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Pharm > Sedatives > Flashcards

Sedatives Flashcards

1
Q

When are sedatives indicated?

A

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

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2
Q

What are benzodiazepines used for?

A 
Sedation
Hypnosis
Anxiolysis
Muscle relaxation
Anticonvulsant activity
Anterograde amnesia
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3
Q

Do benzodiazepines have analgesic effects intrinsically?

A

Nope

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4
Q

What kind of drug is diazepam?

A

Long acting benzodiazepine

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5
Q

What is the most lipid soluble benzo?

A

Diazepam

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6
Q

What is diazepam a vehicle for?

A

Propylene glycol

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7
Q

What is a side effect of diazepam?

A

Hypotension

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8
Q

Where is diazepam metabolized?

A

The liver

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9
Q

How many active metabolites does diazepam have?

A

3

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10
Q

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

A

Desmethyldiazepam

100-200 hours

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11
Q

What is an issue with repetitive dosing of diazepam?

A

Significant accumulation

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12
Q

What 3 general things is diazepam used for?

A

Conscious sedation
Anxiety
Muscle relaxation

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13
Q

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

A

Status epilepticus

IV

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14
Q

What is the adjustment of diazepam for hepatic disease?

A

Reduce dose by 50%

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15
Q

What kind of drug is lorazepam?

A

Intermediate-acting benzodiazepine

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16
Q

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

A

No

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17
Q

What is lorazepam a vehicle for?

A

Propylene glycol

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18
Q

What is an SE of lorazepam?

A

Hypotension

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19
Q

What is a risk of continuous lorazepam infusion?

A

Propylene-glycol induced metabolic acidosis

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20
Q

Under what circumstance is lorazepam the drug of choice?

A

Alcohol withdrawal delirium tremor prevention

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21
Q

What are the two general uses of lorazepam?

A

Anxiety and sedation in adults

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22
Q

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

A

1-2 mg PO 1 hour prior

23
Q

What is an emergency use for lorazepam?

A

Status epilepticus

24
Q

What is the dosing of lorazepam for status?

A

4 mg/dose slow IVP over 2-5 minutes

25
Q

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

A

Usually 5 mg

26
Q

What is the usual dose of midazolam for conscious sedation?

A

2.5-5 mg

27
Q

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

A

Decrease initial dose by 50%

28
Q

What is the reversal agent for benzodiazepines?

A

Flumazenil

29
Q

What does flumazenil do to revers benzos?

A

Reverses excessive CNS depression

30
Q

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

A

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

31
Q

Does propofol have a long or short duration of action?

A

Short

32
Q

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

A

Decreased time of weaning and extubation

Rapid assessment of neurological status

33
Q

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

A

Supports microbial growth

Must change tubing q12 hours

34
Q

What are some adverse effects of propofol?

A

Can cause hyperlipidemia and hypotension

35
Q

How many calories/mL in propofol

A

1.1 Cal/mL

Must count as a calorie source

36
Q

What is an issue with continued use of propofol?

A

Rapid development of tolerance

37
Q

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

A

No they are variable among various agents

38
Q

What kind of affect does dexmedetomidine have?

A

Sedative with some analgesic activity

39
Q

What is a benefit with dexmedetomidine?

A

No respiratory depression

40
Q

How is dexmedetomidine eliminated?

A

95% renally

41
Q

What are some serious side effects w/ dexmedetomidine?

A

Hypotension
Bradycardia
Pt appears awake and alert
Expensive

42
Q

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

A

Rescue drugs required for most pts

Need a multi-drug regimen

43
Q

What is ketamine?

A

Dissociative anesthetic agent

44
Q

What procedures is ketamine helpful for?

A

Debridement of wounds

Transport of patients in pain

45
Q

What is the time of onset for ketamine?

A

30 seconds

46
Q

What can happen during recovery from ketamine?

A

Hallucinations

Vivid dreams

47
Q

What is the drug of choice for urgent endotracheal intubation?

A

Etomidate

48
Q

Where is etomidate commonly used?

A

OR

ER

49
Q

How quickly is unconciousness achieved with etomidate?

A

Rapid -> within seconds

50
Q

What is the duration of action of etomidate?

A

Short -> 5-10 minutes

51
Q

What is an advantage of etomidate?

A

Minimal hypotension or disruption of ventilation

52
Q

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

A

Depression of cortisol synthesis

Use short term

53
Q

What do benzos do?

A

Provide the greatest amnesia, with NO analgesia

Pharm (32 decks)

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