drugs sedatives

Question 1

midazolam (versed)

Answer 1

BENZODIAZEPINE (most common)
PO,IV, IM and nasal
PO 1-2 hrs
IV, IM 30-90 mins
Advantages :
-Anticonvulsant
- Short and rapid duration
- produces amnesia + anxiolysis
- decrease in blood pressure (caution in hypovolemic patient)

Disadvantage:
- No analgesic
- hypotension
- resp depression
- Agressive behavior, agitation

Question 2

Lorazepam (ativan)

Answer 2

BENZODIAZEPINE
PO, SL, IV, IM
duration: 2-24hrs

Advantage:
- SL easy for children
- produces amnesia

Disadvantage:
- Causes resp depression
- slow onset
- long duration

Question 3

Phenobarbital ( Nembutal )

Answer 3

barbiturate
route: IV, IM, PO
duration:
IV 15-60 mins
IM 2-4 hrs
PO 2-4 hrs

Advantages
- safe usage
- inexpensive

Disadvantage
-Hypotension
- Laryngospasm
- no analgesia

Question 4

Chloral hydrate

Answer 4

Alcohol
route: PO (1-8 hrs)

Advantage
inexpensive
safe

Disadvantage
-long acting
- no analgesia
- GI irritation/ nausea
-bitter taste
- delayed effect ( can cause death)

Question 5

morphine

Answer 5

OPIOD
duration : PO 30 mins
IV 5 mins
IM/SC 10-30 mins
route: PO, IV, IM, SC

Advantages
- good analgesia
- longer duration of analgesia > 30 mins

Disadvantages
- No amnesia
-risk of resp depression
-nausea
- causes histamine release

Question 6

Fentanyl (Sublimaze)

Answer 6

Opioid
route: IV, IM, SC (0.5- 2 hrs)
Advantages
- Short and rapid onset
Sufentanil: the most potent opioid
Remifentanil: shorter half life than Fentanyl, rapid onset and offset

Disadvantages
-No amnesia
-resp depression (specially in infants)
- chest wall rigifity

Question 7

Propofol

Answer 7

route: IV
duration: 3-10 mins

Advantages
- Short acting and rapid onset
Bronchodilator effects
easy titratable

Disadvantages
- May cause hypotension and apnea
- painful at injection set (analgesic prior to injection)
- contraindication to allergy of soy or eggs

Question 8

Ketamine

Answer 8

Dissociative agent (nystagmic gaze)
route: IV, IM
duration: IV 5-60 mins, IM 15-60 mins

Advantages
- maintain airway reflexes
- hemodynamic stability
produces alagesia, sedation, immobilization and amnesia
- anticonvulsant properties
increases HR, BP and cardiac output

Disadvantages
- expensive
-hallucinations. dreams
increase secretions/ salovation
- cerebral vasodilator= increased ICP

Question 9

Flumazenil (Anexate)

Answer 9

Reversal for benzodiazepin
route IV
duration: 30-60 mins
used for benzo overdoses
short duration of action ( multiple doses might be necessary)

Question 10

Naloxone (narcan)

Answer 10

Reversal agent for Opioids
route: IV, IM
Iv 20-60 mins
IM 60-90 mins
indicated for opioid- induced resp or CNS depression

May result in:
tachycardia
Systemic HTN
Pulmonary edema
Cardiac Dysrhythmias

Question 11

Propofol (diprivan)

Answer 11

also known as milk of amnesia
rapid metabolism= short duration of action (first by liver then lungs)

CNS
- hypnotics properties
- No analgesic properties
- (MINOR ANTICONVULSANT PROPERTIES)

Cardiovascular
-Profound vasodilation
- small increase in HR

Respiratory system
-potent resp depressent
- reduced minute ventilation

other
antiemetic (stops nausea)
does not potentiate NMB

Question 12

Thiopental (barbituate)

Answer 12

CNS
- potent cerebral vasoconstrictor (used to treat high ICP)
- Anti- analgesic ( potential to reduce a pt’s pain tolerance)
- effects range from sedation to complete anesthesia
- Decreased Systemic BP- peripheral vasodilation and decreased CO

Resp system
leads to apnea (decreased response to hypercarpnia and hypoxia
mild depression of laryngeal reflexes

other effects
extremely painful upon injection

Question 13

Etomidate

Answer 13

hypnotic with no analgesic properties
short acting IV anesthetic agent

Cardiovascular System:
Mild to absent reduction in systemic blood pressure
Minimal changes in HR and cardiac output

Even though it is a cerebral vasoconstrictor it has not proven any neuroprotective properties.
Clinically:
Patients with depressed myocardial stability

Question 14

MORPHINE

Answer 14

Produces:
Analgesia
Sedation
Euphoria
Decreased ability to concentrate

Sedation
Biliary and GI Tract – constipation (decreased peristaltic activity)
Respiratory System:
Decreased Ventilation
Blunted response to increase CO2

Question 15

Succinylcholine (anectine)

Answer 15

Depolarizing NMBA
1.) short onset of action
2.) short duration of action

Clinical concerns:
Fasciculation of muscles after injection before paralysis
Transient increases in:
Intragastric pressures
Intracranial pressures
Intra-ocular pressures
Bradycardia – not used frequently with children
No reversal Agents available

Question 16

curare or tubocuraine

Answer 16

Curare – highly toxic plant found in South America that was discovered used in the late 16th century by European explorers as being used by the south American indigenous culture for hunting. It would paralyze their kill which would die of apnea/suffocation. The tribes also used them on some european explorers and soldiers too.

Centuries later, scientists were able to isolate the active principle, which was called d-tubocurarine, Later to be tested and synthesized into come of the paralytics we use today.

Competitive antagonists with Ach at the N2 receptor, keeps the Na+ ion channels closed, so no contraction (no facciculations)

Question 17

list Non-depolarizing NMBA’s

Answer 17

Mivacurium (short acting)

Atracurium and Rocuronium (medium acting)

Pancuronium or pavulon (long acting)

Question 18

Neostigmine (edrophonium)

Answer 18

Prolongs the life of Acetylcholine – increases receptor site competition
Anticholinergic (Atropine) – to prevent the autonomic responses to increased Acetylcholine:
Increased salivation
Bradycardia
Intestinal cramping