Medication considerations and drug interactions in sedation Flashcards
(103 cards)
1
Q
Define conscious sedation
A
A technique in which the use of a drug or drugs produces a state of depression of the CNS enabling treatment to be carried out
But during which verbal contact is maintained
2
Q
What should the drugs used to provide conscious sedation carry
A
A wide margin of safety to render loss of consciousness unlikey
3
Q
Name the most common drugs used for inhalation sedation
A
Nitrous oxide and oxygen
4
Q
Name the most comely used drugs for intravenous sedation
A
midazolam
5
Q
What class of drugs does midazolam fall under
A
Benzodiazepines
6
Q
What do we want to figure out/ gather by the end of a pre sedation assessment
A
- Is the pt suitable for sedation
- The degree of the patients anxiety
- Nature of the dental treatment required
- The nature severity and stability of patients medical conditions
7
Q
What questions do we need to ask during a medical history
A
- Cardiovascular
- Respiratory
- Neurological
- Endocrine
- Haematological
- Hepatic
- renal
- Medication
- other
8
Q
What do we want o come to by the end of a medical history
A
Patients ASA classification
9
Q
What is the ASA classification split into
A
6 grades:
I- VI
10
Q
Define a grade I ASA classification
A
A normal healthy patients
11
Q
Define a grade II ASA classification
A
A patient with mild systemic disease
12
Q
Define a grade III ASA classification
A
A patient with severe systemic disease
13
Q
Define a grade IV ASA classification
A
A patient with severe systemic disease that is a constant threat to life
14
Q
Define a grade V ASA classification
A
A moribund patient who is not expected to survive without the operation
15
Q
Define a grade VI ASA classification
A
A declared brain dead patient who’s organs are being removed fro donor purposes
16
Q
Give an example of a patient that would fall under grade I ASA classification
A
Non smoker with no or minimal alcohol use
17
Q
Give examples of a patient that would fall under grade II ASA classification
A
- Smoker and social alcohol drinker
- Pregnant pt
- obese pt (30
18
Q
Give examples of a patient that would fall under grade III ASA classification
A
- Pt with one or more moderate to severe disease
- Poorly controlled diabetic
- Pt with poorly controlled hypotension
- Pt who is morbidly obese (BMI>40)
- Pt with a pacemaker
- PT who has had a myocardial infarction more than 3 months ago
19
Q
Give examples of a patient that would fall under grade IV ASA classification
A
- Pt who has had a recent MI in the last 3 months
- Pt suffering from transient ischaemic attack
- Pt who has ongoing cardiac ischemia
20
Q
Give examples of a patient that would fall under grade V ASA classification
A
- Trauma pt
- Multiple oral/ system dysfunction
21
Q
When giving sedation in general practice which ASA grade patients would we treat
A
ASA I or II
22
Q
What is coronary artery disease
A
Plaque build up in an artery
23
Q
What is angina
A
Build up of plaque in artery making it harder for blood to get through
24
Q
What is a heart attack
A
When plaque cracks and a blood cloth blocks the artery
25
How do we calculate cardiac output
Heart rate X stroke volume
26
What is blood pressure
Cardiac output X vascular resistance
27
State a normal blood pressure reading
Systolic 90-120
and
Diastolic 60-80
28
State a low blood pressure reading
Systolic <90
or
Diastolic <60
29
State a pre hypertensive blood pressure reading
Systolic 120-139
or
Diastolic 80-89
30
State a stage 1 hypertensive blood pressure reading
Systolic 140-159
or
Diastolic 90-99
31
State a stage 2 hypertensive blood pressure reading
Systolic more than 160
or
Diastolic more than 100
32
If a patient has a blood pressure of 143 systolic and 88 diastolic what does that suggest
Stage 1 hypertension
33
If a patient has a blood pressure of 68 systolic and 78 diastolic what does that suggest
Low blood pressure
34
If a patient has a blood pressure of 90 Systolic and 65 diastolic what does that suggest
Normal
35
If a patient has a blood pressure of 165 systolic and 102 diastolic what does that suggest
