Apex IV anesthetics Flashcards
Propofol MOA
Direct GABA-A agonist- increases CL conductance - neuronal hyperpolarization
Propofol clearance
Liver p450 enzymes
extrahepatic clearance in the lungs
propofol cardiovascular effects
decreased BP
decreased SVR
decreased venous tone-decreased preload
decreased myocardial contractility
Propofol respiratory effects (which way of the shift?)
shift co2 response cure down and to the right respiratory depression and or apnea
inhibits hypoxic ventilatory drive
propofol CNS effects
decreases cerebral oxygen consumption (CMRO) decreases cerebral blood flow decreases intracranial pressure decreases intraocular pressure anticonvulsant properties
does propofol provide analgesia
NOOOO
why does propofol turn urine green
Phenol excretion
allergy to consider with propofol
the only person you might be concerned with is people who have allergy to egg. but they are PROBABLY SAFE
risk factors for propofol infusion syndrome
propofol dose>75 children>adults infusion >48hours inadequate oxygen delivery sepsis significant cerebral injury
clinical presentation for propofol infusion syndrome
acute refractory bradycardia-asystole- metabolic acidosis rhabdomyolysis enlarged or fatty liver renal failure hyperlipidemia lipemia(cloudy plasma or blood)
treatment for propofol infusion syndrom
discontinue propofol maximize gas exchange cardiac pacing PDE inhibitiros glucagon ecmo RRT
propofol in a syringe must be discarded after how many hours
6hr
propofol infusion must be discarded after how many hours
12hr
propofol dose antipruritic
10mg
propofol dose antimetic
10-15mg
fospropofol
a prodrug
warn your patients of genital and anal burning
ketamine class
phencyclidine derivative
ketamine MOA
NMDA receptor antagonist antagonizes GLUTAMATE!!
ketamine induction dose
1-2mg/kg
ketamine duration
10-20 minutes
clearance of ketamine
liver p450enzyme
ketamine cardiovascular effects
increase SNS tone increase cardiac output increase heart rate increase svr increase PVR
ketamine respiratory effects
bronchodilation
upper airway muscle tone and airway reflexes remain intact
maintains respiratory drive -brief period of apnea may occur
does not significantly shift the co2 response cure
increase oral and pulmonary secretions
ketamine CNS effects
increase cerebral oxygen consumption increase cerebral blood flow increase intracranial pressure increase intraocular pressure increase EEG activity nystagmus Emergence Delirium
ketamine and analgesia
provides good analgesia and opioid sparing effect
relieves somatic pain>visceral pain
blocks central sensitization and windup in the dorsal horn of the spinal cord
prevents opioid induced hyperalgesia
analgesic properties- good for burn patients
ketamine protein binding
12%
etomidate dose
0.2-0.4mg/kg
etomidate MOA
Gaba-A agonist
etomidate key benefit
HEMODYNAMIC STABILITY
etomidate CNS effects
decrease Cerebral oxygen consumption decrease cerebral blood flow decrease intracranial pressure cerebral perfusion pressure remains stable no analgesia
etomidate and PONV
it is more common than any other induction agent
Name one condition that etomidate can’t be used with
porphria
etomidate contraindication
adrenal suppression
thiopental MOA
GABA-A agonist - depresses the RAS
thiopental dose adult
2.5-5mg/kg
thiopental dose kid
5-6mg/kg
thiopental cardiovascular effects
low BP. HR okay
histamine release
respiratory effects thiopental
histamine release (caution with asthma)
thiopental CNS effects
decreases cerebral oxygen consumption decreases cerebral blood flow decreases intracranial pressure decreases EEG activity no analgesia
barbiturates are unsafe for what condition
porphyria
methohexital is the gold standard for what therapy?
electroconvulsive therapy it decreases the seizure threshold and produces a better quality seizure.
methohexital induction dose
1-1.5mg/kg
dexmedetomidine cardiovascular effects
bradycardia and hypotension
dexmedetomidine and respiratory effects
does not cause respiratory depression
dexmedetomidine and CNS effects
decrease CBF
dexmedetomidine other effects
it reduces the incidence of emergence delirium in children
decreases substance P and Glutamate release
has an anti shivering effect
benzodiazepines MOA
GABA A agonist
benodiazepines clearance
liver p450
benzo cardiovascular
decrease BP and SVR induction dose
benzo and respiratory effects
opioids potentiate the respiratory depressant effects patients with COPD are more sensitive to the respiratory depressant effects
Benzo CNS effects
decrease CMRO and CBF anterograde amnesia anticonvulsant anxiolysis no analgesia
potency greatest to least of benzo
lorazepam-midazolam-diazepam
