sedative-hypnotic meds Flashcards
lorazepam-ativan
benzo peak 1-6 hours elimination time 10-18 hours tx -insomnia -anxiety -muscle relaxant
midazolam-versed
peak 0.2 to 1 hour
elimination ultra short 2-5 hours
tx
-pre anesthetic
alprazolam-xanax
peak 1-2 hours elimination short 12-15 hours tx -insomnia -anxiety
non benzos
zolpidem-ambien
zaleplon-sonota
eszopiclone
other anxiolytics
buspirone
doxepin
other hypnotics
ramelteon
diphenydramine
doxylamine
phenobarbital
barbiturate long onset 1-3 hours long elimination 80-120 hours tx -anticonvulsant
pentobarbital
barbiturate onset short to intermediate 0.5 to 1 hour intermediate elimination 15-50 hours tx -preoperative sedation
amobarbital
barbiturate onset ultra short/immediate elimination short 10 hours tx preoperative sedation
thiopental
barbiturate onset ultra short/immediate elimination ultra short 3-10 hours tx anesthetic induction
flumazenil
competitive antagonist of BZD receptor
benzo OD reversal agent
same day surgeries
doest antagonize other CNS/GABA depressants
duration of action shorter than benzo so multiple doses required
buspirone
partial agonist 5HT1a receptor
mainly anxiolytic
1/2 life 2 hours-> take a week for efficacy
doesn’t potentiate sedative-hypnotic effect of CNS depressants
little risk of tolerance/dependance
doxepin
antidrepressant
anxiolytic
ramelteon
melatonin Mt1 and Mt2 agonist in suprachiastmatic nucleus
not CNS depressant, no anxiolytic
take 30 min before bed
little risk of tolerance
sedative-hypnotic AE
drosiness impaired motor impaired judgement anterograde amnesia lightheadness ataxia nausea vertigo incontinence
desflurane
volatile anesthetic MAC 6.6 lowest blood gas Coeff pungent smell -airway irritation --bronchospasm and laryngospasm decreased cerebral metablosism decreased HR, PVR, myocardial function, tidal volume AE N/V, malignant hyperthermia
isoflurane
volatile anesthetic MAC 1.17 highest oil gas coeff pungent - airway irritation --bronchospasm and laryngospasm decreased cerebral metabolism decreased HR, PVR, myocardial function, tidal volume AE N/V, malignant hyperthermia
nitrous oxide
volatile anesthetic
MAC 104, use high percentages, hyperbaric
decreased cerebral metabolism
decreased HR, PVR, tidal volume
AE N/V, diffusion expansion into airspace, neurotoxic in developing brain
sevoflurane
volatile anesthetic MAC 1.8 rotten banana smell decreased cerebral metabolism decreased HR, PVR, myocardial function, tidal volume AE N/V, malignant hypertension
propofol
IV anesthetic
emulsion (soybean oil, glycerol, egg lecithin)
px during injection (use lido)
rapid onset, short duration, low hangover
rapid hepatic metabolism (infusion)
hypotension and profound decreased resp
sodium pentothal
barbiturate
not in US anymore
rapid onset, short duration
long elimination (no infusion)
decreased cerebral metabolism -> decreased ICP
hypotension, tachycardia, upper airway obstruction and apnea
etomidate
iv anesthetic pain on injection rapid onset and rapid redistribution most cardiostable IV induction ventilation less affected 30-60% myoclonus adrenocortical suppression
ketamine
NMDA receptor antagonist
dissociative anesthetic
distribution 1/2 life 10-15 minutes
minimal resp depression
indirect sympathetic stimulation (increased BP)
AE sialorrhea, hallucinations, nightmares, delerium (mollified by benzo)
midazolam (less so lorazepam and diazepam)
benzos premedication and procedural sedation amnesia, anxiolytic potent resp depression antagonized by flumazenil
