Im/ Iv Drugs

Front 1

When is IM recommended for use in sedation

Back 1

-adults when inhalation and IV are unavailable
-disruptive adult/kid when other routes fail
-disruptive adult/kid with disabilities in whome other routes are ineffective

Front 2

What three ways is the intramuscular route used for

Back 2

-premed before IV sedation in pre-cooperative ppl
-administer antiemetic or anticholinergic
-administer emergency drugs when no IV

Front 3

Advantages of IM

Back 3

-rapid onset (15 min)
-maximal clinical effect (30 min)
-more reliable absorption than oral and rectal
-patient cooperation is not as essential

Front 4

Disadvantages of IM

Back 4

-inability to titrate or reverse drug action
-prolonged duration of drug effect
-injection needed

Front 5

What is the BZDP of choice with IM

Back 5

-midazolam - rapid absorption and short duration of action

Front 6

What kind of pain are opioids useful in treating

Back 6

-dull, aching, continuous pain (not sharp, intermittent pain)

Front 7

What are three common opioid agonist/antagonists

Back 7

-pentazocine, butorphanol, nalbuphine

Front 8

What is the most significant undesirable effect of opioids

Back 8

-respiratory depression at normal doses

Front 9

When does maximal respiratory depression occur with opioids:
IV
Im
SubQ

Back 9

IV = 7 min
IM = 30 min
SubQ = 90 min

Front 10

What is the first drug of choice for opioid overdose

Back 10

-naloxone IV

Front 11

In IM opioid agonist/antagonist what are the antagonist actions?

Back 11

-prevent agonist effects if administered together
-reverse agonist if administered after opioid
-precipitation of acute withdrawal immediately in opioid-dependent patient

Front 12

Butorphanol:
-onset time, peak time
-duration
-what reverses butorphanol resp depression
-used in who
-usual dose

Back 12

-10 min, 30-60 min
-3-4 hours
-naloxone
-only in adults
-2 mg IM 15-30 min prior to procedure

Front 13

Nalbuphine
-onset, peak, duration
-half life
-does it increase cardiac work
-what reverses respiratory depression
-given to who in what dose

Back 13

-15 min, 1.5 hours, 3-6 hours
-5 hours
-won't increase cardiac work
-naloxone
-adults only, 10 mg/ 70 kg 15-30 min prior to appt

Front 14

Ketamin is a dissociative anesthetic -- what is this?

Back 14

-patient is mentally dissociated from environment
-low doses produce sedation, high doses produce general anesthesia
-in 5-8 min pt loses conciousness, recovers 10-20 min later

Front 15

Ketamine:
mechanism

Back 15

-dissociative anesthesia works by interrupting cerebral ssociation pathways and depressing thalamocortical tracts

Front 16

Ketamine:
CV effects

Back 16

-CV system is stimulated
-BP elevation fo 20-25%
-HR and CO are increased
-airway patency is maintained and protective reflexes remain

Front 17

Ketamine contraindications
**EXAM**

Back 17

-high BP
-psychiatric disorders
-increased intracranial pressure
-seizure disorders
-arteriosclerotic herat disease
-hx of CVA

Front 18

When is ketamine delirium most likely to occur

Back 18

-over the age of 10

Front 19

What is the biotransformation of IV diazepam

Back 19

-half-life of 30+ hours
-rebound/second peak b/c it is stored in gall bladder and will be released after lipid-rich meal
-demethylation into DMD which is anxiolytic and has a half life- of 96 hours

Front 20

What % develop anterograde amnesia with IV diazepam

Back 20

-75%

Front 21

Diazepam contraindication

Back 21

-allergy, acute narrow angle glaucoma, alcohol intoxication, CNS depression, less than 6 mo old

Front 22

Midazolam biotransformation

Back 22

-three major metabolites have no activity
-half life is 4-18 min
-metabolism/excretion is 1.7-2.4 hours
onset = 55-143 seconds

Front 23

How much more potent is midazolam than diazepam

Back 23

-4 times as potent
-usual dose is 1-2.5 mg

Front 24

How long does midazolam last

Back 24

duration of clinical activity = 1hour

Front 25

Pharmacodynamics of IV propoforl

Back 25

-decreases cerebral metabolism, blood flow and intracranial pressure
-greater respiratory depression
-CV depression

Front 26

IV Propofol:
half life
metabolism

Back 26

-distribution = 2-4 min, elimination = 1-3 hours
-hepatic metabolism, renal excretion

Front 27

Clinical IV Propofol
-used why

Back 27

-rapid onset and recovery
-less residual post-op sedation, fatigue, than with barbiturates
dose = .5-1 mg/kg

Front 28

Contraindications to propofol

Back 28

-allergy to eggs
-pediatric patients
-requires continous monitoring in controlled setting

Front 29

Advantages of propofol

Back 29

-fast onset and recovery, no dose adjustment for renal or hepatic disease, limited post-op hangover

Front 30

Disadvantages of propofol

Back 30

-significant cardiorespiratory depression (limits pt selection), not used in pediatrics, requires training to administer

Front 31

IV fentanyl warnings

Back 31

-may cause rigidity of muscles involved in respiration - related to rate of injection (tx with succinylcholine)
-contraindicated in pts who have taken MAOIs w/in past 14 days
-not for kids under 2
-caution in COPD, renal, hepatic dysfunction

Front 32

Uses of naloxone

Back 32

-reverse opioid depression of natural/synthetic opioids, propoxyphene, agonist/antagonists

Front 33

Protocol with naloxone

Back 33

-pt cannot be discharged for at least one hour in order to detect recurrence of respiratory depression

Front 34

Naloxone adverse reactions

Back 34

-may precipitate acute withdrawal in patients with physical dependence to opioids
-in presence of opioids will cause: N/V, sweating, tachycardia, increased BP, tremulousness