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Flashcards in Sedatives Deck (53):
1

When are sedatives indicated?

Facilitate tolerance to procedures
Reduce unnecessary recall
Mandatory adjunct to neuromuscular blockades

2

What are benzodiazepines used for?

Sedation
Hypnosis
Anxiolysis
Muscle relaxation
Anticonvulsant activity
Anterograde amnesia

3

Do benzodiazepines have analgesic effects intrinsically?

Nope

4

What kind of drug is diazepam?

Long acting benzodiazepine

5

What is the most lipid soluble benzo?

Diazepam

6

What is diazepam a vehicle for?

Propylene glycol

7

What is a side effect of diazepam?

Hypotension

8

Where is diazepam metabolized?

The liver

9

How many active metabolites does diazepam have?

3

10

What is a common active metabolite of diazepam and what is the half-life?

Desmethyldiazepam
100-200 hours

11

What is an issue with repetitive dosing of diazepam?

Significant accumulation

12

What 3 general things is diazepam used for?

Conscious sedation
Anxiety
Muscle relaxation

13

What is an emergency use of diazepam and how is it administered?

Status epilepticus
IV

14

What is the adjustment of diazepam for hepatic disease?

Reduce dose by 50%

15

What kind of drug is lorazepam?

Intermediate-acting benzodiazepine

16

Is lorazepam affected by age, liver disease, or drug interactions?

No

17

What is lorazepam a vehicle for?

Propylene glycol

18

What is an SE of lorazepam?

Hypotension

19

What is a risk of continuous lorazepam infusion?

Propylene-glycol induced metabolic acidosis

20

Under what circumstance is lorazepam the drug of choice?

Alcohol withdrawal delirium tremor prevention

21

What are the two general uses of lorazepam?

Anxiety and sedation in adults

22

What is the dosing of lorazepam for pre-procedural anxity?

1-2 mg PO 1 hour prior

23

What is an emergency use for lorazepam?

Status epilepticus

24

What is the dosing of lorazepam for status?

4 mg/dose slow IVP over 2-5 minutes

25

What is the dosing of midazolam for pre-op sedation?

Usually 5 mg

26

What is the usual dose of midazolam for conscious sedation?

2.5-5 mg

27

How do you adjust the dosing of midazolam for the elderly?

Decrease initial dose by 50%

28

What is the reversal agent for benzodiazepines?

Flumazenil

29

What does flumazenil do to revers benzos?

Reverses excessive CNS depression

30

What is the issue with flumazenil? Why is that an issue? What happens as a result of this?

Short duration of action 30-45 minutes
Benzos last much longer
Risk of resedation

31

Does propofol have a long or short duration of action?

Short

32

What are some benefits of propofol's short duration of action?

Decreased time of weaning and extubation
Rapid assessment of neurological status

33

What is an issue with propofol and how do we deal with it?

Supports microbial growth
Must change tubing q12 hours

34

What are some adverse effects of propofol?

Can cause hyperlipidemia and hypotension

35

How many calories/mL in propofol

1.1 Cal/mL
Must count as a calorie source

36

What is an issue with continued use of propofol?

Rapid development of tolerance

37

Are the half-lives of all propofol agents the same?

No they are variable among various agents

38

What kind of affect does dexmedetomidine have?

Sedative with some analgesic activity

39

What is a benefit with dexmedetomidine?

No respiratory depression

40

How is dexmedetomidine eliminated?

95% renally

41

What are some serious side effects w/ dexmedetomidine?

Hypotension
Bradycardia
Pt appears awake and alert
Expensive

42

What do you do for a pt who seems awake and alert on dexmedetomidine?

Rescue drugs required for most pts
Need a multi-drug regimen

43

What is ketamine?

Dissociative anesthetic agent

44

What procedures is ketamine helpful for?

Debridement of wounds
Transport of patients in pain

45

What is the time of onset for ketamine?

30 seconds

46

What can happen during recovery from ketamine?

Hallucinations
Vivid dreams

47

What is the drug of choice for urgent endotracheal intubation?

Etomidate

48

Where is etomidate commonly used?

OR
ER

49

How quickly is unconciousness achieved with etomidate?

Rapid -> within seconds

50

What is the duration of action of etomidate?

Short -> 5-10 minutes

51

What is an advantage of etomidate?

Minimal hypotension or disruption of ventilation

52

What is a risk with etomidate and how do we deal with that?

Depression of cortisol synthesis
Use short term

53

What do benzos do?

Provide the greatest amnesia, with NO analgesia