Pharmacology of Sedative Agents Flashcards

A 70 kg patient is receiving IV midazolam. The provider notes paradoxical agitation. What is the BEST next step?

Answer: Administer flumazenil and reassess

Paradoxical excitation with benzodiazepines is an indication to reverse the drug with flumazenil rather than escalating the dose.

Which opioid used in conscious sedation has the fastest onset and shortest duration of action?

Answer: Fentanyl

Fentanyl has an onset of 1–2 minutes IV and a clinical duration of 30–60 minutes, making it the preferred opioid for short procedural sedation.

Propofol should be used with caution or avoided in patients with allergy to which substance?

Answer: Soy protein or egg lecithin

Propofol is formulated in a lipid emulsion containing soy bean oil and egg lecithin; patients with confirmed allergies to these components may be at risk.

Which characteristic of ketamine makes it particularly useful in hemodynamically unstable patients?

Answer: It stimulates catecholamine release, maintaining blood pressure

Ketamine stimulates sympathetic nervous system activity and catecholamine release, generally supporting blood pressure and heart rate.

The onset of action for IV midazolam is approximately:

Answer: 2–3 minutes

IV midazolam typically achieves peak sedative effect within 2–3 minutes, allowing for careful titration during procedures.

Which sedative agent is contraindicated in patients with acute porphyria?

Answer: Barbiturates such as thiopental

Barbiturates induce hepatic aminolevulinic acid synthase, precipitating acute porphyric crises; they are absolutely contraindicated in porphyria.

A patient receiving ketamine for procedural sedation develops laryngospasm. What is the MOST likely contributing factor?

Answer: Airway secretions not managed prior to procedure

Ketamine increases oral secretions; if not managed with an antisialagogue (e.g., glycopyrrolate), excess secretions can trigger laryngospasm.