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EHS 462 > Sedative Hypnotics, Anticonvulsants, Antidepressants, Antipsychotics, Cholinesterase Inhibitors > Flashcards

Sedative Hypnotics, Anticonvulsants, Antidepressants, Antipsychotics, Cholinesterase Inhibitors Flashcards

1
Q

Sedative Hypnotics

General Info

A

Suppresses CNS Activity
* Sedative: causes mild depression and relaxation
* Hypnotics: induce drowsiness & encourage sleep, have anmesiac effects

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2
Q

Sedative Hypnotic Types

A
  1. Benzodiazapines
  2. Barbituates
  3. Misc.
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3
Q

Barbituates

A

Agonists
* Paralyze neurons responsible for respiratory drive

Duration of Action
* Long Acting (1-2 days)
* Short (2-8 hours)
* Ultrashort (20 min)

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4
Q

Why have BZ replaced Barbituates?

A
  • Creating tolarence
  • Crerating physical dependence
  • Causing severe withdrawal symptoms
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5
Q

Benzodiazepines

A

CNA depressents that induce calm, drowsiness, and sleep w/o affecting respiratory function

Duration of Action
* Long acting (1-3 days)
* Intermediate (10-20 hours)
* Short (3-8 hours)

Reversed by Flumazenil

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6
Q

MMP

Diazepam

Classification, MoA

A

Pharmacological Class: Benzodiazapines

Theraputic Class: Antianxiety agent, Anticonvulsant, Sedative/Hypnotic, Skeletal muscle relaxants

Schedule 4

Sedation, hypnosis, alleviation of anxiety, muscle relaxation, anticonvulsant activity

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7
Q

MMP

Diazepam

Indications

A
  • Sustained and/or recurrent seizures
  • Severe nerve agent exposure
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8
Q

MMP

Diazepam

Contraindications

A
  • Known Hypersensitivity, head injury
  • AMS
  • Hypotension
  • Acute narrow angle glaucoma
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9
Q

MMP

Diazepam

Adverse Effects

A
  • AMS
  • Additive efect w/ ethanol
  • Irrability & excitation
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10
Q

MMP

Diazepam

Dose, Route

A

Seizures
* Adult: 2.5-10 mg in 2.5 inc. SLOW IVP/IM (max.10 mg)
* Peds: 0.1 mg/kg in 2.5 increments SLOW IVP/IO/IM (max. 5 mg) or 0.2 mg/kg rectal dose (max. 10 mg)

Severe Nerve Agent Exposure
* Adult: 10 mg IM
* Peds: >30 kg; 10 mg auto-injector or 0.1 mg/kg IM (max. 10 mg)

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11
Q

MMP

Ketamine

Classification, MoA

A

Class: General Anesthisia

MoA: Sedation, Analgesia, Bronchodilation

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12
Q

MMP

Ketamine

Indications

A
  1. Moderate to severe pain; musculoskeletal, extremity, and back pain
  2. Severe agitation
  3. Ventilatory difficulty secondary to bucking or combativeness in intubated patients
  4. CPR-induced awareness
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13
Q

MMP

Ketamine

Ccontraindications

A
  1. Known hypersensitivity to ketamine
  2. Penetrating eye injury
  3. Chest pain, abdominal pain, flank pain, or headache
  4. Pregnancy/breastfeeding
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14
Q

MMP

Ketamine

Adverse Effects

A
  1. Respiratory depression and larygospasm is known to occur w/ rapid IV administration
  2. potension may occur
  3. Involuntary myoclonus that may mimic seizure activity
  4. Enhanced secretions
  5. Unpleasent dreams and delirium upon emergece from sedation
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15
Q

MMP

Ketamine

Dose, Route, Pain Mangement:

A

Adult:
* 0.2 mg/kg IV/IO over 1-2 min (max. sing. 20 mg), readminister dose once if pain consists
* 0.5 mg/kg IN/IM, second dose if pain continues

Peds:
* 0.2 mg/kg IV/IO over 1-2 min (max. sing. 20 mg) 2nd dose if pain consists
* 0.5 mg/kg IM/IN, 2nd dose if pain continues

