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30 Cards in this Set
- Front
- Back
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516 BENZODIAZOPINES
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516 BENZODIAZOPINES
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What are some benzos that can be given pre/post/periop?
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1. midazolam
2. lorazepam 3. diasepam |
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Onset, peak, and duration of versed?
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Onset: 30-60 sec
Duration: 15-80 mins Peak: 3-5 mins |
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Onset, peak, and duration time for Lorazepam?
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Onset: 1-2 mins
Peak 20-30 mins Duration: 6-10 hrs |
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What is the ring structure of benzodiazopine?
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1. benzene ring
2. 7-member diazepine ring |
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Actions of benzodiazopine?
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1. sedation
2. anxiolysis 3. anticonvulsant 4. ANTEROGRADE amnesia |
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What they DO NOT do?
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1. analgesic effects
2. antidepressant 3. antipsychotic 4. protect stress of intubation. |
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Clincial uses of benzos?
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1. anxiety
2. insomnia 3. sedation and amnesia 4. treats epilepsy and seizure states. 5. balanced anesthetic |
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Mechanism of action for benzos?
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Act on GABA-a receptor
Hyperpolarization of cell Receptor occupancy determines effect. a. 20% anxiolysis b. 30-50% sedation c. 60% unconsciousness |
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What are the doses for Preop when using Midazolam?
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Kids: 0.5 mg/kg PO 30 mins before (15mg max)
IV: 1-2.5mg |
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What is the dose for IV sedation (ICU sedation)?
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0.5 mg IV load then 1-7 mg/hr IV
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What is the dose for IV induction of anesthesia?
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0.1 - 0.2 mg/kg
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What is the dose for suppression of seizur activity using diazepam?
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0.1mg/kg
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Pharmacokinetics of benzos?
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1. absorption
2. distribution 3. protein binding |
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Absorption
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1. PO (first pass metabolism)
2. IV 3. IM |
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Distribution
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1. dependent on lipid solubility
2. rapid redistribution from brain 3. vol. of distribution |
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Protein binding
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Hypoalbumenia
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How are benzos metabolized?
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Liver oxidation (cyt P450)
Alcohol increases clearance No active metabolites for versed. First pass metabolism |
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How are benzos eliminated?
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Metabolites are excreted in the urine.
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What effects do benzos have on the renal system?
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NONE
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What effects do benzos have on the CNS?
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1. dec. CMRO2 and CBF
2. no isoelectric EEG 3. no change in ICP 4. no evidence of neuroprotection. 5. potent anticonvulsant |
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What effects do benzos have on ventilation?
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Decreases it
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On cardiovascular?
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Minor dec. BP and Inc. HR
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Anticonvulsants and how do they work?
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Tx local anesthetic induced seizures and delirium tremors.
Work by ability of benzos to facilitate the actions of inhibitory GABA. NOTE: barbituates work by suppressing the CNS. |
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What dose of diazepam is effective for lidocaine toxicity, DTs, and status epilepticus?
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0.1mg/kg
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Why do we like Midazolam so much?
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1. 2-3X potent than diazepam (valium).
2. pK 6.15 3. rapid onset 4. short duration 5. PO route NOTE: NOT FOR PREGNANT WOMEN. |
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Why we don't like diazepam and lorazepam (ativan):
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1. thrombophlebitis and venous irritation.
2. active metabolites 3. slow onset 4. long elimination |
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What are some drugs that treat insomnia?
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1. oxazepam
2. flurazepam |
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What are some other drugs for insomnia?
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1. triazolam
2. alprazolam (xanax) 3. zolpidem (ambien) 4. FLUNITRAZEPAM (ROHYPNOL) |
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Reversal of benzo and its doses?
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Flumazenil
0.1-0.2mg IV repeated up to 3 mg. |
