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A Baseline Pharma > Induction Agent - Etomidate > Flashcards

Induction Agent - Etomidate Flashcards

1
Q

What is the chemical characteristic of Etomidate that contributes to its hydrophilic and lipophilic properties?

A) Ester linkage
B) Carboxylated imidazole ring
C) Phenyl group
D) Hydroxyl group

A

B) Carboxylated imidazole ring

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2
Q

At which pH level does Etomidate’s imidazole ring open, making it hydrophilic?

A) Acidic pH
B) Basic pH
C) Neutral pH
D) Variable pH

A

A) Acidic pH

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3
Q

What is the primary action of Etomidate in the context of anesthesia?

A) Analgesic
B) Muscle relaxant
C) GABAA receptor agonist
D) Anticonvulsant

A

C) GABAA receptor agonist

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4
Q

What is the typical intravenous (IV) dose range for Etomidate used for induction?

A) 0.1-0.2 mg/kg
B) 0.2-0.4 mg/kg
C) 0.5-0.7 mg/kg
D) 0.8-1.0 mg/kg

A

B) 0.2-0.4 mg/kg

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5
Q

What concentration is Etomidate typically available in for intravenous use?

A) 1 mg/mL
B) 2 mg/mL
C) 5 mg/mL
D) 10 mg/mL

A

B) 2 mg/mL

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6
Q

Which of the following is NOT a property of Etomidate?

A) Hydrophilic at acidic pH
B) Lipophilic at physiologic pH
C) Histamine release
D) No analgesic effect

A

C) Histamine release

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7
Q

For which type of cardiovascular system is Etomidate particularly well-suited?

A) Stable cardiovascular systems
B) Unstable cardiovascular systems
C) Systemic hypertension
D) Systemic hypotension

A

B) Unstable cardiovascular systems

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8
Q

Which drug is Etomidate an alternative to for intravenous induction?

A) Fentanyl
B) Propofol or barbiturates
C) Succinylcholine
D) Midazolam

A

B) Propofol or barbiturates

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9
Q

What is a notable feature of Etomidate related to its side effects?

A) It releases histamine, leading to potential allergic reactions.
B) It has significant analgesic effects.
C) It does not cause histamine release.
D) It commonly causes respiratory depression.

A

C) It does not cause histamine release.

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10
Q

In addition to being a GABAA receptor agonist, what makes Etomidate suitable for induction in certain patients?

A) It provides analgesia.
B) It has a long duration of action.
C) It is effective for patients with unstable cardiovascular conditions.
D) It produces rapid muscle relaxation.

A

C) It is effective for patients with unstable cardiovascular conditions.

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11
Q

What is the typical onset time for Etomidate when administered intravenously?

A) 10-20 seconds
B) 30-60 seconds
C) 1-2 minutes
D) 2-3 minutes

A

B) 30-60 seconds

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12
Q

What is the duration of effect for Etomidate?

A) 1-3 minutes
B) 3-10 minutes
C) 10-20 minutes
D) 20-30 minutes

A

B) 3-10 minutes

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13
Q

What primarily causes the quick offset of Etomidate’s effects?

A) Rapid metabolism
B) Redistribution to fat and muscle
C) Increased renal clearance
D) Increased hepatic metabolism

A

B) Redistribution to fat and muscle

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14
Q

What is the half-life of Etomidate?
A) 1-2 hours
B) 2-3 hours
C) 3-5 hours
D) 6-8 hours

A

C) 3-5 hours

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15
Q

What is the protein binding percentage of Etomidate?

A) 50%
B) 60%
C) 70%
D) 80%

A

D) 80%

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16
Q

How is Etomidate primarily eliminated from the body?

A) Through metabolism by CYP enzymes and plasma esterases
B) Through renal excretion only
C) Through biliary excretion only
D) Through pulmonary excretion

A

A) Through metabolism by CYP enzymes and plasma esterases

17
Q

What percentage of Etomidate is excreted in the urine?

A) 50%
B) 60%
C) 70%
D) 85%

A

D) 85%

18
Q

Which of the following conditions is a contraindication for the use of Etomidate?

A) Hypertension
B) Diabetes mellitus
C) Adrenal insufficiency (Addison’s disease)
D) Asthma

A

C) Adrenal insufficiency (Addison’s disease)

19
Q

Etomidate can increase the production of which substance, leading to a potential contraindication in Acute Intermittent Porphyria?

