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What is midazolam commonly used for?
What is the benefit of giving analgesic drugs pre-operatively?
Which of the following is a common side effect of opioids?
What is the advantage of using NSAIDs in day surgery?
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Which of the following opioids is 100 times more potent than morphine?
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Why are opioids usually the agents of choice in the presence of acute severe pain?
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What is the effect of clonidine as a premedication in children?
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What is a characteristic of Pethidine compared to Morphine?
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What is a benefit of using Fentanyl over Morphine?
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What is a characteristic of Remifentanil?
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What is the duration of action of Pethidine?
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What is a benefit of using Pethidine in asthmatics?
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What is the bioavailability of Pethidine?
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What is the dose of Fentanyl for analgesia?
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What is the primary mechanism by which ondansetron exerts its antiemetic effects?
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What is the main effect of antacid drugs on gastric juice?
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What is the primary action of histamine H2 receptors antagonists?
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What is the primary route of administration for antiacid drugs?
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What is the primary effect of sodium citrate?
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What is the primary action of proton pump inhibitors?
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What is a property of Fentanyl?
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What is a characteristic of Metoclopramide?
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What is a side effect of Metoclopramide?
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What is a property of Atropine?
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What is a characteristic of Remifentanil?
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What is NOT a characteristic of Fentanyl?
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Which of the following opioids has a rapid onset and offset of analgesic effects?
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Which of the following is NOT a characteristic of pethidine compared to morphine?
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Which of the following is NOT a mechanism of action of ondansetron?
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What is a characteristic of midazolam?
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What is a characteristic of anxiolytic drugs?
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Which of the following drugs is NOT an analgesic?
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What is a characteristic of pethidine compared to morphine?
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What is a characteristic of ondansetron?
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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.
