Sedatives

Question 1

When are sedatives indicated?

Answer 1

Facilitate tolerance to procedures
Reduce unnecessary recall
Mandatory adjunct to neuromuscular blockades

Question 2

What are benzodiazepines used for?

Answer 2

Sedation
Hypnosis
Anxiolysis
Muscle relaxation
Anticonvulsant activity
Anterograde amnesia

Question 3

Do benzodiazepines have analgesic effects intrinsically?

Answer 3

Nope

Question 4

What kind of drug is diazepam?

Answer 4

Long acting benzodiazepine

Question 5

What is the most lipid soluble benzo?

Answer 5

Diazepam

Question 6

What is diazepam a vehicle for?

Answer 6

Propylene glycol

Question 7

What is a side effect of diazepam?

Answer 7

Hypotension

Question 8

Where is diazepam metabolized?

Answer 8

The liver

Question 9

How many active metabolites does diazepam have?

Answer 9

3

Question 10

What is a common active metabolite of diazepam and what is the half-life?

Answer 10

Desmethyldiazepam

100-200 hours

Question 11

What is an issue with repetitive dosing of diazepam?

Answer 11

Significant accumulation

Question 12

What 3 general things is diazepam used for?

Answer 12

Conscious sedation
Anxiety
Muscle relaxation

Question 13

What is an emergency use of diazepam and how is it administered?

Answer 13

Status epilepticus

IV

Question 14

What is the adjustment of diazepam for hepatic disease?

Answer 14

Reduce dose by 50%

Question 15

What kind of drug is lorazepam?

Answer 15

Intermediate-acting benzodiazepine

Question 16

Is lorazepam affected by age, liver disease, or drug interactions?

Answer 16

No

Question 17

What is lorazepam a vehicle for?

Answer 17

Propylene glycol

Question 18

What is an SE of lorazepam?

Answer 18

Hypotension

Question 19

What is a risk of continuous lorazepam infusion?

Answer 19

Propylene-glycol induced metabolic acidosis

Question 20

Under what circumstance is lorazepam the drug of choice?

Answer 20

Alcohol withdrawal delirium tremor prevention

Question 21

What are the two general uses of lorazepam?

Answer 21

Anxiety and sedation in adults

Question 22

What is the dosing of lorazepam for pre-procedural anxity?

Answer 22

1-2 mg PO 1 hour prior

Question 23

What is an emergency use for lorazepam?

Answer 23

Status epilepticus

Question 24

What is the dosing of lorazepam for status?

Answer 24

4 mg/dose slow IVP over 2-5 minutes

Question 25

What is the dosing of midazolam for pre-op sedation?

Answer 25

Usually 5 mg

Question 26

What is the usual dose of midazolam for conscious sedation?

Answer 26

2.5-5 mg

Question 27

How do you adjust the dosing of midazolam for the elderly?

Answer 27

Decrease initial dose by 50%

Question 28

What is the reversal agent for benzodiazepines?

Answer 28

Flumazenil

Question 29

What does flumazenil do to revers benzos?

Answer 29

Reverses excessive CNS depression

Question 30

What is the issue with flumazenil? Why is that an issue? What happens as a result of this?

Answer 30

Short duration of action 30-45 minutes Benzos last much longer Risk of resedation

Question 31

Does propofol have a long or short duration of action?

Answer 31

Short

Question 32

What are some benefits of propofol's short duration of action?

Answer 32

Decreased time of weaning and extubation | Rapid assessment of neurological status

Question 33

What is an issue with propofol and how do we deal with it?

Answer 33

Supports microbial growth | Must change tubing q12 hours

Question 34

What are some adverse effects of propofol?

Answer 34

Can cause hyperlipidemia and hypotension

Question 35

How many calories/mL in propofol

Answer 35

1.1 Cal/mL | Must count as a calorie source

Question 36

What is an issue with continued use of propofol?

Answer 36

Rapid development of tolerance

Question 37

Are the half-lives of all propofol agents the same?

Answer 37

No they are variable among various agents

Question 38

What kind of affect does dexmedetomidine have?

Answer 38

Sedative with some analgesic activity

Question 39

What is a benefit with dexmedetomidine?

Answer 39

No respiratory depression

Question 40

How is dexmedetomidine eliminated?

Answer 40

95% renally

Question 41

What are some serious side effects w/ dexmedetomidine?

Answer 41

Hypotension Bradycardia Pt appears awake and alert Expensive

Question 42

What do you do for a pt who seems awake and alert on dexmedetomidine?

Answer 42

Rescue drugs required for most pts | Need a multi-drug regimen

Question 43

What is ketamine?

Answer 43

Dissociative anesthetic agent

Question 44

What procedures is ketamine helpful for?

Answer 44

Debridement of wounds | Transport of patients in pain

Question 45

What is the time of onset for ketamine?

Answer 45

30 seconds

Question 46

What can happen during recovery from ketamine?

Answer 46

Hallucinations | Vivid dreams

Question 47

What is the drug of choice for urgent endotracheal intubation?

Answer 47

Etomidate

Question 48

Where is etomidate commonly used?

Answer 48

OR | ER

Question 49

How quickly is unconciousness achieved with etomidate?

Answer 49

Rapid -> within seconds

Question 50

What is the duration of action of etomidate?

Answer 50

Short -> 5-10 minutes

Question 51

What is an advantage of etomidate?

Answer 51

Minimal hypotension or disruption of ventilation

Question 52

What is a risk with etomidate and how do we deal with that?

Answer 52

Depression of cortisol synthesis | Use short term

Question 53

What do benzos do?

Answer 53

Provide the greatest amnesia, with NO analgesia