Anesthesia Pharm Test 1 Part 3 Flashcards
which IV anesthetic is a carboxylated imidazole
etomidate
what drug is a good alternative to propofol due to its stable cardiac profile
etomidate
Which isomer of etomidate has sedative properties
(+) isomer
metabolism of etomidate
liver primarily, but also lung and kidney
excretion of etomidate
kidney
which IV anesthetic despite its PK profile, is not ideal for drips d/t rapid redistribution
etomidate
MOA of etomidate
allosterically binds to GABA-A[r] increasing the affinity of the receptor to GABA
CNS effects of etomidate
- dose dependent sedation 2. lowers CMRO2, ICP, and CPP (MAP dependent) 3. can cause myoclonus 4. suitable for ECT but no preferred
CV effects of etomidate
limited to no effect on MAP, CO/CI, SVR, and/or PA pressures post induction
respiratory effects of etomidate
- dose dep decrease in minute ventilation, and increase in RR 2. relaxes PA vasculature but preserves airway reflexes 3. response to CO2 decreased 4. periods of apnea can occur post-induction
etomidate is not approved for use in children < _____________
5
induction dose of etomidate in adults
0.2 - 0.3 mg/kg
sedation dose of etomidate in adults
5-10 mg PRN; titrate to desired LOC
s/e of etomidate
- pain on injection 2. increased PONV 3. myoclonus in 10-60% pts 4. adrenocortical suppression by inhibition of 11 B hydroxylase
which IV anesthetic agent is acknowledged as a “dissociative anesthetic”
ketamine (breaks communication btwn cortex and brainstem)
which IV anesthetic has similar structure to PCP
ketamine
which enantiomer of ketamine is considered safer?
S(+); however, no major advantage; sold in US as racemic mixture only!
low dose ketamine is effective for
- chronic pain management 2. depression 3. PTSD treatment
metabolism of ketamine
liver CYP450 via N-demethylation –> norketamine (active metabolite 1/3-1/5 less potent than ketamine)
1/2 life of ketamine is ______________ hours, but is dependent on _________________
2-3; hepatic blood flow
MOA of ketamine
non-competetitive NMDA antagonism (inhibiting glutamate)
CNS effects of ketamine
- increases limbic activity with simultaneous loss of consciousness 2. increases BIS 3. increases ICP, CMRO2, IOP, and CBF 4. vivid illusions and combativeness with emergence
CV effects of ketamine
cardiac stimulant - increase BP, HR, CI/CO, and CVP
respiratory effects of ketamine
- bronchodilation 2. maintains airway reflexes 3. increased risk of larygngospasm 2/2 increased salivation
IV dose of ketamine for induction in adults
1-2 mg/kg
IM dose of ketamine for induction in adults
4-6 mg/kg
po dose of ketamine for induction in adults
10 mg/kg
IM dose of ketamine in pediatrics
6-13 mg/kg
TIVA dose of keatmine
1-2 mg/kg/hr (rarely the sole agent)
sedation dose of ketamine (when used as adjunct)
0.1-0.3 mg/kg/hr
dose of ketamine for pain
- bolus 10-25 mg PRN up to 0.5 mg/kg
s/e of ketamine
- emergence phenomena 2. nystagmus 3. increased salivation (anti-sialagogue recommended) 4. induces catatonic state
which drug belongs to the class of drugs aka imidozaline
dexmedetomidine
Alpha2:alpha1 selectivity of dexmedetomidine
1620:01:00
primary uses of dexmedetomidine
- sedation 2. analgesia 3. anxiolysis 4. decreased postoperative shivering & agitation 5. CV sympathomimetic actions
which IV anesthetic drug undergoes total biotransformation
dexmedetomidine
metabolism of dexmedetomidine
in liver via glucuronidation and CYP450
T/F: metabolism of dexmedetomidine does not produce active metabolites
TRUE
MOA of dexmedetomidine
selective alpha-2 agonist in the locus coeruleus
CNS effects of dexmedetomidine
- allows pt to remain arousable 2. no alteration to CMRO2 3. decreases CBF but effects on ICP are non-existant to minimal
CV effects of dexmedetomidine
- dose dependent bradycardia and Hotn 2. paradoxical HTN seen with rapid IVP/large doses
respiratory effects of dexmedetomidine
- respiratory drive maintained 2. airway reflexes preserved 3. no risk of histamine induced bronchospasm 4. can decrease airway reactivity in COPD pts
dose of dexmedetomidine for sedation
0.3-0.7 mcg/kg/hr
bolus of dexmedetomidine dose
0.5-1 mcg/kg over 15 minutes
_________________ induced hotn responds really well to fluid and/or vasopressor
precedex
which IV anesthetic produces a diuretic effect
dexmedetomidine
which IV anesthetic has renal benefits, gastroprotective effects, and anti-inflammatory effects
dexmedetomidine
Ketamine “SUPER BRAINS”
- Stimulates SNS 2. Urinary excretion 3. PCP derivative 4. Emergence Delirium 5. Respiratory depression minimal 6. BronchoDILATOR 7. recreational abuse 8. analgesia 9. increased: BP, HR, CO/CI, CVP, PAP, ICP 10. NMDA receptor antagonist 11. salivation
Etomidate “HAMPERS”
- Hypnotic 2. Adrenocortical Suppression (long term use) 3. Minimal CV effects 4. Pain on injection 5. Esterases (and hepatic metabolism) 6. respiratory depression 7. Seizure activity (myoclonic movements)
Dexmedetomidine “AB RASH”
- Alpha-2 agonist 2. Bradycardia 3. Respiratory depression mild 4. Analgesia, anxiolysis 5. Sedation 6. Hotn