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16
Q

MMP

Ketamine

Dose, Route, Severe Agitaion

A

Adult >18yo:
* 1mg/kg IV/IO (smax. 100 mg) readminister dose if agitation persists (max. 200mg)
*4 mg/kg IM (max. 400mg)

Peds:
* 1mg/kg IV/IO (smax. 100mg) (max. 200 mg)
* 4 mg/kg IM (max. 400 mg)

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17
Q

MMP

Ketamine

Dose, Ventilatory difficulty sec. to bucking or combativeness intubated

A

Ketamine may be preferred for patients who have hypotension or possible hypovolemia, or if ventilatory difficulty is thought to be the result of pain response.

2mg/kg over 60 sec., may repeat 2 additional doses of 1 mg/kg for IVP/IO every 10-15 min

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18
Q

MMP

Ketamine

Dose, Route, CPR-Induced Awareness

A

Adult >18yo:
* 1mg/kg IV/IO

Peds:
* Obtain medical consultation from a Pediatric Base Station.

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19
Q

MMP

Midazolam

Classification, MoA

A
  • Pharm: Benzodiazapine
  • Therap: Antianxiety agents, Anticonvulsants, Sedative/hypnotics
  • Schedule 4

A short-acting benzodiazepine with strong hypnotic, anticonvulsant activity, and amnestic properties

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20
Q

MMP

Midazolam

Indications

A
  1. Sustained and/or recurrent seizures
  2. Precardioversion to reduce anxiety
  3. Awake patient requiring transcutaneous pacing (TCP)
  4. Nasal Tracheal Intubation
  5. Implanted Cardioverter Defibrillator (ICD) Malfunction
  6. Nerve/organophosphate exposure
  7. Bucking Endotracheal Intubated patient
  8. Moderate to severe stimulant toxicity
  9. Moderate or severe agitation
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21
Q

MMP

Midazolam

Contraindications

A
  1. Hypotension
  2. Midazolam Hypersensitivity
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22
Q

MMP

Midazolam

Adverse Effects

A
  1. Respiratory depression or apnea
  2. Hypotension
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23
Q

MMP

Midazolam

Dose, Route, All Indications except agitation & bucking

A

Adult
* 0.1 mg/kg in 2 mg increments SLOW IVP OVER 1-2 MIN per increment (max. 5mg)
* 5mg IN/IM, IN 1 mL per nare

Peds
* 0.1 mg/kg in 2 mg increments SLOW IVP over 1-2 min per increment (max. 5 mg)
* 0.2 mg/kg IN/IM (max. 5 mg)

24
Q

MMP

Midazolam

Dose, Route, Moderate to Severe Agitation

A
  • 18-69yo: 5 mg IM/IV
  • <69yo: 2.5 mg IM/IV
  • 5-12yo: 0.1 mg/kg IV or 0.2 mg/kg IM/IN (max. 5 mg)
  • 13-17: 0.1 mg/kg or 0.2 mg/kg IM/IN (max. 5 mg)
25
Q

MMP

Midazolam

Dose, Route, Bucking Endotracheal Intubated patient

A

Adult
* 0.1 mg/kg SLOW IVP over 1-2 min (max. 5 mg)
* STOP ONCE BUCKING HAS RESOLVED

Peds
* 0.05 mg/kg SLOW IVP over 1-2 min (max. 5 mg)

26
Q

MMP

Droperidol

Classifications, MoA

A

Antipsychotic

27
Q

MMP

Droperidol

Indications

A
  1. Moderate agitation due to suspected psychiatric emergency
28
Q

MMP

Droperidol

Contraindications

A
  1. Children under 13 yo
  2. Pregnancy
  3. Parkinson’s disease
  4. CNS Depression
  5. Severe Agitation
29
Q

MMP

Droperidol

Adverse Effects

A

Dystonic reaction
* Adult: Diphenhydramine 25–50 mg IV/IO
*Pediatric: Diphenhydramine 1mg/kg IV/IM (max. 25 mg)

