12a- Sedatives + IV Anaesthetics + Antipsychotics

Question 1

Definitions

Define: Anxiolytics

Answer 1

Drugs used to relieve anxiety and related symptoms

Question 2

Definitions

Define: Sedatives

Answer 2

Drugs that elicit calming effect, ↓anxiety + ↓activity.
- Patient may NOT be as appropriate

Question 3

Definitions

Define: Hypnotics

Answer 3

Drugs that induce drowsiness + promote sleep

Does NOT mean sleep pattern is normal

Question 4

Definitions

Define: Anestnesia

Answer 4

The loss of sensation to the point that a person won’t respond to stimulation
- Can be local (one area, can be conscious).
- General –> Total CNS loss of sensation (unconscious)

Question 5

Definitions

Define: Amnestics

Answer 5

Drugs that prevent conversion of short-term experiences into memory

Cause amnesia

Question 6

Definitions

Define: Antipsychotics

Answer 6

Drugs that attempt to relieve psychotic disorders (impaired comprehension of reality).

Common in critically ill patients

Question 7

CNS Drug Categories

What are the 3 main Drug Categories?

Sloths Always Agree

Answer 7

1. Sedatives –> (3 subcategories)
2. Anesthetics –> (1 Subcategory)
3. Antipsychotics –> No subcategory

Question 8

Sedatives

What are the 3 subcategories of sedatives?

BBA degree

Answer 8

1. Benzodiazepines
2. Barbiturates
3. a2 agonists

Question 9

1a) Benzodiazepines

What are they and how do they induce their effects?

Answer 9

• Common anxiolytics + sedatives
• Induce effects via GABA receptors

Question 10

GABA Receptors

What are they activated by?

Answer 10

1. GABA NTs
2. Benzodiazepines
3. Barbiturates

Question 11

1a) Benzodiazepines

What do they do when binding to GABA receptors?

Answer 11

↑those receptors affinity for GABA NTs
- Leads to ↑GABA receptor activation –> ↑inhibotory effect

Question 12

1a) Benzodiazepines

Break down the steps of GABA activation

Answer 12

More Cl- enter membrane –> Membrane hyperpolarized –> Harder to transmit electric signal –> Greater CNS depression

Question 13

1a) Benzodiazepines

What are 2 benzodiazepine drugs?

Answer 13

1. Atvian (Lorazepam)
2. Versed (Midazolam)

Question 14

1a) Drug: Atvian (Lorazepam)

What is it used for and what are its timings?

Answer 14

• Uses –> Relieve Acute Anxiety + Treat Acute Seizures + Treat withdrawl symptoms
• Onset: 1-2min (when given with IV)
• Duration: 10hrs (w/ short peak effects)

Question 15

1a) Drug: Versed (Midazolam)

What is it used for and what are its timings?

Answer 15

• Uses–> Conscious Sedation + Induction for Procedures + Continuous infusion to maintain sedation
• Onset –> 1-2 min (when given IV)
• Duration –> ~1hr (short peak effects)

Question 16

When is conscious sedation useful?

Answer 16

For quick procedures we do not want to intubate for.

Question 17

Benzodiazepines

What are the CNS effects from these drugs?

Answer 17

1. Cause sedation + amnesia
2. Do not reduce pain
3. Anti-seizure effects

Question 18

Benzodiazepines

What is the (+) cardiovascular effect of these types of drugs?

Answer 18

Does not decrease BP significantly (dose dependent)

Question 19

Benzodiazepines

What are its (+) respiratory effects?

Answer 19

1. Does not depress resp drive (at common doses)
2. Degree of depression dose dependent
3. If combined with other agents, leads to resp depression

Question 20

Delirium

What is it characterized by?

Answer 20

• Fluctuating altered levels of consciousness
• Varying ability to focus and maintain attention

Question 21

Delirium

What are its risk factors?

Answer 21

1. Age (older at larger risk)
2. Meds affecting consciousness
3. Illness (ex: dementia)
4. abnormal sleep cycle
5. Inability to ambulate
6. Loss of orientation

Question 22

Benzodiazipines

What is a BZD reversal drug?

Answer 22

Flumazenil

Question 23

Flumazenil

How does it work and what are its timings?

Answer 23

• Competitive antagonist for BZD receptor sites
• Onset –> 1-2min
• Duration –> 10-15 min

Question 24

1b) Barbiturates

Barbituates work by increasing GABA receptor effects. How do they differ vs BDZs?

