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Specialist Studies 2 > Sedative Drugs > Flashcards

Sedative Drugs Flashcards

1
Q

What factors should be considered when choosing an anaesthetic agent?

A

Pharmacokinetic and pharmacological actions, interaction with concurrent medications

This includes adjustments based on the patient’s health status and medication regimen.

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2
Q

What effect does hypocarbia have on cerebral blood flow?

A

Reduces cerebral blood flow and can worsen pre-existing abnormal EEG activity

Care should be taken to avoid hyperventilation.

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3
Q

What does the EEG reflect?

A

Metabolic activity of the brain

Alterations in energy production can profoundly affect EEG activity.

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4
Q

What are the factors that can adversely affect the EEG?

A
  • Depression of cerebral blood flow*
  • Depressed oxygen or glucose delivery*
  • Hypotension*
  • Hypothermia*
  • Volatile anaesthetics*
  • Nitrous oxide*
  • Most IV anaesthetics*
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5
Q

What is the effect of most anaesthetics on EEG activity?

A

Dose-dependent decrease of EEG frequency and increase in amplitude

This includes volatile agents, propofol, barbiturates, benzodiazepines, and narcotics.

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6
Q

What is the recommended MAC range for isoflurane, desflurane, and sevoflurane in patients monitored by EEG?

A

0.5-1.0 MAC

These agents are commonly used in anaesthesia for EEG monitoring.

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7
Q

What is the characteristic EEG pattern during stage I of Guedel’s classification?

A

Posterior alpha activity

This stage represents the awake state.

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8
Q

What are the signs of early overdose in anaesthesia according to Guedel’s stages?

A
  • Periods of electrical silence <3 seconds*
  • Periods of electrical silence >3 seconds but <10 seconds*
  • Periods of electrical silence >10 seconds*
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9
Q

True or False: Benzodiazepines produce a ceiling effect of CNS depression.

A

True

This is due to their limited modulation at GABA receptor sites.

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10
Q

What are the common benzodiazepines used for ICU sedation?

A
  • Midazolam*
  • Lorazepam*
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11
Q

What is the effect of inhalational anaesthetics on the EEG?

A

Majority cause burst suppression

Enflurane is the exception, causing epileptiform activity.

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12
Q

What type of drug is propofol?

A

Short acting hypnotic drug

It is formulated in an oil-in-water emulsion.

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13
Q

What is a significant side effect of propofol?

A

Strong cardio-respiratory depressant

It can lead to a large drop in systolic and mean arterial pressure.

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14
Q

Fill in the blank: Etomidate produces a high incidence of ______ during induction.

A

Excitatory movements

This includes myoclonus and tremor.

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15
Q

What is the mechanism of action for benzodiazepines?

A

Bind to a specific receptor site of the GABA receptor

This explains their ceiling effect in CNS depression.

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16
Q

What are the physiological changes during the initial stage of status epilepticus?

A
  • Increased cerebral metabolism*
  • Increased blood flow*
  • Increased glucose and lactate concentration*
17
Q

What is the first line therapy for status epilepticus?

A

IV Benzodiazepines

Examples include Lorazepam (0.1mg/kg) or Diazepam (0.1mg/kg).

18
Q

What should be done if seizures are not controlled after 30 minutes with second line therapy?

A

Consider propofol or low dose thiopentone infusion anaesthesia

This should preferably be under EEG control.

19
Q

What is the effect of nitrous oxide on seizures in humans?

A

It has been reported to suppress epileptiform activity

This effect is not replicated in cats.

20
Q

What does the term ‘non-convulsive status epilepticus’ refer to?

A

Electrical seizure patterns on EEG without clinically detectable phenomena

It may represent advanced convulsive SE.

21
Q

What is the mechanism of action of older-generation AEDs such as CBZ and PTN?

A

Leads to decreased plasma concentration of many other medications

This includes immunosuppressants, antibacterials, and cardiovascular drugs.

22
Q

Which cardiovascular drugs are affected by older-generation AEDs?

A

Amiodarone, B-blockers, and Ca channel antagonists

These drugs can have reduced plasma concentrations due to the action of older-generation AEDs.

23
Q

How does Oxycarbamazepine compare to other AEDs in terms of hepatic dysfunction induction?

A

Oxycarbamazepine is a weaker inducer of hepatic dysfunction

This means it has a less significant impact on liver enzyme activity compared to other AEDs.

24
Q

What is the nature of Topiramate’s action?

A

Acts in a dose-dependent manner

The effects of Topiramate increase with higher doses.

25
Q

What role does Valproate play in liver enzyme activity?

A

Inhibitor of hepatic microsomal enzyme systems

This may lead to reduced drug clearance in patients taking Valproate.

26
Q

Which AEDs do not induce hepatic enzymes?

A

Gabapentin, Lamotrigine, Keppra

These medications do not affect hepatic enzyme activity.

Specialist Studies 2 (9 decks)

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