sedation midterm 4 Flashcards
(24 cards)
What is the ideal anxiolytic?
- No antigenic
- Cheap
- Effective via any route
- Rapidly absorbed if given PO
- Tastes good, like chicken
- Reversible – has an antidote
- Makes patient happy, possibly amnesic
Digitalis
Digioxin is deadly in high quanities
What is a favorable therapeutic index for anxiolytic?
- Discuss physiological effects
- Discuss your hepatic metabolism
- Discuss rewards center
The perfect anxioltyic acts ONLY on the emotional center of the CNS and does not influence the cardiovascular or respiratory system.
- There is NO active by products
- Not addicting
what does enteral mean?
oral
checklist for sedation?
- Consent
- Medical history
- Responsible ride/escort
- Reversal drugs/oxygen read
- Baseline vital signs, O2 sats
- Discharge vital signs, O2 sats
- Document (wheel chair) stable to car
IM drugs
Narcotics
Benzodiazepines
Ketamine
Hydroxysine
Antiemetics
Anticholinergics
Narcotics for IM
1) why do ppl take
2) always get what side effect?
3) reversal agent?
1) poeple take for euphoria
2) Know that you ALWAYS get respiratory depression at therapeutic doses - rarely given as sole agent
3) Know that the reversible agent is the Narcan (intranasal)
name Narcotics for IM
Morphine – 7 hour
Meperidine – 3 hours
Fentanyl - 1.5 hours
*some narcotics that last 30 minutes – why do this? You can drip in the narcotic into the root canal
Benzodiazepines for IM
1) similar to oral route how?
2) effective or not?
3) best choice?
4) reversal agent?
1) As with oral route, the best single agent for most patients –Pharmacology similar regardless of route
2) NOT effective
3) Midazolam best choice
4) Romazicon available to reverse
Ketamine in IM
1) commonly used in
2) side effects? KNOW
3) GOOD because?
4) overdose how
1) commonly used for animals
2) nystagmus gaze and that it produces a state of dissassociated anesthesia (lights on with nobody home)
3) Hard to overdose and get a respitory depression
4) increase BP and increase heart rate
Ketamine will cause weird? Help this with what drug?
flashback dreams – we get around the disassociate anesthesia and CUT IT with a VERSED to reduce the effects
Ketamine is a ____ antagonist?
does it have a reversal??
NMDA antagonist and does not have a reversal agent
Anticholinergics
1) ____ usually cut with anticholinergic
2) Atropine
3) Scopolamine
4) Gycopyrrolate
1) Ketamine
2) best for heart rate
3) sedates, combats motion sickness
4) doesn’t cross BBB, no sedation or elevation of heart rate
When you sedate little kids, little kids blood pressure is dependent on their
heart rate
Anticholinergics are occasionally added to an IM cocktail to decrease
salivation, maintain/elevate heart rate
Name Antiemetics can be given IM
Promethazine – H1 antatgonist in the vestibular cochlear area
Hydroysine – H1 antagonist in the vestibular cochlear area
Odansetron – 5HT3 inhibitor that inhibits the vagal stimulation of the nucelus tractus solitarius
What is the advantage of Intranasal vs oral sedation?
Intranasal is faster since much more rapid absorption
Give an example of an intranasal injection?
Midazolam being administered this way
What is another way for antiemetics?
Rectal
What’s an intrathecal injection?
A true spinal injection – used for cancer pain
Can you do fentynl transdermal?
** What else is transdermal?
Yeah common for cancer patients due to nausea
** Nitrates
Orexins
Responsible for keeping people awake
Antihistamines are good and bad why?
Good- can use with N2O, anti-emetic, well known
Bad- no antidote, only mild sedation, pyramidal effect with promethazine
2 antihistamine drugs
1) promethazine -used in perio, causes tardive dyskinesia
2) hydroxyzine - combined with narcotics in hospital
