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Pharmacology II > Characteristics of Common Induction Drugs (Exam 2) > Flashcards

Characteristics of Common Induction Drugs (Exam 2) Flashcards

1
Q

Propofol: E 1/2 Time (Hours)

A

0.5-1.5 Hours

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2
Q

Propofol: Vd (L/kg)

A

3.5 - 4.5

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3
Q

Propofol: Clearance (mL/kg/min)

A

30 - 60

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4
Q

Propofol: Effects on BP & HR (increase/Decrease)

A

BP: Decreased
HR: Decreased

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5
Q

Etomidate: E 1/2 Time

A

2 - 5 Hours

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6
Q

Etomidate: Vd (L/kg)

A

2.2 - 4.5

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7
Q

Etomidate: Clearance (mL/kg/min)

A

10 - 20

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8
Q

Etomidate: Effects on BP & HR (increase/Decrease)

A

BP: No change - Decreased
HR: No Change

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9
Q

Ketamine: E 1/2 Time

A

2 - 3 Hours

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10
Q

Ketamine: Vd (L/kg)

A

2.5 - 3.5

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11
Q

Ketamine: Clearance (mL/kg/min)

A

16 - 18

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12
Q

Ketamine: Effects on BP & HR (increase/Decrease)

A

BP: Increased
HR: Increased

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13
Q

Where do all these drugs work?

A

They all work on GABA!!
Ketamine works at a lot of places
-NMDA as Non-comp. antagonist

-Opioid receptors (mu/kappa/delta)

-GABA A (weak)

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14
Q

Ketamine side effects

A

-Drooling
-Delirium
-Dissociation

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15
Q

Ketamine: How to treat Drooling and Delirium?

A

-Glycopyrorolate (0.2mg)
-Versed (admin 5 min. prior to ketamine dose)

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16
Q

Ketamine: Induction Dose

A

INDUCTION:
-0.5 -1.5 mg/ kg IV
-4-8 mg/kg IM

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17
Q

Ketamine: Maintenance & Sub anesthetic dose

A

0.2-0.5 mg/kg IV

18
Q

Ketamine: Post-Op Sedation & Analgesic Dose

A

1-2 mg/kg/hr

19
Q

Ketamine: Neuroaxial Analgesia

A

-Epidural: 30 mg
-Intrathecal/spinal/ subarachnoid: 5-50 mg

20
Q

Ketamine: Onset & Duration

A

Onset:
-IV: 1 min
-IM: 5 min
Duration : 10-20 min

21
Q

Ketamine: Metabolism

A

-Hepatic, CYP 450
-ACTIVE METABOLITE: Norketamine (1/3 potency of parent, causes prolonged analgesia)

22
Q

Ketamine: Drug interactions and Effects

A

-Volatile anesthetic: Hypotension

-NDNMB drugs: Enhanced

-Succinylcholine: Prolonged

23
Q

Ketamine: CV Effects

A

-THINK SNS EFFECTS!

  • Can cause sudden ↓BP d/t depletion of catecholamine stores.
    -Direct myocardial suppressant
  • Ephedrine won’t work bcuz indirect action
  • so give a direct acting vasopressure like phenelyphrine
24
Q

Ketamine: Pulmonary Effects (There’s a bit here)

A

-↑ Pulm artery pressure up to 44 mmHG
- No depression of ventilation

  • PaCO2 ventilation response maintained

‣ Upper airway relflexes and tone maitained = ↑ of laryngospasms

‣ ↑ Salivation and tracheobrochial mucous secretions

‣ ↑ Bronchodilation (no histamine release)

25
Q

Ketamine: Other Side Effects

A

-Benefits: AMNESTIC and ANALGESIC

-BUUUUT…

 -Dissociative anesthesia

 ‣** Nystagmus**

 ‣ Non- communitave   wakefullness

 ‣ Hypertonic skeletal movements
26
Q

Ketamine: Contraindication

A
  • Systemic /pulm HTN
  • Increased ICP
27
Q

Etomidate: Metabolism

A
  • Hydrolysis hepatic microsomal enzymes
  • Plamsa esterases
28
Q

Etomidate: Excretion / Clearance

A
  • 85% in urine
    ‣ 10-13% in bile

-Clearance 5x faster than thiopenthal
***wake up fast

29
Q

Etomidate: CNS Effects

A

- ↑ incidence of myoclonus (50-80%) Greater than all others

  • Give Benzo or Opiod to inhibit
    myclonus (FENT 1-2 mcg/kg
    IV)
    ‣ USE CAUTION WITH SEIZURE
    PT!!!
30
Q

Etomidate: CV Effects

A

CARDIOPROTECTIVE AGENT

‣ Good for patients with low EF

‣Minimal changes in HR, SV, CO, Contractility

‣ SUDDEN HYPOTENSION w/ HYPOVOLEMIA w/ high 0.45 mg/kg IV induction dose

31
Q

Etomidate: Resp.

A

-Ventilation depression < barbs

-Stimulates CO2 medullary centers

32
Q

Etomidate: Special Considerations

A

-No analgesia, so you will need multimodal anesthesia

-Adrenocorotical Suppression: Dose depenedent, inhibits the conversion of cholesterol to cortisol

 ‣↓ STRESS RESPONSE 
      ‣↓ BP 
      ‣↑Mechanical ventilation
           time
      ‣ USE CAUTION w/ Sepsis     
          and hemorrhage
33
Q

Etomidate: Adverse Effects

A

-Adrenocorotical Suppression: -Dose depenedent,
-Inhibits the conversion of cholesterol to cortisol,
‣↓ STRESS RESPONSE
‣↓ BP
‣↑Mechanical ventilation
time
‣ USE CAUTION w/ Sepsis
and hemorrhage

34
Q

Propofol: Metabolism

A

-Hepatic: CYP 450

-Metabolites: Water soluble sulfate and glucoronic acid excreted by kidney

35
Q

Propofol: Context Sensitive Half Time

A

40 minutes (on 8hr infusions)
Shorter than all barbs, not as lipid soluble

36
Q

Propofol: Clearance (not just a number!!)

A

30-60 mL/kg/min
-Plasma (lungs) > Hepatic flow
-Tissue uptake > CYP 450

37
Q

Propofol: CV

A

-↓ BP (more than thiopental)

  • ↓BP exaggerated in hypovolemia, elderly, LV compromise
38
Q

Propofol: Resp.

A

**-Dose Dependent apnea

-Synergistic with opioids!! = ↑ resp. depression

-Bronchodilator effects = GOOD

39
Q

Propofol: Adverse Effects

A

Prolonged Gtt’s can cause:
‣Hepatocellular injury
‣ PROPOFOL INFUSION SYNDROME

40
Q

PRIS: What is it

A

PROPOFOL SYNDROME:
‣ Gtt’s > 75 mcg/mg/min for > 24 hrs

‣ S/sx: Lactic acidoses, Brady-dysrhthmias, Rhabdo.
‣ SEVERE refractory brady in PEDS

‣ DX: ABG and serum lactate

‣ Reversible in early stages

‣ Cardiogenic shock → ECMO

Pharmacology II (8 decks)

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