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Pharmacology 1 > Induction Agent Dosages > Flashcards

Induction Agent Dosages Flashcards

1
Q

Propofol (alternate name)

A

Diprivan

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2
Q

Propofol structure:

A

Sedative/hypnotic
2, 6 diisopropylphenol
Lipid soluble, weak acid

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3
Q

Propofol MOA:

A
  1. GABA-A agonist (Beta subunit)
  2. Decreases rate of dissociation of GABA from receptor increasing the duration of chloride channel opening
  3. Hyperpolarizes cell
  5. Also inhibits NMDA, stimulates glycine
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4
Q

Propofol Onset:

A

30-60 sec

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5
Q

Propofol duration of action:

A

5-15 min

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6
Q

Propofol PB:

A

98%

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7
Q

Propofol metabolism:

A

CYP2B6, 3A4
50% liver
30% kidneys
20% lungs/intestines

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8
Q

Propofol IV induction dose:

A

IV: 1-2.5 mg/kg (induction)

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9
Q

Propofol IV maintenance dose:

A

IV: 50-300 mcg/kg/min (maintenance)

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10
Q

Propofol IV Sedation dose:

A

IV: 25-75 mcg/kg/min (sedation)

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11
Q

Propofol IV antiemetic dosing:

A

IV: 10 mcg/kg/min or
10-20 mg q5-10 min (antiemetic)

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12
Q

Propofol side effects:

A
  1. Decreased BP (25-40%)
  2. Decreased SV
  3. Decreased CO
  4. Decreased CBF
  5. Decreased CMRO2
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13
Q

Propofol Contraindications / cautions:

A
  1. Crosses Placenta
  2. Decrease in elderly
  3. Discard after 6 hr of drawing up
  4. Do not mix with other agents (PE risk)
  5. Painful injection (Ph? Propylene glycol?)
  6. Myoclonus
  7. Bradycardic death
  8. Green urine – benign
  9. increased Lipid levels
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14
Q

Etomidate (alternate name):

A

Amidate

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15
Q

Etomidate structure:

A

Non-barbiturate hypnotic
imidazole derivative
ester, base, water soluble

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16
Q

Etomidate MOA:

A
  1. GABA-A agonist (Beta subunit)
  2. Decreases rate of dissociation of GABA from receptor increasing the duration of chloride channel opening
  3. Hyperpolarizes cell
17
Q

Etomidate onset:

A

30-60 sec

18
Q

Etomidate duration of action:

A

5-15 min

19
Q

Etomidate PB:

A

75%

20
Q

Etomidate metabolism:

A

Hepatic ester hydrolysis to ethyl alchohol

21
Q

Etomidate IV dose:

A

IV: 0.2-0.6 mg/kg (do not exceed 20 mg, induction)

22
Q

Etomidate side effects:

A
  1. Most CV stable (maintains coronary perfusion)
  2. Myoclonus
  3. PONV (30-40%)
  4. Adrenocortical suppression
  5. Decrease ICP
23
Q

Etomidate Contraindications / cautions:

A
  1. Painful injection (Propylene glycol)
  2. Hiccups
  3. Avoid in pt with chronic steroid use
  4. Avoid in long surgeries (increased stress response)
  5. Avoid if previous anaphylaxis
24
Q

Ketamine (alternate name):

A

Ketalar

25
Q

Ketamine structure:

A

Disociative hypnotic
Phencyclidine derivative
Cyclohexanone hydrochloride
base, lipid soluble

26
Q

Ketamine MOA:

A
  1. NMDA noncompetitive antagonist (glutamate normally stimulates opening and permeability to calcium, potassium, and sodium)
  2. mu, delta, kappa Opioid agonist
  4. Cholinergic receptor agonist (salivation)
  5. Also acts on MAO – inhibits 5Ht, dopamine & NE reuptake
27
Q

Ketamine onset:

A

IV: 30-60 sec IM: 2-4 min

28
Q

Ketamine duration of action:

A

10-20 min

29
Q

Ketamine PB:

A

12%

30
Q

Ketamine metabolism:

A

CYP2B6, 3A4
hepatic demethylation to norketamine

31
Q

Ketamine IV induction dose:

A

IV: 0.5-2 mg/kg

32
Q

Ketamine IM induction dose:

A

IM: 4-8 mg/kg

33
Q

Ketamine IV maintenance of GA dose:

A

IV: 30-90 mcg/kg/min (maintenance of GA)

34
Q

Ketamine IV sedation/analgesia dose:

A

IV: 0.1-0.5 mg/kg q 2-3 min (sedation/analgesia)

35
Q

Ketamine IM sedation/analgesia dose:

A

IM: 2-4 mg/kg (sedation/analgesia)

36
Q

Ketamine side effects:

A
  1. Bronchodilation
  2. Tachycardia
  3. Dissociative state
  4. Increased salivation
  5. Nystagmus
37
Q

Ketamine Contraindications / cautions:

A
  1. Avoid in open eye injury
  2. Avoid in increased ICP
  3. Avoid in pulmonary hypertension
  4. Does not block pharyngeal/laryngeal reflex
  5. Avoid as sole anesthetic for CAD (myocardial depressant)
  6. Emergence delirium
  7. Minimal effect on respiratory drive (minimal apnea risk)
  8. Inhibits NE reuptake (increased BP, increased HR, increased CO)
  9. Always give Versed as well
  10. Don’t give to schizophrenia patients
  11. May cause hypotension in catecholamine depleted pts

Pharmacology 1 (12 decks)

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