Term
Mechanism of Action for Fentanyl citrate (Sublimaze)
-Analgesic
•Reversal agent: naloxone (Narcan) |
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Definition
•Synthetic potent narcotic agonist analgesic with pharmacologic actions qualitatively similar to morphine
•Action is more prompt and less prolonged.
•Fentanyl is 10 times more potent than morphine.
•Principal actions are analgesia and sedation.
•Drug-induced alterations in respiratory rate and alveolar ventilation may persist beyond analgesic effect.
•Emetic effect is less than with other opiates. |
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Term
Indications for Fentanyl citrate (Sublimaze)
-Analgesic
•Reversal agent: naloxone (Narcan) |
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Definition
•Short-acting narcotic analgesia during operative and postoperative periods
•Conscious sedation for short diagnostic and therapeutic procedures
•Adjunct to endotracheal intubation during RSI procedures
•Combined with droperidol or diazepam to produce neuroleptanesthesia |
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Term
Dosages for Fentanyl citrate (Sublimaze)
-Analgesic
•Reversal agent: naloxone (Narcan) |
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Definition
•Titrate 25 mcg slow IV at a time; administer each titration over 1 to 2 minutes
•Total of 1 to 2 mg
•Drug supplied in 100-mcg ampules |
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Term
Mechanism of action for Midazolam (Versed)
•Anesthetic
•Reversal agent: flumazenil (Romazicon) |
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Definition
•Short-acting benzodiazepine (CNS depressant) with muscle relaxant, anticonvulsant, and anterograde amnestic effects
•Works on GABA receptor sites in the CNS; increased GABA activity induces calming, skeletal muscle relaxation, and sleep with higher doses |
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Term
Indications for Midazolam (Versed)
•Anesthetic
•Reversal agent: flumazenil (Romazicon) |
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Definition
•Conscious sedation
•Preoperative sedation
•Adjunct to facilitate endotracheal intubation
•Suppression of acute seizure activity |
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Term
Dosages for Midazolam (Versed)
•Anesthetic
•Reversal agent: flumazenil (Romazicon) |
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Definition
•1 to 5 mg IV over 2 minutes (usually 1 mg increments)
•Repeat after 2 to 3 minutes to desired effect (e.g., initiation of slurred speech, drowsiness)
•Give no more than 2.5 mg IV over 2 minutes and titrate in half-milligram increments; never bolus midazolam. |
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Term
Mechanisms of action for Droperidol (Inapsine)
•Anesthetic |
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Definition
•Produces marked tranquilizer effects with sedation and antiemetic actions (due to dopaminergic-receptor antagonism); allows for reflex alertness
•Mild alpha-adrenergic blockade
•Depresses accessory pathway conduction and may prevent rapid ventricular response during AV reentrant tachycardia (good choice for anesthesia, not to treat condition) |
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Term
Indications for Droperidol (Inapsine)
•Anesthetic |
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Definition
•Induction adjunct to general anesthesia
•Diagnostic procedures (e.g., transesophageal echocardiography TEE)
•Adjunct to general anesthesia where additional sedation is required |
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Term
Dosages for Droperidol (Inapsine)
•Anesthetic |
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Definition
•Premedication/diagnostic procedures: 2.5 to 10 mg IV 30 - 60 minutes before procedure
•Additional doses of 1.25 to 2.5 mg IV may be given to maintain sedation
•Reduce dosages in debilitated patients |
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Term
Mechanisms of action for Naloxone (Narcan)
•Narcotic reversal |
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Definition
•Narcotic antagonist
•Analogue of oxymorphine; essentially free of narcotic agonist properties
•Binds with opioid analgesic mu receptor sites and competitively inhibits or reverses narcotic effects (both respiratory depression and analgesia)
•Does not produce significant analgesia, respiratory depression, or miosis in the absence of narcotics |
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Term
Indications for Naloxone (Narcan)
•Narcotic reversal |
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Definition
•Complete or partial reversal of respiratory depression due to narcotics
•Suspected acute opioid overdose (part of ―coma cocktail‖) – in this capacity, naloxone is both diagnostic and therapeutic |
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Term
Dosages for Naloxone (Narcan)
•Narcotic reversal |
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Definition
•0.4 to 2.0 mg IM or IV every 2 to 3 minutes to a maximum of 10 mg
•May also be given via ETT at 2.0 mg followed by 10 ml of 0.9% NSS and then positive-pressure ventilation (bag-valve mask) |
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Term
Mechanism for action for Flumazenil (Romazicon)
•Narcotic reversal |
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Definition
•Antagonizes effects of benzodiazepines on the CNS: sedation, impairment of recall, and psychomotor impairment
•Blocks GABA receptor sites in the brain
•Does not antagonize narcotic (opioid) medications or their effects |
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Term
Indications for Flumazenil (Romazicon)
•Narcotic reversal |
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Definition
•Complete or partial reversal of sedation induced by benzodiazepines for anesthesia, diagnostics, or therapeutic procedures
•Benzodiazepine overdose (not recommended for routine overdose – instead, supportive measures should be instituted) |
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Term
Dosages for Flumazenil (Romazicon)
•Narcotic reversal |
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Definition
•Reversal of sedation
•0.2 mg IV over 20 seconds
•Repeat at 0.2 mg IV every 60 seconds to total of 1 mg administered
•Benzodiazepine overdose
•0.2 mg IV over 30 seconds
•If no response, then give 0.3 mg IV over 30 seconds.
•Repeat at 0.5 mg IV every 60 seconds for a maximum of 3 mg |
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