Sedative Hypnotics, Anticonvulsants, Antidepressants, Antipsychotics, Cholinesterase Inhibitors Flashcards
Sedative Hypnotics
General Info
Suppresses CNS Activity
* Sedative: causes mild depression and relaxation
* Hypnotics: induce drowsiness & encourage sleep, have anmesiac effects
Sedative Hypnotic Types
- Benzodiazapines
- Barbituates
- Misc.
Barbituates
Agonists
* Paralyze neurons responsible for respiratory drive
Duration of Action
* Long Acting (1-2 days)
* Short (2-8 hours)
* Ultrashort (20 min)
Why have BZ replaced Barbituates?
- Creating tolarence
- Crerating physical dependence
- Causing severe withdrawal symptoms
Benzodiazepines
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
MMP
Diazepam
Classification, MoA
Pharmacological Class: Benzodiazapines
Theraputic Class: Antianxiety agent, Anticonvulsant, Sedative/Hypnotic, Skeletal muscle relaxants
Schedule 4
Sedation, hypnosis, alleviation of anxiety, muscle relaxation, anticonvulsant activity
MMP
Diazepam
Indications
- Sustained and/or recurrent seizures
- Severe nerve agent exposure
MMP
Diazepam
Contraindications
- Known Hypersensitivity, head injury
- AMS
- Hypotension
- Acute narrow angle glaucoma
MMP
Diazepam
Adverse Effects
- AMS
- Additive efect w/ ethanol
- Irrability & excitation
MMP
Diazepam
Dose, Route
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)
MMP
Ketamine
Classification, MoA
Class: General Anesthisia
MoA: Sedation, Analgesia, Bronchodilation
MMP
Ketamine
Indications
- Moderate to severe pain; musculoskeletal, extremity, and back pain
- Severe agitation
- Ventilatory difficulty secondary to bucking or combativeness in intubated patients
- CPR-induced awareness
MMP
Ketamine
Ccontraindications
- Known hypersensitivity to ketamine
- Penetrating eye injury
- Chest pain, abdominal pain, flank pain, or headache
- Pregnancy/breastfeeding
MMP
Ketamine
Adverse Effects
- Respiratory depression and larygospasm is known to occur w/ rapid IV administration
- potension may occur
- Involuntary myoclonus that may mimic seizure activity
- Enhanced secretions
- Unpleasent dreams and delirium upon emergece from sedation
MMP
Ketamine
Dose, Route, Pain Mangement:
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
MMP
Ketamine
Dose, Route, Severe Agitaion
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)
MMP
Ketamine
Dose, Ventilatory difficulty sec. to bucking or combativeness intubated
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
MMP
Ketamine
Dose, Route, CPR-Induced Awareness
Adult >18yo:
* 1mg/kg IV/IO
Peds:
* Obtain medical consultation from a Pediatric Base Station.
MMP
Midazolam
Classification, MoA
- Pharm: Benzodiazapine
- Therap: Antianxiety agents, Anticonvulsants, Sedative/hypnotics
- Schedule 4
A short-acting benzodiazepine with strong hypnotic, anticonvulsant activity, and amnestic properties
MMP
Midazolam
Indications
- Sustained and/or recurrent seizures
- Precardioversion to reduce anxiety
- Awake patient requiring transcutaneous pacing (TCP)
- Nasal Tracheal Intubation
- Implanted Cardioverter Defibrillator (ICD) Malfunction
- Nerve/organophosphate exposure
- Bucking Endotracheal Intubated patient
- Moderate to severe stimulant toxicity
- Moderate or severe agitation
MMP
Midazolam
Contraindications
- Hypotension
- Midazolam Hypersensitivity
MMP
Midazolam
Adverse Effects
- Respiratory depression or apnea
- Hypotension
MMP
Midazolam
Dose, Route, All Indications except agitation & bucking
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)
MMP
Midazolam
Dose, Route, Moderate to Severe Agitation
- 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)
