
Q

What happens at the the end of an Inhalation sedation appointment?

A

The patient is administered with 100% oxygen for 5 minutes to wash out the nitrous oxide and avoid diffusion hypoxia

42
Q

How would diffusion hypoxia occur?

A

Nitrous oxide leaves the blood more quickly than nitrogen in the air is absorbed. This happening in the alveoli dilutes the oxygen with can lead to hypoxia

43
Q

How is transmucosal sedation administered?

A

Squirted into the nose

44
Q

What is the dosage of drugs in transmucosal sedation?

A

40mg Midazolam and 20mg lidocaine in 1ml

45
Q

Who is oral sedation not recommended for?

A

People who take anti-histamines

46
Q

What dose of temazepam is given in oral sedation?

A

10-30mg one hour before treatment

47
Q

What is the half life of diazepam oral sedative?

A

36-57 hours

48
Q

What dosage of diazepam oral sedative is given?

A

10mg one our before treatment

49
Q

What does polypharmacy mean?

A

When 2 drugs and used intravenously at the same time

50
Q

What analgesic can be administered alongside Midazolam to enhance the sedative effect?

A

An opiate such as Fentanyl

51
Q

What is the reversal drug for Opiates (Fentanyl?

A

Naloxone hydrochloride

52
Q

What name is Midazolam also referred to as?

A

Hypnovel

53
Q

What name is Flumazenil also known as?

A

Anexate

54
Q

What is the minimum alveolar concentration for nitrous oxide?

A

50%

55
Q

What type of controlled drug is Midazolam?

A

Schedule 3

56
Q

How is Midazolam disposed of?

A

Mixing the Midazolam with a denaturing kit and binding matrix to make it physically irretrievable
Then disposed of in the blue lockable pharmaceutical container

57
Q

What other name is Propofol known by?

A

Diprivan

58
Q

How long is the onset for propofol?

A

30-45 seconds

59
Q

What does propofol look like?

A

A white, oily liquid

60
Q

How is propofol administered?

A

By a patient controlled electronic infusion pump driver

61
Q

How are vials of propofol presented?

A

200mg/20ml

62
Q

What schedule drug is propofol?

A

Schedule 4 controlled drug meaning it has to be locked away and signed out by 2 members of staff

63
Q

Who can administer propofol?

A

Anaesthetists and clinicians trained in intensive care procedures in hospital

64
Q

What are the advantages of oral sedation?

A 
Easy to administer
Accepted by most
Results in sedation
No cannula so good for needle phobics
Specialised training not required
Not expensive to provide
65
Q

What are the disadvantages of oral sedation?

A

Trusting the patient to take drug at home as directed
Must be able to comply with pre and post operative instructions
No venous access
Dose cant be titrated
Not an analgesic
Takes a long time to take affect
Stays in the body for a long time

66
Q

What is the half life of Temazepam?

A

8-10 hours

Sedation (7 decks)

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