Induction Agent: Ketamine Flashcards
What is the primary mechanism of action of Ketamine?
A) It functions as a hypnotic.
B) It causes dissociative anesthesia.
C) It depresses all cortical brain functions.
D) It stimulates GABA receptors directly.
B) It causes dissociative anesthesia.
NOT a hypnotic
Slide 15
Ketamine is known to supress the neuronal function of the cortex and the thalamus, but it activates which of the following in the nervous system?
Select 3
A) Opioid receptors
B) Limbic system
C) GABA receptors
D) Subcortical neurons in the spinal tract
E) Nicotinic receptors
A) Opioid receptors
B) Limbic system
D) Subcortical neurons in the spinal tract
These factors contribute to its analgesic effects
True or False
Ketamine provides intense analgesia and is profoundly amnestic
True
Patient will lie there with their eyes open and breath, but not remember a thing.
Which of the following are uses of Ketamine in anesthesia?
Select 3
A) Dissociative anesthesia
B) Pain relief
C) Muscle relaxation
D) Adjunct to decrease need of anesthetic drugs
E) Decrease PONV
A) Dissociative anesthesia
B) Pain relief - including chronic pain
D) Adjunct to decrease need of anesthetic drugs - and decreases narcotic use
The most common concentration of Ketamine used for induction is __________.
A) 1% (10 mg/ml)
B) 5% (50 mg/ml)
C) 10% (100 mg/ml)
D) 20% (200 mg/ml)
B) 5% (50 mg/ml)
Comes in 1%, 5%, and 10% solutions, but 5% most common
True or False
Ketamine burns on injection
False
The typical adult induction dose of Ketamine for IV administration is:
A) 1.5 mg/kg
B) 1.7 mg/kg
C) 3 mg/kg
D) 5 mg/kg
A) 1.5 mg/kg
(Onset is about 1 minute)
Which of the following best describes the duration of dissociative anesthesia after a bolus dose of ketamine?
A) 5–10 minutes
B) 10–20 minutes
C) 20–40 minutes
D) 40–60 minutes
B) 10–20 minutes
Extrapyramidal symptoms (EPS), such as akathisia or sensations like “critters crawling” on the skin, can last for how long after onset?
A) 10–20 minutes
B) 30 minutes
C) Up to an hour
D) Several hours
C) Up to an hour
For intense analgesia, Ketamine is often given in lower doses, typically in the range of:
A) 0.1 to 0.2 mg/kg
B) 0.2 to 0.3 mg/kg
C) 0.2 to 0.5 mg/kg
D) 1 to 1.5 mg/kg
C) 0.2 to 0.5 mg/kg
When used as a sedative for pediatric patients, Ketamine is typically administered intramuscularly (IM) at a dose of:
A) 1-3 mg/kg
B) 2-4 mg/kg
C) 5-7 mg/kg
D) 4-8 mg/kg
D) 4-8 mg/kg
given to calm a child. (Five minutes until onset of effects; but it lasts a little longer)
Which of the following are common components of a “Ketamine dart” for sedation in pediatric or uncooperative patients?
A) Fentanyl, and Lidocaine
B) Midazolam, and Robinul
C) Atropine, and Propofol
D) Epinephrine, and Midazolam
B) Versed (Midazolam), and Robinul (Glycopyrrolate)
no pain on injection
Ketamine is metabolized into the active metabolite ______________ by __________%?
A) Nor-ketamine, 20-40
B) Hydroxy-ketamine, 20-30
C) Desmethyl-ketamine, 20-40
D) Nor-ketamine, 20-30
E) Hydroxy-ketamine, 20-40
D) Nor-ketamine, 20-30%
Ketamine induces which enzyme system, potentially impacting the metabolism of other drugs?
A) CYP 3A4
B) CYP 450
C) CYP 2DA
D) CYP 420
B) CYP 450
Ketamine has a high clearance rate and is __________ protein-bound, allowing for quick redistribution within 30min.
A) Highly
B) Moderately
C) Low
D) Variable
C) Low
What is the elimination half-life of Ketamine, which influences the duration of its effects?
A) 30 minutes
B) 1 hour
C) 2 hours
D) 4 hours
C) 2 hours
Repeated doses of Ketamine can lead to __________, a phenomenon where the drug becomes less effective over time.
A) Tolerance
B) Tachyphylaxis
C) Dependence
D) Synergism
B) Tachyphylaxis
One contraindication for Ketamine use is concurrent use of ________, as it increases the risk of elevated epinephrine levels.
A) ACE inhibitors
B) Beta-blockers
C) MAOIs
D) NSAIDs
C) Monoamine oxidase inhibitors (MAOIs)
One of the potential rare side effects of Ketamine at sub-anesthetic doses is:
A) Respiratory depression
B) Delirium
C) Bradycardia
D) Hyperglycemia
B) Delirium
Slide 16
With an induction dose of Ketamine, delirium is most likely to appear __________.
A) During the induction phase
B) As the dissociative effects wear off
C) Only in patients with underlying psychiatric conditions
D) After several repeated doses
B) As the dissociative effects wear off
post op / pacu issues.
Slide 16
Which of the following effects can Ketamine affect due to its sympathomimetic properties?
Select 3
A) Increased SVR
B) Decreased heart rate
C) Increased CO
D) Increased MVO2
E) Severe hypotension
A) Increased systemic vascular resistance (SVR)
C) Increased cardiac output (CO)
D) Increased myocardial oxygen consumption (MVO2)
increased PVR and HR as well due to the increased SNS outflow
Ketamine increases levels of __________ and __________ by inhibiting their reuptake, contributing to its sympathomimetic effects.
A) Serotonin; GABA
B) Norepinephrine; acetylcholine
C) Epinephrine; norepinephrine
D) Glutamate; serotonin
E) Epinephrine; acetylcholine
C) Epinephrine; norepinephrine
Ketamine is useful in patients with certain respiratory conditions due to its:
Select 3
A) Bronchodilatory effects
B) Reduction in airway secretions
C) Airway tone intact
D) Respiratory depressant properties
E) Ability to treat status asthmaticus
A) Bronchodilatory effects - Can treat status asthmaticus.
C) Airway tone intact- Pharyngeal and Laryngeal reflexes are intact
E) Ability to treat status asthmaticus
True or False
Even though there is dissociation, the airway tone is intact and protects the airway.
FALSE
Airway tone intact: Pharyngeal and Laryngeal reflexes are intact; but this is not a
protected airway, again dissociation.
When using Ketamine, pre-treatment with __________ is often recommended to reduce salivary secretions.
A) Propofol
B) Atropine
C) Robinul
D) Epinephrine
C) Robinul (Glycopyrrolate)
To mitigate Ketamine-induced hallucinations, __________ may be administered.
A) Barbiturates
B) Benzodiazepines
C) NSAIDs
D) Anticholinergics
B) Benzodiazepines
Barbiturates/Propofol can also work. (just remember we may be using Ketamine because pt. couldn’t tolerate Barbs or Propofol)
Vitamin V?
