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sedation midterm > sedation midterm 3 > Flashcards

sedation midterm 3 Flashcards

1
Q

5 routes of drug administration

A

Oral​

Inhalation​

I.V.​

I.M.​

Transmucosal/Transdermal

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2
Q

What is the positive of oral/enteral sedation? ​

A
  • Acceptance ​
  • No special skills​
  • Low side effects​
  • No extra equipment​
  • Pt can take night before​
  • No extra state permit?
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3
Q

What is the disadvantage of oral sedation?​

A
  1. Variable absorption ​
    1. First pass effect. When you eat something, it has to go to the liver FIRST. It may become inactive, so may not end up in the brain ​
    2. Lunch will affect absorption of your oral sedation – fattier the meal, the more likely it’ll bind to your drug ​
    3. more anxious you are, the LESS likely you are to absorb a drug – know this exam ​
    4. MAY reach maximum sedation AFTER discharge – know this for exam
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4
Q

How long to reach peak blood levels via ORAL?

A

Average patient will reach peak blood levels 1 hour after taking the oral sedation

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5
Q

What are the positive of inhalation?

A

1) Rapid onset with peak effect​
2) Can titrate​
3) Quick elimination and patient can drive home

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6
Q

Negatives of inhalation?

A
  1. Special equipment​
  2. Special skills​
  3. Need compliance ​
  4. Waste gas
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7
Q

What is the positive of IM sedation?​

A

1- Least cooperation of all techinques ​
2- No skills​
3- Useful in emergencies​
4- Bypasses the gut

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8
Q

What is the negative of IM sedation?

A
  1. Titration difficult​
  2. Hurts​
  3. Parenteral route needs advanced monitoring because you can kill the kiddo
  • WHEN YOU CANNOT FIND A VEIN ON A PATIENT
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9
Q

Indication of IM? ​

A

If you have someone that is agitated and violent and being just a bitch, IM them. Maybe with ketamine? ​

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10
Q

What does it mean to titrate a drug?

A

You can slowly increase levels until you achieve satisfactory levels of sedation​

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11
Q

What is the positives of IV drugs? ​

A
  1. Fastest onset​
  2. Can titra​
  3. Most predictable​
  4. Best route to emergency drugs​
  5. Predictable amnesia
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12
Q

What is the A priori logic?

A

This means without thinking. Because you can titrate and figure out the ideal dose for a patient with IV, but in reality, the A Priori logic doesn’t really hold water since people find a way to fuck it up

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13
Q

What is the negatives of IV drugs? ​

A 
1- Special skills​
2- Need cooperations​
3- Special equiment​
4- Adverse drug​
5- Malpractice
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14
Q

Is there a first pass effect of inhalation?

A

NO, not metabolized at all

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15
Q

What are 4 things you should you monitor when doing sedation?

A
  • CNS – this is like talking back, etc. That’s the best way to monitor ​
  • Respiration – most COMMON cause ​
  • Cardiovascular ​
  • Temperature
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16
Q

What are the 6 oral agents for sedation?Which one is emetic?

A

1) High doses, ETOH makes people throw up​
2) Barbiturates​
3) Benzos​
4) Antihistamines​
5) Narcotics ​
6) Sugars

17
Q

ETOH pros and cons

A

Positives: Fast absorption – 30 min. to peak well studied, minor CV/resp. system effects, many adults with experience, cheap​

Negatives: Stigmata, GI irritant (emetic), hypoglycemia in kids, hangover in high doses​

18
Q

Barbiturates

1) who famous died?
2) why do we like them?
3) side effects?
4) AVOID in what pts?
5) used for…..?
6) classifications?

A

1) elvis
2) predictable, work on everyone, well known
3) Depress respirations, addicting, liver enzyme induction, “hangover” effects, NOOOO analgesic properties
4) avoid in porphyria patients
5) seizures
6) short and ultra short for dental work

19
Q

What schedule are the barbituates? ​ What are the two short acting ones?

A

Pentobarbital (Short)​
Secobarbital (Short)​

ALL are schedule 2 agents​

20
Q

who uses benzodiasepines?

A

EVERYONE

21
Q

Benzodiazepines​ pros and cons

A

PRO: Less respiratory depression and hangover effects compared to barbiturates., work on limbic system in “GABAnergic” way, favorable T.I., schedule 4 agents, older agents cheap, antidote (Romazicon)​

CON: Teratogenic, paradoxical excitement in some kids, psychologically addicting, newer agents $​

22
Q

Benzodiazepines​ work on?

A

GABA nergic – GABA makes you mellow and sedated ​
​**Know that they act as a GABA analog – know that they don’t tend to shut down breathing too much, not as bad as the barbituate

23
Q

reversal agent of benzo?

A

Flumazeil

24
Q

What are the big three benzodiazepines? ​ What is the half life for reach? ​

A
  1. Diazepam or valium? KNOW IT’S THE CHEPAEST ​
    ~~Half life is 24 hours with an active metabolite​
  2. Triazolam (Halicon) – this is a short acting sleeping pill ​~~Half life is 3 hours ​
  3. Midazolam elixer - this is for use in children with rapid resorption in the oral route and rapid degeneratoin​
    ~~Know that very short half life and can cause respiratory depression​
25
Q

Triazolam (Halicon)

A

this is a short acting sleeping pill ​~~Half life is 3 hours ​

  • maximum dose is 0.5 mg/day ​
  • Transmucosal absorption – so if someone is having a heart attack, give them aspirin, and chew it and can be absorbed under the tongue​
  • need EKG monitering
26
Q

________ enzymes in the intestines and the liver metabolize triazolam. Antiretroviral agents inhibit CYP3A, resulting in a two-fold increase in plasma concentrations.

A

CYP3A enzymes… note TWO-FOLD increase in plasma concentrations

27
Q

ESZOPLICONE ZALEPON AND ZOLPIDERM ARE BETTER FOR?

A

prego women

28
Q

Rozerem (Ramelteon)​ is first and only prescription insomnia medication that:​

A

Is nonscheduled––not a controlled substance and approved for long-term use ​

Targets the normal sleep wake cycle​

Has shown no evidence of abuse potential in clinical studies ​

Does not act by general CNS depression​

​

29
Q

When do you do a IM sedation? ​

*** In the even you overdose someone, what can you give them?

A
  1. Totally uncooperative patient​
  2. Unable to get IV ​
  3. Oral route offline due to the fact that they’re taking IM​

*** Narcan or a the Romezacan dose intramuscular ​- Some people are giving Narcan spray nasally

30
Q

What are the muscles that you can inject into?

A

Shoulder – deltoids (NOT GREAT FOR FOUR YEAR OLDS )​

Thigh – Vastus Lateralis (GREAT FOR 4 YEAR OLDS)​

Butt – Gluteus Maximus

31
Q

Deltoid

- pros and con

A 
Overall best for dentistry​
Up to 4 ml. ​
Good perfusion​
Accessible​
Bull's-eye is Mid Deltoid​

BAD: Not for people < 2-3 years old

32
Q

gluteus good and bad why

A

Bull’s-eye is upper outer quadrant​ and “Traditional” I.M. Site​

BAD: Disrobing required​, Poor perfusion​ due to fat, Not for kids< 2-3 years old

33
Q

lateral thigh good and bad why?

A

Best for kids < 2-3 years old, Safe​, Large volumes​
, Fairly good perfusion​

BAD: Disrobing

34
Q

IM… how?

A

20-23 gauge needle, at least 11/4 inch long​ (otherwise sits in fat) advance 1in

  • use topical and band-aid
  • skin tougher than mucous

sedation midterm (4 decks)

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