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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
How long does it take for Inhalation sedation to take effect on the body?
3-5 minutes
26
What state does nitrous oxide come as?
Compressed at 800psi - liquid with a vapour on top
27
What colour gas cylinder holds nitrous oxide?
Blue
28
What are the 2 types of scavenging system?
Active - pumps gases away | Passive - one entry and one exit route for the gas
29
What are the advantages of Inhalation sedation?
``` 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
What are the disadvantages of inhalation sedation?
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
What is stage 1 plane 1 in Inhalation sedation?
Relative/moderate analgesia 5-25% nitrous oxide administered Patient is relaxed
32
What is stage 1 plane 2 in Inhalation sedation?
Dissociation analgesia 20-55% nitrous oxide administered Patient is relaxed and detached from surroundings with a husky voice
33
What is stage 1 plane 3 in Inhalation sedation?
``` 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
What is stage 2 in Inhalation sedation?
``` The excitement stage Loss of consciousness May vomit, hold breath, cannot control movements Heart rate and breathing is irregular Pupils dilate ```
35
What is stage 3 plane 1 in Inhalation sedation?
The surgical stage | Muscles relax, breathing normal, eyes roll and become fixed
36
What is stage 3 plane 2 in Inhalation sedation?
The surgical stage Muscles relax, breathing normal Corneal and laryngeal reflex is lost
37
What is stage 3 plane 3 in Inhalation sedation?
The surgical stage Muscles relax, breathing normal Reflex is lost completely, pupils dilate
38
What is stage 3 plane 4 in Inhalation sedation?
The surgical stage Intercostal muscles paralysed Respiration is shallow Pupils dilate
39
What is stage 4 in inhalation sedation?
Overdose stage Pupils fully dilate Breathing stops
40
What percentage of gases should the patient receive in Inhalation sedation
A maximum is 70% nitrous oxide and minimum of 30% oxygen
41
What happens at the the end of an Inhalation sedation appointment?
The patient is administered with 100% oxygen for 5 minutes to wash out the nitrous oxide and avoid diffusion hypoxia
42
How would diffusion hypoxia occur?
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
How is transmucosal sedation administered?
Squirted into the nose
44
What is the dosage of drugs in transmucosal sedation?
40mg Midazolam and 20mg lidocaine in 1ml
45
Who is oral sedation not recommended for?
People who take anti-histamines
46
What dose of temazepam is given in oral sedation?
10-30mg one hour before treatment
47
What is the half life of diazepam oral sedative?
36-57 hours
48
What dosage of diazepam oral sedative is given?
10mg one our before treatment
49
What does polypharmacy mean?
When 2 drugs and used intravenously at the same time
50
What analgesic can be administered alongside Midazolam to enhance the sedative effect?
An opiate such as Fentanyl
51
What is the reversal drug for Opiates (Fentanyl?
Naloxone hydrochloride
52
What name is Midazolam also referred to as?
Hypnovel
53
What name is Flumazenil also known as?
Anexate
54
What is the minimum alveolar concentration for nitrous oxide?
50%
55
What type of controlled drug is Midazolam?
Schedule 3
56
How is Midazolam disposed of?
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
What other name is Propofol known by?
Diprivan
58
How long is the onset for propofol?
30-45 seconds
59
What does propofol look like?
A white, oily liquid
60
How is propofol administered?
By a patient controlled electronic infusion pump driver
61
How are vials of propofol presented?
200mg/20ml
62
What schedule drug is propofol?
Schedule 4 controlled drug meaning it has to be locked away and signed out by 2 members of staff
63
Who can administer propofol?
Anaesthetists and clinicians trained in intensive care procedures in hospital
64
What are the advantages of oral sedation?
``` 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
What are the disadvantages of oral sedation?
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
What is the half life of Temazepam?
8-10 hours

Sedation (7 decks)

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