Induction Agent: Ketamine

Question 1

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.

Answer 1

B) It causes dissociative anesthesia.
NOT a hypnotic

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Question 2

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

Answer 2

A) Opioid receptors
B) Limbic system
D) Subcortical neurons in the spinal tract

These factors contribute to its analgesic effects

Question 3

True or False

Ketamine provides intense analgesia and is profoundly amnestic

Answer 3

True

Patient will lie there with their eyes open and breath, but not remember a thing.

Question 4

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

Answer 4

A) Dissociative anesthesia
B) Pain relief - including chronic pain
D) Adjunct to decrease need of anesthetic drugs - and decreases narcotic use

Question 5

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)

Answer 5

B) 5% (50 mg/ml)

Comes in 1%, 5%, and 10% solutions, but 5% most common

Question 6

True or False

Ketamine burns on injection

Answer 6

False

Question 7

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

Answer 7

A) 1.5 mg/kg

(Onset is about 1 minute)

Question 8

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

Answer 8

B) 10–20 minutes

Question 9

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

Answer 9

C) Up to an hour

Question 10

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

Answer 10

C) 0.2 to 0.5 mg/kg

Question 11

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

Answer 11

D) 4-8 mg/kg

given to calm a child. (Five minutes until onset of effects; but it lasts a little longer)

Question 12

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

Answer 12

B) Versed (Midazolam), and Robinul (Glycopyrrolate)

no pain on injection

Question 13

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

Answer 13

D) Nor-ketamine, 20-30%

Question 14

Ketamine induces which enzyme system, potentially impacting the metabolism of other drugs?

A) CYP 3A4
B) CYP 450
C) CYP 2DA
D) CYP 420

Answer 14

B) CYP 450

Question 15

Ketamine has a high clearance rate and is __________ protein-bound, allowing for quick redistribution within 30min.

A) Highly
B) Moderately
C) Low
D) Variable

Answer 15

C) Low

Question 16

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

Answer 16

C) 2 hours

Question 17

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

Answer 17

B) Tachyphylaxis

Question 18

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

Answer 18

C) Monoamine oxidase inhibitors (MAOIs)

Question 19

One of the potential rare side effects of Ketamine at sub-anesthetic doses is:

A) Respiratory depression
B) Delirium
C) Bradycardia
D) Hyperglycemia

Answer 19

B) Delirium

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Question 20

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

Answer 20

B) As the dissociative effects wear off

post op / pacu issues.

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Question 21

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

Answer 21

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

Question 22

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

Answer 22

C) Epinephrine; norepinephrine

Question 23

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

Answer 23

A) Bronchodilatory effects - Can treat status asthmaticus.
C) Airway tone intact- Pharyngeal and Laryngeal reflexes are intact
E) Ability to treat status asthmaticus

Question 24

True or False

Even thought there is dissociation, the airway tone is intact and protects the airway.

Answer 24

FALSE

Airway tone intact: Pharyngeal and Laryngeal reflexes are intact; but this is not a
protected airway, again dissociation.

Question 25

When using Ketamine, pre-treatment with __________ is often recommended to reduce salivary secretions.

A) Propofol
B) Atropine
C) Robinul
D) Epinephrine

Answer 25

C) Robinul (Glycopyrrolate)

Question 26

To mitigate Ketamine-induced hallucinations, __________ may be administered.

A) Barbiturates
B) Benzodiazepines
C) NSAIDs
D) Anticholinergics

Answer 26

B) Benzodiazepines

Barbiturates/Propofol can also work. (just remember we may be using Ketamine because pt. couldn’t tolerate Barbs or Propofol)

Vitamin V?