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Oral Boards Study Guide > Hypnotics > Flashcards

Hypnotics Flashcards

1
Q

Propofol : Class

A

Hypnotic

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2
Q

Propofol : Uses

A

Induction
General Anesthesia
MAC

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3
Q

Propofol : Mechanism of Action

A

Mimics GABA at the receptor, directly activating chloride channels, which hyperpolarizes the postsynaptic membrane

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4
Q

Propofol : Dose

A

Induction: 1-2.5 mg/kg

Maintenance of GA:
25-300 mcg/kg/min

Sedation:
25-100 mcg/kg/min

Antiemetic:
10 mcg/kg/min

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5
Q

Propofol : Pharmacokinetics

A

Absorption: IV

Onset: 30 seconds
DOA: 5-15 minutes

Metabolism: Hepatic and extra hepatic (Lungs)

Excretion: Kidneys

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6
Q

Propofol: Contraindications

A

Hypersensitivity

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7
Q

Propofol : Considerations

A

No analgesia

Decreases BP

Painful on injection

Risk for thrombophlebitis

Propofol Infusion syndrome risk with high doses

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8
Q

Etomidate : Class

A

Hypnotic

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9
Q

Etomidate : Uses

A

Induction (CV stability/Trauma)

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10
Q

Etomidate : Mechanism of Action

A

Binds to the GABA-a receptor

Low dose-potentiates GABA

Higher dose- direct GABA stimulation

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11
Q

Etomidate : Dose

A

0.3mg/kg

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12
Q

Etomidate : Pharmacokinetics

A

Absorption: IV

Onset: 1 minute
Duration: 5-15 minutes

Metabolism: Hepatic and PLASMA ESTERASES

Excretion: Kidneys

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13
Q

Etomidate : Contraindications

A

Hypersensitivity
History of Porphyria

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14
Q

Etomidate : Considerations

A

No analgesia

Increased risk of N/V

Inhibits Cortisol (adrenal suppression)

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15
Q

Ketamine : Class

A

Phencyclidine Derivative

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16
Q

Ketamine : Uses

A

Analgesia
Anesthetic
Antidepressant

17
Q

Ketamine : Mechanism of Action

A

Non-competitive antagonist at NMDA receptor ion channels.
Ketamine blocks the opening of channels, inhibiting the excitatory response to glutamate.
Provides amnesic and potent analgesia.
Produces a “dissociative state” by depressing the cerebral cortex and thalamus and stimulating the hippocampus.
It also binds with opioid, MAO, serotonin, NE, muscarinic and sodium channels
Ketamine inhibits neuronal sodium channels (producing a modest local anesthetic action) and calcium channels (causing cerebral vasodilatation)

18
Q

Ketamine : Dose

A

IV Induction- 2mg/kg
IM Induction- 4mg/kg

Sedation-
1-3 mcg/kg/min

Multimodal Infusion-
5 mcg/kg/min

19
Q

Ketamine : Pharmacokinetics

A

Absorption: IV, IM, Intranasal

Onset:
IV - 2 minutes
IM - 20 minutes

Duration: 10 minutes

Metabolism: P450 enzymes in liver
ACTIVE METABOLITE: Norketamine

Excretion: Kidneys

20
Q

Ketamine : Contraindications

A

HTN

Increased Intracranial pressure

History of emergence delirium

21
Q

Ketamine : Considerations

A

Can have dissociative effects (pair with benzodiazepine)

Analgesic effects

SNS Stimulant - Increases BP/HR/CO in most patients

Increased Secretions (Pair with glycopyrrolate)

Bronchodilator

Active metabolite that is really excreted.

22
Q

Dexmedetomidine : Class

A

Selective alpha2 adrenergic agonist

23
Q

Dexmedetomidine : Uses

A

MAC
Induction
Analgesia
Prevent emergence delirium

24
Q

Dexmedetomidine : Mechanism of Action

A

Central and peripheral alpha 2 adrenergic receptor agonist.
Inhibits Norepinephrine release.
Decreases levels of sympathetic outflow from the CNS.

25
Q

Dexmedetomidine : Dose

A

Sedation: 1 mcg/kg over 10 minutes then 0.2-1 mcg/kg/hr

26
Q

Dexmedetomidine : Pharmacokinetics

A

Absorption: IV, IM, Intrathecal, Epidural

Onset: 5 minutes
Duration: 2 hours

Metabolism: Hepaticly via P450 system

Excretion: Liver

27
Q

Dexmedetomidine : Contraindications

A

Hypersensitivity

Bradycardia and Hypotension

28
Q

Dexmedetomidine : Considerations

A

Analgesic properties

Reduces emergence delirium

Hypotension and Bradycardia

29
Q

Midazolam : Class

A

Hypnotic

30
Q

Midazolam : Use

A

Sedative
Anxiolytic
Anticonvulsant

31
Q

Midazolam : Mechanism of Action

A

Enhances the response to the GABA A receptor

32
Q

Midazolam : Dose

A

Premedication:
IV-2mg
PO- .5mg/kg

Induction:
0.3mg/kg

33
Q

Midazolam : Pharmacokinetics

A

Absorption: PO, IV, IM, Intranasal

Onset: 1 minute
Duration: 15 minutes

Metabolism: Hepaticly via CYP 450 system
ACTIVE METABOLITE: 1-hydroxymidazolam

Excretion: Kidneys

34
Q

Midazolam : Contraindications

A

Elderly- associated with post-op delirium

35
Q

Midazolam : Considerations

A

Active metabolite that is really excreted

Associated with post-op delirium in the elderly

Anterograde Amnesia

Decreases CO2/Hypoxia response

No analgesia

Oral Boards Study Guide (15 decks)

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