Sedation

Question 1

Diazepam Dose + Trade Name

Answer 1

Valium

IV: 0.1 mg/kg
PO: 0.2 mg/kg

Question 2

Midazolam Dose + Trade Name

Answer 2

Versed

1 - 5 mg (0.05 mg/kg)

Question 3

Flumazenil Dose + Trade Name

Answer 3

Romazicon

0.2 mg
Repeat 0.1 mg q1 min
Max 3 mg

Question 4

Diazepam Onset

Answer 4

1 -5 minutes

Question 5

Diazepam Duration

Answer 5

2 - 6 hrs

Question 6

Lorazepam Onset

Answer 6

1 - 5 mins

Question 7

Lorazepam Duration

Answer 7

6 - 10 hrs

Question 8

Midazolam Onset

Answer 8

1 - 5 mins

Question 9

Midazolam Duration

Answer 9

15 - 80 mins

Question 10

Flumazenil Onset

Answer 10

1 - 5 mins

Question 11

Flumazenil Duration

Answer 11

30 mins

Question 12

Flumazenil Pharmacodynamics

Answer 12

MOA: Competitive Antagonist of GABA

Cleared by kidneys

S/E: anxiety, htn, tachycardia, changes MAC of volatiles

Question 13

Benzos MOA

Answer 13

Indirect Mediator of GABA

Increased Chloride conductance into cell = hyperpolarize/more resistant to depolarization

alpha 1: sedation, amnesia, anticonvulsant
alpha 2: anxiolytic, muscle relaxation(not adequate for surgery)

Question 14

Diazepam Pharmacodynamics

Answer 14

Highly lipid soluble

E 1/2 time: 20 - 40 hrs

Minimally decreases BP, CO, SVR

Propylene glycol causes pain on injection

Prolonged effects in liver disease and age

Question 15

Lorazepam Pharmacodynamics

Answer 15

Insoluble in Water -> need polyethylene glycol

E 1/2 Time: 14 hours

Not entirely dependent on hepatic enzymes

Question 16

Midazolam Pharmacodynamics

Answer 16

Amnesia > sedation

Imidazole Ring closure/opening is pH dependent (<3.5 = open, > 4.0= closed)

Preserves vasomotor response to CO2

Depresses swallow reflex and upper airway activity = aspiration risk

Increase HR but decrease BP (dec SVR) -> helpful for HF patients?

Question 17

Lorazepam Dose + Trade Name

Answer 17

Ativan

0.04 mg/kg

Question 18

Dexmedetomidine Dose + Trade Name

Answer 18

Precedex

0.5 - 1 mcg/kg over 10 mins
Conc: 4 mcg/mL after dilution

Question 19

Precedex MOA

Answer 19

Alpha 2 adrenoreceptor agonist
Acts centrally on pre & post synaptic receptors
Decreases NE

Question 20

Precedex Onset

Answer 20

< 5 min

Question 21

Precedex Duration

Answer 21

1 - 2 hours

Question 22

Diazepam 1/2 time

Answer 22

20 - 40 hrs

Question 23

Lorazepam 1/2 time

Answer 23

14 hours

Question 24

Midazolam 1/2 time

Answer 24

1 - 4 hours

Question 25

Precedex 1/2 time

Answer 25

2 - 3 hours

Question 26

Flumazenil 1/2 time

Answer 26

1 hour