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Pharm Fall 2019 > Ex1 Benzo Slides > Flashcards

Ex1 Benzo Slides Flashcards

(49 cards)

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1
Q

Receptors effected by Benzos

A

a1 GABA-A

a2 GABA-A

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2
Q

a1 GABA-A Receptor is responsible for

A

Sedation, amnesia, anticonvulsant effects. Most prominent

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3
Q

a2 GABA-A Receptor is responsible for

A

CNS mediated skeletal muscle relaxant effects and anxiolysis

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4
Q

Benzos decrease wakefulness by inhibition of ______ in the _______

A

RAS - reticular activating system

Brain stem

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5
Q

Inhibition in the ______ causes _____ effect

A

RAS

Sedative/hypnotic effects (drowsy/sleep)

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6
Q

Effects of Benzos on CNS

A

Decrease CMRO2, CBF
Increase seizure threshold
Protect against cerebral hypoxia (Midazolam > diazepam)

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7
Q

Benzo effect on Ventilation

A

Mild depression of ventilation
Decreased Vt and MV (dose dependent)
Mildly elevated CO2

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8
Q

Apnea occurs in _____% after Benzo administration in dose starting at _____ mg

A

20; 2

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9
Q

Exceptions to Benzos - ventilation

A

Flatter CO2 curve. NOT shifted.

Sensitive patients: chronic lung disease, obese, elderly

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10
Q

Special population of patients should receive what dose of Benzos?

A

1/4 dose and titrate to effect (better to avoid Benzos altogether)

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11
Q

Benzo effects on CV system

A

Decreased SVR

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12
Q

Benzos will result in _______ blood pressure due to ______

A

Decreased

Decreased SVR

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13
Q

Drugs used to reduce HR/BP which accompanies intubation

A

Opioids, beta antagonists, lidocaine

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14
Q

Most common side effects of Benzos

A

Fatigue, drowsiness

Other: dependence

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15
Q

Important side effect of benzos

A

Withdrawal syndrome - life threatening, irritability, insomnia, tremors, seizures, death

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16
Q

Long acting Benzo withdrawal will occur after _____ days, while short acting will occur after _____ days

A

2-5 days
1-2 days
After cessation

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17
Q

T or F: benzodiazepines do not induce microsomal enzymes

A

True

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18
Q

Benzos should be avoided in who?

A 
Pregnant individuals (teratogenic)
Procedures identifying seizure foci
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19
Q

Benzos will create a _____ effect when combined with opioids, propofol, barbiturates, ETOH

A

Synergistic

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20
Q

Which medications will cause a synergistic effect when given with benzos?

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A

Opioids, propofol, barbiturates, ETOH

21
Q

What combo of Rx is considered “cardiac stable” when given with benzos?

22
Q

Important structure on midazolam

Study These Flashcards
A

Imidazole ring

23
Q

Midazolam in lipid soluble form has a pH of?

24
Q

Midazolam in water soluble form has pH of?

Study These Flashcards
A

< 4

Open ring form

25
PK of midazolam
6.15
26
What does midazolam depend on in order to main closed ring/active form?
pH > 5 = 99% is in active form (closed ring)
27
Midazolam- responsiveness to ______ is preserved
Vasomotor responsiveness to CO2 | Increased CO2=increased CBF
28
Midazolam Sedation Dose - PO
0.5 mg/kg PO 30 min prior to induction in peds
29
Midazolam sedation dose IV
1-2.5mg IV bolus
30
Induction of GA - midazolam dose
Induction: 0.1-0.3 mg/kg
31
Why does diazepam remain in body for such a long time?
Undergoes enterohepatic recirculation
32
Diazepam metabolites undergo ______
Glucuronidation
33
E1/2 of Diazepam
21-37h
34
Delayed clearance and prolonged E1/2t for diazepam may be due to
Inhibition of CYP450 by other substances
35
Diazepam metabolization is notable for
Desmethyl metabolite - active | E1/2t = 48-96h
36
What is responsible for biphasic pattern of sedation in Diazepam?
Desmethyl metabolite
37
Skeletal muscle effects of Diazepam
Muscle relaxant - SPINAL (centrally) mediated
38
What muscular effect will occur with chronic administration of diazepam?
Tolerance to relaxant effect
39
Diazepam dosing - PO
10-15mg peaks 1h
40
Diazepam dosage IV
0.05-0.15 mg/kg | Titrate - start low, go slow
41
Induction dose Diazepam
0.3-0.5mg/kg
42
Rate potency of Diazepam, Lorazepam, Midazolam
Lorazepam > midazolam > diazepam
43
Rate duration of action: diazepam, lorazepam, midazolam
Diazepam > Lorazepam > midazolam
44
Flumazenil duration of action
30-60 min | Re-sedation or infusion may be required
45
Dose of Flumazenil
0.2 mg IV reverses CNS effects in 2 minutes
46
Maximum flumazenil dose
1mg IV | Titrate 0.1 mg each time
47
Flumazenil is a _______ of the GABA A receptor
Competitive antagonist
48
Benzos that have venous irritation and why?
``` Diazepam, lorazepam Propylene glycol (to enhance water solubility) ```
49
Why isn’t lorazepam used for seizures?
Slow onset

Pharm Fall 2019 (33 decks)

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