Hypnotic Pharmacodynamic Flashcards
MOA, Adverse Effect, Systemic Effects
Propofol: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V
CVS: BP:Dec HR:Dec** CO:Dec Contract:Dec Vent: Dep RR: Dep HyperCO2: Dep N/V: Dec **
Thiopental: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V
CVS: BP:Dec HR:~Inc** CO:Dec Contract:~Dec Vent: Dep; RR: Dep; HyperCO2: Dep N/V: Unchanged
Midazolam: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V
CVS: BP: ~dec HR: ~ CO: ~dec Contract: ~ Vent : ~ dec; RR: Unchanged, HyperCO2: Unchanged, Vent drive: dec N/V: Dec/Unchanged
Ketamine:BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V
CVS: BP: very Inc HR: very inc CO: None Contract: Dec if no Catecholamine MinVent: Dec, Vent drive: ~ HyperCO2: Unchanged N/V: Unchanged
Etomidate: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V
CVS: BP:~dec HR:None CO: Non Contract:Non Vent: ~Depress, RR: ~Depress HyperCO2: Depress N/V: Increased
Precedex: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V
CVS: BP: inc (bolus) dec (infuse) HR: dec CO: dec Contract: ~ Minute Vent: ~ dec HyperCO2: Unchanged, Vent drive ~dec N/V: Unchanged
Propofol: CBF, ICP, CMRO2, AED
CBF: Dep x3 ICP: Dep x3 CMRO2: Dep x3 AED: Depress x3, burst suppression Myoclonus x1
Thiopental: CBF, ICP, CMRO2, AED
CBF: Dep x2 ICP:Dep x2 CMRO2: Dep x2 AED: Yes x 3
Midazolam: CBF, ICP, CMRO2, AED
CBF: Unchanged ICP: Unchanged CMRO2: Unchanged AED: Yes Anxiety: Yes
Ketamine: CBF, ICP, CMRO2, AED, Delirium
CBF: ~Increased ICP: ~Increased CMRO2: ~Increased AED: Maybe plus Delirium: Yes** TX with benzo
Etomidate: CBF, ICP, CMRO2, AED, Anxiety, Delirium
CBF: Dep x2 ICP: Dep x 2 CMRO2: Dep x 2 AED: Worsens but treats myoclonus well Painful Injection
Precedex: CBF, ICP, CMRO2
CBF: Dec ICP: SAME CMRO2: Dec
Ketamine: MOA, AE, Benefits
Provides Analgesia, dissociative hypnosis with present eye and limb movement Dec Opipd requiment postop Preserve CO and Resp fxn via NMDA receptor agonism AE increased card work, oral secretions, when low epi, myocardial depressant psychomiminetic tendency tx wi benzo
Propofol MOA, Benefit, AE
MOA: GABA R Benefit: context sensitive half life is 40 min for past 8 hr AE: CV depression, need reduced for elders, ICU, hypovolemic due to dec central distribution vol and dec clearance leading to more myocardial depression Egg yolk lecithin (alkylphenol) -> egg anaphlyaxsis care Lipid emulsion support bacterial growth linked to sepsis, observe aseptic tech and less than 12 hr Propofol infusion syndrome: Prolonged use can lead to arrhythmia, lipemia met acidosis, rhabdomyolysis
Etomidate MOA, Benefit, AE
MOA: Benefit: useful in unstable pt due to less myocardial depression, may cause hypotension still AE: Adrenal Supression (esp hydroxylase) limited use as infusion
Thiopental MOA, Benefit, AE
MOA: Barbituate with fav neurologic profile (neurprotection via dec cerebral perfusion) Benefit: Better CVC compared to Propofol AE:
Precedex MOA, Benefit, AE
MOA: alpha 2 agonist Benefit: sedatitive, analgesic, agnostic, slower onset/offset as comp to propofol useful for icu sedation x 24 hr and fiberoptic intubation Minimal resp depression Decreases periop opioid needs AE: Dose Dependent Hypotension, Bradycardia
Fospropofol: MOA, Use, caution, pharmk different
Water soluable prodrug of Propofol, use in procedural sedation have wide intervals due to prodrug metabolism Slower Induction vs Propofol increases duration Decreased Injection Pain,
Benzo MOA, Indication, general AE
Gaba receptor potentiator Anticonvulsant like in local anesthetics tox Less respiratory depression vs barbiturates, antagonized by fumazenil
Versed Benefit, AE
Produce anxiolytic and antegrade amnesia Fast on, Fast off May Lead to increased delirium, renal excretion of active metabolites Large dose may lead to preload and afterload dec along with prolong sedation
Diazepam, Lorazepam particular AE
Pain on inject due to propyl glycol
Propofol Opening Practice
Bacterial Contamination with pt rxn; 12 hrs of opening, one vial/pt and not in heme line
