Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Apex Review > Intravenous anesthetics 4 > Flashcards

Intravenous anesthetics 4 Flashcards

1
Q

Rank each benzodiazepine according to its elimination half-life

A

midazolam, lorazepam, diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mechanism of action of midazolam?

A

GABA-A agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the onset of action of midazolam?

A

30-60 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the duration of action of midazolam?

A

20-60 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the clearance of midazolam?

A

liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the active metabolite of midazolam?

A

1-hydroxymidazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the IV & PO sedation dose of midazolam?

A

IV: 0.01-0.1 mg/kg
PO: 0.5-1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the respiratory effects of midazolam?

A

minimal but synergistic respiratory depression when combined with other sedatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the CV effects of midazolam?

A

minimal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the CNS effects of midazolam?

A

anterograde amnesia, anticonvulsant properties
anxiolysis
antispasmodic effects
no analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is remimazaolam indicated for?

A

induction & maintenance for adults undergoing procedural sedation lasting 30 minutes or less (e.g. endoscopy, bronchosocpy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Patients with ______ are more sensitive to the respiratory depressant effects of midazolam.

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the IV induction dose of midazolam?

A

0.1-0.4 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What respiratory & CV effects does the induction dose of midazolam have?

A

decreased BP & SVR
respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does midazolam affect EEG?

A

cannot produce isoelectric EEG (propofol and barbiturates can)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does midazolam cause relaxation?

A

spinally mediated skeletal muscle relaxation (antispasmodic-useful for patient with cerebral palsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diazepam undergoes _____

A

enterophepatic recirculation, which explains why it remains in the body for such a long time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diazepam can be used as an

A

anticonvulsant and as a preventative measure against emergence deilirum
antispasmodic agent

19
Q

Lorazepam’s amnestic action lasts up to

A

six hours

20
Q

Lorazepam has a _______ onset.

A

slow onset which limits its useful as an anticonvulsant

21
Q

What is the relative potency (greatest to least) of the benzodiazepines?

A

lorazepam>midazolam>diazepam

22
Q

Do any of our anesthetic drugs provide retrograde amnesia?

A

NO- benzodiazepines do provide anterograde amnesia

23
Q

Propylene glycol is added to diazepam and lorazepam to enhance water solubility which can cause

A

venous irritation

24
Q

Can midazolam cross the blood-brain barrier?

A

yes

25
Q

Midazolam has a ______ which gives it hydrophilic and liphophilic properties.

A

imidazole

26
Q

The adult induction dose of remimazolam is

A

5 mg IV over 1 minute (can reduce to 2.5-5 mg for sicker patients)
maintenance for procedural sedation: may administer 2.5 mg IV over 15 seconds with 2 minutes between each dose

27
Q

Peak sedation for remimazolam occurs

A

3-3.5 minutes after administration

28
Q

After reconstitution of remimazolam, the single-use vial must be discarded if

A

not used within 8 hours

29
Q

Remimazolam is rapidly metabolized by

A

non-specific plasma esterases

30
Q

Although it undergoes organ-independent elimination, patients with severe hepatic dysfunction receiving remimazolam

A

should recieve a doze reduction

31
Q

Compared to midazolam, remimazolam benefits include

A

faster onset of action
deeper sedation
faster recovery

32
Q

Compared to propofol, remimazolam is associated with

A

less respiratory depression
better degree of cardiopulmonary stability

33
Q

Remimazolam is contraindicated in patients with a history of

A

severe hypersensitivity reaction to Dextran 40

34
Q

Can remimazolam be reversed with flumazenil?

A

yes

35
Q

A patient is experiencing a prolonged recovery from midazolam sedation. What is the initial dose of flumazenil?

A

0.2 mg

36
Q

What is the mechanism of action of flumazenil?

A

A competitive antagonist of the GABA-A receptor

37
Q

Why is flumazenil used?

A

to reduce the sedative effects of benzodiazepines

38
Q

What is the repeat dose of flumazenil?

A

0.1 mg may be titrated in 1 minute intervals

39
Q

Side effects of flumazenil include

A

seizures in benzodiazepine-dependent patients

40
Q

What is an important property of flumazenil?

A

it has a short duration so repeated doses may be needed to prevent re-sedation

41
Q

What is the duration of action of flumazenil?

A

30-60 minutes

42
Q

Post-operative benzodiazepine reversal with flumazenil does NOT

A

increase SNS tone, anxiety or neuroendocrine evidence of stress

43
Q

Flumazenil tends to reverse the _____ effects more than the ______ effects of benzodiazepines

A

sedative effects; amnestic effects

Apex Review (224 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions