Drugs

Question 1

Propofol (diprovan) use and MOA

Answer 1

anti-microbial and anti-emetic properties
hypnotic
dissociates GABA from receptor

Question 2

Propofol (diprovan) - metabolism, elimination

Answer 2

liver, kidney

Question 3

Propofol (diprovan) considerations

Answer 3

venous dilation, bronchodilation,
decrease BP (preload, afterload, contractility)
respiratory depression, neuroprotective (decreases CBF, ICP)

Question 4

lidocaine 2% use/dose

Answer 4

propofol causes pain peripherally

0.5-1 mg/kg IV prior to propofol administration

Question 5

Propofol (diprovan) - dose

Answer 5

1-2.5 mg/kg IV - induction
100-200 mcg/kg/min - TIVA
25-75 mcg/kg/min - conscious sedation
10 mcg/kg/min - antiemetic

2-4 min half-life

Question 6

PRIS (propofol infusion syndrome)

Answer 6

usually from long term, high dose therapy: hypotension, dysrhythmias, rhabdo, ARF, hepatomegaly, metabolic acidosis, hyperkalemia, lipedemia

Question 7

barbiturates - MOA

Answer 7

bind to GABAa receptors, depress RAS, suppress acetylcholine transmission

Question 8

barbiturates

Answer 8

anticonvulsant, decreased vasc resistance, muscle excitation, myocardial and respiratory depression, decreased CRMO2, sedation, hypnosis

Question 9

barbiturates contraindication

Answer 9

porphyria, heme synthesis metabolic error::: Severe abdominal pain, N/V, ANS instability, electrolyte disturbances, muscle weakness, neuropsychiatric changes including seizures, cardiac instability

Question 10

thiopenthal

Answer 10

usually 500mg vial, dilute with 20 ml sterile water - 25mg/ml

adult dosing 3-5mg/kg

peak at 1 min, 5-8 min duration of action

Question 11

methohexitol (brevitol)

Answer 11

1-2 mg/kg IV

ultra-short acting barbiturate

Question 12

etomidate (amidate)

Answer 12

20mg/10ml = 2 mg/ml
GABA mimetic
Known for its CV stability!!
Reduces CBF, ICP, CMR02
anticonvulsant
ADRENAL SUPRESSION
0.2-0.4 mg/kg

Question 13

benzodiazepines - effect

Answer 13

Anxiolysis
Amnesia
Sedation
Muscle relaxation
Hypnosis
Anticonvulsant

Question 14

benzodiazepines - commonly used

Answer 14

Midazolam (Versed)
Half-life (1.7-2.6 hrs)
Lorazepam (Ativan)
Half-life (10-22 hrs)
Diazepam (Valium)
Half-life (36-50 hrs)

Question 15

Flumazenil (Romazicon)

Answer 15

Benzodiazepine antagonist
Initial dose: 0.2 mg IV ; repeat doses at 0.1 mg IV (max total 1 mg IV)
Duration of action 30-60 minutes
Continuous infusion: 0.1 – 0.4 mg/hr IV

Question 16

midazolam (versed) dosing

Answer 16

0.1-0.2 mg/kg IV
0.5 - 2 mg preoperative (adult)
Peds 0.05 - 0.1 mg/kg IV/IM
Oral: 0.05 – 1 mg/kg (30 min prior)
Rectal / Intranasal: 0.2 – 0.3 mg/kg

Question 17

ketamine - concentration and dosing

Answer 17

200mg/20ml = 10 mg/ml

Induction: 2-4 mg/kg IV; 4-6 mg/kg IM

Sedation/analgesia: 0.2-0.8 mg/kg IV (over 2-3 min) followed by infusion (5-120 mcg/kg/min)

10-20 mg (pre-emptive analgesia)

Question 18

ketamine - receptor and action

Answer 18

NMDA receptor (inhibits glutamate)
Moderate analgesic
Unconsciousness, amnesia

Question 19

ketamine cautions

Answer 19

in patients with: HTN, angina, CHF, increased ICP, increased IOP, psychiatric disorders, airway issues

increases muscle tone, post op N&V, cardiac stimulant (increases everything), salivation (treat with glycopyrolate), increases CBF

Question 20

good patients for ketamine

Answer 20

Shock or cardiovascular instability
Severe dehydration
Bronchospasm
Severe anemia
Burn dressing changes
OB – acute hemorrhage
Poor risk patients (trauma /elderly)

Question 21

dexmeditomidine (precedex)

Answer 21

Selective alpha-2 adrenoreceptor agonist

Question 22

dexmeditomidine dosing

Answer 22

Requires infusion pump (syringe pump)
Start bolus of1 mcg/kg over 10 minutes
Start maintenance infusion 0.6 mcg/kg/hour