Sedation

Question 1

What are the advantages of sedation?

Answer 1

It’s the process of relieving anxiety, agitation etc. We measure sedation with the RASS score

Question 2

benzodiazepines are popular drugs for sedations in ICU, what are disadvantages?

Answer 2

Drug accumulation and excessive sedation

Question 3

Onset time of midazolam (versed)?

Answer 3

1-2 min. rapid acting because of its high lipid solubility. Supposedly great for rapid sedation.

Question 4

How is midazolam metabolize?

Answer 4

Uptake in tissues, which results in rapid clearance from the bloodstream. Short lived effect of (1-2 hr). Given continuously after bolus dose.
Has metabolite cleared by kidneys

Question 5

Downsize of midazolam? Think where it’s metabolized.

Answer 5

Drug is taken in by tissues vs being eliminating from the body. So Continuous infusion will result in progressive drug accumulation in the tissues. versed infusions should be limited <48hr.
has active metabolites

Question 6

How long does the effects of lorazepam last?

Answer 6

Up to 6 hours after single IV dose.
Ativan contains propylene glycol which can increase drug solubility in the plasma. (this has adverse effects) hence it has max allowable dose.

Has NO active metabolites.

Question 7

midazolam is metabolized by cytochrome P450 enzyme system, what are drugs that may interfere with this system?

Answer 7

Diltiazem, erythromycin. It can inhibit midazolam metabolism.

Question 8

Specific concern of lorazepam usage (think how it’s prepped)

Answer 8

Propylene Glycol Toxicity.

Question 9

Midazolam loading dose?

Answer 9

0.01-0.05mg/kg

Question 10

Ativan loading dose?

Answer 10

0.02-0.04 mg/kg

Question 11

Onset of action for midazolam?

Answer 11

2-5min

Question 12

Lorazepam onset of action?

Answer 12

15-20min

Question 13

Duration of midazolam effect? After bolus

Answer 13

1-2 hr

Question 14

Duration of ativan effect? After bolus.

Answer 14

2-6 hr

Question 15

What are the advantages of benzos? (3)

Answer 15

1. Dose dependent amnestic effect that extends beyond sedation period.
2. anticonvulsant effects
3. sedatives of choice for drug withdrawal syndromes i.e etoh, benzo, opiate

Question 16

Disadvantages of using benzos?

Answer 16

1. drug accumulation w/prolonged sedation
2. tendency for benzos to promote delirium.
3. result in prolonged sedation, making it harder to wean by off ventilator. typically more of a problem with versed