Moderate Sedation

Question 1

What is the 1st major class of moderate sedation agents?

Answer 1

Benzodiazepines

Question 2

What is the MOA of benzodiazepines?

Answer 2

Bind to specific receptor sites in the CNS particularly in the cerebral cortex. Through this action, excitatory impulses are inhibiited

Question 3

What are the characteristics of benzodiazepines?

Answer 3

1. Lipid soluble
2. Readily penetrate the blood-brain barrier
3. Use to achieve the following effects:
   a. anxiolytics
   b. sedation
   c. hypnosis
   d. anti-convulsion
   e. skeletal muscle relaxation

Question 4

Pharmacokinetics of benzo?

Answer 4

Hepatic metabolism and renal excretion

Question 5

What are the cautions of benzodiazepines?

Answer 5

COPD, OSA, cardiopulmonary depression

Question 6

What are the guidelines for Midazolam (Versed)?

Answer 6

1. Reduce doses in elderly, hypovolemic, high-risk patients and with concomitant use of other sedatives or narcotics.
2. COPD patients are unusually sensitive to the respiratory depressant effect.
3. Contraindicated in acute narrow-angle or open-angle glaucoma unless patients are receiving appropriate therapy.
4. Do not administer a rapid bolus.
5. Treat OD w/ supportive measures and reverse with FLUMAZENIL (0.2-1 mg, slowly IVP)

Question 7

What are the principle adverse reactions?

Answer 7

1. CV: tachycardia, vasovagal episode, PVCs, hypotension
2. Pulmonary: bronchospasm, laryngospasm, apnea, hypoventilation.
3. CNS: euphoria, emergence delirium, prolonged emergence, tonic-clonic movements, agitation, hyperactivity.
4. GI: salivation, retching, acid taste
5. Dermatologic: rash, pruritis, warmth, or coldness at injection site.