Induction Agent: Etomidate

Question 1

Etomidate has a unique mechanism of action as a GABA modulator that requires:

A) A special carrier protein
B) GABA to be present for activation
C) A lipid base for solubility
D) Continuous infusion to be effective

Answer 1

B) GABA to be present for activation

(does not mimic – has to have GABA present).

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Question 2

Etomidate’s Carboxylated Imidazole ring is similar to the ring in __________, allowing it to be water-soluble in solution and lipid-soluble in the body.
A) Ketamine
B) Fentanyl
C) Propofol
D) Midazolam

Answer 2

D) Midazolam

When the ring is open, it is water soluble in solution. The ring closes in the body and becomes very lipid soluble.

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Question 3

What is the primary advantage of using Etomidate as an induction agent?

A) Strong analgesic properties
B) Cardiovascular stability
C) Long duration of action
D) High protein binding

Answer 3

B) Cardiovascular stability

however..can induce seizures

Question 4

Etomidate is typically prepared as a __________ solution for induction purposes.

A) 0.1%
B) 0.2%
C) 1%
D) 2%

Answer 4

B) 0.2%

Question 5

Etomidate’s dose for induction in adults is typically:

A) 0.1 mg/kg
B) 0.2 mg/kg
C) 0.3 mg/kg
D) 0.4 mg/kg

Answer 5

C) 0.3 mg/kg

Question 6

True or False

There is no pain on injection with Etomidate

Answer 6

False

Pain on injection

Question 7

True or false

The induction dose of Etomidate is the only dose. There is no change for elderly or sick.

Answer 7

True!

Question 8

Etomidate is commonly used in the following patient scenarios:
Select 2

A) Trauma patients with cardiovascular instability
B) Patients requiring deep, long-term sedation
C) Elderly patients undergoing emergency surgery
D) Patients with adrenal insufficiency
E) Patients with a high risk of postoperative nausea

Answer 8

A) Trauma patients with cardiovascular instability
C) Elderly patients undergoing emergency surgery

Unstable patients

Has a possibly unfair bad reputation due to ICU studies.

Question 9

A rare but significant adverse effect of prolonged Etomidate use is:

A) Increased intracranial pressure
B) Liver toxicitiy
C) Adrenocortical suppression
D) Respiratory depression

Answer 9

C) Adrenocortical Suppression

Question 10

Etomidate can cause adrenocortical suppression due to inhibition of which enzyme?

A) Monoamine oxidase
B) 12-Acetyl-Hydroxylase
C) Aldosterone synthase
D) 11-Beta-Hydroxylase

Answer 10

D) 11-Beta-Hydroxylase

11-B-Hydroxylase converts cholesterol to cortisol

Question 11

Which of the following is true about 11β-Hydroxylase?

A) 11β-Hydroxylase converts cholesterol directly into cortisol.
B) 11β-Hydroxylase results in decreased aldosterone.
C) A deficiency in 11β-Hydroxylase increases cortisol levels.
D) 11β-Hydroxylase is primarily active in the liver.

Answer 11

A) 11β-Hydroxylase converts cholesterol directly into cortisol.

Question 12

Which of the following describes the duration of adrenocortical suppression caused by a single dose of Etomidate?

A) 1-2 hours
B) 4-8 hours
C) 12-24 hours
D) 24-48 hours

Answer 12

B) 4-8 hours

Lowers post operative cortisol levels in healthy patients

Question 13

In addition to adrenocortical suppression, Etomidate is also associated with a high incidence of:

A) Respiratory depression
B) PONV
C) Severe hypothermia
D) Increased intracranial pressure

Answer 13

B) Postoperative nausea and vomiting (PONV)

Corn: sometimes called VOMIDATE

Question 14

Etomidate is considered worst for PONV of all induction drugs, up to ________% of patients.

A) 10
B) 20
C) 30
D) 40

Answer 14

PONV in 30% of patients (worst of all induction drugs)