Pharm: Sedation

What is the main purpose of sedatives?

Sedation before medical or diagnostic procedures.

What is the main purpose of hypnotics?

Short-term management of insomnia.

What is the main purpose of anxiolytics?

Treatment of acute anxiety and chronic anxiety disorders.

What is anterograde amnesia?

Inability to form new memories after a drug is administered.

What is a CNS depressant?

A medication that reduces central nervous system activity.

What is the sedation continuum?

Minimal sedation, moderate sedation, deep sedation, and general anesthesia.

What is another name for minimal sedation?

Anxiolysis.

What is another name for moderate sedation?

Conscious sedation.

How does airway support change as sedation deepens?

It becomes increasingly likely to be needed.

How does spontaneous ventilation change as sedation deepens?

It becomes less reliable and may become inadequate.

Which IV anesthetic groups are listed in the lecture?

Benzodiazepines, barbiturates, and propofol.

Which opioid is listed for IV sedation?

Fentanyl (Sublimaze).

What is the benzodiazepine prototype?

Diazepam (Valium), IV.

How do benzodiazepines work?

Enhance the inhibitory effects of GABA at GABA receptors in the brain.

Which benzodiazepines are commonly used for IV sedation?

Lorazepam, midazolam, and diazepam.

What effects can large benzodiazepine doses produce?

Unconsciousness and amnesia.

What procedural uses do IV benzodiazepines have?

IV induction and conscious sedation.

What other conditions may benzodiazepines treat?

Acute anxiety, status epilepticus, and alcohol withdrawal syndrome.

What patient groups require avoidance or lower benzodiazepine doses?

Avoid during pregnancy/lactation; avoid or use low doses in older adults.

What are major benzodiazepine adverse effects?

Respiratory depression, hypotension, and anterograde amnesia.

Which IV benzodiazepine has solvent-related infusion complications?

Lorazepam.

What solvent-related problems can IV lorazepam cause?

Acute tubular necrosis, lactic acidosis, and hyperosmolar states.

What reverses benzodiazepine overdose?

Flumazenil (Romazicon).

What controlled-substance schedule applies to benzodiazepines?

Schedule IV.

What should nurses monitor after benzodiazepine administration?

Respiratory depression.

What is the IV onset of diazepam?

2–5 minutes.

Does diazepam have active metabolites?

Yes.

What adverse effects are listed for IV diazepam?

Respiratory depression and phlebitis.

What is the IV onset of lorazepam?

5–20 minutes.

Does lorazepam have active metabolites?

No.

What adverse effects are listed for IV lorazepam?

Respiratory depression, acidosis, and renal failure.

What is the IV onset of midazolam?

2–5 minutes.

Does midazolam have active metabolites?

Yes.

What adverse effect is highlighted for midazolam?

Respiratory depression.

What is the barbiturate prototype?

Pentobarbital (Nembutal).

How does pentobarbital work?

Enhances GABA inhibition and reduces excitatory glutamate effects in the CNS.

What is pentobarbital used for?

IV sedation.

How does barbiturate CNS depression compare with benzodiazepines?

Barbiturates have more pronounced CNS depressant effects.

How can barbiturates affect other drugs?

They induce hepatic enzymes, causing many potential drug interactions.

What are the major barbiturate safety concerns?

Respiratory depression; overdose or withdrawal can be lethal.

What is the brand name of propofol?

Diprivan.

How does propofol work according to the lecture?

Promotes release of GABA, a major inhibitory neurotransmitter.

What are propofol therapeutic uses?

Induction and maintenance of general anesthesia and sedation.

What does the propofol IV formulation look like?

A lipid-like phospholipid emulsion.

What is the onset and duration of propofol?

Rapid onset and short duration.

What are major cardiorespiratory adverse effects of propofol?

Respiratory depression/apnea, hypotension, and bradycardia.

What other adverse effects are associated with propofol?

Bacterial infection risk, IV site pain, and propofol infusion syndrome.

How can propofol IV site pain be reduced?

Use a large vein; lidocaine may be used.

Why does continuous propofol need a dedicated IV line?

It is incompatible with many medications.

When should propofol bottle/tubing be changed per the lecture?

After 12 hours of hanging.

What are two important propofol safety concerns?

Abuse potential and narrow therapeutic index.

How does fentanyl produce its effect?

Binds mu opioid receptors; a high-potency opioid analgesic.

What are fentanyl therapeutic uses in this lecture?

IV sedation and pain control.

What are the onset and duration of IV fentanyl?

Rapid onset and short duration.

Which drug class can compound fentanyl sedation?

Benzodiazepines.

Which CYP3A4 inhibitors can increase fentanyl levels?

Ritonavir and ketoconazole.

What are major fentanyl adverse effects?

Respiratory depression, sedation, constipation, urinary retention, and nausea.

What reverses fentanyl overdose?

Naloxone.

What controlled-substance schedule applies to fentanyl?

Schedule II.

Which drugs may be combined for moderate sedation?

A benzodiazepine and an opioid.

Which agents may be used alone for moderate sedation?

Propofol or etomidate, as listed in the lecture.

Who must supervise conscious sedation?

A credentialed provider, with qualified staff and emergency equipment available.

What must be assessed before conscious sedation?

Baseline vital signs, sedation score, and neurologic assessment.

How often should vital signs be checked during conscious sedation?

Every 5 minutes, with blood pressure measured at least once.

Which respiratory monitors are used during conscious sedation?

Pulse oximetry and capnography (end-tidal CO2).

What staffing requirement applies during conscious sedation?

At least one team member must always remain with the patient.

How often are vital signs checked after conscious sedation?

Every 15 minutes until respirations and level of consciousness return to baseline.