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 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)

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)