Flashcards in Sedatives Deck (53):
When are sedatives indicated?
Facilitate tolerance to procedures
Reduce unnecessary recall
Mandatory adjunct to neuromuscular blockades
What are benzodiazepines used for?
Do benzodiazepines have analgesic effects intrinsically?
What kind of drug is diazepam?
Long acting benzodiazepine
What is the most lipid soluble benzo?
What is diazepam a vehicle for?
What is a side effect of diazepam?
Where is diazepam metabolized?
How many active metabolites does diazepam have?
What is a common active metabolite of diazepam and what is the half-life?
What is an issue with repetitive dosing of diazepam?
What 3 general things is diazepam used for?
What is an emergency use of diazepam and how is it administered?
What is the adjustment of diazepam for hepatic disease?
Reduce dose by 50%
What kind of drug is lorazepam?
Is lorazepam affected by age, liver disease, or drug interactions?
What is lorazepam a vehicle for?
What is an SE of lorazepam?
What is a risk of continuous lorazepam infusion?
Propylene-glycol induced metabolic acidosis
Under what circumstance is lorazepam the drug of choice?
Alcohol withdrawal delirium tremor prevention
What are the two general uses of lorazepam?
Anxiety and sedation in adults
What is the dosing of lorazepam for pre-procedural anxity?
1-2 mg PO 1 hour prior
What is an emergency use for lorazepam?
What is the dosing of lorazepam for status?
4 mg/dose slow IVP over 2-5 minutes
What is the dosing of midazolam for pre-op sedation?
Usually 5 mg
What is the usual dose of midazolam for conscious sedation?
How do you adjust the dosing of midazolam for the elderly?
Decrease initial dose by 50%
What is the reversal agent for benzodiazepines?
What does flumazenil do to revers benzos?
Reverses excessive CNS depression
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
Does propofol have a long or short duration of action?
What are some benefits of propofol's short duration of action?
Decreased time of weaning and extubation
Rapid assessment of neurological status
What is an issue with propofol and how do we deal with it?
Supports microbial growth
Must change tubing q12 hours
What are some adverse effects of propofol?
Can cause hyperlipidemia and hypotension
How many calories/mL in propofol
Must count as a calorie source
What is an issue with continued use of propofol?
Rapid development of tolerance
Are the half-lives of all propofol agents the same?
No they are variable among various agents
What kind of affect does dexmedetomidine have?
Sedative with some analgesic activity
What is a benefit with dexmedetomidine?
No respiratory depression
How is dexmedetomidine eliminated?
What are some serious side effects w/ dexmedetomidine?
Pt appears awake and alert
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
What is ketamine?
Dissociative anesthetic agent
What procedures is ketamine helpful for?
Debridement of wounds
Transport of patients in pain
What is the time of onset for ketamine?
What can happen during recovery from ketamine?
What is the drug of choice for urgent endotracheal intubation?
Where is etomidate commonly used?
How quickly is unconciousness achieved with etomidate?
Rapid -> within seconds
What is the duration of action of etomidate?
Short -> 5-10 minutes
What is an advantage of etomidate?
Minimal hypotension or disruption of ventilation
What is a risk with etomidate and how do we deal with that?
Depression of cortisol synthesis
Use short term