Etomidate and Ketamine

Question 1

These drugs are water soluble at an acidic pH. Then when drugs are injected into plasma, become lipid soluble: (2)

Answer 1

etomidate

versed

Question 2

Etomidate is ____ % glycerol which causes what to happen to the patient?

Answer 2

35%

PAIN on injection!!!

Question 3

Both entantiomers of etomidate are active. True or false?

Answer 3

false, only one

Question 4

What is the the mechanism of etomidate and benzodiazepines? (2 points)

Answer 4

GABA

depresses reticular activating system and mimics inhibitory effects of GABA

Question 5

What is the onset of etomidate?

What is the peak?

What is the duration?

Answer 5

30 second onset

1 minute peak

3-5 minutes

Question 6

How much of etomidate is protein bound?

Answer 6

75%

Question 7

What is the elimination half time for etomidate?

Answer 7

~2.5 hours

Question 8

How is etomidate metabolized? (3)

Answer 8

hydrolysis

hepatic enzymes–liver dysfunction not a big deal

elimination by kidneys

Question 9

We can get EEG down to 0 like thiopental? True or false?

Answer 9

true

Question 10

Etomidate

We can get increase in excitatory spikes on EEG so caution in seizure patients. True or false?

Answer 10

true

Question 11

What is the mechanism of ketamine? (4)

Answer 11

NOT GABA

NMDA receptor

Opioid receptor

Muscarinic receptor

MAO

Question 12

What is special about ketamine?

Answer 12

ANALGESIC EFFECTS unlike other drugs

Question 13

What is ketamine also known as?

Answer 13

phencyclidine

Question 14

What is the onset of ketamine?

Peak?

Duration?

Answer 14

30 sec

3-4 minutes

5-10 min IV

12-25 min IM

Question 15

How long does it take for ketamine to be eliminated?

Answer 15

2.5 hours

Question 16

How is ketamine metabolized/eliminated?

Answer 16

hepatic enzymes

active metabolite-norketamine

kidneys eliminate

Question 17

Ketamine has high protein binding. True or false?

Answer 17

false

Question 18

Ketamine subanesthetic dose:

Answer 18

0. 1-0.5 mg/kg/hr
1. 5 is max

Question 19

Ketamine is better for somatic vs. visceral pain. True or false?

Answer 19

true

Question 20

What drug is used for labor in some countries?

Answer 20

ketamine

Question 21

Ketamine works on the ___ receptors which are the ____ receptors. However it is ____ times weaker than morphine.

Answer 21

mu

opioid

10k

Question 22

What drug is good for changing dressing on burn patient?

Answer 22

ketamine

Question 23

Patients spontaneously breathe on ketamine. True or false?

Answer 23

true

Question 24

What is the induction dose of ketamine IV?

What is the onset?

What is the duration?

IM?

Answer 24

1-2 mg/kg, onset 30-60 sec., duration 10-15 min

2-4 mg/kg onset 2-4 min.

Question 25

What are the CNS effects of ketamine?

Answer 25

opposite of everything else

increase EEG, ICP

Question 26

Ventilation depression? Yes or no?

Secretions? Yes or no?

Bronchomotor tone?

Answer 26

NO depression

More secretions

GOOD FOR ASTHMA PTS

Question 27

What are CV effects of ketamine?

_____ BP

_____ HR

_____ CMRO2

_____ cardiac output

_____myocardial strength

Answer 27

increase

increase

increase

increase

decreased myocardial strength! so can fail heart!

Question 28

What are factors for emergence delirium? (3)

Answer 28

age > 15

girls

personality disorder

Question 29

How do you prevent emergence delirium?

Answer 29

benzos and propofol

Question 30

When is it bad to use ketamine? (4)

Answer 30

people with elevated ICP

open eye injury

sole agent in ischemic heart disease

vascular aneurysm