Induction Agents

Question 1

Drug receptors for:

• benzodiazepines
• barbiturates
• etomidate
• propofol
• ethanol

Answer 1

GABA-A (ligand gated ion channel)

Question 2

Egg allergy

Answer 2

Egg albumin (white), NOT egg lecithin (yolk)

Question 3

Side effects of etomidate?

Answer 3

• adrenal suppression
• myoclonus and jaw clenching (pre-treat w/opioids or benzos)
• burning on injection (pre-treat w/lidocaine)
• nausea/vomiting (most of all induction agents)

Question 4

Side effects of ketamine

Answer 4

• psychotomimetic effects

- direct myocardial depression (usually masked by sympathetic nervous system activation)

Question 5

What drugs are metabolized by esterase’s in the RBC cytosol within the plasma?

Answer 5

Succinylcholine
Remifentanil
Cisatracurium
Esmolol
Mivacurium

Question 6

G-protein couple receptor:

• drugs
• pathway

Answer 6

Alpha and beta agonists
Opioids
Serotonin
Histamine
Prostaglandins

Question 7

G-protein couple receptor pathways

Answer 7

• increases levels of cAMP–>PKA–>cellular effect
• eg. beta receptors

-activates phospholipase C–>cleaves PIP2 to IP3–>signals

Question 8

Ligand gated ion channel receptors

Answer 8

GABA-A (BZs, prop, barbs, etomidate)
NMDA receptor (ketamine)

Question 9

Propofol side effects

Answer 9

• vasodilation–>hypotension (both venous/preload and arterial/afterload)
• baroreceptor reflex response inhibition

*does not interrupt sympathetic outflow, per se

Question 10

Fospropofol

Answer 10

• prodrug metabolized by liver to propofol (and formaldehyde)
• slower onset and recovery
• water soluble (doesn’t require lipid emulsion so decreased pain on injection)

Question 11

Barbiturate arterial injection (eg thiopental) and treatment

Answer 11

-spasm–>vasoconstriction–>limb loss
(also barbs crystalize and physically obstruct capillaries)
-central effects: vasodilation (w/o baroreceptor blunting), resp depression, decrease CMRO2/CBF/ICP, and decrease tolerance to pain (antianalgesic)

-treatment: stellate ganglion block

Question 12

Active metabolites

• midazolam
• morphine
• meperidine
• ketamine

Answer 12

• midazolam: alpha-1-hydroxymidazolam
• morphine: morphine-6-gluconoride (major mu-R resp depr)
• meperidine: normeperidine (seizures, esp in renal failure)
• ketamine: norketamine (far less potent, not very imp)