Stage 2 hypertension
36
If a patient has a blood pressure of 125 systolic and 75 diastolic what does that suggest
Pre hypertension
37
If a patient has a blood pressure 125 systolic and 95 diastolic what does that suggest
stage 1 hypertension
38
If a patient has a blood pressure 99 systolic and 55 diastolic what does that suggest
low
39
If a patient has a blood pressure 110 systolic and 88 diastolic what does that suggest
Pre hypertension
40
If a patient has a blood pressure of 105 Systolic and 70 diastolic what does that suggest
normal
41
If a patient has a blood pressure of 170 Systolic and 110 diastolic what does that suggest
stage 2 hypertension
42
Why might a healthy patients have a low blood pressure
They may be very athletic
43
What percentage of the UK is estimated to have hypertension
40%
44
What can untreated hypertension lead to
1. Atherosclerosis
2. Aneurysm
3. Stroke
4. Kidney failure
5. heart failure and heart attack
6. Liver disease
45
In which patients is hypertension more common
1. Older aged patients
2. Secondary to other disease
46
What is the blood pressure cut off for sedation
Stage 2 hypertension so anything over 160/100
47
If a patient comes in with a BP higher than 200/110 what should we do
Refer them to their GP urgently
48
What are patients taking antihypertensive mediations More susceptible to
Postural hypotension
49
If a patient has hypertension can we offer them sedation treatment
Yes as own as their disease is stable
50
What can angina be induced by
Stress
Exercise
Hypertension
51
What can angina cause
Imbalance in myocardial oxygen supply vs demand leadign to myocardial ischemia
52
If a patient has stable angina what ASA category to they fall under
ASA III
53
What questions do we ask a patient who has angina
1. What triggers it
2. When was your last angina attack
3. How often do you suffer
4. Do you carry a GTN spray
5. Does the GTN spray help relieve the symptoms
6. Who takes care of your angina a nurse or cardiologist?
54
Which type of sedation do we tend to offer patients with angina
Inhalation sedation
55
What can inhalation sedation provide to patients with angina
Stress reduction
Analgesia
Oxygenation
56
What precautions can we take prior to sedation to help minimise complications in patients with angina
1. Oral pre medication
2. Consider GTN spray before starting
3. Oxygen prophylactically
57
If a patient has unstable angina what ASA category to they fall under
ASA IV
58
What would we do if a patient with unstable angina needed sedation
We would refer to the hospital for a anaesthetist input
59
How does sedation effect the respiratory system
All sedation causes a degree bof respirant depression
60
Give examples of respirate diseases we need to consider prior to offering sedation
1. Asthma
2. COPD
3. Upper respiratory tract infection
61
What happens to asthmatic patients
Constriction
Inflammation
Secretion build up in lungs
62
What can trigger or make asthma worse
1. Anxiety
2. Stress
3. Exercise
4. Infection
5. Allergy to irritant
63
If a patient has asthma what ASA category to they fall under
ASA II-IV as asthma is a dynamic disease
64
What patents would we ask a patient with asthma
1. What triggers it
2. When was your last asthma attack
3. have you ever been hospitalised because of your asthma
4. are you reviewed by the hospital
5. What medication do you take for your
65
Which sedation would we offer to an asthmatic patients
Can provide wither inhalation or intravenous sedation
As long as the disease is STABLE
66
What can we do pre op to minimise the chances of an asthma attack
Consider asking the patient to take their bronchodilator
67
What does COPD stand for
Chronic obstructive pulmonary disease
68
If a patient has COPD what ASA category to they fall under
ASA II-IV as COPD slowly progresses
69
Which sedation would we offer to a COPD patients
Inhalation sedation
70
What can be a problem with COPD patients and sedation
They rely on a low oxygen drive and giving them oxygen coudl lead to complications however not usually the problem