Answer 24

They exert sedative effects even if GABA NTs are not there

Question 25

# 1b) Barbiturates What is the drug associated with this class? What are they reserved for?

Answer 25

Phenobarbital - Reserved for severe scenarios, b/c they give very deep level of sedation

Question 26

# 1c) a2 agonists What drug falls under this category?

Answer 26

Precedex (Dexmedetomidine) ## Footnote Largely seen in ICU

Question 27

# Precedex (Dexmedetomidine) What are its CNS effects?

Answer 27

1. Causes cooperative sedation 2. Less amnesia vs others 3. Relieves some pain 4. ↓delirium vs others

Question 28

# Precedex (Dexmedetomidine) What are its cardiovascular effects?

Answer 28

1. Affects BP 2. Initial ↑BP 3. ↓BP after initial rise (intended effect)

Question 29

# Precedex (Dexmedetomidine) What are its respiratory effects?

Answer 29

1. Min to no resp depression

Question 30

# Class 2: IV anesthetics What does this class of drugs do?

Answer 30

Rapidly induce the general state of anesthesia

Question 31

# Class 2: IV Anesthetics What are 3 drugs that fall under this category? ## Footnote PKE

Answer 31

1. Diprivan (Propofol) 2. Ketamar (Ketamine) 3. Amidate (Etomidate)

Question 32

# 2a) Propofol What is Propofol's onset and duration time? ## Footnote Milk of amnesia, made in lipid (ex: soybean oil)

Answer 32

- Onset --> 15-30sec - Duration --> 5-10min

Question 33

# 2a) Propofol Why is it good for short term procedures? (4)

Answer 33

1. Facilitate intubation process 2. Day surgeries 3. Procedural sedation 4. Continuous infusion

Question 34

# 2a) Propofol What CNS effect does it bring?

Answer 34

Causes stinging pain at injection site

Question 35

# 2a) Propofol What is its cardiovascular effect?

Answer 35

Causes significant hypotension (vasodilation)

Question 36

# 2a) Propofol What is its respiratory effect?

Answer 36

- Causes ***significant*** resp depression - Degree is unpredictable

Question 37

# 2a) Propofol Why can some people have an allergic reaction to propofol?

Answer 37

Due to it needing to be suspended in egg and soybean oil

Question 38

# 2b) Ketamine What does this drug do?

Answer 38

Cause a dissociative anesthesia by blocking excitatory action at NMDA receptors.

Question 39

# 2b) Ketamine What are its timings?

Answer 39

- Onset --> 30sec - Duration --> 10min

Question 40

# 2b) Ketamine What are its 2 CNS effects?

Answer 40

1. Causes sedation + amnesia 2. Prevents pain reception

Question 41

# 2b) Ketamine What is its cardiovascular effect?

Answer 41

It ↑BP

Question 42

# 2b) Ketamine What are its respiratory effects?

Answer 42

1. Min resp. depression 2. Cause bronchodilation 3. Increase secretion prod

Question 43

# 2b) Ketamine What are its unique side effects?

Answer 43

1. Vidid dreams (upto hallucinations) 2. Can cause delirium

Question 44

# 2c) Etomidate How does it work and what are its timings?

Answer 44

- ↑GABA receptor activity - Onset --> 30sec -Duration --> 10min

Question 45

# 2c) Etomidate What are its CNS effects?

Answer 45

1. Causes sedation + amnesia 2. ↓cereberal O2 demand + metabolism

Question 46

# 2c) Etomidate What is its cardiovascular effect?

Answer 46

It maintains BP

Question 47

# 2c) Etomidate What is its resp effect?

Answer 47

Minimal resp depression

Question 48

# 2c) Etomidate What is its unique side effect? ## Footnote Corticosteroid effect

Answer 48

- It ↓natural cortisol/steroid prod - NOT given as continuous infusion b/c of that

Question 49

# #3. Antipsychotics These drugs are used outside and inside the ICU. What are they used for in each setting?

Answer 49

- Out --> Treating conditions like schizophrenia - In --> Attempt to relieve delirium related symptoms

Question 50

# #3: Antipsychotics What do these drugs focus on? (2)

Answer 50

1. Blocking Dopamine Receptors 2. Blocking Serotonin Receptors

Question 51

# #3: Antipsychotics What are 2 common drugs for RTs in this category?

Answer 51

1. Haldol 2. Nozinan (Methotrimeprazine)