Hypotension & Tachycardia
*Lactated Ringer’s fluid bolus

Tornadoes de Pointes

30
Q

National EMS Clinical Guidelines

Lorazepam

Classification, MoA, When its Used

A
31
Q

MMP

Droperidol

Dose, Route

A

Adult
* 18-68 yo: 2.5mg IM
*>69yo: 1.25 mg IM

Peds
*13-18yo: 2.5mg IM
*<13: Contraindicated

32
Q

Common

Etomidate

Classification, MoA, When its Used

A

Class: General anesthetic, Nonbarbituate

No analgesic activity

33
Q

Common

Propofol

Classification, MoA, When its Used

A

Class: General anesthetic, Nonbarbituate

Causes global CNS depression

34
Q

Anticonvulsant

General Info

A
  • Helps to Normalize nerve impulses in order to prevent or treat seizures
  • Keeps nerve impulses controolled by stimulating on GABA receptors
35
Q

Common

Phenytoin

Classification, MoA, When its Used

A
36
Q

Prescribed

Carbamazepine

Classification, MoA, When its Used

A

Class: Anticonvulsant

Decreases nerve impulses that cause seizure & nerve pain

37
Q

Prescribed

Levetiracetam

Classification, MoA, When its Used

A

Anticonvulsant

38
Q

Carbamazepine

A

Anticonvulsant

39
Q

Prescribed

Valporic Acid

Classification, MoA, When its Used

A

Anticonvulsant

40
Q

Antidepressant

A

Treats chemical imbalances
* Norepinepherine
* Serotonin
* Dopamine
* Histamine

41
Q

Prescribed

Fluoxetine

Classification, MoA, When its Used

A

Antidepressant, Serotonin Reuptake Inhibitor SSRIs

42
Q

Prescribed

Imipramine

Classification, MoA, When its Used

A

Antidepressant, Tricyclinic Antidepressant

43
Q

Phenelzine

A

Antidepressant, Monoamine Oxidase Inhibitors (MOIs)

44
Q

Antipsychotics

General Info

A
45
Q

National EMS Clinical Guidelines

Haloperidol

Classification, MoA

A

Class: Antipsychotic, Butyrophenones

46
Q

National EMS Clinical Guidelines

Olanzapine

Classification, MoA, When its Used

A

Antipsychotic

47
Q

National EMS Clinical Guidelines

Ziprasidone

Classification, MoA, When its Used

A

Antipsychotic

48
Q

Prescibed

Donepezil hydrochloride

Classification, MoA, When its Used

A

Cholinesterase Inhibitor

49
Q

Anticonvulsant

General Info

A
  • Helps to Normalize nerve impulses in order to prevent or treat seizures
  • Keeps nerve impulses controolled by stimulating on GABA receptors
50
Q

Antidepressant

A

Treats chemical imbalances
* Norepinepherine
* Serotonin
* Dopamine
* Histamine

51
Q

Antipsychotics

A

Inhibit dopaminergic neurotransmitters

52
Q

Haloperidol Indications

A

Moderate agitation due to suspected psychiatric emergency

53
Q

Haloperidol contraindications

A
  1. Children under five years of age.
  2. Parkinson’s disease.
  3. CNS depression.
  4. A cute CNS injury.
  5. Severe agitation.
54
Q

Haloperidol adverse effects

A

Dystonic reaction
* Adult: Diphenhydramine 25–50 mg IV/IO
*Pediatric: Diphenhydramine 1mg/kg IV/IM (max. 25 mg)

Hypotension & Tachycardia
*Lactated Ringer’s fluid bolus

Tornadoes de Pointes

55
Q

Haloperidol dosage

A

Adult
*18-68yo: 5 mg IM
*>69yo: 2.5 mg IM

Peds
*<5yo: Contraindicated
*5-12yo: 0.05 mg/kg IM (max. 2.5 mg IM)
*13-18yo: 2.5-5 mg IM

56
Q

Cholinesterase Inhibitor

A

*Decreases the breakdown of acetylcholine
*Used for Alzheimer’s and dementia symptoms

EHS 462 (7 decks)

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