71
What precautions can we take before sedating a patient with COPD
1. Consider salbutamol pre op
2. Keep emergency drugs ready available
72
Give examples of upper respiratory tract infections
1. Cold
2. Acute/chronic sinusitis
3. Chronic mouth breathing
4. Chronic nasal obstruction
5. Sleep apnoea
73
Give examples of common neurological disorders
1. Epilepsy
2. Cerebral palsies
3. Multiple sclerosis
4. Parkinsons
74
How is epilepsy usually managed
Through administration of anticonvulsant medication
75
Name the different types of fit a patient with epilepsy can have
1. Grand Mal
2. Petite mal
3. Status epilepticus
76
If a patient has epilepsy what ASA category to they fall under
Well controlled: ASA II
Poorly uncontrolled ASA III
77
What can trigger epilepsy
1. Stress
2. Alcohol
3. Hypoxia
4. Sleep deprivation
5. Fasting
6. Infection
78
What patents would we ask a patient with epilepsy
1. What triggers it
2. When was your last seizure
3. How often do you get seizures
4.do you usually sense an aura
5. are you in hospital care
79
Can we perform sedation on patients with epilepsy
Only if the epilepsy is very well controlled
80
What precautions can we take before sedating a patient with epilepsy
1. Ensure patient has followed the pre op instruction
2. Give them the sedation drug in small increments to avoid over sedation
3. Consider oxygen via nasal cannulation
81
Give examples of involuntary movement disorders
1. Cerebral palsies
2. Multipel sclerosis
3. Parkinsons
4. Huntingtons disease
82
Which form of sedation would we give to patients with involuntary movement disorders
Intra venous sedation if they have tremors
83
What is myasthenia graves
An autoimmune neuromuscular disease that causes weakness of facial and respiratory muscles
84
Which form of sedation would we give to patients with myasthenia graves
Inhalation sedation
85
Give examples haematological diseases that we must consider prior to offering patient sedation
1. Severe anaemia
2. Sickle cell disease
3. Thalassaemia
86
Which form of sedation would we give to patients with haematological diseases
Inhalation sedation
87
Give examples endocrine diseases that we must consider prior to offering patient sedation
1. Diabetes
2. Adrenal insuffiecny
3. Thyroid disorders
88
Which form of sedation would we give to patients with diabetes
Either Inhalation or intravenous can be offered as long as the patients diabetes is WELL CONTROLLED
89
What happens in adrenal insuffiecny
Response to stress is suppressed and may lead to secondary hypertension and diabetes
90
Do we tend to offer sedation in primary care to patients with adrenal insufficiency
No we refer to an anaesthetist
91
how does having liver disease affect drugs in the body
Can reduce drug metabolism
92
how does having kidney disease affect drugs in the body
Can reduce drug excretion
93
Do we tend to offer sedation in primary care to patients with kidney or liver disease
No we prefer to refer to an anaesthetist and contact the patients constant
94
Do we tend to offer sedation in primary care to patients WHO ARE pregnant
We avoid offering sedation to pregnant patients until baby is born
95
Which drugs can benzodiazepines interact with
1. Alcohol
2. Analgesics
3. Erythromycin
4. Antidepressants
5. Anti-epileptics
6. Antihistamins
7. Anti hypertensives
8. anti ulcer drugs
96
How effect can benzodiazepines have on alcohol
Enhanced sedative effect
97
How effect can benzodiazepines have on analgesics
Enhanced sedative effect
98
How effect can benzodiazepines have on erythromycin
Inhibits metabolism of midazolam
99
How effect can benzodiazepines have on antidepressants
Enhanced sedative effect
100
How effect can benzodiazepines have on anti epileptics
May reduce the effect of the anti epileptic medication
101
How effect can benzodiazepines have on antihistamines
Enhanced sedative effect
102
How effect can benzodiazepines have on antihypertensives
Enhanced hypotensive effect
103
How effect can benzodiazepines have on anti ulcer drugs
Cimetidine inhibits metabolism of benzodiazepines