A) Porphyrins
B) ALA (aminolevulinic acid)
C) Bilirubin
D) Cortisol

A

B) ALA (aminolevulinic acid)

increases ALA synthase making more precursors for ineffective heme conversion = build up toxic

Acute intermittent porphyria is a rare autosomal dominant disease characterized by a deficiency of hydroxymethylbilane synthase (HMBS). It presents with abdominal pain, nausea, vomiting, peripheral neuropathy, and seizures. Treatment for acute attacks is intravenous heme. Definitive treatment is an orthotopic liver transplant.

Porphyria’ has been derived from the ancient Greek word porphura, meaning purple. Porphyrins are precursors of heme, an essential component of hemoglobin.

20
Q

contraindicated in

A

seizure hx

21
Q

In which condition should Etomidate be used with caution due to potential effects on the HPA (hypothalamic-pituitary-adrenal) axis?

A) Chronic obstructive pulmonary disease (COPD)
B) Sepsis and hemorrhage
C) Hyperthyroidism
D) Gastroesophageal reflux disease (GERD)

A

B) Sepsis and hemorrhage

22
Q

What percentage of propylene glycol is present in Etomidate, and what issue does this cause?

A) 10%, causing nausea
B) 25%, causing headache
C) 35%, causing pain at the injection site
D) 50%, causing hypotension

A

C) 35%, causing pain at the injection site

23
Q

What can rapid injection of Etomidate lead to?

A) Severe hypotension
B) Prolonged sedation
C) Brief apnea
D) Acute respiratory distress syndrome

A

C) Brief apnea

24
Q

Which side effect of Etomidate can be attenuated with opioids, benzodiazepines, or 1-2 mcg/kg of fentanyl?

A) Pain at the injection site
B) Involuntary myoclonic movements
C) Nausea and vomiting
D) Bradycardia

A

B) Involuntary myoclonic movements

25
Q

What is a common postoperative side effect associated with Etomidate?

A) Hypotension
B) Delirium
C) Postoperative nausea and vomiting (PONV)
D) Headache

A

C) Postoperative nausea and vomiting (PONV)

26
Q

How long does the enzyme inhibition caused by Etomidate typically last?

A) 1-2 hours
B) 2-4 hours
C) 4-8 hours
D) 8-12 hours

A

C) 4-8 hours
… limit use as infusion

27
Q

caution with …

In which clinical conditions should Etomidate be used with caution due to its effect on the HPA axis?

A) Diabetes and hypertension
B) Sepsis and hemorrhage
C) Hyperthyroidism and hypothyroidism
D) Asthma and chronic bronchitis

A

… sepsis and hemorrhage

B) Sepsis and hemorrhage

27
Q

Adrenocortical Stress Response: Etomidate inhibits which enzyme involved in the cortisol synthesis pathway?

A) 11-beta hydroxylase
B) 21-hydroxylase
C) 17-alpha hydroxylase
D) 3-beta hydroxysteroid dehydrogenase

A

A) 11-beta hydroxylase
(conversion of cholesterol to cortisol)

28
Q

Why is the use of Etomidate as an infusion limited?

A) Due to its short duration of action
B) Because it causes prolonged sedation
C) Due to its inhibition of cortisol synthesis
D) Because it frequently causes allergic reactions

A

C) Due to its inhibition of cortisol synthesis

29
Q

Which of the following effects is associated with the central nervous system (CNS) response described?

a) Decreased cerebral blood flow (CBF)
b) Decreased intracranial pressure (ICP)
c) Decreased cerebral metabolic rate of oxygen (CMRO2)
d) Decreased activation of seizure foci

A

a) Decreased cerebral blood flow (CBF)
b) Decreased intracranial pressure (ICP)
c) Decreased cerebral metabolic rate of oxygen (CMRO2)

May activate seizure foci (good for figuring out EEG aspects)

30
Q

What cardiovascular effect is described in relation to the given condition?

a) Decrease in mean arterial pressure (MAP) due to decreased stroke volume (SV), not HR
b) Slight decrease in MAP due to decreased systemic vascular resistance (SVR)
c) Decrease in MAP due to increased heart rate (HR)
d) Decrease in MAP due to decreased cardiac output (CO)

A

b) Decrease in MAP due to decreased systemic vascular resistance (SVR), not HR, SV CO, inotropy

Does not block SNS response to laryngoscopy. An opioid or esmolol will help.

31
Q

What pulmonary effect occurs transiently according to the described condition?

a) Decrease in tidal volume (VT) lasting 10-15 minutes
b) Increase in tidal volume (VT) with a decrease in respiratory rate (RR)
c) Transient decrease in VT for 3-5 minutes with increased CO2 medullary center stimulation
d) Long-term decrease in CO2 medullary center stimulation

A

c) Transient decrease in VT for 3-5 minutes with increased CO2 medullary center stimulation (inc RR)

A Baseline Pharma (53 decks)

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