Pharmacology: Anesthetic Agents Midazolam and Analgesic Drugs
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Questions and Answers

What is midazolam commonly used for?

  • Analgesic effects
  • Conscious sedation and preoperative sedation (correct)
  • Local anesthesia
  • Postoperative pain relief

    • What is the benefit of giving analgesic drugs pre-operatively?

  • Reduces postoperative pain (correct)
  • Increases the required dose of anesthetic agent
  • Reduces the risk of bronchospasm
  • Reduces patient comfort in the immediate postoperative period

    • Which of the following is a common side effect of opioids?

  • Hypotension
  • Nausea and vomiting (correct)
  • Euphoria
  • Tachycardia

    • What is the advantage of using NSAIDs in day surgery?

    <p>They are commonly used unless there are contra-indications</p> Signup and view all the answers

    Which of the following opioids is 100 times more potent than morphine?

    <p>Fentanyl</p> Signup and view all the answers

    Why are opioids usually the agents of choice in the presence of acute severe pain?

    <p>They provide better analgesic effects</p> Signup and view all the answers

    What is the effect of clonidine as a premedication in children?

    <p>Reduces postoperative pain</p> Signup and view all the answers

    What is a characteristic of Pethidine compared to Morphine?

    <p>It has 1/10th the potency, but similar efficacy</p> Signup and view all the answers

    What is a benefit of using Fentanyl over Morphine?

    <p>It causes less nausea and vomiting</p> Signup and view all the answers

    What is a characteristic of Remifentanil?

    <p>It is a specific mu-type-opioid receptor agonist</p> Signup and view all the answers

    What is the duration of action of Pethidine?

    <p>2-3 hours</p> Signup and view all the answers

    What is a benefit of using Pethidine in asthmatics?

    <p>It is safer in asthmatics</p> Signup and view all the answers

    What is the bioavailability of Pethidine?

    <p>50%</p> Signup and view all the answers

    What is the dose of Fentanyl for analgesia?

    <p>1-5 microgram/kg i.v</p> Signup and view all the answers

    What is the primary mechanism by which ondansetron exerts its antiemetic effects?

    <p>Peripheral action on the vagus nerve</p> Signup and view all the answers

    What is the main effect of antacid drugs on gastric juice?

    <p>Increase pH and decrease volume</p> Signup and view all the answers

    What is the primary action of histamine H2 receptors antagonists?

    <p>Increase the pH of the gastric content</p> Signup and view all the answers

    What is the primary route of administration for antiacid drugs?

    <p>Oral</p> Signup and view all the answers

    What is the primary effect of sodium citrate?

    <p>Increase the pH of the gastric content</p> Signup and view all the answers

    What is the primary action of proton pump inhibitors?

    <p>Decrease the production of gastric acid</p> Signup and view all the answers

    What is a property of Fentanyl?

    <p>It is metabolized in the liver and excreted in the urine</p> Signup and view all the answers

    What is a characteristic of Metoclopramide?

    <p>It acts centrally as a dopaminergic antagonist on the vomiting center</p> Signup and view all the answers

    What is a side effect of Metoclopramide?

    <p>Oculogyric side effect</p> Signup and view all the answers

    What is a property of Atropine?

    <p>It has vagal inhibition</p> Signup and view all the answers

    What is a characteristic of Remifentanil?

    <p>It is a specific mu-type opioid receptor agonist</p> Signup and view all the answers

    What is NOT a characteristic of Fentanyl?

    <p>It is reversed by neostigmine</p> Signup and view all the answers

    Which of the following opioids has a rapid onset and offset of analgesic effects?

    <p>Remifentanil</p> Signup and view all the answers

    Which of the following is NOT a characteristic of pethidine compared to morphine?

    <p>More miosis</p> Signup and view all the answers

    Which of the following is NOT a mechanism of action of ondansetron?

    <p>Releases histamine</p> Signup and view all the answers

    What is a characteristic of midazolam?

    <p>It is water soluble at physiologic pH</p> Signup and view all the answers

    What is a characteristic of anxiolytic drugs?

    <p>They have a good analgesic effect</p> Signup and view all the answers

    Which of the following drugs is NOT an analgesic?

    <p>Midazolam</p> Signup and view all the answers

    What is a characteristic of pethidine compared to morphine?

    <p>Less miosis</p> Signup and view all the answers

    What is a characteristic of ondansetron?

    <p>It has a competitive antagonism at the 5-HT3 receptor</p> Signup and view all the answers

    Study Notes

    Sedation and Anesthesia

    • Midazolam is suitable for conscious sedation, preoperative sedation, and inducing general anesthesia due to its properties.
    • It provides a superior pre-operative sedative effect compared to diazepam, and has good local tolerability and hemodynamic stability.

    Analgesic Drugs

    • Analgesic drugs, such as opioids, paracetamol, and NSAIDs, are given pre-operatively to reduce the required dose of anesthetic agent and improve patient comfort in the immediate postoperative period.
    • NSAIDs are commonly used, especially in day surgery, unless contraindicated.
    • Opioids are the agents of choice for acute severe pain, but may cause variable sedation, cardiorespiratory depression, nausea, and vomiting.

    Classifications of Opioids

    • Natural Opium Alkaloids: Morphine and Codeine
    • Semi-synthetic: Diacetylmorphine (Heroin) and Pholcodeine
    • Synthetic Opioids: Pethidine (Mepiridine) and its congeners Diphenoxylate and Loperamide, Fentanyl and its congeners

    Pethidine versus Morphine

    • Pethidine is 1/10th as potent as Morphine, but has similar efficacy
    • Produces as much sedation, euphoria, and respiratory depression as Morphine
    • Has less spasmodic action in smooth muscles, less miosis, constipation, and urinary retention
    • Has a rapid but short duration of action (2-3 Hrs) and a vagolytic effect
    • Is safer in asthmatics

    Pharmacokinetics of Pethidine

    • Well absorbed orally, with 50% bioavailability
    • Effects appear in 10-15 min after oral absorption
    • Action lasts for 2-3 Hrs after parenteral administration
    • Metabolized in the liver and excreted in the urine

    Fentanyl

    • A potent analgesic, 100 times more potent than Morphine
    • Metabolized in the liver and excreted in the urine
    • Causes respiratory depression, so use with caution in COPD
    • Causes less nausea and vomiting
    • Can be reversed by naloxone
    • Dose: 1-5 microgram/kg i.v.

    Remifentanil

    • A potent ultra-short-acting synthetic opioid
    • Given to patients during surgery for pain relief and as an adjunct to anesthesia
    • A specific mu-type opioid receptor agonist, reducing sympathetic nervous system tone, and causing respiratory depression and analgesia.

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    Description

    This quiz covers the properties and uses of midazolam, a suitable agent for conscious sedation, and the effects of analgesic drugs given pre-operatively.

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