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Flashcards in 2. Oral Sedation Deck (50):
1

What chemical propertie of drugs affects absorption properties

-lipid solubility (because absorption is the drugs ability to traverse membranes which are composed of lipids)
-Molecular weight (the smaller the better the absorption)
-Degree of ionization (uncharged crosses membrane)
-Drug release characteristics (i.e some drugs are sustained release)

2

What must a drug taken orally penetrate in order to be absorbed into the blood

gastrointestinal epithelium

3

T/F Sedatives must cross the blood brain barrier

t

4

sWhat are the patient specific factors that influence drug absorption

-Surface area for absorption
-Gastric and duodenal pH (pH and dissociation constant of the drug (or pKa) should be similar)
-Gastric emptying time
-Bile salt pool size (some drugs require bile salts for breakdown)
-Bacterial colonization
-Presence/extent of underlying disease

5

A person with gastric reflux has (faster/slower) gastric emptying

slower

6

What structure allows bile salts to enter the duodenum

ampulla of vader

7

Why is slow gastric emptying a disadvantage for drug absorption

the drug is inactivated when sitting in a pool of stomach acid

8

Most common causes of delayed gastric emptying

-Peptic ulcers
-DM
-Anticholinergics
-GERD

9

Define bioavailability

Fraction of drug dose reaching systemic circulation following administration

10

T/F Bioavailability is only influenced by the drug properties not the person

f both

11

What are the influences of bioavailability

-Drug formulation
-Particle size
-Solubility
-Degree of absorption from GI tract
-Rapid metabolism during "first pass" through the liver with considerable degree of biotransformation

12

T/F You can titrate a drug into effect with drugs given both IV and orally

f- just IV

13

What are the different transport mechanisms of drugs

-Passive diffusion
-Ion pair transport
-Pinocytosis
-Receptor mediated

14

Define passive diffusion

Movement of molecules from high to low conc.
-Nonpolar lipid soluble compounds diffuse more readily
-Small molecule diffuse more readily than large

15

Describe ion pair transport

Anions combine with cations to form neutral molecules to diffuse via passive diffusion

16

Describe pinocytosis

engulfment by cell membrane/internalization

17

Describe receptor mediated transport

-receptor control ion channels- ligand or voltage gated channels
-Receptors coupled to G proteins (2nd messangers)

18

What factors influence drug distribution

-Lipid solubility
-Degree of ionization
-Tissue perfusion (someone with atherosclerosis will not get as well sedated because they can't distribute the drug as well
-Biochemical composition of tissues

19

Binding of plasma protein to drugs is (reversible/irreversible)

reversible

20

T/F certain disease states may result in reduced production of plasma proteins

t

21

The drug with remain in the body for a (shorter/longer) duration if it binds plasma proteins

longer

22

Well perfused tissues of the body are... low perfused?

Highly perfused
-Brain, heart, liver, and kidneys

Less perfused
-Skin, muscle, bone and fat

23

Metabolism of a drug can involve two different processes, what are they

-Conversion of an inactive "prodrug" to the active drug
-Conversion of the non-polar lipid soluble drug to water soluble form

24

For most drugs metabolism most commonly occurs where? Other places also include

liver... lung, kidney, GI tract, GI bacteria, and placenta

25

Chemical reactions of metabolism are divided into two phases, describe them

Phase I
-Oxidation, Reduction and hydrolysis
-Oxidation performed by cytochrome P450 mixed function oxidase

Phase II
-Conjugation

26

Factors affecting metabolism rate

-Competition between drugs for same enzyme
-Enzyme induction (CYP450 inducers and inhibitors)

27

What is conjugation

combination of drug with activated glucuronic acid to form water soluble components

28

Elimination of drugs are primarily through

renal route

29

Other routes of drug elimination are

-biliary, fecal (enterohepatic cycling)-- conjugation with biliary salts then recycled
-Lungs (via volatile/gaseous agents)

30

What are the 4 stages of anesthesia and describe them

-Stage I= analgesia (less responsive to noxious stimuli)
-Stage II= Delirium/excitement (overreacting)
-Stage III= Surgical anesthesia (Plane 1-4) (People still follow commands but are calm)
-Medullary Paralysis (Stop breathing- need AED and amboo bag)

31

What is the most common complication of sedation

people stop breathing

32

Define minimal sedation

-Minimally depressed level of consciousness
-Responds normally to verbal and tactile stimuli
-Independent and continuous maintenance of airway
-Cognition and coordination impaired modestly
-Ventilatory and cardiovascular function unimpaired
- initial dosing of enteral drug no more than the maximum
recommended dose that can be prescribed for home
unmonitored use

33

Define moderate sedation

-Patients respond to purposeful verbal commands alone or by light tactile stimulation
-Independently maintain airway and ventilatory drive
-CV function maintained
-Wide enough margin of safety to avoid loss of consciousness
-Enteral moderate sedation not recommended for kids 12 and under

34

Define deep sedation

-Patients not easily aroused
-Respond purposefully to repeated verbal or painful stimuli
-May require assistance with airway and spontaneous ventilation may be inadequate
-CV function ususally maintained

35

Define general anesthesia

-Only done with IV agents
-Patients not arousable even with painful stimuli
-Require device or assistance with airway maintenance
-Positive pressure ventilation may be needed due to depression of spontaneous ventilation or pharmacologic depression of neuromuscular function
-CV function may be impaired

36

What patient paramenters should be obtained and monitored throughout the procedure

-Vital signs (BP, Pulse, Respiraiton) Both pre-op and intra-op
-Respiratory (Pulse oximetry (oxygenation), end tidal CO2(ventilation))- Must have supplemental O2

37

Describe how pulse oximetry works

Oxygenated and deoxy blood differ in absorption or red and infrared light

38

Oxy blod absorbs (red/infrared) light? Deoxy?

Oxy= infrared
Deoxy= Red

39

What wavelength is absobed by oxy blood in pulse oximetry? Deoxy?

990 nm (infrared) and 660 nm (red)

40

What is used to ID arterial pulse

Plethysmography

41

What are the three stages of recovery

-Early= awaken from sedation
-Intermediate= Regain full psychomotor function and resume physical activity
-Late= regain full psychological and physical capacity

42

Vital signs in recovery are monitored how frequently

Every 15 mins

43

Supplemental O2 is given to pateints in recovery until when

they reach baseline (maintain O2 saturation >95% on room air)

44

What are the two systems that outline discharge criteria

Wetchler Guidelines
Aldrete Scoring System

45

When discharge criteria system is more rigorous and which more vague

Wetchler= vague and Aldrete Scoring System= rigorous

46

Describe Wetchler Guidelines

-Absence of respiratory distress
-Alert and oriented x3
-Stable vitals
-Ability to swallow and cough
-Ability to ambulate
-Minimal nausea, vomiting or dizziness

47

Describe the Aldrete Scoring System

Activity
-Can move voluntarily on command (number of extremities)

Respiration
-Can breath and cough freely

Circulaiton
-How close is the BP to baseline

Conciousness
-Fully awake, arousable to voice, no response

Color
-Normal, pale, cyanotic

48

Score of _ according to the aldrete scoring system indicates the patient is ready for discharge

10

49

Advantages of oral sedation

-Patient acceptability
-Ease of administration
-Inexpensive
-No specialized equipment needed

50

Disadvantages of oral sedation

-Lack of control (inability to titrate and rely on pt compliance)
-Delayed onset
-Prolonged duration
-Erratic and incomplete absorption
-First pass effect