IV sedation Lecture #2 Flashcards Preview

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Flashcards in IV sedation Lecture #2 Deck (70):
1

What types of sedation are considered conscious sedation?

-Minimal
-Moderate

2

Can the patient control their own airways under conscious sedation?

-Yes

3

If a person is in deep sedation can they control their own airways?

-Possibly but maybe not

4

If a person is in general anesthesia what do you need to do for the respiratory system?

-Intubation of patient

5

Does oral sedation have the ability to go beyond minimal or moderate sedation to deep or general?

-Yes

6

What is minimal sedation?

-Independent airway/respond normally
-Ventilation unaffected

7

What is moderate sedation?

-Responds to verbal commands, respiratory and CVD unaffected

8

What are some common Benzodiazepines used for IV sedation?

-Midazolam (versed)
-Diazepam (Valilum)
-Ativan

9

What are opioids used for IV sedation?

-Morphine
-Fentanyl
-Demerol

10

What are advantages of Oral sedation?

-Pt. acceptability
-Ease of administration
-Cost
-Variable amnesia
-Safe

11

Where does oral sedation absorption occur?

-GI tract

12

T/F No specialized training is required beyond the doctoral level for oral sedation

True

13

What are the disadvantages of oral sedation?

-Slow onset of action
-Pt compliance
-Low efficacy
-Titration of dose unclear
-Prolonged duration of effect
-Difficulty of administering reversal agents
-Meals and drug interaction

14

What are antihistamines/Barbiturates are used for oral sedation?

-Benadryl
-Hydralysine

15

What effects do Benzodiazepines (not analgesic) have?

-Anti-anxiety
-Sedative-hypnotic
-Anti-convulsant
-Skeletal muscle relaxant
-Amnesic effect

16

What do Benzodiazepines target mostly?

-CNS GABA A receptors which are direct and fast acting

17

T/F Benzodiazepine is analgesic

False
-Is not

18

What is the onset of Diazepam (Valium)?

-60-90 minutes

19

What is the half life of Valium?

-20-50 hours

20

What dose of Valium do you give?

-5-15 mg 1 hour prior to appt

21

Is Valium long acting?

-Yes

22

What are the side effects of Valium?

-Drowsiness
-Ataxia
-Psychomotor impariment

23

Do you ever want to give Triazolam to a pregnant patient?

-No because it is an Category X drug

24

What is another name for Triazolam?

-Halcion

25

What is the onset of Triazolam (Halcion)?

-60-90 minutes

26

What is the half life of Triazolam (Halcion)?

2.2 hours

27

What dose do you give for Triazolam (halcion)?

-.25 mg the night before and .25 to .5 mg 1 hr prior to appt.

28

What are the side effects of Triazolam?

-Psychomotor impairment
-Drowsiness
-Light-headed
-Confusion
-Dream abnormalities
-Hallucinations

29

What is the other name for Midazolam?

-Versed

30

What is the onset for Midazolam (Versed)?

-30-60 minutes up to 2 hours

31

What is the half life of Midazolam (Versed)?

-1.5 - 2.5 hours

32

What is the dose of Midazolam (versed)?

-1-2 mg titration (usually given IV but some liquid versed is being used)

33

What are the side effects of Versed (Midazolam)?

-Respiratory depression
(potentiates the respiratory depression of phentenyl)

34

What is the other name for Flumazenil?

-Romazicon

35

What is Flumazenil (Romazicon)?

-A reversal agent

36

T/F The half life of the reversal agent is shorter than the half life of the drug you have given

True

37

What doses of Flumazenil (Romazicon) do you use?

-.2 mg to a maximum dose of 3 mg

38

What is the onset of Flumazenil (Romazicon)?

-1-2 minutes

39

What are the complication/contraindication of Benzodiazepine?

-Glaucoma
-Respiratory depression
-Birth defects (Cleft lip/Cleft Palate)
-Valium

40

Why is valium a contraindication of Benzodiazepine?

-Thrombophlebitis
-Extravasation into tissues

41

Where is Diazepam metabolized?

-Liver

42

T/F Clonazepam has a slower onset of action.

True

43

What is Clonazepam used for?

-Adjunct for anxiolytic and sedative peoperties

44

Is Diazepam soluble in water?

-No

45

What sedative drug is more potent than Diazepam or Clonazepam?

-Midazolam (Versed)

46

What might Midazolam (Versed) do to respirations when used with narcotics?

-Depress

47

Is Midazolam solube in water?

-Yes

48

What are the advantages of Nitrous oxide?

-ease of use
-Rapid onset of action
-Ability to titrate effect
-Analgesic and sedative properties
-Few drug-drug interactions
-Rapid recovery
-No escort/restriction of activities

49

What are the disadvantages of Nitrous oxide?

-Decreased efficacy for severely anxious pt
-Unpredictable amnesia
-Nausea, dizziness
-Sexual hallucinations
-Chronic exposure to staff

50

T/F In all oral sedation the pt needs an escort,

True

51

What are the contraindications of Nitrous oxide?

-Pregnancy
-Sever blockage of nasal passages
-Head injury
-Pneumothoraces
-Respiratory disease
-Sever blocked Eustachian tube

52

What is the deepest plane of anesthesia that you should allow nitrous to go to?

-Plane 1

53

30-40% of nitrous oxide is analgesic and is compared to what amount of what other drug?

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54

What are the predominant effect of opioids?

-Analgesia
-Depression of sensorium and respirations

55

What are opioids used for oral sedation?

-Morphine
-Meperidine
-Fentanyl

56

What do opioids do to the vasculature?

-Vasodilation leading to hypotension and increased CO

57

What side effects do opioids have?

-Nausea
-Chest wall rigidity
-Seizures
-Constipation
-Urinary retention

58

What does of Fentanyl do you give?

-30 to 50 micrograms 10-15 minutes by IV

59

T/F Fentanyl and Versed potentiate respiratory depression.

True

60

When are using Fentanyl and Versed together which do you administer first?

-Fentanyl then Versed

61

What do opioids have to do with histamine?

-Can cause histamine release that could lead to anaphylactic shock

62

What is Naloxone (Narcan)?

-Opioid reversal
-A pure antagonist that reverses analgesia and respiratory depression

63

What is the duration of Naloxone?

-1 hour

64

What dose do you give of Naloxone?

-.1-.2 mg with a max of 10 mg

65

What is Propofol?

-Hypnotic agents

66

What type of analgesic properties does Propofol have?

-None

67

What do you use Propofol for in anesthesia?

-Deep/general anesthesia

68

What dose of Propofol do you use?

-.5 mg - 1 mg/kg dosing

69

Who is propofol contraindicated for?

-Pediatric
-Pts allergic to egg and soy

70

Does Ketamine have analgesic action?

-Yes