induction agents Flashcards
sedativ and hypnotic properties result from substitutions at the…
2 and 5 carbon atoms of barbaturic acid
branched on 5…
greater hypnotic activity than straight chain
phenol group on 5…
enhanced anticonvulsant activity
methyl radical
pro-convulsive effects
oxygen on 2
oxybarbituates
sulfur on 2
thiobarbituates, greater lipid solubility, faster onset, greater potency, shorter DOA
barbituric acid
malonic acid + urea
return of awareness after IV administration reflects…
rapid redistribution to inactive sites
distribution depends on…
- lipid solubility (most important)
- protein binding
- degree of ionization
- tissue blood flow
EEG small dose
low volt, fast wave activity (1-5 HZ), clouding of consciousness
EEG moderate dose
high volt, slow wave activity (<4 Hz), similar to physiologic sleep
EEG large dose
1-3 Hz, electrical silence
barbs stimulate activity of the mitochondrial enzyme…
D-aminolevulnic acid synthetase…production of heme is increased
porphyria exacerbated d/t inc in..
porphobilinogen deaminase….porphyrin accumulates (s/s- abdominal pian, constipation, musc weakness, seizures, severs NV)
Acute Intermittent Porphyria/ Variegate Porphyria Treatment
- d/c causative agent
- consult hematology
- 10% glucose solution
- opioids for pain
- gabapentin for seizures
intra-arterial injection STP
- vasoconstriction, pain, extremity cyanosis, gangrene, limb loss
- treatment: dilution with saline, injection of lidocaine, papaverine, phenoxybenzamine, stelate ganglion block, brachial plexus block, urokinase, heparin
propofol solution made up of…
1% solution (2, 6- diisopropylphenol)
- 10% soybean oil
- 2.25% glycerol
- 1.2% egg phosphatide
- 0.005% disodium edetate added as microbial retardant (or metabisulfite)
propofol…peds require higher dose b/c…
- larger central distribution
- high clearance
(elderly- smaller central distribution, low clearance)
propofol (rigid, arched back, abnormal position…)
opisthotonus
etomidate structure
carboxylated imidazole derivative
isomer responsible for hypnotic effects in etomidate
D-isomer
etomidate metabolism
ester-hydrolysis by plasma esterase’s and microsomal enzymes
ketamine more potent isomer
S- isomer
