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30 Cards in this Set
- Front
- Back
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Flurazepam
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Benzo
Used to produce a full-night's sleep Long acting Useful if pt. can't stay asleep |
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Temazepam
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Benzo
Slow onset Intermediate duration Helpful to fall asleep *Drug of choice for insomnia* |
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Triazolam
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Benzo
Helpful to fall asleep Possible abnormal thinking/behavior |
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Flumazenil
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Benzo antagonist
Effective for OD |
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Phenobarbital
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Barb
Long-acting (8 hrs) Anticonvulsant properties at low dosages |
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Pentobarbital
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Barb
Intermediate (4 hrs) |
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Thiopental
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Barb
Ultrashort-acting (15-30 mins) |
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Zolpidem
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Non-Benzo Sedative
Ambien BZ1 induces sleep, higher doses can decrease REM sleep amnesia (7-8 hours) possible dependence additive effect w/ CNS depressants or tricyclic antidepressants *Drug of choice for insomnia* |
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Chloral hydrate
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Induction of sleep (esp. elderly)
Irritating to the GI tract "Mickey" |
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Paraldehyde
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Similar mechanism to barbs
Irritating to the GI tract *almost totally excreted via lungs in pt. w/ liver/kidney failure OTC may also contain diphenydramine (benadryl) |
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Barbs
Mechanism of action |
GABAa receptors
increase duration of Cl- channel openings (hyperpolarization) blockade of Na+ channels |
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In which Barb is redistribution a major concern with the initial dose?
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Thiopental
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How do you treat a barb OD?
Reasoning? |
Bicarbonate to alkalinize blood & urine
Helps the drug out of the brain and prevents resorption in the kidney. |
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Pharm effects of Barbs?
CNS? CV? Smooth muscle? Liver? |
CNS: ARAS depressed, possible REM deficit, respiratory depression
CV: decrease in BP, HR SM: decrease in contractions of GI, Urinary, uterine tissue Liver: induction of microsomal enzymes, cross-tolerance w/ EtOH, Benzo, anesthetics |
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Zaleplon
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Sonata
similar to zolpidem rapid-acting, less potent dependence possibility no morning-after sedation like zolpidem |
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Eszopiclone
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Lunesta
non-benzo hypnotic GABA complex near BZ receptor retrograde amnesia |
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Ramelteon
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Rozerem
melatonin receptor agonist improves sleep onset, no sleep mx no abuse potential liver dysfunction increases drug half-life decreases testosterone increases prolactin |
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Trazodone
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desyrel
non-tricyclic, non-SSRI antidepressant may be given with other antidepressants less effective than zolpidem priapism expensive contraindicated in pregnancy |
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Halothane
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Disadvantages
only produces sleep nitrous for analgesia & succinylcholine for muscle relax cannot use with catecholamines Advantages short induction/recovery uterine relaxation Status largely replaced by newer agents useful in children |
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Enflurane
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Disadvantages
resp & circ depression @ high doses limited use of catecholamines Advantages medium rate of induction good skeletal muscle relaxation Status not widely used |
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Isoflurane
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Disadvantages
odor progressive respiratory depression, hypotension Advantages no cardiac depression ok w/ catecholamines good muscle relaxation Status most widely used |
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Desflurane
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Disadvantages
odor poor induction tachycardia/hypertension related to sympathetic activation Advantages similar to isoflurane rapid recovery Status partly replacing isoflurane (better corntrol) malignant hyperthermia possible w/ succinylcholine |
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Sevoflurane
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Disadvantages
nausea/vomiting rx. w/ soda-lime to form nephrotoxic metabolite Advantages rapid induction & emergence better control than w/ isoflurane & desflurane Status good replacement for halothane in peds malignant hyperthermia possible w/ succinylcholine |
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Nitrous Oxide
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Disadvantages
only analgesia no surgical anesthesia avoid in conditions w/ "air pockets" Advantages not irritating rapid onset/recovery combine w/ more potent agents Status widely used in dentistry |
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Propofol
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similar to thiopental
hypotension rapid induction & recovery (esp. mood) antiemetic |
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Ketamine
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dissociative anesthetic
blocks glutamic acid (excitatory) Disadvantages emergence excitement increased intracranial pressure poor muscle relaxation stimulation of secretions Advantages profound analgesia resp./reflexes well-mainatined stimulates CV system Status special use: trauma/emergency surgery, dressing changes, combine w/ propofol useful in high-risk (elderly) pt. |
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Sufentanil, Alfentanil
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neuroleptanesthesia produced
can combine w/ NO2 useful for diagnostic exams/minor procedures |
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Thiopental
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Disadvantages
cough, laryngospasm, bronchospasm, CV depression Advantages rapid, pleasant induction fast recovery w/ little excitement/vomiting Status widely used for induction |
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Etomidate
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Rapid induction/recovery
minimal CV/resp change myoclonia (arm flexing) & pain on injection may inhibit steroidogenesis |
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Benzos for anesthesia?
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Midazolam
slow onset/recovery good for short procedures (colonoscopy) amnesia combine w/ opiate Lorazepam retrograde amnesia Other benzos for preanesthetic medication |
